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 3 full time research coordinators, and we are in the proves if hiring a fourth coordinator and research associate. 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 will be presenting 4 abstracts of our research in environmental health at the upcoming American Thoracic Society Conference in May 2015 in Denver, CO.
Here is a list of our projects and publications (2013-2015):
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.
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.
Obesity and Asthma in Preschool Children
Summary: We studied over 750 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. We compared lung function in obese children versus 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.
Fixed Obstruction in Children with Asthma
Summary: We studied differences in the lung clearance index between those who had fixed vs reversible lung function measures in over 2800 children with clinically diagnosed asthma who underwent lung function testing at our Pediatric Lung Function Laboratory.. We demonstrated that a significant number of children had fixed obstruction on testing i.e. abnormal lung function that persisted even after a dose of inhaled bronchodilator. Further, a significant proportion of those with fixed obstruction had prolonged lung clearance indices suggesting non-homogenous ventilation.
Secondhand Tobacco Smoke Exposure And Sleep Apnea
Ongoing study. We are studying the relationship between secondhand smoke (SHS) exposure in children as measured by history as well as cotinine levels in urine with the presence and severity of sleep apnea in children. In our preliminary analysis, a significant number of children were exposed to SHS.
Obesity and Peripheral Airway Mechanics in Children with Asthma
Ongoing study. We are studying peripheral airway mechanics in a cohort of over 550 well characterized children who underwent lung function testing at our Pediatric Pulmonology Laboratory. We hypothesize that there will be significant differences in peripheral airway mechanics and other measures of lung function between those who are obese and those who are not.
Health Literacy Project
Ongoing study. 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. We hypothesize that lower levels of health literacy and numeracy will be associated with poor asthma control.
Severity of Asthma in Children in the Emergency Department
Ongoing study. The objective of this study is to assess the severity level (as per national EPR-3 asthma guidelines) of all children presenting to the emergency department at the Maria Fareri Children’s Hospital over a 9 month period, and to ascertain how many of these children are on appropriate therapy for asthma. This will help us plan educational programs targeted to referring physicians and other health care providers.
Inhaled Corticosteroid (ICS) Prescription in ED for Children Presenting with Acute Severe Asthma
Ongoing study: National and International Asthma guidelines recommend that children who present to the ED with acute severe asthma should be prescribed ICS upon discharge from the ED as controller therapy to prevent recurrences. In this quality improvement initiative, we are studying current prescription patterns from the ED in such patients and then instituting educational measures to encourage all ED physicians to improve adherence to ICS prescriptions at time of discharge.