We continue to be active in Environmental Research and continue to present our research at National/International meetings as well as publish our research regularly. The Pediatric Pulmonology, Allergy & Sleep Medicine division now has a full time Research manager and 3 full time research coordinators. This research staff is assigned to all of our projects at the Center.
We participated in the 6th International Conference on Children's Environment and Safety, in Jerusalem, Israel in November 2013, with an oral presentation and 3 poster presentations. We are also signatories to the Jerusalem Statement on Children's Environmental Health, 2013. We have been presenting our research work at other national/international meetings including the American Thoracic Society and the Pediatric Research Society consecutively for the last several years..
Here is a list of our projects and publications (2013-2017):
Dozor AJ, Amler RW. Children's Environmental Health. J Pediatr. 2013 Jan; 162(1):6-7.e2.
This important publication by the Center's Directors is an overview of Children's Environmental Health and challenges facing children and care-givers in the assessment and treatment of environmental conditions in children
Valsamis C, Krishnan S, Dozor AJ. The effects of low-level environmental tobacco smoke exposure on pulmonary function tests in preschool children with asthma. J Asthma. 2014 Feb 28. [Epub ahead of print]. PMID: 24575853.
Summary: It is now possible to accurately measure lung function in very young children. This study demonstrates that preschool children whose parents claim to only smoke away from their children still have evidence in their urine of exposure to environmental tobacco smoke; and that the lung function of young children with asthma is affected, possibly in a dose-dependent manner.
Gill R, Krishnan S, Dozor AJ. Low-level environmental tobacco smoke exposure and inflammatory biomarkers in children with asthma. J Asthma. 2014 Mar 7. [Epub ahead of print]
Summary: This study demonstrates that children with asthma that are exposed to low levels of environmental tobacco smoke continue to have evidence of increased inflammation, as measured in the urine, despite taking asthma medications. This is consistent with other literature suggesting that the effectiveness of first line treatment for asthma, inhaled anti-inflammatory medication (corticosteroids), may be inhibited by exposure to environmental tobacco smoke, even at very low levels.
Parental Self-Reported Environmental Exposures In Over 9,000 Children With Respiratory Illness
Data collected over an 8-year period on self-reported environmental exposures by parents of children who presented to our offices with respiratory illnesses were studied. Based on zip code of their primary residence, 85% of children lived in suburban areas, 10% in urban and 4% in rural areas. Less than 5% reported no environmental exposures and 56% reported 4 or more environmental exposures. Children 2-12 years of age were more likely to have stuffed animals than infants or adolescents. Homes with older children are more likely to have pets and wood-burning stoves. Rural children were more likely to have multiple exposures as compared to urban or suburban children. As compared to urban children, rural children were more likely to sleep with stuffed animals, have wall-to-wall carpeting in the bedrooms, have pets, be exposed to second-hand smoke, and more likely to have a wood-burning stove. Data from this large cohort will be presented at the ATS meeting in Washington D.C., May 2017.
Resistant Airway Obstruction in Children
Summary: We were the lead site for this important study conducted by the American Lung Association, Airways Clinical Research Centers network (PIs Krishnan, Dozor). A large cohort of 550 children with persistent obstruction following bronchodilator across 15 centers all over the country was characterized, to understand etiologies as well as differences between this cohort and those with reversible obstruction. Description of this unique phenotype will lead to further mechanistic and possibly interventional studies. Data from this important study will be presented in a highlighted session at the ATS meeting in Washington D.C., May 2017.
Obesity and Asthma in School-age Children with asthma
Summary: A cohort of 542 children with asthma was studied. Lung function of those who were obese was compared to those who were non-obese. Obese children with asthma had a greater FVC, reduced FEV1/FVC, and higher pulmonary reactance than those with normal BMI. Obesity influenced boys and girls differently. The data were presented at the ATS conference in San Francisco in 2016.
Impact of Health Literacy and Numeracy on Asthma Control in Children
Summary: Parents with children with asthma who present for a routinely scheduled visit are asked to voluntarily respond to three questionnaires: SAHL, Newest Vital Sign and the Asthma Control Test. The objective is to assess the asthma literacy and numeracy levels of our populating and correlate it to asthma control. 272 children were studied. Those with low NVS scores for literacy had low asthma control scores as compared to those with normal NVS scores. Further, parents who reported low NVS scores for literacy were more likely to have state assisted insurance as compared to those with normal NVS scores. This data were presented at the ATS meeting in San Francisco, May 2016.
Inhaled Corticosteroid (ICS) Prescription in ED for Children Presenting with Acute Severe Asthma
This was a quality improvement initiative to improve prescriptions for an inhaled steroid 9ICS) to children presenting to the ED with acute exacerbation of asthma. For the year prior to the study, new prescription rates were about 4%. After instituting educational measures for the ED teams as well as physicians who work in the ED, the new prescription rate climbed to 28% of all discharges over a six month period. The study is ongoing. Some of these data were presented at the ATS meeting in San Francisco, May 2016.
Air Quality and Hospitalizations for Asthma
In an analysis of five years of hospitalizations for young children with asthma at the Maria Fareri Children's Hospital, there was no direct correlation between hospitalization following an ED visit and ambient air quality at place of residence on the day of hospitalization. The likely reason for hospitalization in this population is by far, viral infections. This data were presented at the ATS meeting in San Francisco, May 2016.
Obesity and Asthma in Preschool Children
Summary: A cohort of 777 children, 3 to 6 years of age, with clinically diagnosed asthma who underwent complete lung function testing at the Maria Fareri Children's Hospital Pediatric Pulmonology Laboratory were studied. Lung function in obese children was compared to those in children with normal weight. We were able to demonstrate that obese preschool children with asthma had lower lung function measures than those who were not obese.
Secondhand Tobacco Smoke Exposure And Sleep Disordered Breathing
Ongoing study.We studied the relationship between secondhand smoke (SHS) exposure in children as measured by history as well as cotinine levels in urine with the presence of sleep disordered breathing in children. 60 children, 42 with sleep apnea symptoms and 18 controls were studied. A significant proportion (75%) of children in this study had elevated urinary cotinine levels consistent with recent exposure to environmental tobacco smoke. Children with symptoms of SDB were more likely to be exposed to ETS than healthy age-matched controls (OR = 6 [95% CI: 1.7-21.3], p = 0.007). This data were presented at the ATS meeting in Denver, May 2015.