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. 2013 Jan;131(1):e127-35.
doi: 10.1542/peds.2012-1072. Epub 2012 Dec 17.

Exercise-induced wheeze, urgent medical visits, and neighborhood asthma prevalence

Timothy R Mainardi  1 , Robert B Mellins, Rachel L Miller, Luis M Acosta, Alexandra Cornell, Lori Hoepner, James W Quinn, Beizhan Yan, Steven N Chillrud, Omar E Olmedo, Frederica P Perera, Inge F Goldstein, Andrew G Rundle, Judith S Jacobson, Matthew S Perzanowski
Affiliations

Exercise-induced wheeze, urgent medical visits, and neighborhood asthma prevalence

Timothy R Mainardi et al. Pediatrics. 2013 Jan.

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.

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Figures

FIGURE 1
FIGURE 1
Map of New York City depicting study subjects’ places of residence overlaying neighborhood asthma prevalence. Neighborhood asthma prevalence was defined for 5-year-old school children as reported by the New York City Department of Health and Mental Hygiene. Participants were recruited from neighborhoods with lower (3%–9%) or higher (11%–18%) neighborhood asthma prevalence.
FIGURE 2
FIGURE 2
Venn diagrams depicting overlap in frequent wheeze, EIW, and urgent medical visits for asthma. There were 89/195 asthmatics who had no report of EIW, frequent wheeze, or urgent medical visits and thus not depicted in this figure.
FIGURE 3
FIGURE 3
Logistic regression lines for univariate analyses are depicted in black with 95% confidence intervals in gray. P values are for the univariate logistic regressions. A, EIW with FEV1/FVC (P < .001); B, frequent wheeze with FEV1/FVC (P = .018); C, EIW with FeNO (P = .21); D, frequent wheeze with FeNO (P < .001); E, EIW with total IgE (P = .22); F, frequent wheeze with total IgE (P = .001). Probability of EIW (A, C, D) and frequent wheeze (B, E, F) with FEV1/FVC (A and B), FeNO (C and D), and total IgE (E and F).
FIGURE 4
FIGURE 4
Logistic regression lines for the univariate analyses in black with 95% confidence in gray. P values are for the univariate logistic regression. A, EIW (P = .011); B, frequent wheeze (P = .054); C, urgent medical visit (P = .098).
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