A computerized decision support tool to implement asthma guidelines for children and adolescents.

Background: Multicenter randomized controlled trials (RCTs) for asthma management that incorporate usual-care regimens could benefit from standardized application of evidence-based guidelines.

Objective: We sought to evaluate performance of a computerized decision support tool, the Asthma Control Evaluation and Treatment (ACET) Program, to standardize usual-care regimens for asthma management in RCTs.

Methods: Children and adolescents with persistent uncontrolled asthma living in urban census tracts were recruited into 3 multicenter RCTs (each with a usual-care arm) between 2004 and 2014.

Allergen-induced activation of natural killer cells represents an early-life immune response in the development of allergic asthma.

Background: Childhood asthma in inner-city populations is a major public health burden, and understanding early-life immune mechanisms that promote asthma onset is key to disease prevention. Children with asthma demonstrate a high prevalence of aeroallergen sensitization and T2-type inflammation; however, the early-life immune events that lead to T2 skewing and disease development are unknown.

Objective: We sought to use RNA sequencing of PBMCs collected at age 2 years to determine networks of immune responses that occur in children with allergy and asthma.

Screen Time Engagement Is Increased in Urban Children With Asthma.

Physical activity in children has been shown to play a role in its relationship to asthma, both in terms of prevalence and incidence. One measure of physical activity in children is sedentary behavior, which might be measured by the degree of engagement with media electronic screens. We found that children with asthma, as compared with children without asthma, engage in significantly more hours of screen time (median 35 vs 26 h/wk, P = .

Patterns of immune development in urban preschoolers with recurrent wheeze and/or atopy.

Background: Disadvantaged urban children have high rates of allergic diseases and wheezing, which are diseases associated with type 2-biased immunity.

Objective: We sought to determine whether environmental exposures in early life influence cytokine responses that affect the development of recurrent wheezing illnesses and allergic sensitization.

Methods: A birth cohort of 560 urban families was recruited from neighborhoods with high rates of poverty, and 467 (83%) children were followed until 3 years of age.

Relationships among Maternal Stress and Depression, Type 2 Responses, and Recurrent Wheezing at Age 3 Years in Low-Income Urban Families.

Rationale: Maternal depression and prenatal and early life stress may influence childhood wheezing illnesses, potentially through effects on immune development.

Objectives: To test the hypothesis that maternal stress and/or depression during pregnancy and early life are associated with recurrent wheezing and aeroallergen sensitivity and altered cytokine responses (enhanced type 2 or reduced virus-induced cytokine responses) from stimulated peripheral blood mononuclear cells at age 3 years.

Methods: URECA (Urban Environment and Childhood Asthma) is a birth cohort at high risk for asthma (n = 560) in four inner cities.

Relation between stress and cytokine responses in inner-city mothers.

Background: Women in poor urban neighborhoods have high rates of stress and allergic diseases, but whether stress or stress correlates such as depression promote inflammatory and type 2 cytokine responses is unknown.

Objective: To examine associations among external stressors, perceived stress, depression, and peripheral blood mononuclear cell cytokine responses of mothers enrolled in the Urban Environment and Childhood Asthma Study and test the hypothesis that stress would be positively associated with type 2 and selected proinflammatory (tumor necrosis factor-α and interleukin-8) responses.

Methods: Questionnaire data from mothers living in 4 inner cities included information about external stress, stress perception, and depression.

Influence of early-life exposures on food sensitization and food allergy in an inner-city birth cohort.

Objective: Previous data suggest that food allergy (FA) might be more common in inner-city children; however, these studies have not collected data on both sensitization and clinical reactivity or early-life exposures.

Methods: Children in the Urban Environment and Childhood Asthma birth cohort were followed through age 5 years. Household exposures, diet, clinical history, and physical examinations were assessed yearly; levels of specific IgE to milk, egg, and peanut were measured at 1, 2, 3, and 5 years of age.

A telephone coaching intervention to improve asthma self-management behaviors.

Long recognizing that asthma, one of the most common chronic childhood diseases, is difficult to manage, the National Asthma Education Prevention Program developed clinical practice guidelines to assist health care providers, particularly those in the primary care setting. Yet, maintenance asthma care still fails to meet national standards. Therefore, in an attempt to improve and support asthma self-management behaviors for parents of children 5 to 12 years of age with persistent asthma, a novel nurse telephone coaching intervention was tested in a randomized, controlled trial.

Lack of a relation between serum 25-hydroxyvitamin D concentrations and asthma in adolescents.

Background: Decreased 25-hydroxyvitamin D [25(OH)D] concentrations have been associated with an increased prevalence and severity of asthma and a lower response to inhaled corticosteroids.

Objective: The objective was to determine the association between serum 25(OH)D concentrations and asthma prevalence, severity, and response to asthma treatment.

Design: Secondary analyses were conducted in 2 samples of adolescents 12-20 y of age: 1) NHANES 2001-2006 (n = 6487), a cross-sectional nationally representative sample of the US population, and 2) a cohort of inner-city adolescents with asthma managed prospectively for 46 wk with guidelines-based therapy in the Asthma Control Evaluation (ACE; n = 226) trial.

Comparison of the etiology of viral respiratory illnesses in inner-city and suburban infants.

Background: The risk of developing childhood asthma has been linked to the severity and etiology of viral respiratory illnesses in early childhood. Since inner-city infants have unique environmental exposures, we hypothesized that patterns of respiratory viral infections would also be distinct.

Methods: We compared the viral etiology of respiratory illnesses in 2 groups: a cohort of 515 infants from 4 inner-city areas and a cohort of 285 infants from mainly suburban Madison, Wisconsin.

Development and validation of the Composite Asthma Severity Index--an outcome measure for use in children and adolescents.

Background: Asthma severity is reflected in many aspects of the disease, including impairment and future risks, particularly for exacerbations. According to the Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma, however, to assess more comprehensively the severity of asthma the level of current treatment needed to maintain a level of control should be included.

Objective: Development and validation of a new instrument, the Composite Asthma Severity Index (CASI), which can quantify disease severity by taking into account impairment, risk, and the amount of medication needed to maintain control.

The influence of environment, as represented by diet and air pollution, upon incidence and prevalence of wheezing illnesses in young children.

Purpose Of Review: The purpose of this review is to consider the collective influence of factors affecting recurrent wheezing in young children.

Recent Findings: Specific allergen sensitization, upper respiratory infections, genetic polymorphisms and environmental factors have collectively been reported in the prevalence of and induction of recurrent wheezing in young children. Two examples of environmental factors are diet and exposure to air pollution, both of which are potentially modifiable.

Relationships among environmental exposures, cord blood cytokine responses, allergy, and wheeze at 1 year of age in an inner-city birth cohort (Urban Environment and Childhood Asthma study).

Background: The Urban Environment and Childhood Asthma study was established to investigate the immunologic and environmental causes of asthma in inner-city children.

Objective: We sought to evaluate potential atopic outcomes in the first 12 months and their relationships to environmental exposures and immune development.

Methods: A birth cohort of 560 children with at least 1 parent with allergy or asthma was established in Baltimore, Boston, New York, and St Louis.

Telephone coaching for parents of children with asthma: impact and lessons learned.

Objective: To determine whether an asthma coaching program can improve parent and child asthma-related quality of life (QOL) and reduce urgent care events.

Design: Randomized controlled trial of usual care vs usual care with coaching. Comparisons were made between groups using mixed models.

Asthma control, adiposity, and adipokines among inner-city adolescents.

Background: There is an association between adiposity and asthma prevalence, but the relationship to asthma control is unclear.

Objectives: We sought to understand the relationships among adiposity, sex, and asthma control in inner-city adolescents with asthma.

Methods: We prospectively followed 368 adolescents with moderate-to-severe asthma (ages 12-20 years) living in 10 urban areas for 1 year.

Prenatal maternal stress and cord blood innate and adaptive cytokine responses in an inner-city cohort.

Rationale: Stress-elicited disruption of immunity begins in utero.

Objectives: Associations among prenatal maternal stress and cord blood mononuclear cell (CBMC) cytokine responses were prospectively examined in the Urban Environment and Childhood Asthma Study (n = 557 families).

Methods: Prenatal maternal stress included financial hardship, difficult life circumstances, community violence, and neighborhood/block and housing conditions.

The exacerbation component of impairment and risk in pediatric asthma.

Purpose Of Review: The new guidelines for assessment of asthma control emphasize two domains: impairment and risk. Exacerbations of asthma are an important component of risk but have not received as much attention as the day-to-day symptoms that make up impairment. The purpose of this review is to report what has recently been learned about exacerbations.