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Risk Factors For Asthma In Pediatrics

Maternal Use Of Paracetamol

The Risk Factors for Development of Asthma and Food Allergies

Several meta-analyses have been published on maternal paracetamol use during pregnancy and childhood asthma. In a meta-analysis of six studies 11, paracetamol use during pregnancy was significantly associated with 1.2 times increased odds of wheeze at ages 2.5 years to 7 years. However, there was high heterogeneity across studies.

A meta-analysis of eleven birth cohort studies12 reported that maternal paracetamol use in the first, third, and second/third trimesters is significantly associated with 39%, 17% and 49% increased odds of childhood asthma, respectively. However, there was considerable heterogeneity across studies. In contrast to the findings for prenatal use of paracetamol, there was no significant association between paracetamol use during infancy and childhood asthma after adjustment for lower respiratory tract infections.12

Data Extraction And Assessment Of Risk Of Bias

Titles, abstracts, and citations for studies meeting the inclusion criteria outlined above were independently analyzed by two authors . Full texts of all studies were then evaluated for eligibility, and the methodological quality of the eligible systematic reviews was assessed using the AMSTAR tool.3 The AMSTAR tool has a maximum of 11 points a systematic review assigned 8 or more points is deemed of good quality. Disagreements between the two reviewers were discussed and resolved by consensus.

Of the two hundred and twenty seven studies retrieved from the databases , 41 studies were included in this review. Of these 41 studies, 9 examined familial or prenatal factors 5 examined perinatal factors and 27 examined post-natal factors. The quality of their methodology is shown in Table 1 .

Evaluation of the quality of the 41 systematic reviews included.

Ref./AMSTAR’s Questions
Van de Loo et al.Y

AMSTAR= Asses Systematic Reviews, Ref. =reference, Y= yes, N=no, CA=cannot answer, NA= not applicable.

Odds ratio or relative risk for childhood asthma or wheeze from systematic reviews of familial or prenatal factors , perinatal factors , and postnatal factors . The OR or RR were chosen for asthma if available, or for current wheezing otherwise. When two ORs or RRs existed for the same outcome, we selected the highest estimate for risk factors and the lowest estimate for protective factors.

Asthma Action Plans For Children

An asthma action planis a clear written summary of instructions for when your childs asthma symptoms change. Everyone with asthma should have a personalised asthma action plan written by their doctor.

Your childs asthma action plan will tell you:

  • how to recognise when your childs asthma is getting worse or an attack is developing, and the steps you should take to manage it
  • symptoms that are serious, indicating a need for urgent medical help
  • your childs asthma triggers.

Make sure you understand and can follow the asthma action plan from your doctor.

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Assessment Of Different Combinations Of Risk Factors For Asthma

We investigated the relative importance of area of residence at birth versus the first years of life, on the asthma risk, by looking at children who migrated between rural and urban areas during these two periods. Children born and raised in rural areas had the lowest risk children born and raised in urban areas had the highest risk , children born in the urban area who migrated and spent most of 05 years in rural areas still had an increased risk of asthma , unlike children who were born in rural areas but migrated and spent most of 05 years in urban areas .

Residence in early life as a risk factor for asthma among schoolchildren enrolled in a case-control study between 201517
Childs residence in early lifeAsthma cases
Born and spent first 5 years in rural50
Born in rural, spent first 5 years in urban24
Born in urban, spent first 5 years in rural22
Born and spent first 5 years in urban4597872.55
  • N = number Adj. OR = adjusted odds ratio CI = confidence interval number shown in 2nd and 3rd column.

    *Adjusted for age, sex, and fathers education level.

  • Combined effects of residence at birth and parental history of allergic disease as risk factors for asthma among schoolchildren in a case-control study from 2015 to 17 .
    Childs residence at birthParental history of allergy
    435.54
    Combined effects of residence at birth and atopy as asthma risk factors among schoolchildren in a case-control study between 201517 .

    Prevalence Risk Factors And Symptoms Of Pediatric Allergic Asthma

    Allergy Prevention &  Risk Factors in 2020

    In part 1 of this 2-part episode, Irum Noor, DO, speaks about allergic asthma in children, including the risk factors and symptoms that parents/guardians should be aware of and monitor for.

    Listen to part 2 of this episode here.

    Irum Noor, DO, is an allergist and immunologist with ENT and Allergy Associates .

    TRANSCRIPTION:

    Jessica Bard: Hello everyone, and welcome to another installment of Podcast 360, your go-to resource for medical news and clinical updates. I’m your moderator, Jessica Bard with Consultant360 Specialty Network. According to the World Health Organization, asthma is the most common chronic disease among children. Dr. Irum Noor is here to speak with us today about the prevalence, risk factors, and symptoms of allergic asthma. Thank you for joining us today, Dr. Noor. Please introduce yourself for the audience with your title, position, and affiliation.

    Dr Irum Noor: Of course. Thank you so much for having me today and giving me the opportunity. My name is Dr. Irum Noor. I am an allergist/immunologist. I work with ENT and allergy associates. I see both pediatric patients and adult patients, but my base training is in pediatrics, and so I am very comfortable working with children. I’m excited to talk today.

    Jessica Bard: Well, thank you again for joining us. We’re talking about allergic asthma today. What is the prevalence of allergic asthma in the United States?

    Jessica Bard: Well, thank you again for your time today, Dr. Noor.

    Dr Irum Noor: Thank you.

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    Why Are More Children Getting Asthma

    No one really knows why more and more children are developing asthma. Suggestions include the following:

    • Children are being exposed to more and more allergens such as dust, air pollution and second-hand smoke.
    • Children aren’t exposed to enough childhood illnesses to build up their immune systems.
    • Lower rates of breastfeeding have prevented important substances of the immune system from being passed on to babies.

    Signs And Symptoms Of Childhood Asthma

    Not all children have the same asthma symptoms. A child may even have different symptoms from one episode to the next. Signs and symptoms of asthma in children include:

    • A cough that doesnât go away
    • Coughing spells that happen often, especially during play or exercise, at night, in cold air, or while laughing or crying
    • A cough that gets worse after a viral infection
    • Less energy during play, and stopping to catch their breath during activities
    • Avoiding sports or social activities
    • Tight neck and chest muscles
    • Feeling weak or tired
    • Trouble eating, or grunting while eating

    Your child’s doctor should check out any illness that makes it hard for them to breathe.

    Experts sometimes use the terms âreactive airways diseaseâ and âbronchiolitisâ when talking about wheezing with shortness of breath or coughing in infants and toddlers. Tests may not be able to confirm asthma in children younger than 5.

    When to get emergency care

    A severe asthma attack needs medical care right away. Watch for these signs:

    • Stopping in the middle of a sentence to catch a breath
    • Using stomach muscles to breathe
    • A belly that sinks in under their ribs when they try to get air
    • Chest and sides that pull in as they breathe
    • Severe wheezing

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    Side Effects Of Asthma Medication

    If you are worried about possible side effects from asthma medication, speak to your doctor. Do not stop or reduce doses of medication for your child without speaking with your doctor. Common side effects from inhaled asthma medication:

    Preventers

    • sore mouth and throat
    • fungal throat infections.

    Using a spacer reduces the risk of these side effects. as does rinsing the mouth with water after using an inhaler.

    Relievers

    • fast heart beat.

    Discharge Instructions For Pediatric Asthma

    Asthma – Pediatric Nursing – Respiratory Disorders – @LevelUpRN
    • Prepare a written asthma action plan with medications and signs to look out for that would necessitate a return to the ED
    • Continue to use a short-acting beta-agonists such as salbutamol until exacerbation resolves and then as needed, with directions to see a health care professional if therapy is needed more often than every 4h.
    • For all but the mildest of asthma patients seen in the ED, a prescription for 3 weeks of inhaled streroid such as fluticasone 50 micrograms, 2 puffs twice daily.
    • Review techniques for using inhaled asthma medications as well as for cleaning/maintaining the inhaler device. Parents must understand that they need to use the MDI spacer and that the mask fits properly, to use the B-agonist BEFORE the inhanled steroid and to wash the mouth out after the steroid inhaler to prevent thrush.
    • Encourage follow-up with the patients primary care physician or a local asthma clinic to review asthma control, environmental history and symptom recognition.

    Peak expiratory flow should NOT be relied upon solely as a measure of severity or as a sole determinate for discharge.

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    The Epidemiology Of Asthma Symptoms

    There were a total of 6,183 valid questionnaires . The age of the children ranged from 3 to 6 years, with an average of 4.2 ± 0.7 years and a median of 4.1 years. Table 1 shows the positive responses to asthma symptoms. A total of 990 children had ever experienced wheezing, while 695 children had experienced wheezing within the past year. The prevalence of doctor-diagnosed asthma was 5.3% . There were 315 and 906 participants reporting exercise-induced wheezing and night cough in the past year, respectively. Regarding the severity of asthma symptoms, 3.2% of children have experienced sleep disturbance due to wheeze or whistle, while 1.3% of children had no less than 4 attacks of wheeze in the past year.

    Table 1. Prevalence of asthma in the study .

    The prevalence of asthma symptoms was significantly higher in boys than in girls, but there were no sex differences observed regarding attack frequency and severity or nocturnal cough in the past year.

    Data Management And Statistical Analysis

    Data were double-entered using OpenClinica open source software version 3.1.4 . Data were analysed in STATA.

    For continuous variables with clinically relevant cut-off points such as for SPT, asIgE, FENO and TST, we used the dichotomous variables in the analysis. Total IgE was analysed as a continuous variable. The variable for maternal or paternal history of allergic disease combines the history of asthma, eczema, allergic rhinitis, allergic conjunctivitis and any other allergies . We conducted a complete case analysis, and did not impute missing values.

    The key variables adjusted for were age, sex, area of residence at time of birth and fathers education. Each of these variables had small numbers of missing values . We therefore created a complete case data set, comprising the 555 cases and 1115 controls which had no missing values for these variables. This complete case data set was used for all analyses.

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    Maternal Folate Or Vitamin D Status During Pregnancy

    Crider et al.6 performed a systematic review of five studies of prenatal folate or folic acid use and childhood asthma. In that meta-analysis, there was no significant association between maternal intake of folic acid supplements before the second trimester of pregnancy and asthma at school age , with no heterogeneity across studies. Because of substantial heterogeneity in exposures and outcomes, no aggregate effect estimates could be generated for other indicators of folate status . However, most primary effect estimates showed no significant association between folate status and asthma.

    Symptoms Of Asthma In Children

    Asthma May Not Be a Significant Risk Factor for Severe COVID

    As the airways narrow in an asthma attack, the child develops difficulty breathing, chest tightness, and coughing Cough in Children Cough helps clear materials from the airways and prevent them from going to the lungs. The materials may be particles that have been inhaled or substances from the lungs and/or airways. Most… read more , typically accompanied by wheezing. Wheezing Wheezing in Infants and Young Children Wheezing is a relatively high-pitched whistling sound that occurs during breathing when the airways are partially blocked or narrowed. Wheezing is caused by a narrowing of the airways. Other… read more is a high-pitched noise heard when the child breathes out.

    Not all asthma attacks cause wheezing, however. Mild asthma, particularly in very young children, may result only in a cough. Some older children with mild asthma tend to cough only when exercising or when exposed to cold air. Also, children with an extremely severe asthma attack may actually not wheeze because there is too little air flowing even to make a noise.

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    Asthma Emergencies In Children

    Symptoms of an asthma attack can worsen and develop into an asthma emergency. To prepare for an asthma emergency, make sure your childs doctor has written an asthma action plan for your child.

    Have a copy of your childs asthma action plan pinned up somewhere easy to access at home, and send a copy to anyone who cares for your child, including their school, kinder, childcare service, family members and friends. You may like to take a photo of their asthma action plan so you always have a copy with you.

    Factors Associated With Sars

    Overall, 10566 children had 1 or more tests for SARS-CoV-2 during the study period. Children with asthma were more likely to be tested for SARS-CoV-2 infection than children without asthma . Patient race and ethnicity, insurance status, and neighborhood deprivation index scores also differed by SARS-CoV-2 testing status . Specifically, children of other racial minority groups or with self-pay insurance status were less likely to be tested for SARS-CoV-2 infection, while children with public insurance and higher neighborhood deprivation index scores were more likely to be tested for SARS-CoV-2. We also observed higher levels of previous health system engagement among children who were tested for SARS-CoV-2 infection. Compared with children who were not tested for SARS-CoV-2, tested children were more likely to have had a well-child visit in the 2 years preceding the study period and were more likely to have a primary care physician in DUHS.

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    Prevalence Of Childhood Asthma

    We have actually questionnaired 13,877 children. A total of 2438 possible asthma patients were selected and 665 children were diagnosed asthma. Among asthma children, 34 children were diagnosed cough variant asthma. The male to female ratio was 1:0.58 . The mean age was 6.9±2.9 year. The prevalence of asthma children was higher in boys than that in girls in some ages . Asthma children were divided into two groups, 05 years , 614 years .

    Fig. 2

    The prevalence of asthma children: The prevalence of asthma children was high in age 3 to 7. Prevalence of boys was higher than that of girls in age 4, 6, 8, 9, 10, 11 and 12, marked with an asterisk

    How Do You Give Your Child Asthma Medication

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    You will be giving your child asthma medications using a valved holding chamber device or a home nebulizer .

    Your child may be able to use a metered dose inhaler with a VHC. A VHC is a chamber that attaches to the MDI and holds the burst of medication. Talk with your child’s provider to see if an MDI with VHC is right for your child.

    The nebulizer delivers asthma medications by changing them from a liquid to a mist. Your child gets the medicine by breathing it in through a facemask or mouthpiece.

    There are some asthma medications that are also breath-actuated, or come as a dry powder. These medications are given to older children who are able to demonstrate the appropriate technique for using them.

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    Pediatric Asthma Therapy With Equivocal Or Mixed Evidence That May Be Indicated When All Else Has Failed

    Up to 26% of children intubated due to asthma suffer complications including pneumothorax, impaired venous return, and cardiovascular collapse because of increased intrathoracic pressure. Mechanical ventilation during an asthma exacerbation is associated with an increased risk of death and should be considered as a last resort and in conjunction with the support of a paediatric ICU specialist.

    IM Epinephrine time tested but no good evidence

    IM epinephrine at the same doses used in anaphylaxis has been used for decades in children with severe asthma, however there have been no robust RCTs to support its use.

    Heliox reserve for the ICU

    According to the Canadian Pediatric Society Guidelines for Managing the Patient with Acute Asthma Exacerbation, using a helium-oxygen gas mixture should be reserved for children in the ICU setting with severe asthma exacerbation who have failed to improve despite maximized therapy.

    Ketamine to avoid intubation 3 Mixed Studies

    A limited case series has reported the effectiveness of a bolus followed by a continuous infusion of ketamine in children with severe asthma who were approaching respiratory failure. In this study, the use of ketamine resulted in prompt improvement and avoided the need for endotracheal intubation. This is an appealing use of ketamine, because it may allow one to avoid the hazards of endotracheal intubation and mechanical ventilation in the patient with asthma.

    High Flow Nasal Cannula gaining popularity

    What Are The Risk Factors For Pediatric Asthma

    Medical research shows that asthma seems to be caused by a combination of genetics and environmental factors.

    For example, children who have symptoms such as coughing and shortness of breath, and who also have a family history of asthma, are more likely to have asthma. Asthma is also closely related to allergies, so children who have other allergy-related conditions such as eczema, hay fever or food allergies or who have a family history of them are also at increased risk.

    The environment is another important factor. Exposure to air pollution and cigarette smoke has also been shown to raise childrens risk of developing asthma symptoms. Children who live in urban areas have higher rates of asthma than those who dont.

    Obesity has also been linked to asthma. Children who are obese are more likely to have the condition diagnosed, and their cases are likely to be more severe, with more frequent symptoms.

    Most children who develop asthma start to have symptoms by 5 years old, and for reasons that are unclear, boys are more likely to have asthma than girls.

    There are many reasons children could have trouble breathing, especially when they have colds or congestion. There are other conditions that cause coughing and/or wheezing, so it is important to have your child evaluated.

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