The prevalence of asthma in children is increasing worldwide, yet risk factors for the development of asthma is unclear. Evidence to date indicates that environmental factors are the main reason of the recent increase in the prevalence of asthma. For example, exposure to air pollution and diet as well as microbial alterations are reported as environmental factors. In addition, we should focus on the critical period of the exposure, especially pregnancy period as an important period for human development. Therefore, environmental exposure during pregnancy to tobacco smoke or air pollutants, maternal stress, obesity, and vitamin D may contribute to the development of childhood asthma. Herein, modifiable prenatal exposure, its mechanisms associated with childhood asthma and multiple intervention controlling risk factors needed during pregnancy in order to achieve primary prevention of asthma has been described.
Air Pollutants ; Air Pollution ; Asthma ; Child ; Critical Period (Psychology) ; Diet ; Environmental Exposure ; Human Development ; Humans ; Obesity ; Pregnancy ; Prevalence ; Primary Prevention ; Risk Factors ; Smoke ; Tobacco ; Vitamin D

Objective: To understand the status, attitude and related risk factors on smoking among 18-65 years old patients with hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD) or asthma in Beijing. Methods: Data was gathered from the 2014 Beijing Non-communicable and Chronic Disease Surveillance Program. Multiple classified cluster sampling method was used and 19 815 participants aged 18-65 were sampled from 16 districts in Beijing. Results: Among all the 18 405 participants, male hypertensive patients showed a higher rate on current smoking than the other groups (χ(2)=17.695, P<0.001). Male patients with dyslipidemia had higher current smoking rate than the other groups (χ(2)=39.292, P<0.001). However, female patients with COPD or with asthma showed higher rate on current smoking than the other groups (χ(2)=6.276, P=0.012), (χ(2)=8.245, P=0.004). Among the smokers, hypertensive patients presented lower rate (χ(2)=20.487, P<0.001) on intention of smoking concession, than the other groups. Patients with COPD showed greater intention in quitting smoking (χ(2)=6.085, P=0.048), than the other groups. Male patients with diabetes (χ(2)=9.219, P=0.010) or dyslipidemia (χ(2)=13.513, P=0.001) who had stopped smoking tobacco appeared having higher rates in keeping the current status. Results from logistic regression analyses showed that smoking was the risk factor for hypertension (OR=1.17), dyslipidemia (OR=1.25), COPD (OR=1.78), and asthma (OR=1.57). Conclusions: Patients with certain kinds of chronic diseases showed higher rate of current smoking and lower rate of quitting. Cigarette consumption appeared an important risk factor for patients with hypertension, dyslipidemia, COPD, or asthma in Beijing.
Adolescent ; Adult ; Aged ; Asthma/epidemiology* ; Beijing/epidemiology* ; Chronic Disease/epidemiology* ; Diabetes Mellitus/epidemiology* ; Female ; Humans ; Hypertension/epidemiology* ; Intention ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/epidemiology* ; Risk Factors ; Smokers ; Smoking/psychology* ; Smoking Cessation ; Nicotiana/adverse effects*

Allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergy, are most common chronic, noncommunicable diseases in childhood. In the past few decades, the prevalence has increased abruptly worldwide. There are 2 possible explanations for the rising prevalence of allergic diseases worldwide, that an increased disease-awareness of physician, patient, or caregivers, and an abrupt exposure to unknown hazards. Unfortunately, the underlying mechanisms remain largely unknown. Despite the continuing efforts worldwide, the etiologies and rising prevalence remain unclear. Thus, it is important to identify and control risk factors in the susceptible individual for the best prevention and management. Genetic susceptibility or environments may be a potential background for the development of allergic disease, however they alone cannot explain the rising prevalence worldwide. There is growing evidence that epigenetic change depends on the gene, environment, and their interactions, may induce a long-lasting altered gene expression and the consequent development of allergic diseases. In epigenetic mechanisms, environmental tobacco smoke (ETS) exposure during critical period (i.e., during pregnancy and early life) are considered as a potential cause of the development of childhood allergic diseases. However, the causal relationship is still unclear. This review aimed to highlight the impact of ETS exposure during the perinatal period on the development of childhood allergic diseases and to propose a future research direction.
Asthma ; Caregivers ; Child ; Critical Period (Psychology) ; Dermatitis, Atopic ; Epigenomics ; Food Hypersensitivity ; Gene Expression ; Genetic Predisposition to Disease ; Humans ; Pregnancy ; Prevalence ; Rhinitis, Allergic ; Risk Factors ; Smoke* ; Tobacco Smoke Pollution ; Tobacco*

OBJECTIVETo compare the clinical features in children with different control levels of asthma and to explore the factors influencing asthma control.

METHODSA cross-sectional study was performed on 115 children diagnosed with asthma between October 2013 and February 2014. All the patients were classified into two groups: fully controlled group (n=65) and non-fully controlled group (n=55), according to the Children Bronchial Asthma Prevention and Treatment Guideline (2008 version) and the asthma control test results. The differences of clinical features between the two groups were compared. The quality of life was evaluated by an asthma-related quality of life questionnaire. The main factors influencing asthma control were analyzed by the logistic regression method.

RESULTSThere were significant differences in the frequencies of respiratory tract infection and acute asthma attacks within the 3 months, and unplanned hospital visits due to acute asthma attacks between the fully controlled and non-fully controlled groups (P<0.05). The scores of asthma-related quality of life in the fully controlled group were significantly lower than in the non-fully controlled group in children under 7 years old. In contrast, the scores of asthma-related quality of life in the fully controlled group were significantly higher than in the non-fully controlled group in children at the age of 7-16 years (P<0.05). The logistic regression analysis showed that the patients without experiencing regular hospital visits (OR=7.715) and with allergic rhinitis (OR=5.531) had increased risks for poor asthma control and that the patients with other allergic diseases (eg. eczema, food allergy) had decreased risks for poor asthma control (OR=0.299).

CONCLUSIONSThe appearance of some clinical features suggests that the asthmatic children may be in the status of poor asthma control and need an active intervention. A poor asthma control status can result in a decreased quality of life. To improve the asthma control level, the incidence of allergic rhinitis should be reduced and a regular hospital visit should be performed in the children.

Adolescent ; Asthma ; drug therapy ; psychology ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Humans ; Logistic Models ; Male ; Quality of Life

Asthma is a reversible chronic inflammatory disorder of the airways that can be effectively controlled without causing any lifestyle limitation or burden on the quality of life of the majority of asthma patients. However, persistently uncontrolled asthma can be frustrating for both the patient and the managing physician. Patients who fail to respond to high-intensity asthma treatment fall into the category of 'problematic' asthma, which is further subdivided into 'difficult' asthma and 'severe refractory' asthma. Establishing the correct diagnosis of asthma and addressing comorbidities, compliance, inhaler technique and environmental triggers are essential when dealing with 'problematic' asthma patients. A systemic approach is also crucial in managing such patients. This is pertinent for general practitioners, as the majority of asthma patients are diagnosed and managed at the primary care level.
Asthma ; psychology ; therapy ; Comorbidity ; Diagnosis, Differential ; Environment ; General Practitioners ; Humans ; Inflammation ; Male ; Middle Aged ; Nebulizers and Vaporizers ; Patient Compliance ; Primary Health Care ; methods ; Pulmonary Medicine ; methods ; Quality of Life

Depression is an important comorbidity of asthma. However, little information is available about depression and its potential impact on asthma control in Korean adult asthma patients. We aimed to estimate the prevalence and risk factors for depression in Korean adults with persistent asthma. The 127 non-elderly (20-64 yr) and 75 elderly (> or =65 yr) patients with asthma were recruited. Demographic and clinical data were extracted, and the patients completed the Asthma Specific Quality of Life (AQOL) questionnaire and asthma control test (ACT). Depression status was defined using the Korean version of the Patient Health Questionnaire-9 (PHQ-9). Depression was more prevalent in non-elderly (18.9%) than in elderly patients with asthma (13.3%). Patients with depression were significantly younger, had lower economic status, shorter disease duration, poorer asthma control, and worse AQOL scores (P<0.05). Within the non-elderly group, younger age and shorter disease duration were significantly associated with depression (P<0.05). Within the elderly group, a higher body mass index and current smoking status were significantly associated with depression (P<0.05). The PHQ-9 score was significantly correlated with worse ACT and AQOL scores in both groups. In conclusion, depression is strongly associated with poor asthma control and quality of life in Korean adult asthma patients. Our results provide important clues that used to target modifiable factors which contribute to development of depression in asthma patients.
Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Asthma/diagnosis/*epidemiology/*psychology ; Causality ; Comorbidity ; Depression/diagnosis/*epidemiology/*psychology ; Female ; Humans ; Male ; Middle Aged ; Prevalence ; Quality of Life/*psychology ; Republic of Korea/epidemiology ; Risk Factors ; Sex Distribution ; Young Adult

OBJECTIVETo investigate the status of asthma control in the city and severity of asthma in children and to identify related factors.

METHODThis study was conducted in one children's hospital or tertiary hospital in each of the 29 provinces except Xinjiang and Xizang Autonomous Regions. Totally, 2960 parents with asthmatic children ages 0 to 14 years, and all had been diagnosed with asthma at least 3 months ago and the course was more than 12 months, who visited those hospitals were selected for the knowledge, attitude, and practice (KAP) questionnaire survey, and separated into the controlled asthma group and uncontrolled asthma group according to children's asthma conditions in the past 12 months. Multivariate analysis was carried out based on the answers to 28 tested factors; 2485 of 2960 questionnaires from 29 provinces were valid.

RESULTOf the 2485 valid questionnaires, 66.0% asthmatic children had asthma attacks in the past 12 months, 26.8% asthmatic children had visited the emergency department, 16.2% asthmatic children had been hospitalized. The total cost was significantly higher in the uncontrolled group than in contro group (χ² = 23.14, P < 0.01). Parents' education level, parents' KAP scores, regular visits for asthma control, knowledge of "3 or more times recurrent wheezing suggesting asthma", knowledge of "cough lasting for more than 4 weeks suggesting asthma", knowledge of "cough improved with bronchodilators suggesting asthma", knowledge of "awareness of using short-acting β₂ agonist for acute attack", avoiding contact with plush toys, adhere to use nasal steroid, inhaled corticosteroids/composite preparation, age of children and course of asthma in children are protective factors that affect asthma control and severity of asthma in children. Food allergies, eczema and family history of asthma are risk factors.

CONCLUSIONAsthma in many children was poorly controlled. Factors that affect asthma control and severity include parents' knowledge about asthma, exposure to adverse environment, the compliance with medication and regular visits for asthma control. Awareness and improvement the related factors about asthma control and severity can help leading asthma to a well-controlled status and reducing the severity of asthma.

Age Factors ; Anti-Asthmatic Agents ; administration & dosage ; therapeutic use ; Asthma ; drug therapy ; epidemiology ; prevention & control ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Glucocorticoids ; administration & dosage ; therapeutic use ; Health Knowledge, Attitudes, Practice ; Health Surveys ; Humans ; Male ; Multivariate Analysis ; Parents ; psychology ; Retrospective Studies ; Rhinitis, Allergic, Perennial ; complications ; Risk Factors ; Severity of Illness Index ; Socioeconomic Factors ; Surveys and Questionnaires

BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are common and can be fatal. However, it is difficult to predict the in-hospital mortality, severity and prognosis of patients. Prognostic tools are needed to assess exacerbations of COPD in the emergency department. Towards this end, we compared DECAF (dyspnea, eosinopenia, consolidation, acidemia, atrial fibrillation) score with other prognostic tools available in the emergency department. METHODS: Consecutive patients admitted to the emergency department with exacerbations of COPD were recruited. We compared the DECAF score to CAPS (chronic obstructive pulmonary disease and asthma physiology score), BAP (blood urea nitrogen, altered mental status, pulse)-65 class and CURB (confusion, urea, respiratory rate, blood pressure)-65 score and assessed in-hospital mortality, endotracheal intubation, admission to the intensive care unit and admission to the hospital. RESULTS: The in-hospital mortality rate was 4.9%. The DECAF score showed excellent discrimination for in-hospital mortality (AUROC = 0.72, p = 0.002), endotracheal intubation (AUROC = 0.92, p < 0.001), admission to the intensive care unit (AUROC = 0.90, p < 0.001) and admission to the hospital (AUROC = 0.83, p < 0.001). CONCLUSIONS: The DECAF score is a simple and effective prognostic tool for assessing cases involving exacerbation of COPD in the emergency department. Emergency physicians should consider hospital admission if the DECAF score is more than 1 and consider admission to the intensive care unit and endotracheal intubation if the DECAF score is more than 3.
Asthma ; Discrimination (Psychology) ; Emergencies* ; Hospital Mortality ; Humans ; Intensive Care Units ; Intubation, Intratracheal ; Lung Diseases ; Lung Diseases, Obstructive ; Nitrogen ; Physiology ; Prognosis ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Rate ; Urea

PURPOSE: Asthma inhalation therapy is important for the treatment of childhood asthma. Therefore, it is necessary to educate patients on the correct inhalation techniques. The purpose of this study was to determine the effectiveness and necessity of educating patients on the correct inhalation techniques. METHODS: A total of 86 patients with bronchial asthma and who were over 7 years old were enrolled and educated on handling inhaler devices for 2 years. The inhaler devices used were the diskus (n=27), turbuhaler (n=12) and metered dose inhaler with a spacer (n=47). Trained pharmacists provided the education. Four steps (breathing out prior to inhalation, inhalation, holding the breath, exhaling slowly) that were critical for handling each device were evaluated and each step was scored as good, fair or poor. We evaluated the symptom score (daytime cough, nighttime cough, sleep disturbance and limitation of activity) and lung function before treatment and 4 weeks later. RESULTS: Over 90.0% of the diskus users performed fair to good in each step. The symptom score and lung function at 4 weeks later after education were significantly improved (P=0.000). The turbuhaler users all performed fair to good on each step. The symptom score was significantly improved (P<0.005), but the lung function was not difference. Over 95% of the users of a metered dose inhaler with a spacer performed moderate to good on each step. The symptom score and lung function were significantly improved (P<0.05). CONCLUSION: The structured, detailed education on inhaler devices by trained specialists was very important for performing correct inhalation therapy to control asthma, and repeated education might be also necessary.
Asthma ; Cough ; Exhalation ; Handling (Psychology) ; Humans ; Inhalation ; Lung ; Metered Dose Inhalers ; Nebulizers and Vaporizers ; Pharmacists ; Respiratory Therapy ; Specialization

OBJECTIVETo study the correlation between the temperament dimension and the stress reaction in children with bronchial asthma.

METHODSBetween February 2008 and May 2010, two hundred and twenty children with bronchial asthma and aged from 3-7 years were enrolled (asthma group). Eighty children without asthma, respiratory tract infections, serious body diseases and mental disorders who were age- and gender-matched to the asthma group served as the control group. The Carry temperament rating scales were filled by the children's parents from the asthma and control groups. The serum levels of cortisol at 8am and 4pm and nerve growth factor (NGF) were measured by immunochemiluminescent assays.

RESULTSThe scores of the rhythmicity and persistence in temperament dimensions in the asthma group were significantly lower than those in the control group; in contrast, the scores of phobotaxis, response intensity, emotion entity, adaptability and attention dispersion in the asthma group were significantly higher than those in the control group (P<0.05). The levels of serum cortisol at 8am and 4pm were lower, while the serum level of NGF was higher in the asthma group than those in the control group (P<0.05). The scores of response intensity, emotion entity and adaptability in temperament dimensions were positively correlated with serum NGF level (r=0.348,0.468,0.195, respectively; P<0.05), and inversely correlated with serum cortisol level at 8 am (r=-0.297, -0.462, -0.152, respectively; P<0.05) in the asthma group.

CONCLUSIONSThe temperament dimension is associated with the stress reaction in children with bronchial asthma. This provides a basis for the treatment of bronchial asthma by neuropsychological adjustment.

Adaptation, Psychological ; Asthma ; blood ; psychology ; Child ; Child, Preschool ; Female ; Humans ; Hydrocortisone ; blood ; Male ; Nerve Growth Factor ; blood ; Stress, Psychological ; blood ; Temperament