Peak Flow Feedback Intervention Improves Under-Perception of Airflow Limitation in Pediatric Asthma: A Randomized Clinical Trial.

Rationale: Under-perception of asthma symptoms is associated with poor asthma outcomes.

Objective: We assessed the effects of a behavioral intervention for improving perception of airflow limitation and asthma outcomes.

Methods: A two-arm randomized controlled trial compared peak expiratory flow (PEF) feedback versus supportive counseling.

Real-world phenotyping and risk assessment of childhood asthma burden using national registries.

Background: Phenotype classification contributes to risk assessment of asthma. Previous studies have applied this concept primarily to adult populations and in the setting of research protocol assessments which may not be applicable to clinical settings.

Objective: Exploring the value of routinely collected clinical data for phenotype classification and risk assessment of childhood asthma.

A clinician's guide to effects of obesity on childhood asthma and into adulthood.

Introduction: Obesity, one of the most common chronic conditions affecting the human race globally, affects several organ systems, including the respiratory system, where it contributes to onset and high burden of asthma. Childhood onset of obesity-related asthma is associated with high persistent morbidity into adulthood.

Areas Covered: In this review, we discuss the disease burden in children and adults to highlight the overlap between symptoms and pulmonary function deficits associated with obesity-related asthma in both age ranges, and then discuss the potential role of three distinct mechanisms, that of mechanical fat load, immune perturbations, and of metabolic perturbations on the disease burden.

Impact of family socioeconomic position on childhood asthma outcomes, severity, and specialist referral - a Danish nationwide study.

Background: Asthma is the most common chronic illness in children, carrying a major burden. Socioeconomic position (SEP) affects adult asthma outcomes, but its impact on childhood asthma, particularly in primary versus specialist care, has not been studied thoroughly.

Methods: In a Danish cohort consisting of all children aged 2-17 years redeeming inhaled corticosteroids in 2015, parental SEP impact on asthma outcomes was investigated.

Asthma prevalence among US 9th-12th graders who report past 30-day cannabis use in 2019.

Introduction: Little is known about the relationship between cannabis use and asthma among youth in the US. The aims of this study were to estimate prevalence of asthma among youth who reported any cannabis use in the past 30 days, relative to those who did not, and to investigate the relationship between frequency of cannabis use and prevalence of asthma, adjusting for demographic characteristics and cigarette use.

Methods: Data were drawn from the 2019 Youth Risk Behavior Surveillance System (YRBSS), a CDC national high school survey, which collects data from students in grades 9-12 across the US bi-annually.

Cannabis use and the prevalence of current asthma among adolescents and adults in the United States.

Objectives: Cannabis use has increased among adolescents and adults in the United States (US) in recent years. Few data are available on the prevalence of asthma by frequency of cannabis use. This study aimed to estimate the prevalence of asthma by frequency of past 30-day cannabis use among US individuals.

Immune profile of adipose tissue from youth with obesity and asthma.

Background: Obesity is a risk factor for paediatric asthma. Obesity-mediated systemic inflammation correlates with metabolic dysregulation; both are associated with asthma burden. However, adipose tissue inflammation is not defined in obesity-related asthma.

Attention-Deficit Hyperactivity Disorder Symptoms, Underperception of Respiratory Compromise, and Illness Representations in Black and Latino Children With Asthma.

Objective: This study examined the associations between attention-deficit/hyperactivity disorder (ADHD) symptoms, underperception of respiratory compromise, and illness representations in Black and Latino children with asthma. We hypothesized that increased child-reported ADHD symptoms, as well as parent reports for their child, would be associated with underperception of respiratory compromise, and maladaptive asthma beliefs.

Methods: Two hundred ninety-six parent-child dyads were recruited from pediatric asthma and primary care clinics in the Bronx.

Childhood Asthma and Parental Antidepressant Use in a Nationwide Danish Cohort.

Background: Paediatric asthma is associated with caregiver depression, which in turn is associated with poor asthma control. Although sociodemographic risk factors are associated with parental depression among children with asthma, the contribution of these factors to caregiver depression in free-to-access universal healthcare settings is unknown.

Methods: The association between childhood asthma and parental antidepressant use was investigated in a Danish nationwide cohort of children aged 2-17 years that redeemed inhaled corticosteroids in 2015.

Burden and unmet need for specialist care in poorly controlled and severe childhood asthma in a Danish nationwide cohort.

Background: Asthma is a common disease in childhood and adolescence with lifelong consequences particularly among those at risk of severe disease, poor control and/or frequent exacerbations. Specialist care is recommended for at-risk children and adolescents, yet access to specialist management in free-to-access healthcare settings remains poorly understood.

Methods: A Danish nationwide cohort of children and adolescents aged 2-17 years with persistent asthma, defined as repeated redemption of inhaled corticosteroids (ICS) during 2015, were followed for two years, to identify at-risk children and adolescents comprising those with severe asthma (classified according to GINA 2020 guidelines), poor control (defined as use of 400/600 (ages 2-11/12 +) annual doses of short-acting bronchodilators), or frequent exacerbations (defined as use of oral steroids or hospitalization), and access to specialist care.

Carnitine supplementation increases serum concentrations of free carnitine and total acylcarnitine in preterm neonates: A retrospective cohort study.

Objective: Our goal was to determine the efficacy of the American Society for Parenteral and Enteral Nutrition's recommended carnitine dosage of 5 mg/kg/day in maintaining normal serum free carnitine and total acylcarnitine levels in preterm neonates receiving parenteral nutrition (PN).

Study Design: A retrospective cohort study was conducted on neonates born <30 weeks gestation and weighing <1250 g, comparing those who received carnitine supplementation to those without supplementation. Free carnitine and total acylcarnitine data were collected from routine newborn screens in the first days of life and on full enetral feeds.

Complications associated with incorrect use of nasal CPAP.

Nasal continuous positive airway pressure (nCPAP) is a safe, effective, non-invasive respiratory modality to deliver positive end expiratory pressure in neonates. Many studies have established its associated improved respiratory outcomes without increase in major morbidities associated with preterm neonates. In contrast, there is paucity in literature addressing complications such as nasal injury, abdominal distention, air leak syndromes (especially pneumothorax), hearing loss, heat and chemical burns, swallowing and aspiration of small components of the nasal interface and delay in escalation of respiratory support associated with the use of nCPAP, most frequently due to its incorrect use.

The Relationship Between Pediatric Attention-Deficit/Hyperactivity Disorder Symptoms and Asthma Management.

Purpose: Children with comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and asthma are at an increased risk for adverse health outcomes and reduced quality of life. The objective of these analyses was to examine if self-reported ADHD symptoms in children with asthma are associated with asthma control, asthma controller medication adherence, quick relief medication use, pulmonary function, and acute healthcare utilization.

Methods: We analyzed data from a larger study testing a behavioral intervention for Black and Latinx children with asthma aged 10-17 years and their caregivers.

Risk Factors for Pneumothorax and Its Association with Ventilation in Neonates.

Objective: The mode of ventilation that is implicated in pneumothorax is the one at the time of its diagnosis. Although there is evidence that air leak starts many hours before it is clinically evident, there are no prior studies that have investigated the association of pneumothorax with the mode of ventilation few hours before rather than at the time of its diagnosis.

Study Design: A retrospective case-control study was conducted in the neonatal intensive care unit (NICU) between 2006 and 2016 where cases of neonates with pneumothorax were compared with gestational age-matched control neonates without pneumothorax.

Metabolic Contributions to Pathobiology of Asthma.

Asthma is a heterogenous disorder driven by inflammatory mechanisms that result in multiple phenotypes. Given the complex nature of this condition, metabolomics is being used to delineate the pathobiology of asthma. Metabolomics is the study of metabolites in biology, which includes biofluids, cells, and tissues.

Mechanistic Links Between Obesity and Airway Pathobiology Inform Therapies for Obesity-Related Asthma.

Obesity-related asthma is associated with a high disease burden and a poor response to existent asthma therapies, suggesting that it is a distinct asthma phenotype. The proposed mechanisms that contribute to obesity-related asthma include the effects of the mechanical load of obesity, adipokine perturbations, and immune dysregulation. Each of these influences airway smooth muscle function.

Multi-omic association study identifies DNA methylation-mediated genotype and smoking exposure effects on lung function in children living in urban settings.

Impaired lung function in early life is associated with the subsequent development of chronic respiratory disease. Most genetic associations with lung function have been identified in adults of European descent and therefore may not represent those most relevant to pediatric populations and populations of different ancestries. In this study, we performed genome-wide association analyses of lung function in a multiethnic cohort of children (n = 1,035) living in low-income urban neighborhoods.

Obesity-related pediatric asthma: relationships between pulmonary function and clinical outcomes.

Objective: We hypothesized that children with obesity-related asthma would have worse self-reported asthma control, report an increased number of asthma symptoms and have lower FEV/FVC associated with worse clinical asthma outcomes compared to children with asthma only.

Methods: Cross sectional analyses examined two hundred and eighteen (obesity-related asthma = 109, asthma only = 109) children, ages 7-15 that were recruited from clinics and hospitals within the Bronx, NY. Pulmonary function was assessed by forced expiratory volume in the first second (percent predicted FEV) and the ratio of FEV to the forced vital capacity of the lungs (FEV/FVC).

Asthma as a comorbidity in COVID-19 pediatric ICU admissions in a large metropolitan children's hospital.

Rationale: Children contribute to 5% of coronavirus disease of 2019 (COVID-19)-related hospitalizations in the United States. There is mounting evidence suggesting childhood asthma is a risk factor for severe disease. We hypothesized that asthma is associated with longer length of stay (LOS) and need for respiratory support among children admitted to pediatric intensive care unit (PICU) with COVID-19.

Crosstalk between CD4 T Cells and Airway Smooth Muscle in Pediatric Obesity-related Asthma.

Pediatric obesity-related asthma is a nonatopic asthma phenotype with high disease burden and few effective therapies. RhoGTPase upregulation in peripheral blood T helper (Th) cells is associated with the phenotype, but the mechanisms that underlie this association are not known. To investigate the mechanisms by which upregulation of CDC42 (Cell Division Cycle 42), a RhoGTPase, in Th cells is associated with airway smooth muscle (ASM) biology.

African-specific alleles modify risk for asthma at the 17q12-q21 locus in African Americans.

Background: Asthma is the most common chronic disease in children, occurring at higher frequencies and with more severe disease in children with African ancestry.

Methods: We tested for association with haplotypes at the most replicated and significant childhood-onset asthma locus at 17q12-q21 and asthma in European American and African American children. Following this, we used whole-genome sequencing data from 1060 African American and 100 European American individuals to identify novel variants on a high-risk African American-specific haplotype.