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1.
Antibiotics (Basel) ; 11(4)2022 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-35453258

RESUMO

In this study, our objective was to assess the association of body mass in preschool children with the use of antibiotics within 6 months after birth. National administrative databases were used to examine all children born between 2008 and 2009 in Korea. Exposure was defined as the use of systemic antibiotics during the first 6 months of age. The observed outcomes were stunting (height for age [HFA] z score < -2.0), short stature (HFA z score < -1.64), overweight (body mass index [BMI] for age z score ≥ 1.04), and obesity (BMI for age z score ≥ 1.64), and the children's height and body weight were measured from three to six years of age. To balance characteristics between the antibiotic user and non-user groups, propensity score matching was performed. The outcomes were evaluated using a generalized estimation equation with the logit link function. Analysis of antibiotic use by children during the first 6 months of life indicated there were 203,073 users (54.9%) and 166,505 non-users (45.1%). After PS matching, there were 72,983 antibiotic users and 72,983 non-users. Antibiotic use was significantly associated with stunting (aOR = 1.198, 95% CI = 1.056 to 1.360) and short stature (aOR = 1.043, 95% CI = 1.004 to 1.083), and had significant negative association with HFA z score (weighted ß = -0.023). The use of an antibiotic for 14 days or more had a marked association with stunting. Antibiotic use was also associated with overweight, obesity, and increased BMI for age z score. Antibiotic use during the first 6 months of life increased the risk of stunting, short stature, overweight, and obesity in preschool children.

2.
Pediatr Allergy Immunol ; 33(4)2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35470936

RESUMO

BACKGROUND: Asthma exacerbation (AE) leads to social and economic costs and long-term adverse outcomes. We aimed to predict exacerbation-prone asthma (EPA) in children. METHODS: The Korean childhood Asthma Study (KAS) is a prospective nationwide pediatric asthma cohort of children aged 5-15 years followed every 6 months. Patients with AE during the 6 months prior to all three visits, with AE prior to one or two visits, and without AE prior to any visit were defined as having EPA, exacerbation-intermittent asthma (EIA), and exacerbation-resistant asthma (ERA), respectively. Risk factors and prediction models of EPA were explored. RESULTS: Of the 497 patients who completed three visits, 42%, 18%, and 15% had exacerbations prior to visits 1, 2, and 3 and 5%, 47%, and 48% had EPA, EIA, and ERA, respectively. Univariate and multivariable logistic regression revealed forced expiratory volume in 1 s (FEV1) z-score, forced vital capacity (FVC) z-score, white blood cell (WBC) count, and asthma control test (ACT) score as relevant EPA risk factors. The EPA prediction model comprised FVC z-score, WBC count, ACT score, sex, and parental education level (area under the receiver operating characteristic curve [AUROC] 0.841 [95% confidence interval (CI): 0.728-0.954]). CONCLUSION: With appropriate management, AE decreases over time, but persistent AEs may occur. Apart from asthma control level, baseline lung function and WBC count predicted EPA.


Assuntos
Asma , Asma/epidemiologia , Criança , Volume Expiratório Forçado , Humanos , Fenótipo , Estudos Prospectivos , República da Coreia/epidemiologia
3.
Children (Basel) ; 9(2)2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-35204856

RESUMO

OBJECTIVE: The objective of this study was to analyze the effect of consuming formula powder prepared with tap water or purified water during the first 4 to 6 months of life on the subsequent development of irritable bowel syndrome (IBS). STUDY DESIGN AND SETTING: A total of 917,707 children who were born in Korea between 2007 and 2008 were analyzed. All children were followed up until they lost eligibility for health care services or until 2017. Data on the water used to prepare formula powder were from questionnaires answered by the parents when the child was 4 to 6 months old. IBS was defined as two or more diagnoses of IBS after the age of 4 years. Inverse probability of treatment weighting (IPTW) using the propensity score was used to balance the two groups. The risk of IBS was evaluated using a Cox proportional hazards model. RESULTS: After weighting, there were 73,355 children in the tap water group and 73,351 in the purified water group. The purified water group had a higher risk of IBS (HR: 1.05; 95% CI: 1.01, 1.09). This relationship was also present after the subgroup analyses of males and females and the sensitivity analysis that used different definitions of IBS. CONCLUSIONS: Drinking formula powder prepared with purified water rather than tap water during the first 4 to 6 months of age was found to be associated with IBS.

4.
Biomed Res Int ; 2021: 5513611, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34840976

RESUMO

OBJECTIVE: Determining sensitivity to allergens is an essential step in diagnosing children with allergic diseases. Chronic cough has remained poorly understood with causative triggers. The purpose of our study was to shed light on the relationship between sensitization to aeroallergens and chronic cough. METHODS: This population-based study examined children (aged 7 years to 13 years) between June and July 2016. The 1,259 children, 72 of whom (5.7%) had a chronic cough, and 1,187 of whom (94.3%) did not (controls), completed the questionnaire, but 1,051 children completed skin prick tests (SPTs) with eight aeroallergens. RESULTS: There were positive SPT results to at least 1 allergen in 549 children (52.2%). Sensitization to house dust mite (HDM) was most common (chronic cough = 46.9%; controls = 47.2%), followed by pollen (chronic cough = 21.9%; controls = 16.5%) in both groups, but there was no difference in allergic profile and sensitization to aeroallergen (P > 0.05 for all comparisons). Multivariable analysis with adjustment for confounding indicated that children who were in sensitization to pollen had an increased risk of chronic cough (aOR = 2.387; 95% CI: 1.115 to 5.111; P = 0.025). Multivariable analysis with adjustment for confounding indicated that children who were exposed to current smoking (aOR = 4.442; 95% CI: 1.831 to 10.776; P = 0.001) and mold (aOR = 1.988; 95% CI: 1.168 to 3.383; P = 0.011) were associated with chronic cough. CONCLUSION: Sensitization to pollen should be considered as a potential contributing factor to the development of chronic cough in school-aged children.


Assuntos
Alérgenos/imunologia , Tosse/imunologia , Adolescente , Aerossóis , Alérgenos/administração & dosagem , Animais , Estudos de Casos e Controles , Criança , Doença Crônica , Tosse/diagnóstico , Tosse/etiologia , Estudos Transversais , Feminino , Humanos , Hipersensibilidade/complicações , Hipersensibilidade/diagnóstico , Hipersensibilidade/imunologia , Masculino , Análise Multivariada , Pólen/imunologia , Estudos Prospectivos , Pyroglyphidae/imunologia , República da Coreia , Fatores de Risco , Testes Cutâneos
5.
Pediatr Allergy Immunol ; 32(8): 1681-1690, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34291496

RESUMO

BACKGROUND: Phthalates can cause respiratory and immunological disorders. However, little is known about the role of serum periostin and YKL-40 levels in mediating the effects of phthalates. We investigated the mediating role of these biomarkers in the relationship between phthalates and airway dysfunction. METHODS: A total of 487 children (aged 10-12 years old) were examined. Four high-molecular-weight phthalate (HMWP) [Σ4 HMWP] metabolites and 3 low-molecular-weight phthalate (LMWP) [Σ3 LMWP] metabolites in urine samples were measured. Serum periostin and YKL-40 levels were measured. Airway function was measured using impulse oscillometry. A mediation model was used to quantify the mediating effects of periostin and YKL-40 on airway dysfunction. RESULTS: After adjustment for height, gender, BMI z-score, aeroallergen sensitization, secondary smoking, and vitamin D level, the level of urinary Σ3 LMWP metabolites was significantly associated with respiratory system resistance at 5 Hz (Rrs5; adjusted ß: 0.020, 95% CI: 0.005-0.034; p = .010). The levels of urinary Σ4 HMWP and Σ3 LMWP metabolites were significantly associated with periostin level, but not with YKL-40 level. In addition, the periostin level was associated with Rrs5 (adjusted ß: 0.048, 95% CI: 0.015-0.081; p = .005) and Rrs20-5 (adjusted ß: 0.040, 95% CI: 0.011-0.069; p = .007). Serum periostin level had a significant effect in mediating the relationship between Σ3 LMWP and Rrs5 (13.9%, 95% CI: 10.7-77.0; p < .001). CONCLUSION: Exposure to LMWPs was significantly associated with airway dysfunction, and this effect was partially attributable to increased serum periostin level.


Assuntos
Ácidos Ftálicos , Biomarcadores , Criança , Humanos , Testes de Função Respiratória , Sistema Respiratório
6.
Clin Respir J ; 15(8): 870-877, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33848060

RESUMO

BACKGROUND: Associations between anemia and allergic diseases have been reported, but the relationship of iron deficiency with airway dysfunction in children remains unclear. We aimed to investigate the relationship between abnormal iron parameters and lung function in schoolchildren. METHODS: Four hundred and forty-five children (10-12 years-old) from 11 elementary schools in were enrolled. The relationships of different iron parameters (hemoglobin, serum iron, transferrin saturation, and serum ferritin) with lung function evaluated by impulse oscillometry (airways resistance at 5 Hz [Rrs5], 10 Hz [Rrs10], and the difference of Rrs5 and Rrs20 Hz [Rrs5-20]), and with exhaled nitric oxide (FeNO) were evaluated after adjustment for confounders including height, sex, and body mass index z-score, and for additional covariates that could affect airway function. RESULTS: Total airway dysfunction represented by Rrs5 was reduced in participants with low serum iron level (aß: -0.13, 95% CI: -0.23 to -0.03, p = 0.040) after adjustment for key confounders, but did not correlate with other iron profiles. Reduced oscillometric lung function recorded as Rrs5-20 was related with low serum iron and high serum ferritin, but the results were inconsistent after multiple comparisons. Associations were not observed with serum hemoglobin. CONCLUSIONS: Decreased serum iron level was related with airway dysfunction represented as oscillomteric Rrs5. Our results suggest a relationship of reduced lung function with abnormal iron status in children.


Assuntos
Ferro , Pulmão , Resistência das Vias Respiratórias , Criança , Humanos , Oscilometria , Testes de Função Respiratória
7.
Sci Rep ; 11(1): 3772, 2021 02 12.
Artigo em Inglês | MEDLINE | ID: mdl-33580129

RESUMO

Propyl-paraben exposure is associated with aeroallergen sensitization, but its association with atopic dermatitis (AD) is inconclusive. No studies have been conducted on the metabolomic pathways underlying these associations. We investigated the associations between propyl-paraben exposure and aeroallergen sensitization, AD, and Eczema Area and Severity Index (EASI) score and identified the underlying pathways using untargeted metabolomics analysis. We enrolled 455 children in a general population study. Skin prick tests were performed with the assessment of EASI score. Urinary propyl-, butyl-, ethyl-, and methyl-paraben levels were measured. Untargeted metabolomics analysis was performed on the first and fifth urine propyl-paraben quintile groups. The highest urine propyl-paraben quintile group was associated with aeroallergen sensitization, but not with AD. Glycine, threonine, serine, ornithine, isoleucine, arabinofuranose, D-lyxofuranose, citrate, and picolinic acid levels were higher, whereas palmitic acid and 2-palmitoylglycerol levels were lower in the highest quintile propyl-paraben group, than in the lowest quintile group. The propyl-paraben-induced metabolic perturbations were associated with serine and glycine metabolisms, branched-chain amino acid metabolism, and ammonia recycling. Propyl-paraben exposure was associated with aeroallergen sensitization and EASI score, partially via metabolomic changes related with oxidative stress, mTOR, peroxisome proliferator-activated receptors pathway, aryl hydrocarbon receptor signaling pathways, and tricarboxylic acid cycle.


Assuntos
Alérgenos/imunologia , Alérgenos/metabolismo , Parabenos/efeitos adversos , Adolescente , Criança , Eczema/etiologia , Eczema/imunologia , Feminino , Humanos , Masculino , Metabolômica/métodos , Parabenos/análise , República da Coreia/epidemiologia , Pele/imunologia
8.
Pediatr Allergy Immunol ; 32(2): 322-330, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33040380

RESUMO

BACKGROUND: The association between dyslipidemia and atopic dermatitis in children is unclear. This study investigated the association between dyslipidemia and atopic dermatitis in children by analysis of disease onset, risk factors, and disease severity. METHODS: Subset I examined 7-year-old children in elementary school (n = 248), and Subset II was a retrospective long-term follow-up hospital-based study (n = 52 725) conducted from 1986 to 2016 that used propensity score matching. In the Subset I study, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were determined, and the SCORing Atopic Dermatitis (SCORAD) index was determined. In the Subset II study, the time of atopic dermatitis onset was determined for asymptomatic subjects whose TC levels were below or above 170 mg/dL. RESULTS: Our Subset I study indicated that children with atopic dermatitis (n = 69, 27.8%) had significantly higher levels of TC and TG, and that the SCORAD index had significant associations with high levels of TC and TG, and a low level of HDL-C. Our Subset II study (1722 with high TC and 6735 with normal TC after propensity score matching) indicated the high TC group had a greater hazard ratio (HR) for the onset of atopic dermatitis (consensus-based HR: 2.47; 95% CI: 1.23, 5.06, P = .012) during 5 years. CONCLUSION: An abnormal blood lipid profile in children is associated with the presence of atopic dermatitis and the SCORAD index. The risk of atopic dermatitis onset was significantly greater with high levels of TC.


Assuntos
Dermatite Atópica , Dislipidemias , Criança , HDL-Colesterol , LDL-Colesterol , Dermatite Atópica/diagnóstico , Dermatite Atópica/epidemiologia , Humanos , Estudos Retrospectivos
9.
Allergy Asthma Immunol Res ; 13(1): 42-55, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33191676

RESUMO

PURPOSE: Asthma is a heterogeneous airway disease occurring in children, and it has various clinical phenotypes. A clear differentiation of the clinical phenotypes can provide better asthma management and prediction of asthma prognosis. Little is currently known about asthma phenotypes in Korean children. This study was designed to identify asthma phenotypes in school-aged Korean children. METHODS: This study enrolled 674 children with physician-diagnosed asthma from the Korean childhood Asthma Study (KAS) cohort. The physicians verified the relevant histories of asthma and comorbid diseases, as well as airway lability and hyper-responsiveness from the results of pulmonary function tests and bronchial provocation tests. Questionnaires regarding the participants' baseline characteristics, their environment and self-rating of asthma control were collected at the time of enrollment. Laboratory tests were performed to assess allergy and airway inflammation. Children with asthma were classified by hierarchical cluster analysis. RESULTS: Of the 674 patients enrolled from the KAS cohort, 447 were included in the cluster analysis. Cluster analysis of these 447 children revealed 4 asthma phenotypes: cluster 1 (n = 216, 48.3%) which was characterized by male-dominant atopic asthma; cluster 2 (n = 79, 17.7%) which was characterized by early-onset atopic asthma with atopic dermatitis; cluster 3 (n = 47, 10.5%) which was characterized by puberty-onset, female-dominant atopic asthma with the low lung function; and cluster 4 (n = 105, 23.5%) which was characterized by early-onset, non-atopic dominant asthma. CONCLUSIONS: The asthma phenotypes among Korean children can be classified into 4 distinct clusters. Long-term follow-up with these phenotypes will be needed to define their prognosis and response to treatment.

10.
Mediators Inflamm ; 2020: 8713908, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33061832

RESUMO

YKL-40, also known as chitinase-3-like protein 1, is an inflammatory glycoprotein that is secreted by various cell types under acute, chronic, and subclinical inflammation conditions. Elevated serum YKL-40 levels are reportedly independently related to diabetes mellitus, coronary artery disease, acute myocardial infarction, and cardiovascular mortality in adults. Therefore, we aimed to investigate the relationship between serum YKL-40 levels, lipid abnormalities, and the atherogenic index of plasma (AIP) in children. We enrolled 479 children aged 10-12 years (mean age: 11.52) in this general population-based, cross-sectional study. All subjects completed questionnaires and were subjected to multifrequency bioelectrical impedance analysis (BIA) to measure their height, weight, and body mass index (BMI). We collected serum samples from all participants to measure YKL-40, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels. Mean serum YKL-40 levels were significantly higher in the low-HDL-C (p = 0.017) and high-TG (p = 0.010) groups but were not related to TC and LDL-C levels. YKL-40 levels were also higher in the high AIP group (p = 0.007). After adjusting for age, gender, and BMI z-score, the associations between serum YKL-40 levels and TG levels (p = 0.003), the TG-to-HDL-C ratio (p = 0.019), and the AIP value (p = 0.012) remained significant. Based on these findings, we suggest that serum YKL-40 may be a useful initial screening tool or follow-up risk indicator for lipid abnormalities, atherosclerosis, and cardiovascular disease in children and adolescents with risk factors, regardless of obesity.


Assuntos
Aterosclerose/sangue , Proteína 1 Semelhante à Quitinase-3/sangue , Biomarcadores/sangue , Criança , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Humanos , Metabolismo dos Lipídeos/fisiologia , Masculino , Triglicerídeos/sangue
11.
Allergy Asthma Proc ; 41(6): 428-435, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33109308

RESUMO

Background: It is widely acknowledged that food sensitization is related to atopic dermatitis in infants and young children. Objective: To investigate the association of aeroallergen sensitization with increased rates and severity of atopic dermatitis in school children. Methods: We enrolled 576 children (mean age, 9.4 ± 1.8 years) from six elementary schools. Atopic dermatitis was diagnosed by questionnaires, and severity was rated by physical examinations graded by using the Scoring Atopic Dermatitis (SCORAD) index. Skin-prick tests to 22 common allergens (6 aeroallergens and 16 food allergens) were conducted. Logistic and linear regression analyses were performed by using two models: model I adjusted for age, sex, and body mass index z score; and model II adjusted for all model I factors plus asthma and allergic rhinitis. Results: We diagnosed atopic dermatitis in 22.4% (n = 129) of the children, sensitization to foods in 48.3% (n = 278), and sensitization to aeroallergens in 11.3% (n = 65). A total of 26.2% of the children (n = 149) had mild and 6.5% had moderate-to-severe symptoms and signs of atopic dermatitis (n = 37). Atopic dermatitis was associated with sensitization to aeroallergens and eosinophilia (model I), but this risk was no longer significant after additional adjustment for current allergic status (model II). However, the relationship of the total SCORAD score with aeroallergen sensitization and eosinophilia was significant in model I and model II. Conclusion: The severity of atopic dermatitis correlated with the extent of allergic sensitization and eosinophilia. Analysis of our results suggests that more sensitization to dust mites and eosinophilia are related to increased rates and high severity scores of atopic dermatitis.


Assuntos
Asma/diagnóstico , Dermatite Atópica/diagnóstico , Eosinofilia/diagnóstico , Hipersensibilidade Alimentar/diagnóstico , Alérgenos/imunologia , Asma/epidemiologia , Criança , Dermatite Atópica/epidemiologia , Eosinofilia/epidemiologia , Feminino , Hipersensibilidade Alimentar/epidemiologia , Humanos , Imunização , Imunoglobulina E/metabolismo , Masculino , Material Particulado/imunologia , Risco , Índice de Gravidade de Doença , Testes Cutâneos
12.
Pediatr Pulmonol ; 55(12): 3279-3286, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32965787

RESUMO

BACKGROUND: To determine the response of airway mechanics and the changes in asthma symptoms to stepping down of leukotriene receptor antagonist (LTRA) therapy. METHODS: Thirty children (mean age: 7.1 years) with mild, well-controlled, and persistent asthma who took LTRA as maintenance treatment were randomized into a double-blind, placebo-controlled, cross-over study. Each group received an LTRA (montelukast) or placebo daily for 2 weeks, followed by a 1-week washout period, and then the alternate treatment for 2 weeks. Spirometry and impulse oscillation system (IOS) measurements before and after four puffs of salbutamol inhalation, fractional exhaled nitric oxide (FeNO), and the childhood asthma control test (C-ACT) were evaluated at baseline, the end of placebo treatment, and the end of LTRA treatment. RESULTS: Changes of FEV1 /FVC (p = .113) and FEV1 (p = .109) from baseline to posttreatment did not differ significantly between the placebo and montelukast groups. In the placebo group, prebronchodilator (pre-) FEV1 /FVC was decreased (83% vs. 86%) and bronchodilator response (BDR) in FEV1 was diminished (10.7% vs. 6.4%) at posttreatment compared with baseline. However, the montelukast group had no significant changes in pre-FEV1 /FVC (p = .865) and BDR in FEV1 (p = .461). In addition, compared with the montelukast group, the placebo group showed no significant changes in Rrs5 (total airway resistance), Rrs5-20 (peripheral airway resistance), FeNO, and symptoms by the C-ACT. CONCLUSION: In children with well-controlled mild persistent asthma, changes in spirometry, IOS, FeNO, and C-ACT results did not differ between the placebo and montelukast groups within 2 weeks.


Assuntos
Acetatos/administração & dosagem , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Ciclopropanos/administração & dosagem , Antagonistas de Leucotrienos/administração & dosagem , Quinolinas/administração & dosagem , Sulfetos/administração & dosagem , Administração por Inalação , Albuterol/administração & dosagem , Asma/metabolismo , Asma/fisiopatologia , Broncodilatadores/administração & dosagem , Criança , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Óxido Nítrico/metabolismo , Espirometria , Suspensão de Tratamento
13.
Medicine (Baltimore) ; 99(10): e19469, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150106

RESUMO

The profiles of sensitization based on component-resolved diagnosis (CRD) differ from region to region in populations sensitized to birch pollen. We investigated the endotypes of birch pollen-sensitized Korean children with allergic diseases using CRD and distinguished the endotypes of oral allergy syndrome (OAS) among them.Thirty-one birch pollen-sensitized children with allergic diseases were enrolled. Specific immunoglobulin E (IgE) to birch pollen and fruit including apple, peach, and kiwi were evaluated via skin prick tests and ImmunoCAP in all subjects. Sensitization profiles based on CRD were evaluated with the Immuno-solid-phase Allergen Chip for birch pollen-sensitization using birch pollen components (Bet v 1, Bet v 2, and Bet v 4), and for OAS using the allergen families pathogenesis-related class 10 proteins (PR-10), lipid transfer proteins, and profilin.All patients (n = 13) with OAS were sensitive to Bet v 1. However, 61% (11/18) of patients without OAS were sensitized to Bet v 1. The level of specific IgE to Bet v 1 was higher in patients with OAS than in those without OAS. All birch pollen-sensitized Korean children with OAS were sensitized to PR-10, and 69% (9/13) of them were mono-sensitized to PR-10. Among patients without OAS, 33% (6/18) were not sensitized to any of the allergen families.Birch pollen-sensitized Korean children with allergic diseases showed unique patterns of sensitization to Bet v 1, Bet v 2, and Bet v 4, and the sensitization profiles based on CRD were totally different according to the presence of OAS.


Assuntos
Alérgenos/imunologia , Betula/imunologia , Hipersensibilidade Alimentar/imunologia , Pólen/imunologia , Adolescente , Criança , Pré-Escolar , Reações Cruzadas , Feminino , Hipersensibilidade Alimentar/complicações , Frutas/imunologia , Humanos , Masculino , Reprodutibilidade dos Testes , República da Coreia , Sensibilidade e Especificidade , Testes Cutâneos
14.
J Asthma ; 57(6): 648-653, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-30969134

RESUMO

Objective: Various numerical asthma control tools have been developed to distinguish different levels of symptom control. We aimed to examine whether the asthma control test (ACT) is reflective of objective findings such as lung function, fractional exhaled nitric oxide (FeNO) and laboratory data in patients with stable asthma.Methods: We included patients who were enrolled in the Korean Childhood Asthma Study. ACT, spirometry, blood tests and FeNO were performed in patients after stabilization of their asthma. We examined differences among spirometry parameters, blood tests and FeNO according to control status as determined by ACT and investigated for any significant correlations.Results: The study population consisted of 441 subjects. Spirometry showed that forced expiratory volume in one second (FEV1), forced expiratory flow between 25% and 75% of forced vital capacity and FEV1/forced vital capacity were all significantly higher in the controlled asthma group. Likewise, FeNO and percent-change in FEV1 were both significantly lower in the controlled asthma group. In blood tests, the eosinophil fraction was significantly lower in the controlled asthma group while white blood cell count was significantly higher in the controlled asthma group. Lastly, among the various factors analyzed, only provocative concentration of methacholine causing a 20% fall in FEV1 significantly correlated with ACT score.Conclusion: ACT is useful as part of the routine evaluation of asthmatic children and should be used as a complement to existing tools such as spirometry and FeNO measurement.


Assuntos
Asma/diagnóstico , Índice de Gravidade de Doença , Adolescente , Asma/sangue , Asma/fisiopatologia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulina E/sangue , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/fisiopatologia , Contagem de Leucócitos , Pulmão/fisiopatologia , Masculino , Óxido Nítrico/análise
15.
Allergy Asthma Immunol Res ; 12(1): 86-98, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31743966

RESUMO

PURPOSE: Childhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity. METHODS: This study was performed on 667 children aged 5-15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity. RESULTS: Mild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma. CONCLUSIONS: Modification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.

16.
Int Arch Allergy Immunol ; 180(3): 195-201, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31505505

RESUMO

BACKGROUND: Previous studies have used serum periostin levels as a biomarker of Th2-driven inflammatory responses. However, no population-based study has yet examined the association of serum periostin levels with the allergic status of children. OBJECTIVES: The aim of this study was to determine the usefulness of periostin as a biomarker for allergy in a group of 7-year-old Korean children. METHOD: This prospective cross-sectional study examined 451 children (aged 7 years to 7 years and 11 months) from the general pediatric population who attended 6 different schools between June and July 2016. A total of 249 children, all of whom completed the questionnaire and skin prick test and provided blood samples, were included in the final analysis. RESULTS: The geometric mean serum periostin level was 107.6 ng/mL (95% CI 104.5-110.7). After adjustment for confounding, serum periostin levels were significantly associated with sensitization to poly-allergens (adjusted odds ratio, aOR 1.032, 95% CI 1.006-1.059, p = 0.016) and pollen (aOR 1.020, 95% CI 1.002-1.039, p = 0.026). Serum periostin levels were also associated with eosinophil levels (adjusted ß = 0.023, SE = 0.009, p = 0.010), but were unrelated to body mass index, sex, obesity, or presence of an allergic disease. CONCLUSIONS: Our results suggest thatserum periostin level may have limited usefulness as a biomarker of allergic disease in children.


Assuntos
Biomarcadores/sangue , Moléculas de Adesão Celular/sangue , Eosinófilos/imunologia , Hipersensibilidade/diagnóstico , Imunização/estatística & dados numéricos , Alérgenos/imunologia , Criança , Estudos Transversais , Feminino , Humanos , Hipersensibilidade/epidemiologia , Coreia (Geográfico)/epidemiologia , Masculino , Grupos Populacionais , Estudos Prospectivos , Testes Cutâneos
17.
BMC Pulm Med ; 19(1): 64, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876418

RESUMO

BACKGROUND: Asthma is a syndrome composed of heterogeneous disease entities. Although it is agreed that proper asthma endo-typing and appropriate type-specific interventions are crucial in the management of asthma, little data are available regarding pediatric asthma. METHODS: We designed a cluster-based, prospective, observational cohort study of asthmatic children in Korea (Korean childhood Asthma Study [KAS]). A total of 1000 Korean asthmatic children, aged from 5 to 15 years, will be enrolled at the allergy clinics of the 19 regional tertiary hospitals from August 2016 to December 2018. Physicians will verify the relevant histories of asthma and comorbid diseases, as well as airway lability from the results of spirometry and bronchial provocation tests. Questionnaires regarding subjects' baseline characteristics and their environment, self-rating of asthma control, and laboratory tests for allergy and airway inflammation will be collected at the time of enrollment. Follow-up data regarding asthma control, lung function, and environmental questionnaires will be collected at least every 6 months to assess outcome and exacerbation-related aggravating factors. In a subgroup of subjects, peak expiratory flow rate will be monitored by communication through a mobile application during the overall study period. Cluster analysis of the initial data will be used to classify Korean pediatric asthma patients into several clusters; the exacerbation and progression of asthma will be assessed and compared among these clusters. In a subgroup of patients, big data-based deep learning analysis will be applied to predict asthma exacerbation. DISCUSSION: Based on the assumption that asthma is heterogeneous and each subject exhibits a different subset of risk factors for asthma exacerbation, as well as a different disease progression, the KAS aims to identify several asthma clusters and their essential determinants, which are more suitable for Korean asthmatic children. Thereafter we may suggest cluster-specific strategies by focusing on subjects' personalized aggravating factors during each exacerbation episode and by focusing on disease progression. The KAS will provide a good academic background with respect to each interventional strategy to achieve better asthma control and prognosis.


Assuntos
Asma/fisiopatologia , Progressão da Doença , Adolescente , Testes de Provocação Brônquica , Criança , Pré-Escolar , Análise por Conglomerados , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Pico do Fluxo Expiratório , Estudos Prospectivos , República da Coreia , Fatores de Risco , Espirometria , Inquéritos e Questionários
18.
Asian Pac J Allergy Immunol ; 36(3): 137-144, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29549705

RESUMO

BACKGROUND: Small airway hyperresponsiveness is a critical aspect in preschool children with asthmatic symptoms interms of asthma control. The aim of this study was to elucidate the relationship of changes in reactance (Xrs) and resistance (Rrs) of IOS and FEV1 with those in clinical parameters and to determine which IOS parameter is correlated with bronchial hyperresponsiveness before positive clinical endpoints. METHODS: We performed the methacholine challenge test in ninety-four preschool children (4.2±1.1 years) with suspected asthma. The end of test (EOT+) was defined as one or more of the following: audible wheezing (PCw+), a fall in the oxygen saturation (w92%, PCs+) or development of respiratory symptoms (PCr+). RESULTS: Mean changes in FEV1, Xrs5, and Rrs5 in the EOT+ group were 39.2±14.3% (95% CI 35.1-43.2%), 176.8±78.0 (95% CI 154.9-198.8) and 53.6±30.2 (45.1-62.0), respectively. The changes of Xrs5 in three EOT+ groups exceeded 80% and were lowest in PCr+(median, 95.9, IQR;73.4 to 132.4), followed by PCw+ and PCs+. However, Rrs5 did not show greater than 40% changes in PCr+. Xrs5 showed a higher correlation with changes in saturation (r=-0.578) than Rrs5 (r=-0.426). A49% decrease in Xrs5 was the optimal point for predicting a 80% change of Xrs5 at the following step. CONCLUSION: When examining the 5 step methacholine challenge test in preschoolers, the use of clinical parameters alone as an endpoint is of little value. The reactance value of 5 Hz is a useful predictive marker for bronchial hyperresponsiveness.


Assuntos
Asma/diagnóstico , Testes de Provocação Brônquica/métodos , Oscilometria/métodos , Broncoconstritores/farmacologia , Pré-Escolar , Feminino , Humanos , Masculino , Cloreto de Metacolina/farmacologia , Hipersensibilidade Respiratória
19.
Biomed Res Int ; 2017: 9460190, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28740854

RESUMO

OBJECTIVE: To investigate the repeatability and safety of measuring impulse oscillation system (IOS) parameters and the point of wheezing during bronchoprovocation testing of preschool children. METHODS: Two sets of methacholine challenge were conducted in 36 asthma children. The test was discontinued if there was a significant change in reactance (Xrs5) and resistance (Rrs5) at 5 Hz (Condition 1) or respiratory distress due to airway obstruction (Condition 2). The repeatability of PC80_Xrs5, PC30_Rrs5, and wheezing (PCw) was assessed. The changes in Z-scores and SD-indexes from prebaseline (before testing) to postbaseline (after bronchodilator) were determined. RESULTS: For PC30_Rrs5, PC80_Xrs5, and PCw for subjects, PC80_Xrs5 showed the highest repeatability. Fifteen of 70 tests met Condition 2. The changes from pre- and postbaseline values varied significantly for Rrs5 and Xrs5. Excluding subjects with Z-scores higher than 2SD, we were able to detect 97.1% of bronchial hyperresponsiveness during methacholine challenge based on the change in Rrs5 or Xrs5. A change in IOS parameters was associated with wheezing at all frequencies. CONCLUSION: Xrs5 and Rrs5 have repeatability comparable with FEV1, and Xrs5 is more reliable than Rrs5. Clinicians can safely perform a challenge test by measuring the changes in Rrs5, Xrs5, and Z-scores from the prebaseline values.


Assuntos
Asma/fisiopatologia , Testes de Provocação Brônquica , Cloreto de Metacolina/administração & dosagem , Mecânica Respiratória/efeitos dos fármacos , Pré-Escolar , Feminino , Humanos , Masculino
20.
Korean J Pediatr ; 58(5): 159-64, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-26124845

RESUMO

Most guidelines for chronic urticaria (CU) in infants and children are based on limited pediatric evidence. Current evidence used to guide treatment in children is extrapolated from data focusing on older age groups. CU in children is a different and complex condition than that in adults. Furthermore, there is little published information regarding urticaria in Korean children. The aim of the present article is to review recent research on chronic childhood urticaria and improve the current understanding of its pathogenesis and management. The classification and definition of urticaria in adults also applies to children. CU is defined as a daily occurrence of spontaneous wheals, angioedema, or both for >6 weeks. The precise pathophysiology of CU is unknown and the rates of successful identification of a cause in children with CU vary from 20%-50%. There is no established laboratory test to evaluate the presence of urticaria. The natural course of childhood CU is undetermined, with limited reports discussing long-term outcomes. Second-generation H1 antihistamines are the cornerstone of management, while limited therapeutic drugs are available for adults.

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