Asthma exacerbations {middle dot} 1: Epidemiology

Johnston, Neil; Sears, Malcolm R.

doi:10.1136/thx.2005.045161

Cited by 224 publications

(176 citation statements)

References 56 publications

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“…Exacerbations of asthma symptoms diminish the quality of life of the patients and their families (25)(26)(27). Asthma exacerbations are triggered by several environmental factors including allergens, air pollutants (28) and respiratory viral infections, rhinoviruses being the most frequent (29)(30)(31). The mechanisms of viralinduced asthma exacerbations are different from those with allergen exposure, possibly explaining the degree of refractoriness to inhaled or oral corticosteroids (32,33).…”

Section: Discussionmentioning

confidence: 99%

Filaggrin null mutations are associated with increased asthma exacerbations in children and young adults

Basu

Palmer

Lipworth

et al. 2008

Allergy

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Background: Filaggrin (FLG) null mutations are important genetic predisposing factors for atopic asthma and have recently been shown to influence controller and reliever medication needs in asthmatic children. Our objective was to study the role of FLG null alleles in asthma exacerbations.Methods: FLG mutations R501X and 2282del4 were assayed in 1135 individuals ranging from 3 to 22 years old with asthma from Tayside and Dumfries, Scotland. Asthma exacerbations over the previous 6 months were also studied.Results: The FLG mutations were significantly associated with greater risk of exacerbations in children with asthma. Exacerbations were significant for the R501X but not the 2282del4 mutation and the combined genotype compared to the wild‐type with odds ratios of 1.97 (95% CI, 1.19–3.22; P = 0.009) and 1.61 (95% CI, 1.08–2.40; P = 0.021), respectively. Individuals with FLG null alleles were more likely to require oral steroids (31.4%vs 19.5%; OR = 1.89; P = 0.021) for their exacerbations. There was also a 1.71‐fold increased risk (42.6%vs 30%; P = 0.041) of school absence owing to asthma exacerbations in asthmatic individuals with FLG null mutation. On sub‐group analysis, the effect of FLG mutations on asthma exacerbations is significant (P = 0.045) only for participants with relatively mild asthma controlled on inhaled steroids, with inhaled albuterol according to need.Conclusion: In addition to their effect on asthma medication requirements reported previously, there is an association between the presence of FLG null mutations and the risk of asthma exacerbations in asthmatic children and young adults.

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Section: Discussionmentioning

confidence: 99%

Filaggrin null mutations are associated with increased asthma exacerbations in children and young adults

Basu

Palmer

Lipworth

et al. 2008

Allergy

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“…21,22 Environmental exposures and asthma symptoms can vary by season, and these exposures affect asthma control. 23 One study, demonstrated that mean FeNO levels were higher in the winter than the spring, but only winter and spring FeNO levels were examined. 24 Taken together, these studies suggest that FeNO may be used as a biomarker to identify children with ongoing exposure to environmental triggers.…”

Section: Introductionmentioning

confidence: 99%

Seasonal variation and environmental predictors of exhaled nitric oxide in children with asthma

Spanier

Hornung

Kahn

et al. 2008

Pediatric Pulmonology

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SummaryThe fraction of exhaled nitric oxide (FeNO), a measure of airway inflammation, shows promise as a noninvasive tool to guide asthma management, but there is a paucity of longitudinal data about seasonal variation and environmental predictors of FeNO in children. The objective of this project was to evaluate how environmental factors affect FeNO concentrations over a 12-month study period among children with doctor diagnosed asthma. We conducted a prospective cohort study of 225 tobacco-smoke exposed children age 6 to 12 years with doctor-diagnosed asthma including measures of FeNO, medication use, settled indoor allergens (dust mite, cat, dog, and cockroach), and tobacco smoke exposure. Baseline geometric mean FeNO was 12.4 ppb (range 1.9 to 60.9 ppb). In multivariable analyses, higher baseline FeNO levels, atopy, and fall season were associated with increased FeNO levels, measured 6 and 12 months after study initiation, whereas inhaled steroid use, summer season, and increasing nicotine exposure were associated with lower FeNO levels. In secondary analyses of allergen sensitization, only sensitization to dust mite and cat were associated with increased FeNO levels. Our data demonstrate that FeNO levels over a year long period reflected baseline FeNO levels, allergen sensitization, season, and inhaled steroid use in children with asthma. These results indicate that FeNO levels are responsive to common environmental triggers as well as therapy for asthma in children. Clinicians and researchers may need to consider an individual's baseline FeNO levels to manage children with asthma.

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“…4,5 It also accounts for disproportionate health care costs when compared to the management of stable state asthma.…”

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confidence: 99%

Prevalence and pattern of asthma exacerbation in children seen at the University of Nigeria Teaching Hospital, Enugu

Edelu¹,

Eze²,

Ayuk³

et al. 2016

Nig. J. Paed.

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Abstract:Background: Acute exacerbation is a major cause of morbidity in asthmatic children. It can occur even in well controlled asthma. Aim: To determine the prevalence and pattern of acute exacerbation of asthma in children seen at the emergency room of the University of Nigeria Teaching Hospital (UNTH), Enugu. Materials and methods:This was a descriptive, cross sectional study in which consecutive children with acute exacerbation of asthma presenting to the Children Emergency Room (CHER) of UNTH, Enugu were recruited. Information from the history and examination were documented with a structured questionnaire completed by the attending doctor. Severity of their exacerbation was determined using the Global Initiative for Asthma (GINA) guidelines. The children were treated using the written management protocol used in CHER, UNTH, Enugu which was adapted from GINA guidelines.Results: There were a total of 114 presentations (episodes) of acute exacerbation asthma by 104 children within the study period with eight children having multiple episodes. This represented 6.5% of the overall number of emergency cases seen during the period. Nearly an equal number (ratio; 1: 1.04) of males and females were enrolled with the mean age of 7.9 ± 4.7 years. More children with asthma exacerbations were admitted during the rainy season months of May and June, while the dry season months of December and January recorded lower number of episodes.Most (86.0%) cases were mild to moderate exacerbations and 16 (15.3%) were severe. Three of the 22 (13.6%) children on controller medications were among the 16 that had severe exacerbation. No death was recorded during the period. Conclusion:The prevalence of asthma exacerbation is relatively high in our tropical environment and the pattern is similar to those of the developed countries in terms of age and sex distribution, however, the peak period of presentation differ in our environment.Key words: Asthma, exacerbation, children, prevalence, pattern tized asthmatics.2 These exacerbations are characteristically worse at night and can progress to severe airflow obstruction, shortness of breath, and respiratory distress and insufficiency.2 Rarely, severe sequelae such as hypoxic seizures, respiratory failure, and death can occur. It has also been noted that severe asthma exacerbation can occur in children with mild or controlled asthma. 3Exacerbations of asthma symptoms produce significant cost to health care systems and seriously diminish the quality of life of patients and their families. 4,5 It also accounts for disproportionate health care costs when compared to the management of stable state asthma.5 It is the most common cause of childhood emergency room visits, hospitalization and school absenteeism in

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Asthma exacerbations {middle dot} 1: Epidemiology

Cited by 224 publications

References 56 publications

Filaggrin null mutations are associated with increased asthma exacerbations in children and young adults

Filaggrin null mutations are associated with increased asthma exacerbations in children and young adults

Seasonal variation and environmental predictors of exhaled nitric oxide in children with asthma

Prevalence and pattern of asthma exacerbation in children seen at the University of Nigeria Teaching Hospital, Enugu

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