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Asma/terapia , Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Adolescente , Antiasmáticos/uso terapéutico , Asma/diagnóstico , Asma/epidemiología , COVID-19 , Niño , Enfermedad Crónica , Ensayos Clínicos como Asunto , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Diagnóstico Diferencial , Progresión de la Enfermedad , Salud Global , Humanos , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Factores de Riesgo , SARS-CoV-2 , Determinantes Sociales de la Salud , TelemedicinaAsunto(s)
Salud Infantil , Ciencia de los Datos , Investigación sobre Servicios de Salud , Pediatría , Niño , HumanosAsunto(s)
Glucocorticoides/administración & dosificación , Glucocorticoides/efectos adversos , Ruidos Respiratorios , Administración Oral , Asma/tratamiento farmacológico , Recuento de Células Sanguíneas , Densidad Ósea/efectos de los fármacos , Preescolar , Eosinófilos/metabolismo , Humanos , Terapia de Inmunosupresión , Uso Excesivo de Medicamentos Recetados , Ensayos Clínicos Controlados Aleatorios como Asunto , Infecciones del Sistema Respiratorio/complicacionesAsunto(s)
Asma/terapia , Automanejo , Adolescente , Humanos , Medios de Comunicación Sociales , Envío de Mensajes de TextoRESUMEN
Asthma is a common chronic childhood disease that is associated with high rates of school absenteeism and educational disparities. Effective school-based programs exist that are able to reduce school absenteeism and the burden that asthma exacts on students. However, despite the availability of effective school-centered asthma programs conducted as research projects, many schools have struggled to implement the programs and experience their benefits. As the literature from the implementation sciences highlights, readiness of the school environment is crucial and central to success. This is an often overlooked and underacknowledged aspect to successful implementation. This article provides a case study of a large school district, highlighting its experience in preparing the district for broad-scale implementation of a school-centered asthma program.
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Asma/enfermería , Práctica Clínica Basada en la Evidencia/normas , Guías de Práctica Clínica como Asunto , Servicios de Salud Escolar/normas , Servicios de Enfermería Escolar/normas , Adolescente , Niño , Preescolar , Colorado , Femenino , Humanos , Masculino , Estudios de Casos Organizacionales , Desarrollo de ProgramaRESUMEN
BACKGROUND: Genome-wide association studies have yet to identify the majority of genetic variants involved in asthma. We hypothesized that expression quantitative trait locus (eQTL) mapping can identify novel asthma genes by enabling prioritization of putative functional variants for association testing. OBJECTIVE: We evaluated 6706 cis-acting expression-associated variants (eSNPs) identified through a genome-wide eQTL survey of CD4(+) lymphocytes for association with asthma. METHODS: eSNPs were tested for association with asthma in 359 asthmatic patients and 846 control subjects from the Childhood Asthma Management Program, with verification by using family-based testing. Significant associations were tested for replication in 579 parent-child trios with asthma from Costa Rica. Further functional validation was performed by using formaldehyde-assisted isolation of regulatory elements (FAIRE) quantitative PCR and chromatin immunoprecipitation PCR in lung-derived epithelial cell lines (Beas-2B and A549) and Jurkat cells, a leukemia cell line derived from T lymphocytes. RESULTS: Cis-acting eSNPs demonstrated associations with asthma in both cohorts. We confirmed the previously reported association of ORMDL3/GSDMB variants with asthma (combined P = 2.9 × 10(-8)). Reproducible associations were also observed for eSNPs in 3 additional genes: fatty acid desaturase 2 (FADS2; P = .002), N-acetyl-α-D-galactosaminidase (NAGA; P = .0002), and Factor XIII, A1 (F13A1; P = .0001). Subsequently, we demonstrated that FADS2 mRNA is increased in CD4(+) lymphocytes in asthmatic patients and that the associated eSNPs reside within DNA segments with histone modifications that denote open chromatin status and confer enhancer activity. CONCLUSIONS: Our results demonstrate the utility of eQTL mapping in the identification of novel asthma genes and provide evidence for the importance of FADS2, NAGA, and F13A1 in the pathogenesis of asthma.
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Asma , Linfocitos T CD4-Positivos/inmunología , Ácido Graso Desaturasas , Estudio de Asociación del Genoma Completo , Polimorfismo de Nucleótido Simple , alfa-N-Acetilgalactosaminidasa , Asma/epidemiología , Asma/genética , Asma/inmunología , Asma/patología , Linfocitos T CD4-Positivos/patología , Niño , Preescolar , Costa Rica , Método Doble Ciego , Ácido Graso Desaturasas/genética , Ácido Graso Desaturasas/inmunología , Femenino , Humanos , Masculino , alfa-N-Acetilgalactosaminidasa/genética , alfa-N-Acetilgalactosaminidasa/inmunologíaRESUMEN
OBJECTIVE: To identify the predictive factors of early childhood wheezing in children of low socioeconomic status. STUDY DESIGN: The Childhood Asthma Prevention Study enrolled 177 low-income children (9-24 months old) with frequent wheezing. At age 7 years, presence of asthma was assessed through caregiver reports of physician diagnosis of asthma (CRPDA) and corroborated by assessment of bronchial hyperresponsiveness (BHR). Lung function, inflammatory markers, and asthma symptom severity were compared for children with ±CRPDA, ±BHR, and asthma. Baseline predictors for CRPDA, BHR, and asthma at 7 years of age were examined. RESULTS: Maternal symptom report strongly differentiated children with +CRPDA (49%) despite comparable airflow measurements (P < .0001), and spirometric lung function measurements were different for +BHR (65%) versus -BHR (P < .005). Univariate analyses revealed different baseline predictors of +CRPDA and +BHR for children at age 7 years. Higher levels of maternal psychological resources were associated with +CRPDA, but not +BHR. Only 39% of children with a history of frequent wheezing met the conservative definition of asthma at age 7 years, with the following significant predictors found: low birth weight, baseline symptom severity, and maternal psychological resources. CONCLUSIONS: This low-income, multi-ethnic group of wheezing infants represents a unique population of children with distinct characteristics and risks for persistent asthma. Determination of asthma status at 7 years of age required objective measurement of BHR in addition to CRPDA. The association of maternal psychological resources with +CRPDA may represent a previously unrecognized factor in the determination of asthma status among low-income groups.
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Asma/diagnóstico , Hiperreactividad Bronquial/diagnóstico , Ruidos Respiratorios/diagnóstico , Asma/epidemiología , Asma/fisiopatología , Preescolar , Femenino , Humanos , Lactante , Masculino , Pobreza , Ruidos Respiratorios/fisiopatología , Factores de Riesgo , EspirometríaRESUMEN
OBJECTIVES: To determine whether long-term, continuous use of inhaled anti-inflammatory medications affects asthma outcomes in children with mild to moderate asthma after use is discontinued. STUDY DESIGN: Of the 1041 participants in the Childhood Asthma Management Program randomized clinical trial, 941 (90%) were followed to determine whether 4.3 years of twice-daily budesonide or nedocromil administration (each compared with placebo) affected subsequent asthma outcomes during a 4.8-year posttrial period in which treatment was managed by the participants' physicians. RESULTS: The groups treated continuously during the trial with either budesonide or nedocromil did not differ from the group given placebo in terms of lung function, control of asthma, or psychological status at the end of 4.8 years of posttrial follow-up. However, the decreased mean height in the budesonide group relative to the placebo group at the end of the trial (1.1 cm; P = .005) remained statistically significant (0.9 cm; P = .01) after an additional 4.8 years and was more pronounced in girls (1.7 cm; P = .001) than in boys (0.3 cm; P = .49). Participants in all groups used inhaled corticosteroids during 30% of the posttrial period. CONCLUSIONS: Clinically meaningful improvements in the control of asthma and in airway responsiveness achieved during continuous treatment with inhaled corticosteroids do not persist after continuous treatment is discontinued.
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Antiinflamatorios/uso terapéutico , Asma/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Budesonida/uso terapéutico , Nedocromil/uso terapéutico , Adolescente , Estatura , Utilización de Medicamentos , Urgencias Médicas , Femenino , Estudios de Seguimiento , Volumen Espiratorio Forzado , Humanos , Masculino , Nebulizadores y Vaporizadores , Evaluación de Resultado en la Atención de Salud , Prednisona/uso terapéutico , Índice de Severidad de la Enfermedad , Factores Sexuales , Capacidad VitalRESUMEN
OBJECTIVE: Exhaled nitric oxide (FE(NO)) was evaluated in children with asthma after 4 to 6 years of treatment with budesonide, nedocromil, or albuterol as needed. STUDY DESIGN: FE(NO), spirometry, total eosinophil count, and serum eosinophil cationic protein levels were obtained from 118 children at the Denver site of the Childhood Asthma Management Program upon completion of treatment and after a 2- to 4-month washout. RESULTS: Budesonide-treated patients had significantly lower median (1st, 3rd quartile) FE(NO) (21.5 [13.2, 84.4] vs 62.5 [26.2, 115.0] ppb, P <.01) and eosinophil cationic protein levels (17.4 [10.1, 24.3] vs 24.0 [15.4, 33.9] mg/dL, P =.05) compared with placebo, whereas no differences were noted between nedocromil and placebo groups. After washout, FE(NO) levels were similar between the three treatments. FE(NO) levels significantly correlated with degree of bronchial hyperresponsiveness, bronchodilator reversibility, allergen skin prick tests, serum IgE, and total eosinophil count. FE(NO) levels were also higher in patients with nocturnal symptoms and in patients requiring beta-agonist use at least once weekly. CONCLUSIONS: Budesonide therapy was more effective than nedocromil in reducing FE(NO). Unfortunately, the effects of long-term budesonide were not sustained after its discontinuation. FE(NO) may be a complementary tool to current practice guidelines in assessing asthma control and medication response.
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Antiasmáticos/uso terapéutico , Antiinflamatorios/uso terapéutico , Asma/tratamiento farmacológico , Asma/metabolismo , Budesonida/uso terapéutico , Volumen Espiratorio Forzado/efectos de los fármacos , Nedocromil/uso terapéutico , Óxido Nítrico/metabolismo , Respiración , Ribonucleasas , Antiasmáticos/farmacología , Antiinflamatorios/farmacología , Asma/diagnóstico , Proteínas Sanguíneas/metabolismo , Broncoconstrictores , Budesonida/farmacología , Niño , Preescolar , Estudios de Cohortes , Proteínas en los Gránulos del Eosinófilo , Eosinófilos , Femenino , Humanos , Hipersensibilidad/complicaciones , Hipersensibilidad/diagnóstico , Inmunoglobulina E/sangre , Recuento de Leucocitos , Masculino , Cloruro de Metacolina , Nedocromil/farmacología , Pruebas de Función Respiratoria , Índice de Severidad de la Enfermedad , Pruebas Cutáneas , Espirometría/métodos , Estadísticas no ParamétricasRESUMEN
OBJECTIVES: To examine the prevalence rates of household smoking and ownership of a furred or feathered pet, the intercorrelation of these home environment measures, and their association with sociodemographic, family, and child asthma variables. STUDY DESIGN: Children with asthma (n = 152, aged 7-18 years) with asthma and their primary parent were evaluated through the use of reliable and valid questionnaires focusing on exposure to household smoke and furred or feathered pets as well as sociodemographic, family, and asthma variables. RESULTS: Prevalence of household smoking and pet ownership were high and comparable to normal levels in the US population. Smoking and pet ownership were not correlated with each other or with asthma medication adherence. Sociodemographic, family, and asthma variables showed distinct patterns of correlation with smoking and pet status. Household smoking was associated with poorer family resources and greater stress; pet ownership was associated with greater resources. CONCLUSIONS: Smoke exposure and pet ownership are not related to one another in children with asthma and will require independent counseling strategies because they relate in different and opposite ways to socioeconomic status.