“TIME TO CLEAR THE AIR SYMPOSIUM” TO ADDRESS INDOOR AIR POLLUTION MAY 3 – 4, 2023. – FREE

WORLD ASTHMA FOUNDATION TO HOST “TIME TO CLEAR THE AIR SYMPOSIUM” TO ADDRESS INDOOR AIR POLLUTION AND ITS IMPACT ON HEALTH

The World Asthma Foundation, a non-profit organization dedicated to improving the lives of people living with asthma, is proud to announce the “Time to Clear the Air Virtual Symposium is underwritten by the foundation to raise awareness about the impact of air pollution on human health.

The symposium, scheduled for May 3-4, 2023, from 9 a.m. to 5 p.m. Eastern Time, will bring together experts from academia, government, and the private sector to discuss strategies for improving air quality and protecting human health. The event is FREE to attend and open to the public. Registration is required.

Air pollution is a major public health threat, responsible for over 6.5 million deaths globally each year, according to the World Health Organization.

The quality of air we breathe has a major impact on respiratory and cardiovascular health, as well as other diseases spread by air. The World Asthma Foundation believes that raising awareness about the impact of air pollution is essential to improving public health and well-being.

The ‘Time to Clear the Air Symposium is an opportunity for experts and individuals alike to come together and discuss strategies for improving air quality,” said Alan Gray, Director of the World Asthma Foundation. “We are thrilled to underwrite this event and look forward to engaging with stakeholders from across the globe.”

The symposium will cover a range of topics related to air pollution, including:

Clean air strategies for homes and offices
The impact of air pollution on vulnerable populations

The latest research on air pollution and health

The role of legislation and innovation in improving air quality

Strategies for mitigating the risk of airborne contaminants, including viruses and bacteria

“The symposium will provide an opportunity to learn about cutting-edge research and strategies for improving air quality,” said Alan Gray, a speaker at the symposium. “We hope that attendees will come away with a deeper understanding of the impact of air pollution on health, and with practical strategies for improving air quality in their own lives and communities.”

The “Time to Clear the Air Symposium” is underwritten by the World Asthma Foundation, a non-profit organization dedicated to improving the lives of people living with asthma worldwide.

For more information about the symposium, including registration details, please visit the World Asthma Foundation’s event at TimeToClearTheAir.com

About the World Asthma Foundation:
The World Asthma Foundation is a non-profit organization dedicated to improving the lives of people living with asthma worldwide. Our mission is to raise awareness about asthma, support research into new treatments and technologies, and provide resources and support for individuals living with asthma and their families.

Bisphenol A or BPA in Pregnancy and Asthma Study

The Barcelona Institute for Global Health supported study concludes suggests that in utero BPA exposure may be associated with higher odds of asthma and wheeze among school-age girls.

Study Background

In utero, (before birth) exposure to bisphenols, widely used in consumer products, may alter lung development and increase the risk of respiratory morbidity in the offspring. However, evidence is scarce and mostly focused on bisphenol A (BPA) only.

Study Objectives

There is growing concern over the role of chemical pollutants on early life origins of respiratory diseases (Gascon et al., 2013, Vrijheid et al., 2016, Casas and Gascon, 2020, Abellan and Casas, 2021), specifically on bisphenols due to their large production worldwide (CHEMTrust, 2018) and its widespread exposure to human populations (Calafat et al., 2008, Haug et al., 2018). Bisphenol A (BPA) is the most commonly used bisphenol. It is present in polycarbonate plastics and epoxy resins, used in many consumer products, and diet is the main source of exposure (Liao and Kannan, 2013). In 2017, the European Chemical Agency considered BPA as a “substance of very high concern” (Calafat et al., 2008, Agency and Bisfenol, 2017). Consequently, BPA production is restricted in some countries, which has resulted in the emergence of substitutes such as bisphenol F (BPF) and bisphenol S (BPS), with suspected similar toxicity (Lehmler et al., 2018, Rochester and Bolden, 2015). Bisphenols can cross the placenta and are also found in breastmilk, which results in exposure to foetuses and newborns (Lee et al., 2018). To examine the associations of in utero exposure to BPA, bisphenol F (BPF), and bisphenol S (BPS) with asthma, wheeze, and lung function in school-age children, and whether these associations differ by sex.

Methods

We included 3,007 mother–child pairs from eight European birth cohorts. Bisphenol concentrations were determined in maternal urine samples collected during pregnancy (1999–2010). Between 7 and 11 years of age, current asthma and wheeze were assessed from questionnaires and lung function by spirometry. Wheezing patterns were constructed from questionnaires from early to mid-childhood. We performed adjusted random-effects meta-analysis on individual participant data.

In utero exposure to bisphenols, widely used in consumer products, may alter lung development and increase the risk of respiratory morbidity in the offspring. However, evidence is scarce and mostly focused on bisphenol A (BPA) only.

Study Objective

To examine the associations of in utero exposure to BPA, bisphenol F (BPF), and bisphenol S (BPS) with asthma, wheeze, and lung function in school-age children, and whether these associations differ by sex.

Results

Exposure to BPA was prevalent with 90% of maternal samples containing concentrations above detection limits. BPF and BPS were found in 27% and 49% of samples. In utero exposure to BPA was associated with higher odds of current asthma (OR = 1.13, 95% CI = 1.01, 1.27) and wheeze (OR = 1.14, 95% CI = 1.01, 1.30) (p-interaction sex = 0.01) among girls, but not with wheezing patterns nor lung function neither in overall nor among boys. We observed inconsistent associations of BPF and BPS with the respiratory outcomes assessed in overall and sex-stratified analyses.

Conclusion

This study suggests that in utero BPA exposure may be associated with higher odds of asthma and wheeze among school-age girl

According the U.S. National Institute of Health, Bisphenol A (BPA) is a chemical produced in large quantities for use primarily in the production of polycarbonate plastics. It is found in various products including shatterproof windows, eyewear, water bottles, and epoxy resins that coat some metal food cans, bottle tops, and water supply pipes.

How does BPA get into the body?

The primary source of exposure to BPA for most people is through the diet. While air, dust, and water are other possible sources of exposure, BPA in food and beverages accounts for the majority of daily human exposure.

Bisphenol A can leach into food from the protective internal epoxy resin coatings of canned foods and from consumer products such as polycarbonate tableware, food storage containers, water bottles, and baby bottles. The degree to which BPA leaches from polycarbonate bottles into liquid may depend more on the temperature of the liquid or bottle, than the age of the container. BPA can also be found in breast milk.

Why are people concerned about BPA?
One reason people may be concerned about BPA is because human exposure to BPA is widespread. The 2003-2004 National Health and Nutrition Examination Survey (NHANES III) conducted by the Centers for Disease Control and Prevention (CDC) found detectable levels of BPA in 93% of 2517 urine samples from people six years and older. The CDC NHANES data are considered representative of exposures in the United States. Another reason for concern, especially for parents, may be because some animal studies report effects in fetuses and newborns exposed to BPA.

If I am concerned, what can I do to prevent exposure to BPA?

Some animal studies suggest that infants and children may be the most vulnerable to the effects of BPA. Parents and caregivers can make the personal choice to reduce exposures of their infants and children to BPA:

  • Don’t microwave polycarbonate plastic food containers. Polycarbonate is strong and durable, but over time it may break down from over use at high temperatures.
    Plastic containers have recycle codes on the bottom. Some, but not all, plastics that are marked with recycle codes 3 or 7 may be made with BPA.
  • Reduce your use of canned foods.
    When possible, opt for glass, porcelain or stainless steel containers, particularly for hot food or liquids.
  • Use baby bottles that are BPA free.

There is growing concern over the role of chemical pollutants on early life origins of respiratory diseases (Gascon et al., 2013, Vrijheid et al., 2016, Casas and Gascon, 2020, Abellan and Casas, 2021), specifically on bisphenols due to their large production worldwide (CHEMTrust, 2018) and its widespread exposure to human populations (Calafat et al., 2008, Haug et al., 2018). Bisphenol A (BPA) is the most commonly used bisphenol. It is present in polycarbonate plastics and epoxy resins, used in many consumer products, and diet is the main source of exposure (Liao and Kannan, 2013). In 2017, the European Chemical Agency considered BPA as a “substance of very high concern” (Calafat et al., 2008, Agency and Bisfenol, 2017). Consequently, BPA production is restricted in some countries, which has resulted in the emergence of substitutes such as bisphenol F (BPF) and bisphenol S (BPS), with suspected similar toxicity (Lehmler et al., 2018, Rochester and Bolden, 2015). Bisphenols can cross the placenta and are also found in breastmilk, which results in exposure to foetuses and newborns (Lee et al., 2018).

Managing Asthma during COVID-19: An Example for Other Chronic Conditions in Children and Adolescents

 

The novel coronavirus COVID-19, caused by the pathogen SARS-CoV-2, has now spread around the globe with over 1.8 million individuals affected and over 110,000 deaths internationally.(1, 2, 3, 4) As of April 12, 2020 there are 530,830 cases in the U.S. with over 20,000 deaths(2,3) The Institute for Health Metrics and Evaluation (IHME) has predicted that this pandemic could exceed current healthcare capacity in the United States (US) with a total of 81,114 deaths (95%UI 38,242 to 162,106) through August 2020.(5)

Asthma is one of the most common chronic diseases of childhood in the United States. Data from the U.S. Department of Health and Human Services notes that asthma prevalence increased between 2001 and 2010 and is now at its highest prevalence ever (overall 8.4% in 2010).(6) In the US, approximately 7 million children have asthma.(6) The morbidity of asthma in the US is high, and is higher in children than adults. Children missed 10.5 million school days due to asthma in 2008; there were 6.7 million primary care visits related to asthma and 600,000 asthma-related ED visits for children in 2007.(7)

Multiple guidelines have emerged from international societies on the management of medical care during COVID-19 which include a section on pediatric asthma, including a North American guideline on contingency planning for allergy and immunology clinics during a pandemic and a Canadian Pediatric Society statement on asthma management during COVID-19.(8,9) Due to the high prevalence of asthma in the United States, which is at the current epicenter of a global pandemic, the goal of this commentary is to provide an overview of what is known, and what is yet to be learned, about COVID-19 and pediatric asthma.
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Differentiating Asthma from COVID-19

Symptoms of COVID-19 can be similar to those of worsening asthma, or an asthma exacerbation. Dry cough and shortness of breath, commonly seen in asthma, are among the most common presenting symptoms of COVID-19 in case series of children admitted to the hospital in China, as well as in available CDC data in the U.S.(10, 11, 12)

Fever, a common presenting symptom of COVID-19, may help differentiate COVID-19 from an asthma exacerbation, although fever can be present in other virus-triggered asthma exacerbations as well.(3,10, 11, 12) Other less common symptoms of COVID-19, better described in the adult population, may help differentiate COVID-19 from asthma and include myalgia, confusion headache, pharyngitis, rhinorrhea, loss of sense of smell and taste, diarrhea, nausea and vomiting.(12) A travel history, close contact with someone infected with COVID-19, and absence of a prior atopic history in a child also help to differentiate the two.

Since there is substantial overlap between the clinical presentation of worsening asthma and COVID-19 and increasing community spread lessens likelihood of known contact with a case, screening for COVID-19 is required if available in any asthmatic child who comes to medical attention with worsening cough or shortness of breath.(8,13)

The Role of Asthma in COVID-19 Morbidity and Mortality

There is a theoretical risk that infection with COVID-19 in an asthmatic child may increase the risk of pneumonia or acute respiratory disease. (14) As a result, the CDC lists moderate to severe asthma as a risk factor for COVID-19 morbidity and mortality.(14) However, to date the literature is ambiguous on whether pre-existing asthma increases the risk of either COVID-19 infection, or morbidity/mortality due to COVID-19, in children.

The evidence on COVID-19 risk factors derives largely from the adult population. Four case series, all from Wuhan, China, of adults admitted to hospital with COVID-19 did not list asthma as an underlying pre-existing condition in any of those patients.(12,15, 16, 17) In a large case series of 1099 adult patients from 552 hospitals in 30 provinces in China, asthma was not listed as a pre-existing condition in any of the patients described.(18) In contrast, recent data released from the CDC of U.S. hospitalizations in March,2020 notes that 27.3% of adults 18-49 years of age who were hospitalized with COVID-19 had a history of asthma.(3) In adults aged 50-64 years of age hospitalized for COVID-19 asthma was present in 13.2% and in those 65 years or older asthma was present in 12.9%.(3,19) As a result, the American Academy of Allergy, Asthma & Immunology (AAAAI) notes that ‘those with asthma in the 18-49 year old age range may be at increased risk of hospitalization due to COVID-19.’(19)

Although there is a paucity of literature on pediatric risk factors, the case series to date from Wuhan on hospitalized pediatric cases don’t list asthma as a pre-existing risk factor for morbidity or mortality.(10,11) It is further reassuring that children appear to be at lower risk of COVID-19 morbidity and mortality than the adult population in general, although severe infection still can occur.(13,20) The CDC morbidity and mortality report notes that among the 149,082 reported U.S. cases of COVID-19 for which age is known, only 2572 (1.7%) occurred in children 18 years and younger.(3) Although among the patients with information on underlying conditions, 23% had at least one underlying condition such as asthma, only 5.7% of children infected with COVID-19 required hospitalization (compared with 10% of adults aged 18-64 years) and only 3 deaths were reported in children (<1% of pediatric cases). In a case series from China of 72,000 cases, approximately 1% were children aged 0 to 18 years of age with only 1 death reported in the adolescent population (and none in children under the age of 10 years).(13,21)

Another risk in children with asthma is that infection with COVID-19 could trigger a viral-induced asthma exacerbation. There is minimal literature on this risk from COVID-19, but there are data on the risk of asthma exacerbations triggered from other coronavirus infections, with mixed findings. Severe acute respiratory syndrome (SARS), due to human coronaviruses HCoV-229E and HCoV-OC43, did not cause an increase in asthma exacerbations in children during the 2002 epidemic, nor induce bronchial hyperreactivity or eosinophilic inflammation.(22) In fact, paradoxically, asthma exacerbations actually decreased during that time, which was attributed to improvements in hygiene measures related to the epidemic.(22) However, in contrast, non-epidemic coronaviruses are found commonly in the respiratory tracts of children with an asthma exacerbation and have contributed to bronchial hyper-reactivity and eosinophilic inflammation.(23, 24, 25, 26)

In summary, based on available information to date, it is unclear whether there is a significantly increased risk of COVID-19 morbidity among asthmatic children.(8,9) It is also unknown whether asthma medications such as high-dose inhaled corticosteroids or asthma biological therapies pose a risk in managing COVID-19 infections. Before any definitive conclusions can be drawn, larger scale data are required from pediatric populations, and from heterogeneous locations that have been impacted by COVID-19. It also remains unclear if COVID-19 increases the risk of asthma exacerbations. As a result, good asthma control is essential as a precautionary measure during this time.(8,9,13,20)
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Treatment of Asthma During COVID-19

In addition to the current burden of COVID-19, the spring season is often a time for asthma exacerbations due to emergence of seasonal aeroallergens, and other respiratory viruses.(27) The best way to prevent an exacerbation is consistent proper use of medicines to control asthma, such as inhaled corticosteroids and/or montelukast. As a result, children should remain on their current asthma medications during COVID-19.(8,9) This recommendation is supported by multiple international organizations, including the Centers for Disease Control, the Global Initiative for Asthma, and the North American consensus guideline on allergy care during COVID.(8,9,28,29) It is recommended that children not ‘step down’ any controller medication during this time unless ‘this is clearly favorable from an individual standpoint, with careful consideration of the balance between benefit and harm/burden.’(8) Other recommendations to maintain asthma control include avoiding known asthma triggers such as aeroallergens, frequent handwashing, physical distancing, and regular review of inhaler technique.(9,29) An exacerbation, if it occurred, ‘could require [children] to enter the healthcare system, which would put them at increased risk of being exposed to SARS-CoV-2 during the current pandemic.’(8)

Some biologic agents, such as omalizumab (anti-IgE) and mepolizumab (anti-IL5), are approved for use in moderate to severe asthma in adolescents(30) The current recommendation for adolescents who are using these medications is to continue their use.(8) There is no current evidence that use of these medications increases the risk of COVID-19 infection or morbidity.

If a child is using a nebulized asthma relief medication, this should be switched to a metered-dose inhaler (MDI) or dry powder inhaler (turbuhaler or diskus) under most circumstances.(8,9) Nebulization increases the risk of viral lower lung deposition.(8,9,31) It also increases the risk of infection transmission due to both stimulating a cough reflex, as well as generating ‘a high volume of respiratory aerosols that may be propelled over a longer distance than is involved in a natural dispersion pattern.’(31) It was poignantly noted in a recent editorial that ‘there is a possibility that nebulizer therapy in patients with COVID-19 infection can transmit potentially viable coronavirus to susceptible bystander hosts.’(31) The only possible reasons for a child to use a nebulizer at home during the COVID-19 pandemic are a poor response to a MDI/spacer, a child who is either uncooperative or unable to follow the directions required for MDI use, or medication shortages (which are discussed in more detail below).(8,9,31)
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Treatment of Asthma Exacerbations during COVID-19

The CDC and World Health Organization (WHO) have recommended against oral corticosteroid (OCS) use as a treatment for COVID-19.(32,33) This recommendation is based on experience with influenza, SARS-CoV, and Middle East Respiratory Syndrome Coronavirus (MERS-CoV), where OCS use prolonged viral replication and was associated with prolonged viral clearance, increased complication rates, increased risk of mechanical ventilation and higher mortality rates.(34, 35, 36, 37) It has been noted that OCS therapy increases the risk of nosocomial infection and secondary infection.(38) However, there is a distinction between OCS use as a therapy for COVID-19, and OCS use as a treatment of asthma exacerbations.(8) There is broad consensus that asthma exacerbations should be treated aggressively and in keeping with current guideline recommendations.(9) Multiple national and international organizations such as the Global Initiative for Asthma recommend OCS use as required, and in keeping with the child’s asthma action plan, during COVID-19.(8,9,28)

The use of nebulized medications are especially discouraged in a healthcare setting, where infection transmission to other vulnerable patients is a risk.(9,31) If used, proper personal protective equipment (PPE) is required. It must also be considered that nebulized viral droplets can persist in the air for hours.(39)

For any child with asthma who is having progressive or worsening symptoms, COVID-19 screening protocols must be used to help determine their level of risk as well as the need for COVID-19 testing at an appropriate facility.(8)

For children hospitalized with an asthma exacerbation either documented or suspected to be associated with COVID-19 that is progressing, it might be decided to use one of the agents currently being considered in adults, for example, hydroxychloroquine.(40,41) or to seek compassionate release of remdesivir. There is no current data on the safety and efficacy of these agents in children and thus should be discussed in the setting of the hospital policy.(42,43) Although dosage of these medications in adolescents may be similar to adults, the appropriate adjustment for children under 12 years remains to be defined.
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Ongoing Challenges during COVID-19

Medication shortages. There is a growing medication shortage across North America, including asthma medications such as albuterol.(39) In many cases, such as with albuterol, these medications increasingly are being used in confirmed or suspected COVID-19 patients to help with respiratory issues. To help combat the shortage of albuterol specifically, the US Food and Drug Administration (FDA) approved the first generic albuterol inhaler on April 8,2020.(44) If faced with albuterol shortage, other available options include substituting other short acting beta-agonists, using an expired albuterol inhaler, and ensuring good asthma control which reduces the need for reliever medications in general.(9,39) Many of the substitute short acting beta-agonists are dry powder inhalers (diskus or turbuhaler) and as such children often need to be at least 6 years of age to produce enough inspiratory force to use these devices properly.(9,45) For adolescents 12 years and older, another option is ICS-formoterol for both maintenance and relief therapy as supported by the Global Initiative for Asthma 2019 update.(46,47) Nebulized albuterol should only be considered as a last resort, and proper infection prevention protocols need to be followed.(8,9,31) If no other medications are available, epinephrine inhalers might be considered as well, if used prudently.

Virtual visits. With the need for significant healthcare resource reallocation, as well as shortages of PPE, much of the allergy/immunology specialty has converted to largely virtual visits, or visit deferral, during COVID-19.(8) Due to the need for almost exclusively virtual visits at this time, having a peak flow meter in homes may be helpful to diagnose an acute exacerbation at home, by comparing baseline measurements with those during highly symptomatic times. There are several advantages to virtual visits, including access to specialists, removing the transportation barrier required for an in-person visit, allowing those too sick to travel to connect with a healthcare provider, and most importantly in the current context, prevention of infection transmission with in-person visits.(48)

Virtual visits should be prioritized for children who have poorly controlled asthma, have worsening asthma symptoms, or who have required dose escalations of their asthma medications in the past several months’ time.(8) It is recommended that follow-up visits for children with mild-to-moderate or well-controlled asthma be postponed during COVID-19, or converted to virtual visits if time permits.(8) It also is recommended that children of any asthma severity who have been well controlled for the past 6-12 months (no ER visits, <1 OCS dose, <2 exacerbations in the past 6-12 months) have visits deferred or converted to virtual visits (time permitting).(8) For children with moderate to severe asthma exacerbations, an in-person visit likely is necessary but as noted in the joint North American guideline on COVID-19 and allergy contingency planning, ‘If the allergy/ immunology office does not have PPE available, it would be recommended that no patients with a co-potential for an asthma exacerbation and COVID-19 be seen at that office; the patient should instead be seen at another facility capable of COVID-19 isolation which is staffed and equipped to assess and manage asthma.’(8) Recommendations may be adjusted over time, based on the duration of COVID-19 and the time required for physical distancing.

Asthma Clinical Trials. It is currently recommended that entry into any asthma clinical trial be suspended during COVID-19.(8) For asthmatic children already participating in clinical trials, consideration could be given to virtual visits if possible.(8) Procedures that require forced expiratory maneuvers such as spirometry, methacholine challenge or induced sputum samples should be postponed in order to minimize staff risk and potential room contamination. Medication withdrawal as part of research protocols also should be deferred to a later time. Consideration should be given to telephone or telemedicine visits in order to limit exposure to a medical setting.

Impact of Social Determinants of Health on Asthma and COVID-19. There are many social determinants of health that have an impact on pediatric asthma morbidity including caregiver income, physical environment including exposure to second-hand smoke, access to health services, and race/ethnicity.(49, 50, 51) There is likely an interplay between some of these social determinants of health and the impact of COVID-19 on children with asthma. It has been suggested that exposure to second-hand smoke increases COVID-19 morbidity.(52,53) Of those hospitalized in the US for COVID-19, data from the CDC indicates that 33.1% were non-Hispanic black, while they only make up 18% of the catchment area population.(3) A recent editorial notes that low-income families are at higher risk of COVID-19 as low income jobs mostly can’t be performed remotely, often don’t pay sick days, are often not associated with insurance benefits and as a result it may not be possible for these families to afford the steps necessary for physical distancing.(54)

Although the relationships between these variables needs to be further elucidated, it is possible that measures that impact social determinants of health, such as reducing exposure to second-hand smoke or improving healthcare access in low income neighborhoods, may improve prognosis in children with asthma who contract COVID-19. In addition, these families could benefit from counseling on having the appropriate amount of medications available for home during this period of restricted travel. In addition, they should check medications to be sure that none is expired.

Impact of COVID Restrictions. It is possible that children may not be severely affected by SARS-CoV-2 for some undefined reason to date, but they can still be carriers and could transmit virus to vulnerable people, including elderly relatives. Therefore, social distancing has included children, which has necessitated discontinuing school. It remains to be determined what impact this step has on children including those children with asthma. Often parents will discontinue medications in children during the summer months because they are doing well and they are out of school.(55) However, this year is different, because school was discontinued during the spring season, a time of seasonal allergen exacerbation and viral infection. School adds a certain structure to the day and there is some level of administration of asthma medication administration around the school day. Clinicians and parents should observe for potential breakdowns in adherence to controlling medications, especially in families in chaotic circumstances. The impact on education of home schooling, especially in families that lack an organizational structure remains to be seen. Finally, it has been suggested that school closure will increase the risk of childhood obesity, a known risk factor for worsening asthma.(56) Whether this occurs, and how this influences asthma control, also is yet unknown.

Conclusion

In the face of unchartered territory and unprecedented times, there remains much to be learned about the impact of pediatric asthma on the course of SARS-CoV-2 virus infection. Although adult data suggest that asthma is a risk factor for COVID-19 morbidity and mortality such a risk in children is unclear. Differentiating COVID-19 from worsening asthma, or an asthma exacerbation, is challenging. As a result, pediatricians and families have an essential role in ensuring that children with asthma maintain good asthma control during this time. Children and adolescents with asthma should remain on their current asthma medications and practice physical distancing, regular handwashing, and aeroallergen avoidance. Treatment of asthma exacerbations should include oral corticosteroids if required. Nebulized medications are not recommended at this time due to increased risk of viral transmission. Healthcare providers should remain alert for changing policies and recommendations knowledge advances.

WAF would like to thank the following for granting permission

Elsevier

Elissa M. Abrams, MD, MPH?
Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba
Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia
Stanley J. Szefler, MD
The Breathing Institute, Children’s Hospital Colorado and Section of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO

Toxicants and Asthma – Recognizing Health Advocates and Champions for Asthmatics Everywhere

Toxicants and Asthma – Recognizing Health Advocates and Champions for Asthmatics Everywhere

“Polycyclic aromatic hydrocarbons, or PAHs — Exposure can come from breathing car exhaust, fossil fuel combustion, cigarette smoke, and wood smoke, among other routes. The toxicants were linked to problems such as reduced birth weight, asthma, and lower IQ.” Frederica Perera, Ph.D., Renowned environmental health scientist.

On behalf of the Asthma community around the globe, the World Asthma Foundation (WAF) salutes Frederica Perera as she is being honored for pioneering research, community engagement.

The NIEHS Spirit Lecture Awardee collaborates with disadvantaged groups to study how chemicals affect children and other vulnerable people.

Renowned environmental health scientist Frederica Perera, Ph.D., delivered the 2020 NIEHS Spirit Lecture on Mar. 5. Her talk was titled “Translational Research to Prevent Environmental Threats to Children: From Chemicals to Climate Change.”

Frederica Perera, Ph.D. stands at podium “NIEHS has been the main, visionary funder of our work on children’s environmental health. It’s so important to our field to have this enlightened support,” said Perera. (Photo courtesy of Steve McCaw)

Perera is a Columbia University professor and the founding director of the school’s Center for Children’s Environmental Health, which is co-funded by NIEHS. Her work focuses on pregnant women, children, and minority groups, who can be especially vulnerable to pollution.

“She is internationally recognized as a pioneer in the field of molecular epidemiology as it relates to better understanding how problems in the environment can lead to adverse health effects and disease,” said NIEHS Acting Director Rick Woychik, Ph.D.
Early-life vulnerability

In the late 1970s, after learning about an environmental disaster in Minamata Bay, Japan, Perera became inspired to pursue a scientific career in environmental health.
Rick Woychik, Ph.D. smiles at the audience from the podium “Dr. Perera has been a prolific author, with over 330 publications,” noted Woychik. (Photo courtesy of Steve McCaw)

“Women there had been eating fish that were very polluted by mercury from industrial sources,” she told the audience. “The women were fine, but their children had serious cerebral palsy-like symptoms and intellectual disorders.”

“There are 82 billion neurons in the average brain, but almost all were formed before we were born,” she said. “You can imagine how highly choreographed and complex this development is over a short time window, and how readily any external exposure — whether a physical toxicant or psychosocial stressor — could disrupt these processes.”
Frederica Perera, Ph.D. speaks to a large audience A packed audience listened closely to Perera’s lecture. (Photo courtesy of Steve McCaw)
Health effects over time

At Columbia, Perera and her colleagues seek to understand how early-life chemical exposures affect children’s health and brain development, and they look for potential long-term problems. The scientists follow cohorts of mother-child pairs in New York City (NYC), Poland, and China, tracking health effects of various substances over time.

In NYC, participants come from low-income African-American and Dominican households. Some findings from that cohort include the following.

Chlorpyrifos — Prenatal exposure to this insecticide was associated with lower birth weight, memory problems, and Parkinson’s Disease-like changes.
Phthalates — Found in cosmetics and plastic packaging, these chemicals were linked to reduced IQ in children who had been exposed to high concentrations prenatally.
Polybrominated diphenyl ethers, or PBDEs — These flame retardants were linked to reduced IQ in children who had high concentrations at birth.
Polycyclic aromatic hydrocarbons, or PAHs — Exposure can come from breathing car exhaust, fossil fuel combustion, cigarette smoke, and wood smoke, among other routes. The toxicants were linked to problems such as reduced birth weight, asthma, and lower IQ.

Many factors at play

According to Perera, understanding the effects of such exposures often is complicated by other factors, including genetics, nutrition, socioeconomic status, and climate change. She said that despite that complexity, studying individual chemicals still is beneficial.

“Most diseases require a set of sufficient causes,” Perera explained. “If we can take one of those causes out, it would be possible to prevent a child from developing a disease. Environmental exposures, by their very nature, are preventable once we identify them as harmful.”

Perera said that lowering the risks of environmental exposures will require a mix of regulatory policies, market reforms, and better data on the health and economic benefits of pollution mitigation.
Special award

“It’s a real honor for me to have the privilege to introduce Dr. Perera as this year’s recipient of the NIEHS Spirit Lecture Award,” said Woychik.

Angela King-Herbert, D.V.M. stands by Frederica Perera, Ph.D. holding an award Angela King-Herbert, D.V.M., Spirit Lecture Committee member and head of the National Toxicology Program Laboratory Animal Medicine Group, presented the award to Perera. (Photo courtesy of Steve McCaw)

The award recognizes outstanding women who balance their careers with public engagement, volunteering, and mentorship.

“She works with many different community groups to address the safety and health of children,” he said. “Dr. Perera is a fabulous communicator and is doing cutting-edge, exciting research.”

(Payel Sil, Ph.D., is an Intramural Research Training Award fellow in the NIEHS Inflammation and Autoimmunity Group.)

World Asthma Foundation: Seeking Solutions

Chances Are You know Someone with Asthma

Tinka Davi, executive director

It’s a condition that varies from person to person and it’s a serious health problem. People who have the disease and their families want information on care and treatment, triggers and medications.

That’s why the World Asthma Foundation was launched.

Our purpose is to compile information about asthma, to educate and inform patients and the public and to help asthma sufferers live with the disease. We also aim to advocate for better treatment options from the medical field and to campaign for and support research.

We believe we need to seek viable solutions to the problem. Why? Why should the focus be on this disease? Why should people care?

Asthma affects millions. In the U.S. alone nearly 40 million people have been diagnosed with asthma, according to National Institute of Environmental Health Sciences. The World Health Organization (WHO) states that some 235 million people suffer from asthma world-wide.

Asthma was once considered a minor ailment, but the prevalence of the disease has progressively increased in the U.S. over the past 15 years and affects 13.3 percent of adults and 13.8 percent of children. (Centers for Disease Control and Prevention)

The mortality rate for asthma also has increased. Each day 11 Americans die from asthma and each year there are more than 4,000 deaths due to asthma. Asthma is also a contributing factor for nearly 7,000 other deaths annually.

Asthma is one of the major non-communicable diseases, a chronic disease of the air passages of the lungs which inflames and narrows them.

Asthma may start out as mild and controllable with medications, but often it becomes progressively worse, developing into severe asthma. And those with severe asthma often have just 35 percent of lung function. They can’t breathe, they wheeze and cough, they can’t go outside, they can’t tolerate the aromas of common cleansers, medications frequently cause serious side effects and many asthmatics wind up in hospital emergency rooms.

Asthma is under-diagnosed and under-treated, according to WHO. It also creates a substantial burden to individuals and families and often restricts individuals’ activities for a lifetime.

Medical professionals don’t know what causes asthma and they don’t know how to cure it.

We need solutions. Whether it’s from better medication, increased research, even legislation and monetary support for asthma sufferers, we need to focus on this prime medical problem.

We plan to keep patients, their families and the public informed through our website, www.WorldAsthmaFoundation.org. We at the WAF want patients with the disease to breathe well and live well.

Tinka Davi, executive director

Asthma defined
Asthma is a major non-communicable disease characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person.

Symptoms may occur several times a day or week and may become worse during physical activity or at night. During an asthma attack, the lining of the bronchial tubes swell, which causes the airways to narrow and reduce the flow of air into and out of the lungs. Recurrent asthma symptoms can cause sleeplessness, daytime fatigue, reduced activity levels and absenteeism from school and work.

Since 1980 asthma death rates overall have increased more than 50 percent among all genders, age groups and ethnic groups and the death rate for children under 19 years old has increased by nearly 80 percent. More females die of asthma than males, and women account for nearly 65 percent of asthma deaths overall.