British Society for Allergy and Immunology Abstracts From the 2024 Annual Conference
Asthma In Children And Pollution: NO2 Exposure May Affect Treatment Response
Some asthma therapy appeared to be less effective in Black children living in areas with high levels of nitrogen dioxide (NO2), according to study findings published in the Journal of Allergy and Clinical Immunology.
Researchers assessed the effect of air pollutants on asthma treatments, using data from the randomized Best African American Response to Asthma Drugs (BARD) trial (ClinicalTrials.Gov Identifier: NCT01967173). The trial enrolled 280 children aged 5 to 11 years with inadequately controlled asthma using low-dosage corticosteroids, with children assigned to a random sequence of commonly prescribed treatments of baseline low inhaled corticosteroids (ICS) dose, double ICS with long-acting beta-agonists (2×ICS+LABA), quintuple ICS (5×ICS), and quintuple ICS with LABA (5×ICS+LABA) for 14 weeks per treatment regimen.
The current ancillary analysis included 224 children (80% of total sample size) with self-reported Black ancestry. Outcomes included annualized asthma control days, lung function per percent predicted forced expiratory volume in 1 second (ppFEV1), and asthma exacerbations. Air pollutant exposures were estimated for particulate matter less than or equal to 2.5 micrometers (PM2.5), NO2, and ozone (O3).
A majority of participants were male (59%), non-Hispanic/Latino (91%), and lived in census blocks with median incomes greater than the federal poverty rate. Participants' mean (SD) age was 8.47 (1.82) years.
"
These outcomes not only reinforce the existing evidence concerning the detrimental effects of ambient air pollution on pediatric asthma but also highlight its potential to diminish the therapeutic benefits of pharmaceutical interventions.
PM2.5, NO2, and O3 did not significantly modify the effect of any treatment on the number of exacerbation events in generalized linear mixed model analyses. However, children with high residential exposure to NO2 saw an increase in the predicted number of exacerbations after the addition of LABA (2×ICS+LABA) compared with children in low NO2 areas (0.65; 95% CI, 0.30-1.43, vs 0.34; 95% CI, 0.09-1.25), although the increase in exacerbations was not statistically significant.
PM2.5 moderately changed the treatment effect on annualized asthma control days. Treatment with 5×ICS+LABA significantly reduced the number of control days but only for individuals who had below-median PM2.5 exposures (-14.97 days; 95% CI, -52.11 to 22.16). For children with above-median PM2.5 exposures, the greater ICS dose with LABA led to more control days (43.44 days; 95% CI, 1.26-85.63). Interactions between the treatment effect and NO2 and ozone were not statistically significant (P for interaction =.59 and .76, respectively).
A statistically significant interaction effect occurred between treatment and NO2 (P for interaction =.05), and treatment with 5×ICS+LABA significantly increased the ppFEV1 in children from low NO2 exposure areas (5.86; 95% CI, 1.16-10.56) compared with those from high NO2 exposure areas (0.57; 95% CI, –4.66 to 5.8). Models assessing the relationship between treatment and PM2.5 and O3 did not achieve statistical significance (P for interaction =.12, and .13, respectively).
Among several limitations, 20% of the trial population was not included in the analyses, and predicted lung function calculations did not include race corrections that reflect current guidelines. Also, data were unavailable on environmental triggers within the school environment.
"These outcomes not only reinforce the existing evidence concerning the detrimental effects of ambient air pollution on pediatric asthma but also highlight its potential to diminish the therapeutic benefits of pharmaceutical interventions," the investigators stated.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors' disclosures.
Asthma News
Dec. 19, 2024 — A team has discovered a new communication pathway between the gut and lung. Their findings highlight how a little-known member of the gut microbiome reshapes the lung immune environment to have both ...
Dec. 9, 2024 — A research team has uncovered a molecular strategy employed by worm parasites (helminths) to evade host immune defenses. This discovery opens new avenues for the development of innovative vaccines ...
Nov. 27, 2024 — A recent trial finds an injection given during some asthma and COPD attacks is more effective than the current treatment of steroid tablets, reducing the need for further treatment by ...
Nov. 19, 2024 — A new study sheds light on a potential link between exposure to certain everyday chemicals during pregnancy and the development of asthma in children. The study analyzed data from over 3,500 ...
Nov. 11, 2024 — Asthma is associated with memory difficulties in children, and early onset of asthma may exacerbate memory deficits, according to a new ...
Nov. 1, 2024 — Windblown dust from the shrinking Salton Sea harms the respiratory health of children living nearby, triggering asthma, coughing, wheezing and disrupted sleep, USC research shows. The problem is ...
Oct. 30, 2024 — Researchers have discovered a way that ovarian cancer tumors manipulate their environment to resist immunotherapy and identified a drug target that could overcome that resistance. The study used a ...
Oct. 28, 2024 — An abnormal BMI in children -- be it high or low -- can now be associated with impaired lung function, but if their BMI is normalized before they reach adulthood, the impairment can be offset, ...
Oct. 25, 2024 — Drawing on evidence involving about 25 million population worldwide, an international research team demonstrates that long-term exposure to ambient PM2.5 significantly increases the risk of asthma, ...
Oct. 24, 2024 — A new medically challenging case warns that, for those with allergies and asthma, health problems from burning incense can be a significant risk to adults and ...
Oct. 10, 2024 — The risk of asthma in the child can be reduced by nearly half if the mother engages in active physical exercise at least three times a week during pregnancy, compared to a child of a mother who is ...
Oct. 9, 2024 — Genome-wide association studies have great potential for advancing our understanding of the genetic background of diseases, but so far, few association studies have focused on maternal and newborn ...
Sep. 26, 2024 — What factors lead to chronic respiratory disease? Researchers investigated this question using health data from about 780 infants. Their analysis shows that children's risk of developing asthma ...
Sep. 19, 2024 — Human breast milk regulates a baby's mix of microbes, or microbiome, during the infant's first year of life. This in turn lowers the child's risk of developing asthma, a new study ...
Sep. 10, 2024 — Women who are being treated for asthma are more likely to miscarry and need fertility treatment to get pregnant, according to a large study. However, the study also suggests that most women with ...
Sep. 10, 2024 — A scientific team has created a preclinical blood test to identify adults most likely to develop severe respiratory conditions, including chronic obstructive pulmonary disease (COPD). The blood test ...
Sep. 5, 2024 — A cancer study found that certain gut bacteria may influence whether or not a patient's immune system is successful in fighting mesothelioma, an aggressive form of ...
Aug. 29, 2024 — Researchers have developed a prototype for a smart mask that can be used to monitor a range of medical conditions, including respiratory ailments, such as asthma, COPD (chronic obstructive pulmonary ...
Aug. 22, 2024 — Managing hard-to-treat respiratory illnesses like asthma and pulmonary fibrosis just got easier if a new drug-carrying molecule is as sneaky as its inventors ...
Aug. 14, 2024 — Being born in autumn or winter is associated with asthma and allergic rhinitis in Finland, a new registry-based study ...
VIDEO: World Lung Health Award Celebrates Refiloe Masekela, Impactful Career
Choose a Section
Video CornerJune 12, 2025
9 min watch
Add topic to email alerts
Receive an email when new articles are posted on
Please provide your email address to receive an email when new articles are posted on . Subscribe We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.Com.Back to Healio
Key takeaways:SAN FRANCISCO — "It's been a fantastic ride. I've enjoyed every moment of it," Refiloe Masekela, MD, PhD, chair of the Pan African Thoracic Society, told Healio at the American Thoracic Society International Conference.
Masekela was on hand to receive ATS's World Lung Health Award in recognition of her lengthy career, which includes founding the African Chronic Respiratory Disease Observatory CHEST AFRICA.
Also, Masekela is co-chair of the Global Asthma Network and a National Institute for Health and Care Research Global Health Research Professor, with a focus on pediatric asthma clinical trials.
"In South Africa, where I come from, asthma is actually very common," she said. "One in five adolescents in South Africa actually has it."
Masekela began her career in a small, rural hospital where she was a medical doctor in the asthma clinic and frequently encountered patients with wheeze. Her mentors told her that if patients were wheezing, then they were not well and their asthma was uncontrolled.
"That's where it all started. I was really worried," she said. "Why is this disease, which is so common, not well managed?"
At first, Masekela attributed disease severity to a lack of medication adherence. But as she got older, she said, she understood the barriers in treatment such as the stigma associated with inhalers for many adolescents as well as access to care itself.
"There's challenges in accessing medicines, coming to clinics, standing in long queues to get your chronic medication and also challenges in people actually getting the asthma label," she said.
Most patients that Masekela sees have been referred to her, especially young children, by clinicians who do not feel confident in diagnosing them with asthma.
And like the United States, distance to clinics is an obstacle in South Africa too.
"Where I'm working at the moment, in KwaZulu-Natal, it's a big province," Masekela said. "We see patients come from up to 600 km away."
Fortunately, she said, the government provides inhalers for those who cannot afford them, but they need an asthma diagnosis first.
Masekela said she and her colleagues strive to provide good notes so patients can connect with services closer to home, with regional hospitals engaged to ensure continuity of care.
"That's very important. We work in a world where everything is still paper based," she said. "We don't have good electronic record keeping systems, so it's really important that you do provide that patient with that letter so that they can continue to access care."
Access to biologics and other therapies for severe asthma is limited to those with private health insurance in South Africa as well, Masekela added, as she estimated that fewer than 1% of patients can access them through state care.
Despite these obstacles, Masekela said she remains engaged in her work, which also includes roles as academic head of the department of Pediatrics and Child Health at the University of KwaZulu-Natal and global health professor studying interventions among children with asthma at the Africa Health Research Institute, where she is a faculty member.
"A journey, of course, has its ups and downs," she said. "But for me, it's been a great ride because I've managed to merge my two passions in both being both a clinician and a researcher."
Masekela also calls her work leading the Pan African Thoracic Society, which comprises 52 countries, a privilege. As chair of the organization, she was a member of the panel at the ATS conference's International Women in Pulmonary Leadership Brainstorming and Planning Session.
The session was hosted by ATS fellow Kaharu Sumino, MD, MPH, ATSF, and ATS international health committee chair Samya Nasr, MD, ATSF.
The panel also included Lynn M. Schnapp, MD, ATSF, former ATS president; Judith Garcia-Aymerich, MD, PhD, secretary-general of the European Respiratory Society; Juliana C. Ferreira, MD, PhD, ATSF, member of the Brazilian Thoracic Society; and Fanny Ko, MD, past president of the Hong Kong Thoracic Society.
The discussion provided an opportunity for these leaders to connect with each other and with members of the audience while coming up with ideas for the International Women in Pulmonary CCM workshop.
"It's actually a privilege and to really try to find ways to support other women, especially in Africa, where there's a real dire need," Masekela said. "I'm really, really happy to be part of the process."
Members of the panel also described the influential roles that mentors played in their careers. Masekela noted the influence that Sonia Buist, MD, ATSF, had on her development. Buist additionally had attended the session.
"Whenever I've had some challenges, or I felt locked in my career, she's always there to bounce off ideas," Masekela said.
Masekela also called Andrew Bush, MBBS (Hons), a great person whose experience and expertise she values, and she said the late Robin J. Green, PhD, FCCP, was influential too.
"He was a great mentor and a person who really got me involved in the asthma world," she said.
Looking ahead, Masekela said she will continue to develop research with the Global Asthma Network. For example, she is involved in a clinical trial comparing the efficacy and health economics of tracks one and two of the Global Initiative for Asthma guidelines in younger children.
"If we see that the strategy works in young children, we can then recommend this to policymakers to be adopted as a treatment strategy," she said.
Masekela also said she will be involved in advocacy, prioritizing access to inhaled medicine since people around the world are unable to afford basic treatment.
"Really working on policy impact is what I'm really passionate about," she said, "so that we can really change lives of people, not only in my context, but globally."
Reference:For more information: Sources/DisclosuresCollapse Disclosures: Refiloe Masekela, MD, PhD, can be reached at masekelar@ukzn.Ac.Za.Masekela reports no relevant financial disclosures.Add topic to email alerts
Receive an email when new articles are posted on
Please provide your email address to receive an email when new articles are posted on . Subscribe We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.Com.Back to Healio
Comments
Post a Comment