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Pais-Cunha I, Fontoura Matias J, Almeida AL, Magalhães M, Fonseca JA, Azevedo I, Jácome C. Telemonitoring of pediatric asthma in outpatient settings: A systematic review. Pediatr Pulmonol 2024. [PMID: 38742250 DOI: 10.1002/ppul.27046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Abstract
Telemonitoring technologies are rapidly evolving, offering a promising solution for remote monitoring and timely management of asthma acute episodes. We aimed to describe current pediatric asthma telemonitoring technologies. A systematic review was conducted until September 2023 on Medline, Scopus, and Web of Science. We included studies of children (0-18 years) with asthma or recurrent wheezing whose respiratory condition was telemonitored outside the healthcare setting. A narrative synthesis was performed. We identified 40 telemonitoring technologies described in 40 studies. The more frequently used technologies for telemonitoring were mobile applications (n = 21) and web-based systems (n = 14). Telemonitoring duration varied between 2 weeks and 32 months. Data collection included asthma symptoms (n = 30), patient-reported outcome measures (PROMs) (n = 11), spirometry/peak flow readings (n = 20), medication adherence (n = 17), inhaler technique (n = 3), air quality (n = 2), and respiratory sounds (n = 2). Both parents and children were the technology target users in most studies (n = 23). Technology training was reported in 23 studies of which 3 provided ongoing support. Automatic feedback was found in 30 studies, mostly related with asthma control. HCP were involved in data management in 27 studies. Technologies were tested in samples from 4 to 327 children, with most studies including school-aged children and/or adolescents (n = 38) and eight including preschool children. This review provides an overview of existing technologies for the outpatient telemonitoring of pediatric asthma. Specific technologies for preschool children represent a gap in the literature that needs to be specifically addressed in future research.
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Affiliation(s)
- Inês Pais-Cunha
- Serviço De Pediatria, Unidade De Gestão Autónoma Da Mulher E Da Criança, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento De Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
| | - José Fontoura Matias
- Serviço De Pediatria, Unidade De Gestão Autónoma Da Mulher E Da Criança, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento De Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Ana Laura Almeida
- Serviço De Pediatria, Unidade De Gestão Autónoma Da Mulher E Da Criança, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento De Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Manuel Magalhães
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
- Serviço De Pediatria, Centro Materno Infantil Do Norte, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
- Allergy Unit, Instituto CUF Porto E Hospital CUF Porto, Porto, Portugal
| | - Inês Azevedo
- Serviço De Pediatria, Unidade De Gestão Autónoma Da Mulher E Da Criança, Centro Hospitalar Universitário São João, Porto, Portugal
- Departamento De Ginecologia-Obstetrícia e Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of University of Porto, Porto, Portugal
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Terry D, Peck B, Kloot K. Paediatric Emergency Asthma Presentations: Temporal Trends and Representations in Rural Australia. Healthcare (Basel) 2023; 11:3113. [PMID: 38132002 PMCID: PMC10742987 DOI: 10.3390/healthcare11243113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
Asthma is a key illness driving children to present to emergency departments, and although paediatric emergency asthma presentations have been examined, the temporal trends remain somewhat elusive. The aim is to highlight, describe, and model the temporal trends of emergency paediatric asthma presentations, using comprehensive hospital emergency presentation data. A retrospective cross-sectional study examined de-identified paediatric (0 to 14 years) emergency asthma presentation data over a three-year period. Data were obtained from nine healthcare facilities in Victoria, Australia. Episode-level data were collected through RAHDaR, a comprehensive emergency data register which includes missing data (35.0%) among rural health facilities not currently captured elsewhere. Monthly presentation rates demonstrate a significant difference in presentations between fall/autumn and spring, and males had higher presentation rates in February and June-August. Emergency presentations were more likely to occur Sunday-Tuesday, peaking in the time periods of 8-9 a.m., 11 a.m.-12 p.m., and 8-9 p.m. Significant differences were noted between all age groups. Examining previously unavailable rural data has highlighted patterns among emergency asthma presentations for children 0-14 years of age. Knowledge of these by season, month, and day of the week, in combination with time of day, offers scope for more focused workforce education and planning, and nuanced referral pathways, particularly in resource-limited settings.
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Affiliation(s)
- Daniel Terry
- School of Nursing and Midwifery, University of Southern Queensland, Ipswich, QLD 4305, Australia;
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC 3350, Australia;
| | - Blake Peck
- Institute of Health and Wellbeing, Federation University, Ballarat, VIC 3350, Australia;
| | - Kate Kloot
- School of Medicine, Deakin University, Warrnambool, VIC 3280, Australia
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Donath H, Klenner H, Hutter M, Meoli A, Trischler J, Schulze J, Blumchen K, Zielen S. Severe bronchial hyperresponsiveness along with house dust mite allergy indicates persistence of asthma in young children. Pediatr Allergy Immunol 2023; 34:e14047. [PMID: 38146109 DOI: 10.1111/pai.14047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Significant risk factors for persistence of asthma later in life are family history of allergies, early allergic sensitization and bronchial hyperresponsiveness (BHR). The evolution of BHR in young children without allergic sensitization and with house dust mite allergy (HDM) was investigated. METHODS In this retrospective analysis, electronic charts of 4850 young children with asthma and wheezy bronchitis between 2005 and 2018 were reviewed in order to study all patients ≤6 years with BHR assessed by methacholine provocation tests (MCT) at least once (n = 1175). Patients with more than two follow-up measurements were divided in group 1 (no allergic sensitization; n = 110) and group 2 (HDM allergy; n = 88). Additionally, skin prick test, exhaled nitrite oxide (eNO), and asthma treatment were analyzed. RESULTS Forty-seven patients of group 1 aged median 4.3 years and 48 patients of group 2 aged median 4.7 years showed initially severe BHR <0.1 mg. At follow-up, patients with HDM were more likely to show persistence of severe BHR than non-sensitized patients (severe BHR group 1: n = 5 (10.6%) vs. group 2: n = 21 (43.8%), p < .001). In addition, 89.4% of group 1 had mild to moderate or no BHR, compared to only 56.2% of group 2. There was a significant difference in eN0 (median group 1: 9 ppb vs. group 2: 26 ppb, p < .001), at last follow-up. Age, sex, and asthma therapy had no effect on BHR. CONCLUSION In young children without sensitization BHR normalizes, whereas HDM allergy indicates a persistence of asthma beyond infancy.
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Affiliation(s)
- Helena Donath
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Hans Klenner
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Martin Hutter
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Aniello Meoli
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Jordis Trischler
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Johannes Schulze
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Katharina Blumchen
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Zielen
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Institute for Respiratory Diseases, Medaimun GmbH, Frankfurt, Germany
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Chen KYH, Aye Tun N, Jones R, Shanthikumar S, Carlin JB, Hiscock H. Effectiveness of asthma preventer dispensing for preventing childhood asthma readmissions: a multisite cohort linkage study. Arch Dis Child 2023:archdischild-2022-324549. [PMID: 37185082 DOI: 10.1136/archdischild-2022-324549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To (1) describe the dispensing of asthma preventers at hospital discharge and estimate its effect on hospital readmissions, and (2) estimate the effect of community asthma preventer dispensing on readmissions for the subgroup of children who were not prescribed an asthma preventer at discharge. DESIGN Multisite cohort study with linked administrative data. PARTICIPANTS Children aged 3-18 years admitted with asthma to a tertiary paediatric, mixed paediatric and adult, or regional hospital between 2017 and 2018. MAIN OUTCOME MEASURE Hospital readmission for asthma within 12 months. RESULTS Of the 767 participants, 201 (26.2%) were newly prescribed or requested to continue with asthma preventers. Of these, only 91 (45.3%) dispensed their discharge prescription within 3 days or had an active prescription. There was no evidence for a protective effect of discharge asthma preventer dispensing on asthma hospital readmissions within 12 months (OR 1.17, 95% CI 0.69 to 1.97, p=0.57). Of the 566 children who were not prescribed asthma preventers at discharge, 269 (47.5%) had one or more prescriptions dispensed in the community within 12 months. Participants who were in the protected period (asthma preventer dispensed) had reduced risk of an asthma hospital readmission (HR 0.61, 95% CI 0.36 to 1.02, p=0.06), including preschool children (HR 0.48, 95% CI 0.25, 0.93, p=0.03) on subgroup analysis. CONCLUSIONS There was a low rate for prescribing and dispensing of hospital discharge asthma preventers and no protective effect was found for its impact on readmissions. A protective effect on readmissions was found for community asthma preventer dispensing.
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Affiliation(s)
- Katherine Ya-Hui Chen
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nilar Aye Tun
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Renee Jones
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Shivanthan Shanthikumar
- Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Respiratory Diseases Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - John B Carlin
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Health Services Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
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Bhardwaj P, Tyagi A, Tyagi S, Antão J, Deng Q. Machine learning model for classification of predominantly allergic and non-allergic asthma among preschool children with asthma hospitalization. J Asthma 2023; 60:487-495. [PMID: 35344453 DOI: 10.1080/02770903.2022.2059763] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma is the most frequent chronic airway illness in preschool children and is difficult to diagnose due to the disease's heterogeneity. This study aimed to investigate different machine learning models and suggested the most effective one to classify two forms of asthma in preschool children (predominantly allergic asthma and non-allergic asthma) using a minimum number of features. METHODS After pre-processing, 127 patients (70 with non-allergic asthma and 57 with predominantly allergic asthma) were chosen for final analysis from the Frankfurt dataset, which had asthma-related information on 205 patients. The Random Forest algorithm and Chi-square were used to select the key features from a total of 63 features. Six machine learning models: random forest, extreme gradient boosting, support vector machines, adaptive boosting, extra tree classifier, and logistic regression were then trained and tested using 10-fold stratified cross-validation. RESULTS Among all features, age, weight, C-reactive protein, eosinophilic granulocytes, oxygen saturation, pre-medication inhaled corticosteroid + long-acting beta2-agonist (PM-ICS + LABA), PM-other (other pre-medication), H-Pulmicort/celestamine (Pulmicort/celestamine during hospitalization), and H-azithromycin (azithromycin during hospitalization) were found to be highly important. The support vector machine approach with a linear kernel was able to diffrentiate between predominantly allergic asthma and non-allergic asthma with higher accuracy (77.8%), precision (0.81), with a true positive rate of 0.73 and a true negative rate of 0.81, a F1 score of 0.81, and a ROC-AUC score of 0.79. Logistic regression was found to be the second-best classifier with an overall accuracy of 76.2%. CONCLUSION Predominantly allergic and non-allergic asthma can be classified using machine learning approaches based on nine features. Supplemental data for this article is available online at at www.tandfonline.com/ijas .
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Affiliation(s)
- Piyush Bhardwaj
- Centre for Advanced Computational Solutions (C-fACS), Department of Molecular Biosciences, Lincoln University, Lincoln, Christchurch, New Zealand
| | - Ashish Tyagi
- Department of Forensic Medicine & Toxicology, SHKM Govt. Medical College, Nuh, Haryana, India
| | - Shashank Tyagi
- Department of Forensic Medicine & Toxicology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Joana Antão
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal.,Department of Research and Education, CIRO, Horn, The Netherlands
| | - Qichen Deng
- Department of Research and Education, CIRO, Horn, The Netherlands.,Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, Limburg, The Netherlands
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Chung HL. Diagnosis and management of asthma in infants and preschoolers. Clin Exp Pediatr 2022; 65:574-584. [PMID: 35436814 PMCID: PMC9742764 DOI: 10.3345/cep.2021.01746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/31/2022] [Indexed: 01/06/2023] Open
Abstract
Asthma is one of the most common chronic disease affecting children, and it often starts in infancy and preschool years. In previous birth cohorts, frequent wheezing in early life was associated with the development of asthma in later childhood and reduced lung function persisting into adulthood. Preschool wheezing is considered an umbrella term for distinctive diseases with different clinical features (phenotypes), each of which may be related to different underlying pathophysiologic mechanisms (endotypes). The classification of phenotypes of early wheezing is needed to identify children at high risk for developing asthma later who might benefit from early intervention. However, diagnosis of asthma in infants and preschoolers is particularly difficult because objective lung function tests cannot be performed and definitive biomarkers are lacking. Moreover, management of early asthma is challenging because of its different phenotypic presentations. Many prediction models and asthma guidelines have been developed to provide useful information for physicians to assess young children with recurrent wheezing and manage them appropriately. Many recent studies have investigated the application of personalized medicine for early asthma by identifying specific phenotypes and biomarkers. Further researches, including genetic and molecular studies, are needed to establish a clear definition of asthma and develop more targeted therapeutic approaches in this age group.
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Affiliation(s)
- Hai Lee Chung
- Department of Pediatrics, School of Medicine, Daegu Catholic University, Daegu, Korea
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Al-Iede M, Aleidi SM, Al Oweidat K, Dannoun M, Alsmady D, Faris H, Issa H, Abughoush L, Almoslawi O, Al-Zayadney E, Alqutawneh B, Daher A. Characteristics of inpatients with atopic asthma in a tertiary center: Do age and gender have an influence? Multidiscip Respir Med 2022; 17:883. [DOI: 10.4081/mrm.2022.883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Several studies have demonstrated gender influence on asthma prevalence, being higher among males during early childhood. Little is known about the impact of gender and age on asthma exacerbation characteristics in pediatrics. This study aimed to determine the differences in acute asthma between males and females in three different age groups regarding perinatal characteristics of asthmatic patients, comorbidities, medication adherence, level of blood eosinophils, and pattern of hospitalization.Methods: The medical records of 130 pediatric patients with asthma, who presented to the emergency department at Jordan University hospital with asthma exacerbations, were retrospectively reviewed. Demographic information and clinical characteristics were collected.Results: The mean age of patients was 10.7±4.7 years. The age at diagnosis and gestational age were significantly higher in older children. Furthermore, younger children were significantly more likely to experience winter exacerbations and more emergency presentations. Male patients were considerably younger than their female counterparts and were diagnosed younger. In addition, male patients were more likely to have eosinophil levels higher than 3% than female patients.Conclusion: Gender plays a role in the development and outcome of asthma exacerbations at different ages of pediatrics. A better understanding of gender-based and age-based differences in asthma dictates a personalized approach to treatment.
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Trischler J, von Blumroeder M, Donath H, Kluge S, Hutter M, Dreßler M, Zielen S. Antibiotic Use in Paediatric Patients Hospitalized with Acute Severe Asthma. KLINISCHE PADIATRIE 2022; 234:277-283. [PMID: 35315003 DOI: 10.1055/a-1712-4225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antibiotic use during asthma exacerbations in paediatric patients is not routinely recommended but common practise in out-patient and in-patient settings. Objective of this study was to analyse frequency of antibiotic use during acute severe asthma exacerbations, antibiotic classes utilized and clinical decision-making. METHODS All in-patient admissions over 10 years in a single German Children's University hospital due to acute severe asthma were included in this retrospective analysis. Age, length of stay, oxygen supplementation, treatment, laboratory parameters and chest x-rays of all patients ranging from 1 to 17 years were analysed. RESULTS 580 hospital admissions were included in this study. Overall antibiotic use was high but decreased with age (1-5 years 69,6%, 6-11 years 57,6% and 12-17 years 39,7%, p<0.001). Analysis of antibiotic treatment without clear indication showed a consistently lower treatment rate of 28.3%, with macrolides being the most common antibiotic class. Younger age significantly decreased, whereas, increase of CrP value, use of oxygen supplementation and concomitant fever all significantly increased the odds ratio (OR 0.967; 4.366, 2.472 and 2.011 respectively) of receiving antibiotic treatment without clear indication. CONCLUSION Antibiotic treatment without clear indication during acute severe asthma is common in this German single-centre cohort. Clinical parameters of more severe disease affect clinician's decision to administer antibiotics despite evidence of bacterial infection or improved outcome.
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Affiliation(s)
- Jordis Trischler
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Malin von Blumroeder
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Helena Donath
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Sven Kluge
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Martin Hutter
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Melanie Dreßler
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - Stefan Zielen
- Division of Allergy, Pulmonology and Cystic fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
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The First 1000 Days: Impact of Prenatal Tobacco Smoke Exposure on Hospitalization Due to Preschool Wheezing. Healthcare (Basel) 2021; 9:healthcare9081089. [PMID: 34442226 PMCID: PMC8391353 DOI: 10.3390/healthcare9081089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/26/2022] Open
Abstract
Preschool wheezing and related hospitalization rates are increasing. Prenatal tobacco smoke exposure (PTSE) increases the risk of wheezing, yet >20% of French women smoke during pregnancy. In this observational retrospective monocentric study, we assessed the link between PTSE and hospital admissions. We included infants <2 years of age admitted for acute wheezing. A phone interview with mothers was completed by electronic records. The primary endpoint was the ratio of cumulative duration of the hospitalization stays (days)/age (months). 129 children were included (36.4% exposed to PTSE vs. 63.6% unexposed). There was a significant difference in the duration of hospitalization/age: 0.9 days/month (exposed) vs. 0.58 days/month (unexposed) (p = 0.008). Smoking one cigarette/day during pregnancy was associated with an increase in hospitalization duration of 0.055 days/month (r = 0.238, p = 0.006). In the multi-variable analysis, this positive association persisted (β = 0.04, p = 0.04; standardized β = 0.27, p = 0.03). There was a trend towards a dose-effect relationship between PTSE and other important parameters associated with hospital admissions. We have demonstrated a dose-effect relationship, without a threshold effect, between PTSE and duration of hospitalization for wheezing in non-premature infants during the first 2 years of life. Prevention campaigns for future mothers should be enforced.
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