What Is A Risk Factor Associated With Childhood Asthma

Adherence With Asthma Medication

It is well established that asthma medications, when taken properly, reduce asthma morbidity, emergency room visits, and hospitalizations, and poor adherence to asthma controller medications is associated with increased severe asthma exacerbations , uncontrolled asthma , asthma morbidity , and asthma mortality . However, asthma controller medications tend to be underused in children and medication non-adherence is a significant concern , especially among urban minority patients . Given these results, interventions to improve medication adherence are important for reducing asthma morbidity and mortality. Additionally, improved asthma medication adherence and consequent improved asthma control can lead to increased quality of life .

Basic Characteristics And Quality Control

A comprehensive questionnaire was self-designed for both children and their parents or guardians, aiming to collect potential factors responsible for the development of childhood asthma and wheeze. Items from the questionnaire were selected a priori based upon published literature and clinical experience.

From children, items of interest included age, sex, region, body mass index , birth weight, ABO blood type, delivery mode, breastfeeding duration, daily sleep duration, secondhand smoke exposure, vitamin D supplement duration, probiotics supplement, exposure of average daily screen time, intake frequency of night meals, history of allergic rhinitis, hay fever, eczema, and initial age of using antibiotics. Body weight and height were measured by trained health physicians.

From parents or guardians, data on age, sex, weight, height, education, family income, maternal pre-pregnancy weight, gestational weight gain , maternal pregnancy smoking exposure, gestational hypertension, gestational diabetes mellitus, and family history of asthma were self-reported and recorded simultaneously.

What Puts People At Risk For Developing Asthma

While these factors increase a person’s risk for developing the disease, there are additional factors, such as poverty and lack of health insurance, that contribute to more asthma symptoms, emergency room visits and hospitalizations. Learn more about ways to improve asthma by understanding the risks related to exposure to things in the environment that are known to make asthma worse and management steps.

Reviewed and approved by the American Lung Association Scientific and Medical Editorial Review Panel.

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Childhood Asthma Risk Factors

Asthma is the leading cause of long-term illness in children. It affects about 7 million kids in the United States. Those numbers have been going up, and experts arenât sure why.

Most children have their first symptoms by age 5. But asthma can begin at any age.

Things that can make a child more likely to have asthma include:

• Exposure to secondhand tobacco smoke before or after birth
• African-American or Puerto Rican descent
• Being raised in a low-income environment

Search Strategy And Inclusion Criteria

We conducted a search of the PubMed database from 1990 to October 2017 to identify meta-analyses evaluating the association between individual risk factors and asthma development. We used the search term asthma and restricted the results to meta-analyses, children or adolescents , and articles published in English. A second search was completed and limited to meta-analyses and female gender to capture maternal pregnancy risk factors. Inclusion of abstracts identified by the initial screen was based on specific criteria: published by a peer-reviewed journal provided a point estimate such as odds ratio with corresponding 95% confidence intervals and outcomes were assessed in children or adolescents. The outcome of interest was the risk of developing incident asthma in childhood. For risk factors with more than one meta-analysis available for review, we selected either the most recent analysis or that with the largest study population. The characteristics derived from each selected article included the type of risk factor, study authors, year of publication, size of the study population, definition of asthma diagnosis, and odds ratio estimates with corresponding 95% CI.

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Asthma In Children And Adultswhat Are The Differences And What Can They Tell Us About Asthma

• 1Division of Pediatric Pulmonology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
• 2Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
• 3Department of Respiratory Medicine, Alfred Hospital, Melbourne, VIC, Australia
• 4Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia

Asthma varies considerably across the life course. Childhood asthma is known for its overall high prevalence with a male predominance prior to puberty, common remission, and rare mortality. Adult asthma is known for its female predominance, uncommon remission, and unusual mortality. Both childhood and adult asthma have variable presentations, which are described herein. Childhood asthma severity is associated with duration of asthma symptoms, medication use, lung function, low socioeconomic status, racial/ethnic minorities, and a neutrophilic phenotype. Adult asthma severity is associated with increased IgE, elevated FeNO, eosinophilia, obesity, smoking, and low socioeconomic status. Adult onset disease is associated with more respiratory symptoms and asthma medication use despite higher prebronchodilator FEV1/FVC. There is less quiescent disease in adult onset asthma and it appears to be less stable than childhood-onset disease with more relapses and less remissions.

Identification Of Potential Factors

As shown in Table 2, significant differences between children with and without asthma were observed for probiotics supplement, allergic rhinitis, history of hay fever, eczema, initial age of using antibiotics, and family history of asthma . Univariate analyses suggested statistically significant associations of sex, BMI category, intake frequency of night meals, probiotics supplement, screen time, allergic rhinitis, history of hay fever, eczema, initial age of using antibiotics, and family history of asthma with childhood wheeze.

Table 2. Baseline characteristics of study participants after propensity score matching in this study.

Table 3 shows the estimated coefficients for candidate factors with childhood asthma and wheeze in the logistic LASSO regression analysis. For doctor-diagnosed childhood asthma, the -values ranged from 0.000328 to 0.1344, and the opted -value was 0.02475 in this study . Finally, the LASSO regression analysis revealed that seven factors contributed to the development of childhood asthma, including children with a history of allergic rhinitis , hay fever , eczema , initial age of using antibiotics , vitamin D supplement duration , BMI category , and family history of asthma .

Table 3. The estimated coefficients for logistic least absolute shrinkage and selection operator regression between candidate risk factors with doctor-diagnostic childhood asthma and parent-reported wheeze.

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Presentation Of Asthma: Early Childhood

Studies of asthma’s natural history have shown that almost 80% of cases begin during the first 6 years of life . The symptoms of pediatric asthma in this age group are varied and not specific to asthma making the diagnosis challenging. The primary symptoms of asthma in infancy and early childhood include cough, both dry and productive , wheeze, shortness of breath, and work of breathing. Asthma symptoms are a result of airway inflammation, bronchospasm, airway edema, and airway mucous gland hypertrophy. Interestingly, these symptoms can also present with a multitude of other pediatric diseases including respiratory tract infections and congenital airway anomalies posing a diagnostic challenge. It is well-established that asthma in this age group is frequently under-diagnosed and undertreated .

Often in this age group, particularly over 03 years, symptoms are virally triggered rather than allergically triggered. Infants will often have very few symptoms until they experience an upper respiratory infection, which can trigger a significant and severe inflammatory cascade.

Will Your Child Outgrow Asthma

Once a person’s airways become sensitive, they remain that way for life. About half of the children who have asthma have a noticeable decrease in symptoms by the time they become adolescentsâtherefore, appearing to have “outgrown” their asthma. However, about half of these children will develop asthma symptoms again in their 30s or 40s. Unfortunately, there is no way to predict whose symptoms will decrease during adolescence and whose will return later in life.

A note from Cleveland Clinic

Last reviewed by a Cleveland Clinic medical professional on 04/01/2019.

References

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Epidemiology Of Asthma: An Overview

The recent substantial increase in the reported prevalence of asthma worldwide has led to numerous studies of the prevalence and characteristics of this condition. Foremost among these are 2 major international initiatives that have collected data using validated questionnaires, one among children, the International Study of Asthma and Allergies in Childhood, and the other among young adults, the European Community Respiratory Health Survey. Follow-up investigations for both of these studies, have examined temporal trends within and across populations. During a mean of 7 years following phase I of the International Study of Asthma and Allergies in Childhood, which in most participating countries was conducted between 1991 and 1993, the prevalence of asthma was stable or decreased in some areas of the world but increased substantially in many other areas, especially among children 1314 years of age .

Changes in prevalence of diagnosed asthma and asthma symptoms over time among children and young adults. Reproduced, with permission, from Eder W, Ege MJ, von Mutius E. The asthma epidemic. N Engl J Med 2006 355:222635. Copyright 2006 Massachusetts Medical Society.

Causes And Triggers Of Childhood Asthma

Common triggers include:

• Airway infections. This includes colds, pneumonia, and sinus infections.
• Allergens. Your child might be allergic to things like cockroaches, dust mites, mold, pet dander, and pollen.
• Irritants. Things like air pollution, chemicals, cold air, odors, or smoke can bother their airways.
• Exercise. It can lead to wheezing, coughing, and a tight chest.
• Stress. It can make your child short of breath and worsen their symptoms.

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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

Environmental Factors And Asthma

Indoor air pollution such as cigarette smoke, mold, and noxious fumes from household cleaners and paints can cause allergic reactions and asthma. Environmental factors such as pollution, sulfur dioxide, nitrogen oxide, ozone, cold temperatures, and high humidity are all known to trigger asthma in susceptible individuals. In fact, asthma symptoms and hospital admissions are greatly increased during periods of heavy air pollution. Ozone is the major destructive ingredient in smog. It causes coughing, shortness of breath, and even chest pain — and can boost the susceptibility to infection. Sulfur dioxide, another component of smog, also irritates the airways and constricts the air passages, resulting in asthma attacks.

Gas stoves are the primary source of indoor nitrogen dioxide, a common indoor pollutant. Studies show that people who cook with gas are more likely to have wheezing, breathlessness, asthma attacks, and hay fever than those who cook with other methods. It is estimated that more than half of the households in the U.S. use gas stoves.

Weather changes can also result in asthma attacks in some people. For instance, cold air causes airway congestion and an increase in mucus production. Increases in humidity may also cause breathing difficulty in a certain population.

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What Makes A Child More Likely To Develop Asthma

There are many risk factors for developing childhood asthma. These include:

• Allergies.
• Family history of asthma, allergies and atopy .
• Frequent respiratory infections.
• Being African American.
• Being raised in a low-income environment.

In children who are under five years of age, the most common cause of asthma symptoms is upper respiratory viral infections such as the common cold.

Association Between Childhood Asthma And Copd

Children with asthma have an increased risk of developing chronic obstructive pulmonary disease in adulthood. Specifically, it has been shown that children who smoke tobacco and also have asthma are at increased risk for developing low lung function and COPD as adults, when compared to smokers who did not have asthma in childhood .

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Environmental Factors Are Associated With Symptomseverity

Children who lived lower than the 6th floor were more likelyto have moderate asthma than to be symptom-free or have mild asthma . However, there were nostatistical differences in other environmental risk factors, includingexposure to secondhand smoke, pets, mold, age of housing, andremodeling .

Table 2: Environmental factors associated with asthma symptom severity.

Are There Genetic Risk Factors Of Asthma

Family history of asthma is a main risk factor for asthma. For example, people with a parent with asthma are 3 to 6 times more likely to develop asthma.2

This means there is a genetic element to asthma development. Researchers have identified mutations in many genes that may be linked to asthma or wheezing. However, we do not yet understand what the most important genes are and their specific roles.3,4

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The Late Onset Wheeze

These children develop wheezing between age 3 and 6 years. Late-onset wheeze is strongly associated with fractional exhaled nitric oxide levels and sensitization to inhaled allergens at 6 years and at 4 years. There appears to be severe and irreversible reduction in lung function in this phenotype and asthma medication use is common .

Presentation Of Asthma: Late Childhood

Symptoms in this age group transition more from discrete episodes of wheezing in response to viral infections to allergic triggered exacerbations. In this age group, exercise-induced symptoms manifest more clearly which may be due to a true change in the clinical presentation of asthma in this age group or also due to sports and exercise becoming a more discreet activity for children of this age wherein caretakers are able to appreciate the symptoms of dyspnea or cough with exertion. In children who avoid or develop a loss of interest in exercise or physical activities, it is important to consider that asthma may be underlying.

Some children in this age group will have few day-to-day symptoms, but have severe asthma attacks in response to specific triggers such as cold weather, cigarette smoke, or seasonal allergies. Virally triggered asthma exacerbations occur in this age group but less often than in the 06 year age range and may contribute to the lower rates of healthcare utilization in this age group as compared with younger years of 04 years .

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Risk Factors Associated With Childhood Asthma: A Case Control Study

World Congress on Allergy and ImmunotherapyMay 16-17, 2018 Osaka, Japan

Srijana Dongol Singh and Shrestha A

Kathmandu University Hospital, Nepal

Scientific Tracks Abstracts: J Allergy Ther

Abstract :

Biography :

Srijana Dongol Singh is currently working as an Associate Professor at Dhulikhel Hospital, Kathmandu University Hospital, Nepal.

Other Childhood Asthma Clinical Presentations:

In clinical practice, there are different clinical presentations of symptoms that point to an underlying diagnosis of childhood asthma, and clinical improvement can occur in response to starting a child on preventive asthma therapy, such as a daily-inhaled corticosteroid and use of bronchodilator therapy for acute episodes.

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How Will You Know When Your Child’s Asthma Is Well

You will know that your child’s asthma is well-controlled if, while on medications, your child:

• Lives an active, normal life.
• Has few troublesome symptoms.
• Performs daily activities without difficulty.
• Has had no urgent visits to the doctor, emergency department or hospital.
• Has few or no side effects from the medications.

How Is Asthma In Children Diagnosed

Asthma is often difficult to diagnose in infants. However, the disease can often be diagnosed in older children based on the child’s medical history, symptoms, and physical examination, and on certain tests:

• Medical history and symptom description: The healthcare provider will ask about any history of breathing problems your child may have, as well as a family history of asthma, allergies, a skin condition called eczema, or other lung diseases. Be sure to describe your child’s symptoms in detail, including when and how often these symptoms have been occurring.
• Physical exam: During the physical examination, the doctor will listen to your child’s heart and lungs.
• Tests: Many children will have a chest X-ray and pulmonary function tests, which measure the amount of air in the lungs and how fast it can be exhaled . The results will help the provider determine how severe the asthma is. Children younger than 5 are usually unable to perform pulmonary function tests, so doctors rely heavily on history, symptoms, and physical examination in making the diagnosis.

The doctor may order other tests to help identify particular asthma triggers, including allergy skin testing and blood tests.

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Etiology Of And Risk Factors For Asthma

Asthma comprises a range of heterogeneous phenotypes that differ in presentation, etiology and pathophysiology. The risk factors for each recognized phenotype of asthma include genetic, environmental and host factors. Although a family history of asthma is common, it is neither sufficient nor necessary for the development of asthma.

The substantial increases in the incidence of asthma over the past few decades and the geographic variation in both base prevalence rates and the magnitude of the increases support the thesis that environmental changes play a large role in the current asthma epidemic. Furthermore, environmental triggers may affect asthma differently at different times of a persons life, and the relevant risk factors may change over time.

Short-term studies of risk factors may suggest a lower likelihood of asthma, whereas the same factors may be associated with greater risk if follow-up is more prolonged. This pattern may relate to overlap between different wheezing phenotypes in early childhood, only some of which persist as asthma in later childhood and adulthood. Because of this phenomenon, we examine here the risk factors for persistent asthma at different ages, specifically the prenatal period, infancy, childhood and, briefly, adulthood.