Exposure To Traffic And Indoor Pollutants Puts Some Kids At Higher Risk For Asthma Later
New research presents strong evidence that the "synergistic" effect of early-life exposure to both outdoor traffic-related pollution and indoor endotoxin causes more harm to developing lungs than one or the other exposure alone.
Environmental health scientists at the University of Cincinnati (UC) College of Medicine have shown that children exposed to both high levels of traffic-related particles and indoor endotoxin during early life are six times more likely to experience persistent wheezing than children exposed to low levels of traffic and indoor-related pollutants.
They report their findings in the Dec. 1, 2009, edition of the American Journal of Respiratory and Critical Care Medicine. This is believed to be the first study to look at the combined effects of traffic-related exposures and sampled endotoxin in children during infancy as an indicator of asthma later in life. Endotoxin, a component of bacteria thought to trigger an immune response in humans, was measured from dust samples collected prior to age 1.
Based on a long-term study of children deemed at high risk for allergies later in life, UC environmental health researchers have found that 36 percent of the children studied who were exposed to high levels of both traffic-related pollution and indoor endotoxin demonstrated persistent wheezing at age 3, an early warning sign of asthma and other pulmonary conditions. Only 11 percent of children exposed to low levels of both indoor and outdoor allergens experienced wheezing; 18 percent of children exposed to low levels of indoor endotoxin and high levels of traffic-related particles experienced persistent wheezing. Endotoxin exposure alone appeared to have little effect.
"There is a clear synergistic effect from co-exposure to traffic-related particles and endotoxin above and beyond what you would see with a single exposure that can be connected to persistent wheezing by age 3," explains Patrick Ryan, PhD, lead author of the study and a research assistant professor of environmental health at UC."These two exposure sources - when simultaneously present at high levels - appear to work together to negatively impact the health of young children with developing lungs."
To conduct this study, Ryan and his colleagues utilized land-use regression modeling to calculate study participants' exposures to traffic-related particles, such as diesel exhaust. The model was designed to capture exposures at locations where the child spent more than eight hours a week between birth and age 3; for example, in their homes or at day care.
"Traffic-related particles and endotoxin both seem to trigger an inflammatory response in the children monitored in this study. When put together, that effect is amplified to have a greater impact on the body's response," adds Ryan. "The earlier in life this type of exposure occurs, the more impact it may have long term. Lung development occurs in children up through age 18 or 20. Exposure earlier in life to both endotoxin and traffic will have a greater impact on developing lungs compared to adults whose lungs are already developed."
This research is part of the Cincinnati Childhood Allergy and Air Pollution Study, a long-term epidemiological study examining the effects of traffic particulates on childhood respiratory health and allergy development. Funded by the National Institute of Environmental Health Sciences, the study began in 2001 and is led by Grace LeMasters, PhD, of the UC Department of Environmental Health. Study participants were chosen based on family history and residence's proximity to a major road.
UC's LeMasters, David Bernstein, MD, James Lockey, MD, Tiina Reponen, PhD, Linda Levin, PhD, Sergey Grinshpun, PhD, Manuel Villareal, MD and Jeff Burkle were co-authors of the study. Gurjit Khurana Hershey, MD, PhD, of Cincinnati Children's Hospital Medical Center also participated in the research study.
Source: Amanda Harper
University of Cincinnati Academic Health Center
Saturday, November 28, 2009
Helping Preschoolers To Achieve Asthma Control
Helping Preschoolers To Achieve Asthma Control
Asthma is the commonest chronic disease in children and a major reason for admissions to hospital, yet inadequate asthma control is present in 26% to 45% of children, states a review http://www.cmaj.ca/embargo/cmaj071638.pdf in CMAJ (Canadian Medical Association Journal).
The review incorporates the latest scientific information that has come out of randomized controlled trials since the Canadian Pediatric Asthma Consensus Guidelines were published in 2003. It was produced as an initiative of the Canadian Thoracic Society.
The review provides key points for distinguishing between transient asthma and chronic asthma in preschoolers and information on managing both types.
For children with intermittent asthma, using inhaled corticosteroids only during attacks does not appear to be effective. Regular therapy with inhaled steroids should be used for children with more severe intermittent or persistent symptoms. Treatment with leukotriene receptor antagonists during the viral season may help to reduce symptoms and visits to health care providers. The possibility of another condition should be considered if children do not respond to optimal therapy.
The authors state that more research is needed to evaluate effectiveness of treatments in young children.
Source: Kim Barnhardt
Canadian Medical Association Journal
Asthma is the commonest chronic disease in children and a major reason for admissions to hospital, yet inadequate asthma control is present in 26% to 45% of children, states a review http://www.cmaj.ca/embargo/cmaj071638.pdf in CMAJ (Canadian Medical Association Journal).
The review incorporates the latest scientific information that has come out of randomized controlled trials since the Canadian Pediatric Asthma Consensus Guidelines were published in 2003. It was produced as an initiative of the Canadian Thoracic Society.
The review provides key points for distinguishing between transient asthma and chronic asthma in preschoolers and information on managing both types.
For children with intermittent asthma, using inhaled corticosteroids only during attacks does not appear to be effective. Regular therapy with inhaled steroids should be used for children with more severe intermittent or persistent symptoms. Treatment with leukotriene receptor antagonists during the viral season may help to reduce symptoms and visits to health care providers. The possibility of another condition should be considered if children do not respond to optimal therapy.
The authors state that more research is needed to evaluate effectiveness of treatments in young children.
Source: Kim Barnhardt
Canadian Medical Association Journal
Friday, November 20, 2009
Asthma A Significant Risk Factor For Complications In Children With H1N1
Asthma A Significant Risk Factor For Complications In Children With H1N1
A new study on pediatric H1N1 influenza admissions has found that asthma is a significant risk factor for severe disease in children with pandemic H1N1 compared with the seasonal flu. The study (http://www.cmaj.ca/cgi/rapidpdf/cmaj.091724), led by researchers from The Hospital for Sick Children (SickKids) in Toronto, Ontario, is published online in CMAJ (Canadian Medical Association Journal). This is the second largest study on the topic published to date. It looked at the charts of 58 children admitted to SickKids between May 8 and July 22, 2009 and compared them to 200 children admitted with seasonal influenza between 2004 and 2009. Every year, the hospital admits about 40 children under 18 years of age with seasonal influenza. Twenty-two per cent of children admitted with H1N1 had asthma compared with 6% of those admitted with seasonal influenza. Asthma was determined as a prior diagnosis of asthma or reactive airways disease, or a history of wheeze with the use of inhalers. Almost half of all admissions to the ICU for H1N1 influenza were children with asthma. The children with H1N1 influenza were older than those admitted for seasonal flu, with significantly more over the age of 5 years. Many children (49 or 84%) presented with fever and cough, with or without additional symptoms and 37% (21 children) had gastrointestinal symptoms such as vomiting and/or diarrhea. The median duration of hospital stay for both H1N1 and seasonal influenza was 4 days. "The most striking finding in our study was the high prevalence of asthma among children admitted with pandemic H1N1 influenza compared with those admitted in previous influenza seasons," write Dr. Upton Allen from The Hospital for Sick Children and coauthors. "Asthma has been identified as a significant risk factor for admission with pandemic H1N1 influenza, present in 21%-30% in the larger samples." None of the children admitted with pandemic influenza died compared with 1 death (0.4%) over 5 years in those admitted for seasonal influenza. Principal investigator Dr. Dat Tran and co-authors found that severity of asthma was broad and that children with mild asthma were also at risk. They conclude that children with mild asthma should be vaccinated for H1N1 and considered for antiviral therapy.
Source: Kim Barnhardt Canadian Medical Association Journal
A new study on pediatric H1N1 influenza admissions has found that asthma is a significant risk factor for severe disease in children with pandemic H1N1 compared with the seasonal flu. The study (http://www.cmaj.ca/cgi/rapidpdf/cmaj.091724), led by researchers from The Hospital for Sick Children (SickKids) in Toronto, Ontario, is published online in CMAJ (Canadian Medical Association Journal). This is the second largest study on the topic published to date. It looked at the charts of 58 children admitted to SickKids between May 8 and July 22, 2009 and compared them to 200 children admitted with seasonal influenza between 2004 and 2009. Every year, the hospital admits about 40 children under 18 years of age with seasonal influenza. Twenty-two per cent of children admitted with H1N1 had asthma compared with 6% of those admitted with seasonal influenza. Asthma was determined as a prior diagnosis of asthma or reactive airways disease, or a history of wheeze with the use of inhalers. Almost half of all admissions to the ICU for H1N1 influenza were children with asthma. The children with H1N1 influenza were older than those admitted for seasonal flu, with significantly more over the age of 5 years. Many children (49 or 84%) presented with fever and cough, with or without additional symptoms and 37% (21 children) had gastrointestinal symptoms such as vomiting and/or diarrhea. The median duration of hospital stay for both H1N1 and seasonal influenza was 4 days. "The most striking finding in our study was the high prevalence of asthma among children admitted with pandemic H1N1 influenza compared with those admitted in previous influenza seasons," write Dr. Upton Allen from The Hospital for Sick Children and coauthors. "Asthma has been identified as a significant risk factor for admission with pandemic H1N1 influenza, present in 21%-30% in the larger samples." None of the children admitted with pandemic influenza died compared with 1 death (0.4%) over 5 years in those admitted for seasonal influenza. Principal investigator Dr. Dat Tran and co-authors found that severity of asthma was broad and that children with mild asthma were also at risk. They conclude that children with mild asthma should be vaccinated for H1N1 and considered for antiviral therapy.
Source: Kim Barnhardt Canadian Medical Association Journal
A Risk Factor In Childhood Asthma Symptoms May Be Mother's Depression
A Risk Factor In Childhood Asthma Symptoms May Be Mother's Depression
Asthma symptoms can worsen in children with depressed mothers, according to research from Johns Hopkins Children's Center published online in the Journal of Pediatric Psychology. Analyzing data from interviews with 262 mothers of African-American children with asthma - a population disproportionately affected by this inflammatory airway disorder - the Hopkins investigators found that children whose mothers had more depressive symptoms had more frequent asthma symptoms during the six-months of the study. Conversely, children whose mothers reported fewer depressive symptoms had less frequent asthma symptoms. Researchers tracked ups and downs in maternal depression as related to the frequency of symptoms among children. "Even though our research was not set up to measure just how much a mom's depression increased the frequency of her child's symptoms, a clear pattern emerged in which the latter followed the earlier," says senior investigator Kristin Riekert, Ph.D., a pediatric psychologist and co-director of the Johns Hopkins Adherence Research Center. But while maternal depression appeared to aggravate a child's asthma, the opposite was not true: How often a child had symptoms did not seem to affect the mother's depressive symptoms, an important finding that suggests maternal depression is an independent risk factor that can portend a child's symptoms, researchers say. Past studies have shown that children with chronic health conditions fare worse if their primary caregiver is depressed, but none have teased out the exact interplay between the two. "Intuitively, it may seem that we're dealing with a chicken-egg situation, but our study suggests otherwise," Riekert says. "The fact that mom's depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first." Researchers did not study why and how a mother's depression affects a child's asthma status, but because depression often involves fatigue, memory lapses and difficulty concentrating, it can affect a parent's ability to manage the child's chronic condition, which can involve daily, and sometimes complex, drug regimens and frequent visits to the doctor. "Mom is the one who must implement the doctor's recommendations for treatment and follow-up, and if she is depressed she can't do it well, so the child will suffer," says lead investigator Michiko Otsuki, Ph.D., a behavioral medicine fellow at Johns Hopkins at the time of the study, now at the University of South Florida St. Petersburg. Investigators say their findings should prompt pediatricians who treat children with asthma to pay close attention to the child's primary caregiver - whether or not it is the mother - and screen and refer them for treatment if needed. "We ask these parents if they are smokers all the time, so maybe it's time to start asking them if they are coping well emotionally," said co-investigator Arlene Butz, Sc.D., a pediatric asthma specialist at Johns Hopkins Children's Center. "Doctors are trained to pick up on subtle clues, so if they see a red flag in mom, they should follow-up with a depression screener and referral if needed." Treating depressed mothers whose children are at high-risk for asthma complications will likely benefit both mother and child, researchers say, while providing a clear treatment target to help reduce the burden of asthma in the United States. Asthma is the country's leading pediatric chronic illness, affecting 6.5 million children under the age of 18, according to the CDC. The Hopkins study included only mothers but investigators believe a similar pattern would emerge regardless of who the primary caregiver is. Researchers caution that the mothers in their study were screened for depression with a standard questionnaire, which is a reliable detector of symptoms but not a firm diagnosis. The Hopkins findings came from a high-risk, inner-city population and thus cannot be statistically extended to other ethnic and socioeconomic groups, but researchers say the effect of caregiver depression on a child's asthma likely transcends demographics.
The research was funded by the National Heart Lung Blood Institute.
Other Hopkins researchers involved in the study included Michelle Eakin, Ph.D., Lisa Arceneaux, Psy.D., Cynthia Rand, Ph.D. Source: Ekaterina Pesheva Johns Hopkins Medical Institutions
Asthma symptoms can worsen in children with depressed mothers, according to research from Johns Hopkins Children's Center published online in the Journal of Pediatric Psychology. Analyzing data from interviews with 262 mothers of African-American children with asthma - a population disproportionately affected by this inflammatory airway disorder - the Hopkins investigators found that children whose mothers had more depressive symptoms had more frequent asthma symptoms during the six-months of the study. Conversely, children whose mothers reported fewer depressive symptoms had less frequent asthma symptoms. Researchers tracked ups and downs in maternal depression as related to the frequency of symptoms among children. "Even though our research was not set up to measure just how much a mom's depression increased the frequency of her child's symptoms, a clear pattern emerged in which the latter followed the earlier," says senior investigator Kristin Riekert, Ph.D., a pediatric psychologist and co-director of the Johns Hopkins Adherence Research Center. But while maternal depression appeared to aggravate a child's asthma, the opposite was not true: How often a child had symptoms did not seem to affect the mother's depressive symptoms, an important finding that suggests maternal depression is an independent risk factor that can portend a child's symptoms, researchers say. Past studies have shown that children with chronic health conditions fare worse if their primary caregiver is depressed, but none have teased out the exact interplay between the two. "Intuitively, it may seem that we're dealing with a chicken-egg situation, but our study suggests otherwise," Riekert says. "The fact that mom's depression was not affected by how often her child had symptoms really caught us off guard, but it also suggested which factor comes first." Researchers did not study why and how a mother's depression affects a child's asthma status, but because depression often involves fatigue, memory lapses and difficulty concentrating, it can affect a parent's ability to manage the child's chronic condition, which can involve daily, and sometimes complex, drug regimens and frequent visits to the doctor. "Mom is the one who must implement the doctor's recommendations for treatment and follow-up, and if she is depressed she can't do it well, so the child will suffer," says lead investigator Michiko Otsuki, Ph.D., a behavioral medicine fellow at Johns Hopkins at the time of the study, now at the University of South Florida St. Petersburg. Investigators say their findings should prompt pediatricians who treat children with asthma to pay close attention to the child's primary caregiver - whether or not it is the mother - and screen and refer them for treatment if needed. "We ask these parents if they are smokers all the time, so maybe it's time to start asking them if they are coping well emotionally," said co-investigator Arlene Butz, Sc.D., a pediatric asthma specialist at Johns Hopkins Children's Center. "Doctors are trained to pick up on subtle clues, so if they see a red flag in mom, they should follow-up with a depression screener and referral if needed." Treating depressed mothers whose children are at high-risk for asthma complications will likely benefit both mother and child, researchers say, while providing a clear treatment target to help reduce the burden of asthma in the United States. Asthma is the country's leading pediatric chronic illness, affecting 6.5 million children under the age of 18, according to the CDC. The Hopkins study included only mothers but investigators believe a similar pattern would emerge regardless of who the primary caregiver is. Researchers caution that the mothers in their study were screened for depression with a standard questionnaire, which is a reliable detector of symptoms but not a firm diagnosis. The Hopkins findings came from a high-risk, inner-city population and thus cannot be statistically extended to other ethnic and socioeconomic groups, but researchers say the effect of caregiver depression on a child's asthma likely transcends demographics.
The research was funded by the National Heart Lung Blood Institute.
Other Hopkins researchers involved in the study included Michelle Eakin, Ph.D., Lisa Arceneaux, Psy.D., Cynthia Rand, Ph.D. Source: Ekaterina Pesheva Johns Hopkins Medical Institutions
Sunday, November 15, 2009
Wednesday, November 11, 2009
Thursday, November 5, 2009
Folic Acid Supplements Linked To Asthma, Study Suggests
ScienceDaily (2009-11-04) -- A new study may have shed light on the rise in childhood asthma in developed countries like Australia in recent decades. Researchers have identified a link between folic acid supplements taken in late pregnancy and allergic asthma in children aged between 3 and 5 years, suggesting that the timing of supplementation in pregnancy is important. ... > read full article
Acetaminophen May Be Linked To Asthma In Children And Adults
ScienceDaily (2009-11-05) -- New research shows that the popular pain reliever, acetaminophen, may be tied to asthma in both children and adults. ... > read full article
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