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Risk Factors for Asthma at Age 7 to 8 in Early Childhood Wheezers: Results from a Japanese Asthma Cohort Study
Abstracts AB7
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
An Analysis of Obesity and Asthma Morbidity in Patients Managed at the Children's Hospital at Montefiore's Asthma Center
Gary K. Soffer, MD1, Jennifer Toh, MD2, Sunit P. Jariwala, MD3, Deepa Rastogi, MD4; 1Children’s Hospital at Montefiore, Bronx, NY, 2Albert Einstein/Montefiore Medical Center, Bronx, NY, 3Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Bronx, NY, 4Division of Pulmonology, Children’s Hospital at Montefiore. RATIONALE: Previous studies suggest a relationship between obesity and childhood asthma. We investigated the impact of body weight and clinic visit compliance on asthma morbidity. METHODS: We reviewed 45 charts of children with moderate to severe persistent asthma seen at the Montefiore Asthma Center (MAC), a multidisciplinary center comprised of Allergy, Pulmonary, and Asthma Education services. Patients had 1 or more asthma-related emergency department (ED) visit or hospitalization or 3 or more steroid courses within 12 months of their first visit. Patients were categorized as obese/overweight (n524) and normal-weight (n521), based on CDC guidelines. Betweengroup comparisons were done for compliance with MAC appointments, asthma-related hospitalizations, and ED visits one year following the patient’s last visit. Compliance was defined as 3 MAC visits. RESULTS: Most patients lived in the Bronx (82%), were of minority ethnicities (37% Latino, 35% African-American) and were obese/overweight (53%). Visit compliance was similar between both groups (50% obese/overweight vs 48% normal-weight.). However, more obese/overweight patients (45%) were hospitalized the year following their last visit than normal-weight children (28%) with more hospitalizations than normal-weight children (12 vs 2, p50.05). Similarly, 50% of obese/ overweight patients had asthma-related ED visits the year following their last visit compared to 23% of normal-weight children with more ED visits than normal-weight children (30 vs 10, p 5 0.045). CONCLUSIONS: In spite of being compliant with asthma center evaluations, obese and overweight patients had more asthma-related ED visits and hospitalizations, suggesting continued higher asthma morbidity. This relationship requires further investigation as it may imply that obesity interventions might play a substantive role in asthma management.
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Predicting Factors for Asthma Remission in Children
Natcha Siripattarasopon, MD, Punchama Pacharn, MD, Orathai Jirapongsananuruk, MD, Nualanong Visitsunthorn, MD, Pakit Vichyanond, MD, FAAAAI, Jittima Veskitkul, MD; Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. RATIONALE: Factors contributing to outcome of childhood asthma are important for planning treatments and, potentially, in preventive interventions and advising on prognosis. Limited data are available on the asthma remission in Thai children. The objective of this study was to determine the predicting factors for asthma remission in children. METHODS: This is a prospective cohort study. Children who were diagnosed as having asthma during the period of 2004-2007 were reevaluated in 2015. The clinical characteristics and pulmonary function test were assessed. Clinical asthma remission (CR) was defined as having no asthma symptoms and no use of asthma medication during the past 12 months. RESULTS: One hundred and twenty children (63.3% male) with asthma were recruited. The median age at onset of wheezing was 2.0 years (range 0.212.6 years), 95.7% had allergic rhinitis, 65.8% had aeroallergen sensitization and 20.8% had parental asthma. At reevaluation, 58 patients (48.3%) were in CR. CR rates at 15 and 18 years of age were 50% and 80%, respectively. Patients with CR had less significantly airway obstruction compared with patients with persistent asthma (FEV1/FVC 97.667.3% VS 102.065.9%; p 5 0.004). Predicting factors for asthma remission were age
at onset of wheezing > 5 years (adjusted odds ratio [OR] 3.87; 95% CI 1.25-12.02), and sensitization to house dust mites (HDM) (adjusted OR 0.44; 95% CI 0.20-0.97). CONCLUSIONS: The probability of CR at 18 years of age was 80%. Predicting factors for asthma remission were determined by age at onset of wheezing > 5 years and without HDM sensitization.
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Risk Factors for Asthma at Age 7 to 8 in Early Childhood Wheezers: Results from a Japanese Asthma Cohort Study
Mayumi Furukawa, MD1, Mari Sasaki, MD1, Hiroko Watanabe, MD2, Koichi Yoshida, MD1, Takao Fujisawa, MD, PhD, FAAAAI3, Motohiro Ebisawa, MD, PhD, FAAAAI4, Hiroshi Odajima, MD, PhD5, AkiraAkasawa, MD, PhD1; 1Division of Allergy, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan, 2National Hospital Organization Kanagawa Hospital, Kanagawa, Japan, 3Allergy Center and Institute for Clinical Research, Mie National Hospital, Japan.4Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan, 5Fukuoka National Hospital, Fukuoka, Japan. RATIONALE: Previous studies have demonstrated that a proportion of children with wheezing episodes in early childhood do not have asthma at school age. We sought to determine the risk factors for asthma at school age among early childhood wheezers in a Japanese asthma cohort study. METHODS: A total of 632 children aged 0 to 3 with recurrent wheezing episodes were recruited in 2004 to 2006. Information including family history, environmental factors, wheezing symptoms and treatment were collected by annual questionnaires. Among the 545 children with adequate baseline information, we analyzed the 433 children followed up at 7 to 8 years old. Asthma at 7 to 8 years old was defined as having wheeze or the regular use of asthma controller medication in the past 12 months. RESULTS: Of the analyzed 433 children, 299 (69.1%) were boys and 350 (80.8%) children were on treatment of inhaled corticosteroids (ICS) or leukotriene receptor antagonists at recruitment. At 7 to 8 years of age, 276 (63.7%) had asthma. Multivariate regression analysis showed that low birth weight, personal history of atopic dermatitis and food allergy at baseline, parental allergic rhinitis or pollinosis, the use of ICS at baseline were significantly associated with asthma at age 7 to 8 (each p<0.05). CONCLUSIONS: Predisposition to atopy was a significant risk factor for asthma at school age in early childhood wheezers, similar to previous studies. Children with the early use of ICS had a high risk of asthma at school age in our study population, probably due to the initial severity.
SATURDAY
20
J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2
An Analysis of Obesity and Asthma Morbidity in Patients Managed at the Children's Hospital at Montefiore's Asthma Center
Gary K. Soffer, MD1, Jennifer Toh, MD2, Sunit P. Jariwala, MD3, Deepa Rastogi, MD4; 1Children’s Hospital at Montefiore, Bronx, NY, 2Albert Einstein/Montefiore Medical Center, Bronx, NY, 3Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Bronx, NY, 4Division of Pulmonology, Children’s Hospital at Montefiore. RATIONALE: Previous studies suggest a relationship between obesity and childhood asthma. We investigated the impact of body weight and clinic visit compliance on asthma morbidity. METHODS: We reviewed 45 charts of children with moderate to severe persistent asthma seen at the Montefiore Asthma Center (MAC), a multidisciplinary center comprised of Allergy, Pulmonary, and Asthma Education services. Patients had 1 or more asthma-related emergency department (ED) visit or hospitalization or 3 or more steroid courses within 12 months of their first visit. Patients were categorized as obese/overweight (n524) and normal-weight (n521), based on CDC guidelines. Betweengroup comparisons were done for compliance with MAC appointments, asthma-related hospitalizations, and ED visits one year following the patient’s last visit. Compliance was defined as 3 MAC visits. RESULTS: Most patients lived in the Bronx (82%), were of minority ethnicities (37% Latino, 35% African-American) and were obese/overweight (53%). Visit compliance was similar between both groups (50% obese/overweight vs 48% normal-weight.). However, more obese/overweight patients (45%) were hospitalized the year following their last visit than normal-weight children (28%) with more hospitalizations than normal-weight children (12 vs 2, p50.05). Similarly, 50% of obese/ overweight patients had asthma-related ED visits the year following their last visit compared to 23% of normal-weight children with more ED visits than normal-weight children (30 vs 10, p 5 0.045). CONCLUSIONS: In spite of being compliant with asthma center evaluations, obese and overweight patients had more asthma-related ED visits and hospitalizations, suggesting continued higher asthma morbidity. This relationship requires further investigation as it may imply that obesity interventions might play a substantive role in asthma management.
21
Predicting Factors for Asthma Remission in Children
Natcha Siripattarasopon, MD, Punchama Pacharn, MD, Orathai Jirapongsananuruk, MD, Nualanong Visitsunthorn, MD, Pakit Vichyanond, MD, FAAAAI, Jittima Veskitkul, MD; Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. RATIONALE: Factors contributing to outcome of childhood asthma are important for planning treatments and, potentially, in preventive interventions and advising on prognosis. Limited data are available on the asthma remission in Thai children. The objective of this study was to determine the predicting factors for asthma remission in children. METHODS: This is a prospective cohort study. Children who were diagnosed as having asthma during the period of 2004-2007 were reevaluated in 2015. The clinical characteristics and pulmonary function test were assessed. Clinical asthma remission (CR) was defined as having no asthma symptoms and no use of asthma medication during the past 12 months. RESULTS: One hundred and twenty children (63.3% male) with asthma were recruited. The median age at onset of wheezing was 2.0 years (range 0.212.6 years), 95.7% had allergic rhinitis, 65.8% had aeroallergen sensitization and 20.8% had parental asthma. At reevaluation, 58 patients (48.3%) were in CR. CR rates at 15 and 18 years of age were 50% and 80%, respectively. Patients with CR had less significantly airway obstruction compared with patients with persistent asthma (FEV1/FVC 97.667.3% VS 102.065.9%; p 5 0.004). Predicting factors for asthma remission were age
at onset of wheezing > 5 years (adjusted odds ratio [OR] 3.87; 95% CI 1.25-12.02), and sensitization to house dust mites (HDM) (adjusted OR 0.44; 95% CI 0.20-0.97). CONCLUSIONS: The probability of CR at 18 years of age was 80%. Predicting factors for asthma remission were determined by age at onset of wheezing > 5 years and without HDM sensitization.
22
Risk Factors for Asthma at Age 7 to 8 in Early Childhood Wheezers: Results from a Japanese Asthma Cohort Study
Mayumi Furukawa, MD1, Mari Sasaki, MD1, Hiroko Watanabe, MD2, Koichi Yoshida, MD1, Takao Fujisawa, MD, PhD, FAAAAI3, Motohiro Ebisawa, MD, PhD, FAAAAI4, Hiroshi Odajima, MD, PhD5, AkiraAkasawa, MD, PhD1; 1Division of Allergy, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan, 2National Hospital Organization Kanagawa Hospital, Kanagawa, Japan, 3Allergy Center and Institute for Clinical Research, Mie National Hospital, Japan.4Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan, 5Fukuoka National Hospital, Fukuoka, Japan. RATIONALE: Previous studies have demonstrated that a proportion of children with wheezing episodes in early childhood do not have asthma at school age. We sought to determine the risk factors for asthma at school age among early childhood wheezers in a Japanese asthma cohort study. METHODS: A total of 632 children aged 0 to 3 with recurrent wheezing episodes were recruited in 2004 to 2006. Information including family history, environmental factors, wheezing symptoms and treatment were collected by annual questionnaires. Among the 545 children with adequate baseline information, we analyzed the 433 children followed up at 7 to 8 years old. Asthma at 7 to 8 years old was defined as having wheeze or the regular use of asthma controller medication in the past 12 months. RESULTS: Of the analyzed 433 children, 299 (69.1%) were boys and 350 (80.8%) children were on treatment of inhaled corticosteroids (ICS) or leukotriene receptor antagonists at recruitment. At 7 to 8 years of age, 276 (63.7%) had asthma. Multivariate regression analysis showed that low birth weight, personal history of atopic dermatitis and food allergy at baseline, parental allergic rhinitis or pollinosis, the use of ICS at baseline were significantly associated with asthma at age 7 to 8 (each p<0.05). CONCLUSIONS: Predisposition to atopy was a significant risk factor for asthma at school age in early childhood wheezers, similar to previous studies. Children with the early use of ICS had a high risk of asthma at school age in our study population, probably due to the initial severity.
SATURDAY
20