Exercise-Induced Wheeze, Urgent Medical Visits, and Neighborhood Asthma Prevalence

Abstract

OBJECTIVE: Exercise-induced wheeze (EIW) may identify a distinct population among asthmatics and give insight into asthma morbidity etiology. The prevalence of pediatric asthma and associated urgent medical visits varies greatly by neighborhood in New York City and is highest in low-income neighborhoods. Although increased asthma severity might contribute to the disparities in urgent medical visits, when controlling for health insurance coverage, we previously observed no differences in clinical measures of severity between asthmatic children living in neighborhoods with lower (3%–9%) versus higher (11%–19%) asthma prevalence. Among these asthmatics, we hypothesized that EIW would be associated with urgent medical visits and a child’s neighborhood asthma prevalence. METHODS: Families of 7- to 8-year-old children were recruited into a case-control study of asthma through an employer-based health insurance provider. Among the asthmatics (n = 195), prevalence ratios (PRs) for EIW were estimated. Final models included children with valid measures of lung function, seroatopy, and waist circumference (n = 140). RESULTS: EIW was associated with urgent medical visits for asthma (PR, 2.29; P = .021), independent of frequent wheeze symptoms. In contrast to frequent wheeze, EIW was not associated with seroatopy or exhaled NO, suggesting a distinct mechanism. EIW prevalence among asthmatics increased with increasing neighborhood asthma prevalence (PR, 1.09; P = .012), after adjustment for race, ethnicity, maternal asthma, environmental tobacco smoke, household income, and neighborhood income. CONCLUSIONS: EIW may contribute to the disparities in urgent medical visits for asthma between high- and low-income neighborhoods. Physicians caring for asthmatics should consider EIW an indicator of risk for urgent medical visits.

Infant rhinitis and watery eyes predict school-age exercise-induced wheeze, emergency department visits and respiratory-related hospitalizations

“…15 Further, we found that EIW was more common among asthmatic children living in neighborhoods with greater asthma ED visits and hospitalizations, suggesting that EIW could offer some explanation for the excesses in these burdens afflicting children living in lower-income neighborhoods. 15,16 …”

“…11–14 Previously, among middle-income asthmatic children living in NYC, we observed an association between EIW and urgent medical visits for asthma. 15 Strikingly, this association was independent of established markers of asthma severity and control, including lower lung function and greater frequency of asthma symptoms, potentially linking an EIW phenotype to acute onset exacerbations that lead to urgent medical visits. 15 Further, we found that EIW was more common among asthmatic children living in neighborhoods with greater asthma ED visits and hospitalizations, suggesting that EIW could offer some explanation for the excesses in these burdens afflicting children living in lower-income neighborhoods.…”

Distinct Serum Sphingolipid Profiles among School-aged Children with Exercise-induced Wheeze and Asthma Persistence

“…Exercise-induced wheezing (EIW) in school-aged children has been identified as an asthma phenotype that includes both atopic and nonatopic asthma (4). Because many school-aged children with asthma will not continue to have asthma symptoms, identifying risk factors that predict persistence of wheezing has been challenging.…”

“…We hypothesized that serum sphingolipids would be altered with asthma symptoms, EIW, and asthma persistence among a case-control study of children with and without asthma, the New York City Neighborhood Asthma and Allergy Study, described previously (4). Briefly, during home visits, spirometry, fractional exhaled nitric oxide testing, and waist circumference measurements were conducted and serum was collected in 7-to 8-year-old children.…”

“…Children were classified as cases on the basis of symptoms or asthma medication use in the past year (4). Children classified as a case at baseline (age 7-8 yr) were considered to have asthma persistence if they again met the case definition at age 10 to 11 years.…”