asthma in children

Name of the Student
Professor’s Name
Biology
28th November 2015
Assessment of Predisposing Factors for Childhood Asthma in the United States: A Retrospective Analysis
Abstract
Asthma is an obstructive lung disease that is marked by a difficulty to exhale out the inspired air. The prevalence of asthma is on the rise and there are various triggering factors which cause asthma in adults and children. Children are susceptible to such triggers which cause asthmatic episodes in them. Childhood asthma is a growing across parents and pediatricians, all across the world. The present study attempted to evaluate the episodes of asthma based on age, gender and race, in a group of asthmatic and non-asthmatic children in the United States. Moreover, the study also evaluated relation of various factors like age, gender, socio-economic status, physical activity, place of habitation, and race as individual risk factors for increasing the episodes of asthma.
The methodology was based on a semi-qualitative study and retrospective study. The responses were based on an interview questionnaire that was presented to parents 40 individuals. The study included 20 boys and 20 girls with an age range of 5 to 8 years. The sample was pooled from the electronic data records of the online questionnaire and doctor’s interview. Purposive sampling was applied, to include only those patients, who presented themselves at the emergency outdoor.
The study showed that the doctor’s perception for individual factors as a risk for asthma is nearly matched parents’ responses.

It reflects the parents’ responses concerning gender prevalence of asthma nearly match with doctor’s perception. In other categories too the figures are quite close like 45% individuals were asthmatic in fast food category in parent’s response compared to 40% as per doctor’s response concerning obesity, 65% individuals were found to come from heavy traffic area in parent’s response compared to 70% as per doctor’s response concerning pollution, 80% individuals were found to have decreased physical activity as per parent’s response compared to 60% as per doctor’s response concerning physical activity as a factor for asthma. However, socioeconomic status was rated lower in doctor’s perception compared to parents’ response (87% in parents’ response versus 65% as per doctor’s perception). Interestingly concerning race doctor agreed that 70% of asthmatic children to “Whites”, which matched the parent’s response of 72%.
Asthmatic episodes were shown to be holistically related to the age, gender, socio-economic status and race of an individual. The correlation coefficients reciprocated asthma to be significantly positively correlated with socioeconomic status, and race of the individual. This meant as the affluence of the family increases; the child also suffer from asthma and more the extent of “White”, more is the asthmatic prevalence. On the other hand asthma was significantly negatively correlated with age, and gender of the individual. This meant that as age decreases, the incidences of childhood asthma increases, and females will have more asthmatic episodes than males.
The finding of the present study was postulated, through the environmental trigger hypothesis of asthma. It was contended that exposure of a child to extreme clean environments, during the early years of his or her life, and predisposed the individual to childhood asthma. The current study supported the evidence as obtained from literature survey. It is important that for prevention of asthma, children must be provided an ambience to increase their immunity. They should not be exposed to polluted areas or sources of acute and chronic pollution. Parents and care givers must encourage physical activity in both boys and girls, irrespective of gender bias. Parents must be more vigilant, regarding the respiratory health of their child and should take help from the physicians. This means parents must take their children for a lung function test, whenever they witness a shortness of breath in their child. This is because, being a child, one may not express himself or herself regarding difficulties in breathing.
Assessment of Predisposing Factors for Childhood Asthma in the United States: A Retrospective Analysis
Background
Asthma is a respiratory disorder, which affects the lungs of an individual. The prevalence of asthma is on the rise and there are various triggering factors that cause asthma in adults and children. Children are susceptible to such triggers that cause asthmatic episodes in them. Childhood asthma is a growing across parents and pediatricians, all across the world. Although various studies have been carried out, regarding the pathogenesis and treatment modalities of asthma, data regarding prevalence of asthma with respect to age, gender and race are scanty and sporadic (Muraro et al 681-689).
In fact various studies have expressed the need of conducting research in different children, according to ethnicity. Such studies might indicate the genetic patterns or triggering factors or the factors responsible for hyper-responsiveness in specific groups could be elucidated (Jackson et al 1165-1174). This will help in implementing precautionary measures or may stimulate modifications in treatment modalities, which will improve quality of life of a patient.
The present study would attempt to evaluate episodes of asthma based on age, gender and race, in a group of asthmatic and non-asthmatic group of children in the United States. Moreover, the study will also try to evaluate, whether the factors like age, gender and race possess a risk factor for asthma and if so how they are related, either alone or in combination with different factors. The outcomes of the study may improve the prognosis of children suffering from asthma and may also help in devising, appropriate therapeutic approach that may be tailor-made for a specific age group, or a specific race or a specific gender.
Review of Literature
Asthma is an obstructive lung disease. This means that air may be breathed into the lungs easily, but it cannot be exhaled out with ease to the outside. Therefore, air is obstructed from going out of the lungs. The sites of obstruction are the bronchioles. Asthma may be viewed as a homeostatic response that the lungs activate against the environmental triggers or foreign particles that enter the lungs. By obstructing the bronchioles through bronchoconstriction, further entry of such particles are prevented. However, such a phenomenon will increase the work of breathing and lead an individual to respiratory distress. Asthma occurs due to triad phenomenon. This means it is a combination of three processes. They are airway obstruction, airway hypersensitivity and increased modeling of the respiratory tract. When the foreign particle invades the lungs, it leads to the stimulation of mast cells. Stimulation of mast cells will increase the liberation of histamine (Nuijsink et al 457-466).
Histamine will act upon the histamine receptors situated in the bronchioles. Histamine causes bronchoconstriction and prevents further entry of polluted air or air filled with foreign particles (like pollen grains).Histamine also causes stimulation of the inflammatory mediators like leukotrienes and different cytokines which cause inflammatory cells to build up in the bronchioles. Therefore, bronchoconstriction on one hand and increased deposition of inflammatory particles narrow the orifice of bronchioles. This aggravates the problem of obstruction (Drazen, Israel & O’Byne 197-206).
Current treatment modalities for asthma, under the pharmacological perspective include symptomatic relieve of bronchoconstriction. Administration of mast cell stabilizers and steroids would reduce the accumulation of inflammatory particles in the bronchioles which will provide symptomatic relief to a patient (Guilbert et al 1985-997). Vaccines against asthma and specially childhood asthma have been developed. However, beneficial effects are not perceived uniformly either by the patients or their family members.
The diagnosis of asthma is typically based on the lung function tests that measures for chronic obstructive lung diseases. The forced expiratory volume in 1 second is assessed against the total Forced Vital Capacity. This means that if the bronchioles are not constricted then, the inhaled air will come out easily in the first second. On the other hand, if the bronchioles are constricted, then the inhaled air would not come out easily in the first second, and hence the volume exhaled out in the first second would be lesser than individuals who are not asthmatics. This is the basis of FEV1/FVC tests, which are the most popular lung function test parameters, for measuring restrictive or obstructive diseases. FEV1/FVC > 80% indicates that an individual does not suffer from obstructive diseases. On the other hand if the ratio decreases below 60%, it may be speculated that the individual might suffer from obstructive diseases. Asthma is confirmed when such ratio goes further below 48% (Nishimuta et al 147-169)
For appropriate diagnosis, the lung function tests are correlated to the physical chest examinations. Asthma is expressed by rapid hyperventilation and muscle pain. The individual may complain of chest tightness, wheezing, shortness of breath and extreme difficulty in breathing. Asthma is triggered by polluted air, allergens and dust and smoke. Individuals should wear respiratory protectors, in order to keep away from smoke and dust.
Current research propositions in asthma are evaluating various domains. There has been a necessity to acknowledge the asthma phenotypes in childhood in a detailed manner. Robust epidemiological, statistical and biological data must be matched and correlated to find out the exact cause and effect relationship between the causative factors for asthma. Geopolitical particulars must also be evaluated on the basis of socio-economic status of children and their families and moreover the clinical presentation of asthma in different groups of individual must be documented. Moreover, immunological biomarkers must be researched to provide a robust diagnosis to the severity of asthma or possibility of severity amongst risky populations (Szefler 485-494).
Medications are also venturing into newer possibilities. Since, inflammation has been attributed as one of the key elements in the genesis of asthma; various leukotriene inhibitors are being evaluated. Inhibition of leukotrienes would inhibit accumulation of immune cells in the bronchioles and this might be a mechanism through which chronic asthmatic episodes may be managed (Taylor et al 545-554).
Methodology
The methodology was based on random selection of samples. The approach was a semi-qualitative study and retrospective study. The responses were based on an interview questionnaire that was presented to parents. 40 parents were included for the interview. Upon final interview, 40 individuals including 20 boys and 20 girls were selected in the study. The age range of the children varied from 5 to 8 years. The parents were surveyed through an online questionnaire. The sample was pooled from the electronic data records to have equal representation of boys and girls. This was done to minimize the chances of experimental bias.
Purposive sampling was applied to include only those individuals who presented themselves at the emergency outdoor leading to an admission in the Department of Chest or Department of Pulmonology, as per parent’s feedback. This was done to be sure regarding asthmatic episode, which was a concern in the family. However, random selection was done on the data. This meant we had two sets of individuals, group 1(who did not have asthmatic episode-confirmed) and group 2(who did have an asthmatic episode-confirmed). Data from individuals above the age of 8 years or below the age of 5 years were excluded from the study.
Further, individuals who had other co-morbid diseases along with asthma were excluded too. Data confidentiality and accessing of database was ethically permitted by the Clinical Trial Ethical Committee of the State. Further, an undertaking was declared to the State authorities, that this study would not jeopardize the interests of any community, or race, or caste and religion who are resident of United States/or have visited the United States as a matter of kinship.
A chest physician belonging to the locality was also interviewed for certain aspects (Table 1) to validate the findings from parents’ responses and feedback. This design was done to put power to the study.
Data Collection
The data that was collected for the study included asthmatic/non-asthmatic status, age, racial status, socioeconomic status, gender, pattern of fast food consumption, place of inhabitation (areas of high traffic/low traffic), and episodes of shortness of breath (Table 1). Each and every data was kept anonymous and no personal identity of a child was accessed. The interview data is represented in Table 1and the responses are reflected in Table 2.
Parent Questionnaire Response
Do you have a boy child or girl child or both?  
What is the age of your child?  
Does he or she often present with shortness of breath?  
Does he or she actively engage in physical activity?  
Which race do you belong? ( Afro-American/White/Asian)  
Is she or he detected as asthmatic?  
What is the family income? ( > 50000$/annum or <50000$/Annum0  
Do you have pets in your home? Is there dander around?  
What is the frequency of consuming fast foods?  
How is the environment around your home? Heavy traffic or low traffic  
Did your ward have to be hospitalized for asthma? Yes/no  
Doctor’s Questionnaire  
What is the prevalence of asthma in between both sexes who visits your clinic?  
Which factor/factors you think are the reasons of asthma?  
( Obesity, Pollution, Less Physical activity, income of the family, race)  
asthma race age Socioeconomic status gender Shortness of breath Physical activity Pets at home Fast Food
yes white 7 high male yes No yes No
yes white 6 high male yes No yes No
no afro-america 6 low male yes Yes yes yes
no afro-america 7 high male no Yes no no
no asian 5 low male yes No yes yes
yes asian 6 high male yes No yes yes
no white 6 low male no Yes no no
no asian 8 high male no Yes no no
no asian 8 low male no Yes no no
no afro-america 7 low male no No no no
no afro-america 6 low female no Yes no no
yes white 6 high female yes No yes yes
yes white 7 high female yes No yes yes
yes white 5 low female yes No yes yes
no asian 6 low female no No no no
yes afro-america 7 high female yes Yes yes yes
no afro-america 8 low female no No no no
no asian 8 low female yes No yes yes
yes white 7 high female yes Yes yes yes
no asian 7 low female no Yes no no
yes white 7 high male yes No yes yes
yes white 6 high male yes No yes yes
yes afro-america 6 low male no Yes no no
no afro-america 7 high male no Yes no no
no asian 5 low male no No no no
yes asian 6 high male yes No yes yes
no white 6 low male no Yes no no
no asian 8 high male no Yes no no
no asian 8 low male no Yes no no
no afro-america 7 low male no No no no
no afro-america 6 low female no Yes no no
yes white 6 high female yes No yes yes
yes white 7 high female yes No yes yes
yes white 5 low female yes No yes yes
no asian 6 low female no No no no
yes afro-america 7 high female yes Yes yes yes
no afro-america 8 low female no No no no
no asian 8 low female no No no no
yes white 7 high female yes Yes yes yes
no asian 7 low female no Yes no no
Results

Fig 1: Represents the % of asthmatics based on gender and females were more asthmatic than males

Fig 2: Represents the % of asthmatics based on socio-economic status. People with higher socio-economic status had more prevalence of asthma

Fig 3: Represents the % of asthmatics based on socio-economic status. The Americans who were whites had more prevalence of asthma compared to their African and Asian counterparts

Fig 4: It represents that families who had pets and dander had greater percentage of asthmatic patients

Fig 5: It represents individuals who did not have adequate physical activity were more asthmatic than individuals in the group who had more physical activity

Fig 6: Indicated that individuals who were rated asthmatic in whom shortness of breath was detected compared to individuals who did not have shortness of breath and was diagnosed as asthmatic

Fig7: Indicates that individuals who consumed more fast foods and may be predicted as obese were more asthmatic than their counterparts who did not consume much fast food

Fig 8: Indicated that the % of individuals who presented with asthma were more, who belonged to areas infested with heavy traffic, compared to individuals who were from low traffic areas.

Fig 9: Doctors perception for individual factors as a risk for asthma is indicated. It reflects the parents’ responses concerning gender prevalence of asthma nearly match with doctor’s perception. In other categories too the figures are quite close like 45% individuals were asthmatic in fast food category in parent’s response compared to 40% as per doctor’s response concerning obesity, 65% individuals were found to come from heavy traffic area in parent’s response compared to 70% as per doctor’s response concerning pollution, 80% individuals were found to have decreased physical activity as per parent’s response compared to 60% as per doctor’s response concerning physical activity as a factor for asthma. However, socioeconomic status was rated lower in doctor’s perception compared to parents’ response (87% in parents’ response versus 65% as per doctor’s perception). Interestingly concerning race doctor agreed that 70% of asthmatic children to “Whites”, which matched the parent’s response of 72%.
Discussion and Conclusion
From the present study it was clearly evident that the females were more asthmatic than males, from the responses of both parents’ and doctor. On the other hand, individuals who belonged to lower socio-economic status had lower incidences of asthma as per parents’ feedback, but such findings did not match doctor’s response. Concerning racial considerations, the prevalence of asthma was more with “whites” compared to “Afro-American” and “Asians” residing in the United States, and interestingly this figure was same between doctor and parents’. Our study indicated that children who belonged to more congested areas( heavy traffic), had more fast food consumption and was at risk of obesity, had a baseline of more shortness of breath, were found to be more asthmatic. Moreover, presence of pets and dander increased the prevalence of asthma.
The above results and findings may be postulated, through the environmental trigger hypothesis of asthma. It is contended that exposure of a child to extreme clean environments, during the early years of his or her life, predisposes the individual to childhood asthma. Individuals who were exposed to more and continuous traffic zones were more asthmatic, but this was chronic exposure. Perhaps, initial exposure during childhood and decreased care might have reduced the prevalence of asthma in these group of individuals too.
It is commonly noted that females have a lower physical activity than males, across all age groups. Hence, the boys go out to the outdoor settings gets exposed to unclean environments and which increases their immune profile. While, lack of physical activity in girls, confines them in indoors and perhaps they are not exposed to unclean environments and thus immunity levels are low in girls. With respect to socio-economic status, it may be assumed that people with lower socio-economic status may not be able to maintain the qualities and cost of healthy ambience. Therefore, exposure to less healthy environments may be related with decreased episodes of asthma in children belonging to lower socio-economic status. On the other hand, as the age increases exposure to various environmental triggers increases and perhaps adapts the child to their environment. However, at lower ages asthma is more due to lack of adaptation to environmental triggers (Morgan et al 1068-1080).
Concerning the racial observations “whites” are more concerned with health and hygiene of their children during early stages of life compared to their Afro-American or Asian counterparts. This sense of “extreme hygiene”, may keep their children from early environmental triggers, which may lead to their decreased adaptation of the immune system towards environmental triggers. The study further indicated that shortness of breath might act as an indicator of asthma. The presence of pets and dander was also shown to precipitate asthma. Moreover, individuals consuming fast food were found to be more asthmatic. This may be either due to obesity and hence, a decreased physical activity, which might precipitate asthma in them.
The current study supported the evidence as obtained from literature survey. It is important that for prevention of asthma, children must be provided an ambience to increase their immunity. They should not be exposed to polluted areas or sources of acute and chronic pollution. Parents and care givers must encourage physical activity in both boys and girls, irrespective of gender bias. Parents must be more vigilant, regarding the respiratory health of their child and should take help from the physicians. This means parents must take their children for a lung function test, whenever they witness a shortness of breath in their child. This is because, being a child, one may not express himself or herself regarding difficulties in breathing.
Future Directions
The present study provided some insights regarding the prevalence and incidence of asthma concerning race, socioeconomic status, gender and age. However, a decrease or increase in immune profile should have been evaluated. This would have provided power to the study as because statistical significance could have been linked and evaluated in the perspective of clinical significance. Therefore, future studies may be designed as per the present study, but the immunological parameters should be assessed too.
Works Cited
Jackson DJ, Sykes A, Mallia P, & Johnston SL. Asthma exacerbations: origin, effect, and prevention. J Allergy Clin Immunol 128(2011):1165–1174
Guilbert TW, Morgan WJ, Zeiger RS, Mauger DT, Boehmer SJ, & Szefler SJ Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med; 354(2006):pp.1985–1997. Print.
Jackson DJ, Sykes A, Mallia P, Johnston SL. Asthma exacerbations: origin, effect, and prevention. J Allergy Clin Immunol , 128 (2011):pp.1165–1174. Print
Drazen JM, Israel E, & O’Byrne PM. Treatment of asthma with drugs modifying the leukotriene pathway. N Engl J Med, 340(1999):pp.197–206. Print
Morgan WJ, Crain EF, Gruchalla RS, O’Connor GT, Kattan M, & Evans R.. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med 351(2004):pp.1068–1080. Print
Muraro A, Clark A, Beyer K, Borrego LM, Borres M, Lodrup & Carlsen KC. The management of the allergic child at school: EAACI/GA2LEN Task Force on the allergic child at school. Allergy , 65(2010):pp. 681–689. Print
Nishimuta T, Kondo N, Hamasaki Y, Morikawa A, & Nishima S. Japanese guideline for childhood asthma. Allergol Int 60(2011):pp.147–169. Print
Nuijsink M, Hop WC, Sterk PJ, Duiverman EJ, de Jongste JC. Long-term asthma treatment guided by airway hyperresponsiveness in children: a randomised controlled trial. Eur Respir J 2007;30:pp.457– 466. Print
Szefler SJ. Advancing asthma care: the glass is only half full! J Allergy Clin Immunol 2011;128:pp 485–494. Print
Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, & Casale TB. A new perspective on concepts of asthma severity and control. Eur Respir J, 32(2008):pp 545–554. Print
Wilkinson, Leland (1999). “Statistical Methods in Psychology Journals; Guidelines and Explanations”. American Psychologist 54.8(1999):pp. 594–604.Print