Presence of atopy increases the risk of asthma relapse

Clinical characteristics of children with asthma exacerbations: a cross-sectional descriptive study

AIM

In this cross-sectional descriptive study, we aimed to determine the clinical characteristics of children admitted to a tertiary hospital with asthma exacerbations in a city in southern Turkey where aeroallergens are common and to determine how these characteristics affect the severity of exacerbations.

METHODS

Data from a cross-sectional analysis of children with asthma exacerbations who were followed up at the Cukurova University Medical Faculty Pediatric Emergency Department (ED) and Pediatric Allergy & Immunology inpatient clinic were retrospectively analyzed. The study included 106 children who were diagnosed with asthma and did not have any additional comorbidities. In a comparative analysis, the clinical characteristics and laboratory parameters of children with mild/moderate and severe exacerbations were examined.

RESULTS

While 81.1% of the patients had mild/moderate exacerbation, 18.8% had severe exacerbation. Additional atopic disease, Alternaria positivity in the skin prick test, the frequency of exacerbations in the previous year, Streptococcus pneumoniae infection, and the rate of noncompliance with treatment were significantly higher in children with severe asthma exacerbations. PEF, FEV1, and FEV1/FVC values were considerably lower in patients with severe exacerbations.

CONCLUSIONS

Bacterial infections, presence of atopic disease, Alternaria exposure, low spirometric measures, number of exacerbations in the previous year, and low rate of treatment adherence may be relevant in predicting the severity of asthma exacerbations.

Translation and cross-cultural adaptation of a Nepali version of the Dutch Participation and Activity Inventory for Children and Youth (PAI - CY) with visual impairment

Background

Visual impairment is an important cause of disability in children. There is a lack of information on rehabilitation needs and low vision support services for children with visual impairment in Nepal. This is a pilot study designed to translate, culturally adapt and pre-test the Dutch version of the Participation and Activity Inventory for Children and Youth (PAI-CY) with visual impairment aged 7–17 years to develop a Nepali version.

Questionnaires (PAI-CY versions for 7–12 and 13–17 years) were translated using standardized methods and were culturally adapted by a panel of experts. They were pretested to evaluate comprehensibility and relevance among six children with visual impairment and blindness. Finally, participants completed a questionnaire evaluation form.

Results

The translation and cultural adaptation process resulted in the adaptation of nine items to make them suitable for Nepali culture. Most children had comprehensibility problems with some specific items because of vocabulary, sentence structure and the composition of items. Most of the children were satisfied with the questionnaires.

Conclusion

The study resulted in the development of a Nepali version of the PAI-CY. We worked with a small group of content experts and a small but representative sample of children which allowed us to use rigorous translation procedures to address language and cultural differences. A population based study has been planned to investigate the psychometric properties of these questionnaires.

How Does the Canadian Acute Respiratory Illness and Flu Scale Relate to Other Scales in Pediatric Asthma Exacerbations?

Objectives: In children with asthma exacerbations, we evaluated the relationship between Canadian Acute Respiratory Illness and Flu Scale (CARIFS) scores and (a) Asthma Diary Scale (ADS) scores for 14 days; (b) Pediatric Asthma Caregiver's Quality of Life (QoL) Questionnaire (PACQLQ) scores on days 1, 7 and 14; (c) viral detection. We hypothesized that in children with acute asthma, CARIFS scores correlate with ADS and PACQLQ scores over time and that viruses have little impact on CARIFS scores.Methods: In children aged 2-16 years who presented with acute asthma to the Emergency Departments of 2 hospitals, we documented the clinical history, examination, asthma severity at baseline and on presentation. Eighteen respiratory pathogens were determined by PCR on nasopharyngeal aspirate (NPA) collected on recruitment. The parent(s) recorded their child's daily CARIFS and ADS and weekly PACQLQ for 14 days. We used Spearman's correlation to relate the scores of 108 children.Results: CARIFS scores correlated well with ADS scores throughout 14 days (r_s ranged 0.30-0.67). CARIFS and PACQLQ scores correlated -0.28, -0.14 and -0.44 on days 1, 7 and 14 respectively. There was no significant difference in CARIFS scores between children whose NPAs were PCR virus-positive or -negative over 14 days.Conclusions: CARIFS and ADS scores correlated well as a disease severity measure during the recovery period in children with acute asthma and this was not influenced by the virus state. The ADS may be used as an alternative in selected situations. The CARIFS reflects different aspects to acute asthma severity and QoL.

Determinants of cough and caregivers' quality of life in pediatric asthma exacerbations

OBJECTIVES

In hospitalized and nonhospitalized children with asthma exacerbations, we evaluated the determinants of (a) prolonged cough on day-14 and (b) asthma quality of life (QoL) questionnaires for parents (PACQLQ) on day-21. We hypothesized that children with more severe acute asthma are more likely to have prolonged cough and/or poorer PACQLQ during the recovery phase.

DESIGN

Prospective cohort study performed during 2009-2011.

METHODOLOGY

Two hundred and forty-four children aged 2-16 years presenting with acute asthma to the Emergency Departments of two hospitals were recruited. Clinical history, examination, baseline asthma severity, and acute asthma severity on presentation were documented. Validated daily cough diaries and weekly PACQLQ were recorded for 14 and 21 days, respectively.

RESULTS

34.4% and 32.2% of children who returned the daytime and nighttime cough diaries respectively had a prolonged cough. Those on regular inhaled corticosteroids (ICS) were significantly more likely to have a daytime or nighttime cough score of ≥1 on day-14 (odds ratio [OR_adjusted ] = 4.70, 95% confidence interval [CI] 1.65, 13.35, p = .004 and OR_adjusted  = 2.65, 95% CI 1.05, 6.69, p = .040, respectively). PACQLQ on day-21 was significantly poorer in younger children (mean difference [MD] = -0.04 per year, 95% CI -0.08, -0.01, p = .016), those on ICS (MD = -0.31, 95% CI -0.52, -0.09, p = .005), leukotriene antagonists (MD = -0.42, 95% CI -0.83, -0.02, p = .040) and in those who had an unplanned visit for asthma on day-21 (MD = -1.20, 95% CI -1.61, -0.78, p = .0001).

CONCLUSIONS

Post an acute asthma exacerbation, children on regular ICS were more likely to have prolonged cough and poorer QoL. While this may be reflective of asthma severity or control, its association deserves further evaluation.

Chlamydiae from Down Under: The Curious Cases of Chlamydial Infections in Australia

In Australia, the most researched and perhaps the most successful chlamydial species are the human pathogen Chlamydia trachomatis, animal pathogens Chlamydia pecorum and Chlamydia psittaci. C. trachomatis remains the leading cause of sexually transmitted infections in Australians and trachoma in Australian Indigenous populations. C. pecorum is globally recognised as the infamous koala and widespread livestock pathogen, whilst the avian C. psittaci is emerging as a horse pathogen posing zoonotic risks to humans. Certainly not innocuous, the human infections with Chlamydia pneumoniae seem to be less prevalent that other human chlamydial pathogens (namely C. trachomatis). Interestingly, the complete host range for C. pecorum and C. psittaci remains unknown, and infections by other chlamydial organisms in Australian domesticated and wildlife animals are understudied. Considering that chlamydial organisms can be encountered by either host at the human/animal interface, I review the most recent findings of chlamydial organisms infecting Australians, domesticated animals and native wildlife. Furthermore, I also provide commentary from leading Australian Chlamydia experts on challenges and future directions in the Chlamydia research field.

Sensitization to inhaled allergens in asthmatic children in southern Jordan: a cross-sectional study

BACKGROUND

Sensitization to inhaled allergens in children with bronchial asthma significantly affects asthma pathogenesis, severity and persistence into late childhood and adulthood. The present study determined the prevalence of sensitization to inhaled allergens in children with bronchial asthma and wheezing episodes in order to investigate the effect of positive sensitization on the severity and control of asthma symptoms and to screen for other associated allergic conditions.

METHODS

A cross-sectional study was conducted, including children between 6 months and 14 years of age attending the chest clinic of Al-Karak, south of Jordan, between November 2013 and February 2016. Skin prick tests (SPTs) using 11 standardized allergen extracts were conducted in 277 children. The severity of asthma was determined based on the Global Initiative for Asthma (GINA) assessment and the Childhood Asthma Control Test (C-ACT) in addition to the history of use of systemic steroids and hospital admissions within the past 12 months.

RESULTS

Sixty-seven percent of children with bronchial asthma reported sensitization to one or more of the inhaled allergens. The most common allergens were olive pollens (18%), cat fur (13.5%), and Dermatophagoides pteronyssinus (11.9%). There was a significant increase in allergen sensitization with age (p < 0.001). The most common concomitant allergic condition among children was allergic rhinitis (71.5%); however, allergic conjunctivitis was the only allergic condition that correlated with the skin test reactivity (p = 0.01). A family history of bronchial asthma was confirmed in 40.4% of children. Children with positive SPTs had lower ACT scores and reported more frequent use of systemic steroids and admissions to hospital within the past 12 months; however, this effect was not statistically significant (p > 0.05).

CONCLUSIONS

Sensitization to inhaled allergens is highly prevalent in children with asthma and wheezing episodes in southern Jordan and may be correlated with the severity of the disease. Therefore, appropriate measures to recognize and avoid these allergens are highly recommended. Most children in our study suffered from concomitant allergic rhinitis, indicating that an appropriate diagnosis and treatment of allergic rhinitis could significantly improve asthma control and thus the quality of life of these children.

TRIAL REGISTRATION

This study is not a clinical trial.

Asthma exacerbation trajectories and their predictors in children with incident asthma

BACKGROUND

Asthma exacerbation trajectories in children after incident asthma diagnosis are understudied.

OBJECTIVE

To identify trajectories of asthma exacerbation and predictors of these trajectories in children with incident asthma.

METHODS

Children from the National Longitudinal Survey of Children and Youth, Canada, with incident asthma were followed-up for up to 12 years during childhood. Latent class growth modeling was used to identify distinct asthma exacerbation trajectory groups. Multinomial logistic regression was performed to identify predictors of trajectory group membership.

RESULTS

The mean age at asthma diagnosis among 403 children was 5.9 years. Three distinct trajectories were identified: low increasing (21.3% of children), medium decreasing (45.8% of children), and high decreasing (32.8% of children). Asthma attack probability increased gradually after diagnosis in low increasing group, decreased from moderate level after diagnosis to almost zero probability at the end of follow-up in the medium decreasing group, and decreased after diagnosis but remained higher in the high decreasing group than the other 2 groups at 12 years after diagnosis. Children having more siblings at home were more likely to belong to the medium decreasing and high decreasing trajectory groups, whereas children older at asthma diagnosis were less likely to belong to the medium decreasing and high decreasing trajectory groups than the low increasing trajectory group.

CONCLUSION

Our results suggest that children with incident asthma follow 3 distinct trajectories of asthma exacerbations after asthma diagnosis. The trajectory group with initial moderate exacerbation probability has better long-term prognosis.