Home Conditions and Outdoor Air Pollution May Together Influence Children’s Asthma Risk, ECHO Study Finds

Authors: Akihiro Shiroshita, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Childhood asthma may be influenced by multiple indoor and outdoor environmental exposures. Prior research has examined indoor and outdoor exposures separately and frequently lacked the power to fully evaluate their cumulative or interacting effects on childhood asthma. The ECHO Cohort allowed researchers to bring together data from many sites across the country, providing a clearer picture of how different environmental factors may influence childhood asthma.

What were the study results?

The study found that several environmental exposures during early childhood were linked to asthma risk. First, exposure to ambient fine particulate air pollution (PM_2.5) was associated with an increased risk of developing asthma. In addition, water damage or dampness in the home was also linked to a higher asthma risk, even after accounting for PM_2.5exposure, indicating an independent effect. In contrast, having a dog in the home during infancy was associated with a reduced risk of childhood asthma.

What was this study's impact?

The study demonstrated the importance of considering multiple early-life exposures together when assessing risk factors for childhood asthma. It highlighted that both indoor (home dampness, pets) and outdoor (PM_2.5) exposures should be considered in prevention strategies.

Who was involved?

Participants included 6,413 children born between 1987 and 2016, enrolled in nine ECHO Study Sites across the United States. These sites included both general-risk and high-risk populations at higher risk, defined by a parental history of asthma or allergy.

What happened during the study?

The study looked at children’s early-life environments to understand how they relate to asthma risk. Researchers examined levels of outdoor air pollution during the first three years of life, along with conditions inside the home, such as water damage or dampness, whether dogs or cats were present during infancy, and exposure to dust mites. Childhood asthma was identified based on reports from caregivers or a doctor’s diagnosis between birth and age five. The analysis considered differences in family and neighborhood factors that could also affect asthma risk, helping to isolate the role of these environmental exposures.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Additional studies examining how indoor and outdoor exposures interact could help researchers better understand their role in childhood asthma risk. Future research could also explore ways to reduce or prevent harmful exposures in early life.

Where can I learn more?

Access the full journal article, titled “Individual and combined effects of indoor home exposures and ambient PM_2.5during early life on childhood asthma in US birth cohort studies,” in Environmental Epidemiology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 23, 2025

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Home Conditions and Outdoor Air Pollution May Together Influence Children’s Asthma Risk, ECHO Study Finds

The BREATHE Study: Bronchiolitis Recovery and Use of HEPA Filters

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Study Summary: Lay Summary for Participant Families

The BREATHE Study: Bronchiolitis Recovery and Use of HEPA Filters

Author(s): The BREATHE Study Team

Why was this study conducted?

Bronchiolitis is an infection that affects the airways of a child. Babies with bronchiolitis may need hospital treatment. These babies may still have breathing problems, such as coughing and wheezing, after they go home.

Many things can affect a person’s ability to breathe. One of those things is the level of very small particles in the air. These particles are called PM2.5, which are particulate matter that is less than 2.5 micrometers across. That size is smaller than the size of most pollen and mold. The level of these very small particles in the air in someone’s home can be lowered by special air filters called high efficiency particulate air (HEPA) filters.

The BREATHE study was done to find out if HEPA filters used in a baby’s house can help them breathe better than if no filter is used in their house. Specifically, the study looked at how many days infants, who previously had bronchiolitis, had specific breathing problems such as coughing, wheezing, or other breathing problems.

What was done?

Babies chosen for this study were less than 12 months old and had been hospitalized for bronchiolitis for the first time. Babies were selected from 17 hospitals, each in a different state. A total of 228 families were given either 2 HEPA units or 2 control units (identical units but with filters removed). One unit was to be used in the baby’s sleep space and the other unit in a common room of the home. Families did not know which types of units they were given. Air quality monitors measured the level of very small particles (PM2.5) in their homes. Families reported the number of days that their babies had breathing troubles. These reports were done weekly for 6 months. At the end of the study, families learned whether they had been using HEPA units or control units. All families were then given new HEPA filters. They also received individual reports about the PM2.5 levels in their home.

What was found?

The number of days babies had breathing problems were counted. The number of problem days for the babies living in homes with HEPA filters were compared to the number of problem days for the babies living in homes that had control units. Generally, babies in homes with working HEPA units had fewer breathing problems than babies in homes with the control units. Babies in homes with HEPA units had an average of 5 fewer days with breathing problems than did babies in homes with the control units. However, because the difference between the 2 groups is quite small, it is not clear if the breathing improvement was related to HEPA filter use or due to chance. This does not mean that the HEPA filters were not useful. It only means that it could not be proven with this study.

Compared to those with control units, babies who had HEPA filter units in their home had a 9% lower chance of unscheduled healthcare visits, such as hospitalizations, emergency room visits, and doctor’s office visits for breathing problems, but the difference between the 2 groups is small and may be due to chance. Babies who had HEPA filter units running most of the time during the study had a 25% lower chance of unscheduled doctor’s office visits for breathing problems.

On average, homes with working HEPA units had average common room PM2.5 equal to 11 micrograms per cubic meter (μg/m3). On average, levels were higher in the common room of homes with control units (15 μg/m3). The difference was even bigger in the infant’s sleep space. On average, homes with HEPA units had sleep space PM2.5 equal to 11 μg/m3. On average, homes with control units had sleep space PM2.5 equal to 21 μg/m3.

What do the results mean?

Filtering air with a HEPA unit may help infants who have been in the hospital for bronchiolitis. Infants in houses with HEPA units may have fewer days of breathing trouble than infants in houses without HEPA units. However, we would need to do a larger study to know for sure.

Who sponsored the study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, the Office of the Director, National Institutes of Health.

Appreciation

The authors appreciate the children and families whose participation made the research possible.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Lay Summary for the BREATHE Study (for participant distribution)
cIRB # 274137 V-01 (27-October-2025)

ECHO Study Observes Health Disparities in Air Pollution-associated Risk of Childhood Asthma

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ECHO Study Observes Health Disparities in Air Pollution-associated Risk of Childhood Asthma

Authors: Veronica A. Wang, Rima Habre, Diane R. Gold, Antonella Zanobetti, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Asthma is one of the most common chronic childhood diseases in the United States, affecting over 4.5 million children. Although air pollution levels have decreased over the past decades, individuals living in certain areas have seen lower reductions in air pollution and may also be more vulnerable to its effects. For this study, researchers examined sociodemographic disparities in the association between air pollution and incident childhood asthma until age 10.

What were the study results?

The study found that higher exposures to fine particulate matter, nitrogen dioxide, and ground ozone were associated with a higher incidence of asthma in the first 10 years of a child’s life. For fine particulate matter and nitrogen dioxide, children from areas with a higher proportion of Black residents or higher population density were identified being at a higher risk for air pollution-associated asthma.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study showed that sociodemographic disparities in air pollution-associated asthma persist despite reductions in the overall air pollution levels. The study highlighted the potential to mitigate childhood asthma risk by reducing air pollution and addressing the root causes of these disparities.

Who was involved?

The study involved over 23,000 children, born between 1981-2021, from 34 sites in the Environmental influences on Child Health Outcomes (ECHO) Program with data on asthma diagnosis until age 10 in the contiguous US.

What happened during the study?

During the study, the study team collected data on each participant’s asthma status, month of diagnosis, and length of their follow-up. They also collected sociodemographic data that included sex, race/ethnicity, maternal education, and more. Lastly, they used area-level data from the 1980-2019 Census Bureau and the American Community Survey on the percent of low-income residents, Black residents, residents with less than a high school education, unemployed residents, and female residents, and overall population density. The study team then analyzed this data, first examining the association between air pollution exposures (fine particulate matter, nitrogen dioxide, and ground ozone) and childhood asthma, then determining whether the sociodemographic and economic variables modified the air pollution-asthma association.

What happens next?

Future studies could help researchers better understand the root causes of susceptibility to air pollution. Additional studies with longer follow-up could also help researchers understand how asthma risk may change throughout childhood as the climate and environmental conditions change. Lastly, additional studies may help researchers understand how personal exposures affect asthma in children, including indoor sources of air pollution.

Where can I learn more?

Access the full journal article, titled “Disparities in the Association of Ambient Air Pollution with Childhood Asthma Incidence in the ECHO Consortium: a US-wide Multi-cohort Study,” in Environmental Epidemiology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 2025

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ECHO Study Observes Health Disparities in Air Pollution-associated Risk of Childhood Asthma

Children Living in Low-income Neighborhoods with Low Food Access at Higher Risk of Developing Asthma, ECHO Study Finds

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Children Living in Low-income Neighborhoods with Low Food Access at Higher Risk of Developing Asthma, ECHO Study Finds

Authors: Veronica Wang, Antonella Zanobetti, Diane Gold, Rima Habre, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Asthma is characterized by chronic inflammation in the lungs, and prior research shows that a nutritious diet can reduce airway inflammation. However, access to affordable and healthy foods is often difficult for many communities that have limited access to supermarkets or grocery stores. In this study, the researchers wanted to learn whether residing in a low-income-low-food access neighborhood was associated with childhood asthma and whether this association was modified by sociodemographic factors.

What were the study results?

This study found that living in a low-income neighborhood with low food access was associated with higher risks of developing asthma in both cumulative early (age 0-5 years) and cumulative middle (age 0-11 years) childhood, with stronger associations observed in cumulative early childhood. The increased risk of asthma was more prominent among girls, Hispanic children, and children whose mothers had less than a high school education.

What was the study's impact?

This study demonstrates the importance of the neighborhood food environment to children’s respiratory health, particularly in early childhood. The findings suggest that food access in the immediate vicinity of residence and that vehicle access may be important and may contribute to disparities in childhood asthma development.

Who was involved?

The study included 16,012 children from 35 ECHO Cohort study sites, born between 1998 and 2021, from across the United States.

What happened during the study?

During the study, researchers collected information on participants’ residential addresses and whether they were diagnosed with asthma in cumulative early childhood (by age 5) or middle childhood (by age 11). Using the U.S. Department of Agriculture’s Food Access Research Atlas, the researchers evaluated whether each child lived in a low-income neighborhood that was within 0.5-1 mile of a supermarket (for urban areas) or 10-20 miles (for rural areas). They also evaluated whether each child lived in a low-income area where more than 100 households do not have a vehicle or a nearby supermarket. Using this data, researchers looked at how living in a low-income-low-food-access neighborhood might affect childhood asthma incidence. They also took into account factors like the child's sex, race/ethnicity, mother's education, whether the mother smoked during pregnancy, and whether the parents had asthma.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Additional studies could help researchers better understand how community access to healthy, nutritious foods affects asthma development. Future studies could also consider how other influences, such as the affordability of healthy foods and school-based food programs, might influence child health outcomes.

Where can I learn more?

Access the full journal article, titled “Residing in a low-income-low-food-access neighbourhood and asthma in early and middle childhood in the Environmental influences on Child Health Outcomes (ECHO) program: a multisite cohort study,” in BMJ Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published June 30, 2025

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Children Living in Low-income Neighborhoods with Low Food Access at Higher Risk of Developing Asthma, ECHO Study Finds

Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

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Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

Authors: Rachel Miller, Christine C. Johnson, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health supported this research.

Why was this study needed?

Neighborhood conditions—such as access to housing, healthy food, transportation, and education—can influence the development of childhood asthma. Researchers often use the Child Opportunity Index (COI) to measure these conditions, linking residential addresses at different stages of early life to data about the resources available in the surrounding neighborhood. This index looks at various aspects of a neighborhood to see how they might affect children's chances of success and health. It combines information from 29 indicators, such as access to good schools, healthy food, parks, clean air, and job opportunities. Studies have shown that neighborhoods with higher COI scores tend to have better conditions that help children grow up healthier and have more opportunities for economic success. So, the higher the COI score, the better the neighborhood is believed to be for children's development and future prospects. Previous research suggests that these factors can all play a role in shaping different types of childhood asthma. This ECHO study was needed to explore how conditions before and at the time of birth can affect children’s rates of asthma with recurrent exacerbations (ARE)—a type of asthma where children experience frequent, severe episodes of asthma.

What were the study results?

The study found that children born in neighborhoods with low community opportunity, when measured at birth and as measured by the COI, had a much higher incidence rate of asthma with recurrent exacerbations compared to those from other neighborhoods. Non-Hispanic Black children had significantly higher rates than non-Hispanic White children across all neighborhood categories. Among children from very low-opportunity neighborhoods, the rates were several times higher for non-Hispanic Black and Hispanic Black children compared to White children. Even after accounting for individual factors, children from these low-opportunity areas had higher adjusted incidence rates for asthma with recurrent exacerbations, especially those aged 2 to 4 years or those who had a parent with asthma.

What was the study's impact?

Earlier ECHO research found that living in a neighborhood with higher opportunity at birth was associated with lower asthma incidence than living in a neighborhood with lower opportunity. This study highlights the importance of addressing neighborhood-level conditions to help prevent asthma flare-ups in children. It supports the idea that improving conditions in under-resourced areas can positively impact children’s health.

Who was involved?

The study used data from 15,877 children born between 1990 and 2018. These children were from 60 ECHO cohorts across the U.S.

What happened during the study?

In this study, researchers followed children from ages 2 to at least 5, and up to age 19. They collected information on asthma diagnoses and the use of corticosteroids, a medication that helps reduce inflammation in the body. ARE was identified if a child used corticosteroids at least twice while being monitored by ECHO researchers. The study also looked at the connection between the COI and the children's birth addresses, examining how neighborhood conditions influenced the rates of asthma flare-ups while considering individual factors like child race and ethnicity, sex and parental history of asthma.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Additional studies could help researchers further understand the prenatal and early childhood determinants of ARE at both the individual and neighborhood levels.

Where can I learn more?

Access the full journal article, titled “Child Opportunity Index at Birth and Asthma with Recurrent Exacerbations in the U.S. ECHO Program,” in the Journal of Allergy and Clinical Immunology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published March 13, 2025

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Children Born in Lower-Opportunity Neighborhoods Had Higher Rates of Asthma with Recurrent Exacerbations

No Significant Associations Observed Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

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No Significant Associations Observed Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

Authors: Rachel Greenberg, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Wheezing symptoms occur in 20-40% of infants, contributing to a substantial impact on children’s quality of life and their use of healthcare. Multiple early exposures, such as prenatal exposure to cigarette smoking, have been associated with these wheezing symptoms.

Previous studies have suggested a possible link between antibiotic exposure during pregnancy and an increased risk of wheezing and cough in children, caused by an imbalance in the birthing parent’s microbiome due to antibiotic use. However, these studies had some limitations. Additional research was needed to include enough participants to produce reliable results and account for other factors that might have influenced outcomes. This study examined the association between prenatal antibiotic exposure and the development of wheezing during infancy using a large national sample of infants and birthing parents.

What were the study results?

In this study, 36% of pregnant participants used at least one antibiotic while pregnant, and about 26% of infants had a report of wheezing. Overall, the research team observed that exposure to antibiotics during pregnancy was not associated with infant wheezing during the first 18 months after birth. Note that most outcome data were based on birthing parent/caregivers’ self-reports.

Prenatal antibiotic exposure was also not associated with an increase in emergency room visits or hospitalizations for wheeze during infancy. However, prenatal antibiotic use was associated with higher odds of medication use for wheeze or dry cough during infancy, which could imply more severe symptoms and a medical provider’s diagnosis. It is important to note that the study team found an association between prenatal antibiotic exposure and medication use for wheeze or cough during infancy only among children born via vaginal delivery and thus exposed to the birthing parent's microbiota. This finding supports the theory that a change in the microbiome of the birthing parent and infant is related to this association.

The researchers also observed an association between prenatal antibiotic exposure and wheeze in research sites that recruited participants who had a family history of asthma, suggesting that a genetic or environmental risk within these families may increase the likelihood of wheeze.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

The results of this study raise the possibility of an association between prenatal use of prenatal antibiotics and medication use for wheezing in the 18 months after birth. It suggested that prenatal antibiotics may influence respiratory outcomes during infancy, but further studies are needed to understand how the timing and type of antibiotic use may influence these effects.

Who was involved?

This study included 4,721 pregnant participants and their 4,779 infants from 12 study sites in the ECHO Cohort Consortium. Most pregnant participants were between 25 and 35 years old, non-Hispanic White, and had a college degree or more. Overall, 36% of the pregnant participants used at least one antibiotic during their pregnancy.

What happened during the study?

The study team analyzed data collected using questionnaires, interviews, or medical records to analyze associations between prenatal antibiotic exposure and airway symptoms (e.g., wheeze, cough) during infancy. The study team confined the outcome of wheezing to infancy (prior to the age when asthma is typically diagnosed), and they evaluated antibiotic exposure throughout pregnancy.

What happens next?

Future research is needed to understand how the timing and type of antibiotic use during pregnancy influences infant wheeze outcomes. Additional studies are also needed to replicate these findings, which could then lead to clinical implications.

Where can I learn more?

Access the full journal article, titled “Association Between Prenatal Antibiotic Exposure and Infant Wheeze Outcomes,” in Acta Paediatrica.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Published February 27, 2025

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No Significant Associations Observed Between Prenatal Antibiotic Use and Wheezing Symptoms in Infants

Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

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Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

Authors: Amy Non, James Gern, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, National Institutes of Health supported this research.

Why was this study needed?

Spirometry (spy-ROM-uh-tree) is a test used to check how well your lungs work. It measures how much air you breathe in, how much you breathe out, and how quickly you breathe out. Healthcare professionals use spirometry to diagnose asthma and other respiratory conditions. Historically, healthcare providers have used different spirometry equations based on a person’s race for interpreting test results, relying on the assumption that Black and White bodies are biologically different. For this study, researchers wanted to know whether using the same spirometry equations for everyone (race-neutral) or different ones for specific races (race-specific) changes the reliability of lung function tests used to check for asthma in children. This research addresses concerns that race-specific test interpretations might hide lung problems in children from certain backgrounds and could lead to differences in how asthma is diagnosed and treated in kids from racial and ethnic minority groups.

What were the study results?

Black children may be more likely to be identified as having reduced lung function when doctors use the same spirometry equations to interpret test results for everyone (race-neutral) instead of race-specific ones. The study found that using the race-neutral equations resulted in significantly lower lung function scores for Black children compared to the race-specific equations. This led to a higher percentage of Black children being classified as having low lung function. Furthermore, Black children were more likely to be diagnosed with asthma, regardless of the equation The way lung function was measured did not seem to make much difference in how often children needed asthma-related healthcare, like emergency room visits or hospital stays.

What was the study's impact?

The study's findings support using race-neutral equations when evaluating children for asthma, as they may provide a more uniform assessment of lung function across different racial and ethnic groups.

Who was involved?

The research included 8,719 children aged 5 to 12 years from 27 research sites across the United States. These children were grouped by parent-reported race and ethnicity, including Black, non-White Hispanic, and White children, with a smaller percentage classified as "Other Race."

What happened during the study?

The study examined how using the same equations for everyone changes how lung function tests are understood. These tests measure how much air a child can blow out in one second, the total amount of air they can blow out in one breath, and the balance between the two. Researchers also checked if the test results matched real-life asthma problems, like being diagnosed with asthma, needing emergency care, or staying in the hospital.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Further research is needed to better understand the racial differences in lung function and asthma outcomes. Future studies could also explore the impact of environmental and social factors affect respiratory health in children from different racial and ethnic groups.

Where can I learn more?

Access the full journal article, titled “Comparison of Race-neutral Versus Race-specific Spirometry Equations for Evaluation of Child Asthma,” in American Journal of Respiratory and Critical Care Medicine.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 3, 2024

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Black Children May Benefit from Race-Neutral Assessments for Asthma Diagnosis, Study Finds

How Much Vitamin D do Children with Asthma and Increased Body Weight Need to Correct Low Vitamin D Levels?

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How much vitamin D do children with asthma and increased body weight need to correct low vitamin D levels?

Study title: Pharmacokinetics of Oral Vitamin D in Children with Obesity and Asthma

Author(s): Jason E. Lang, Rodrigo Gonzalez Ramirez, Stephen Balevic, Brian O’Sullivan, Scott Bickel, Christoph P. Hornik, J. Marc Majure, Saranya Venkatachalam, Jessica Snowden, Laura James

Why was this study conducted?

Among children with asthma, children who also have increased body weight for their height (body mass index (BMI) of ≥85 percentile) tend to have more severe asthma symptoms than their healthy weight peers. Children with asthma and increased body weight also tend to have lower vitamin D levels than other children. Helping children with asthma and increased body weight reach higher vitamin D levels may help their asthma symptoms by lowering inflammation in the lungs. However, there is not enough information on how much vitamin D children with asthma and increased body weight should take to safely raise their vitamin D levels.

What was done?

ECHO ISPCTN research teams in 15 states enrolled children ages 6‑18 years with asthma and increased body weight in a clinical trial. The children took vitamin D capsules for 16 weeks and gave blood samples every month so researchers could check their vitamin D levels. The goal of the study was to find a vitamin D dose that helped children raise their vitamin D levels in their blood to 40 ng/mL, a level that might lower inflammation.

There were two parts of the study. In the first part, children were split into four groups that each took one of four different doses of vitamin D to find a dose that raised children’s vitamin D levels over 16 weeks without causing side effects. All four dosing options were higher than what is usually recommended to raise vitamin D levels. Then, researchers compared the vitamin D dose from part 1 that raised vitamin D levels quickly and safely to the usually recommended daily vitamin D dose to confirm that the higher dose could safely help children reach vitamin D levels that may decrease inflammation. This study was approved by the Institutional Review Board and all participants consented to participate in the study.

What was found?

The first part of the study found that taking a 50,000 international units (IU) vitamin D dose on the first day of treatment and then an 8,000 IU vitamin D dose every day for 16 weeks was most effective at raising vitamin D levels safely. In the second part of the study, researchers confirmed that using this approach raised vitamin D levels in most children to the recommended level while avoiding undesired higher levels. In contrast, no children who followed the current standard-of-care dosing of 600 IU each day achieved the target vitamin D level sufficient to potentially reduce inflammation.

What do the results mean?

Most children with asthma and increased body weight who take vitamin D the vitamin D dose used in this study (50,000 IU vitamin D on day one, then 8,000 IU each day) can safely raise their vitamin D level in a short period of time. The newly determined dose is much greater than the typically recommended dose. This study shows how important it is that children and adolescents with increased body weight get enough vitamin D in their diet or in vitamin supplements every day since the higher the body weight, the faster vitamin D was processed and removed from the body. The results of this study may help children with asthma or other illnesses if having enough Vitamin D lowers inflammation.

Who sponsored the study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

Appreciation

All of the families in ECHO ISPCTN trials help study teams across the country learn more every day about how to bring rural and underserved families into research studies. This is critical to ensure that families that are not near large academic centers still get the benefits of research and that the “answers” research studies find are meaningful for children and families across all parts of the country, not just those who live in large cities.

You may learn more about this publication here: https://link.springer.com/article/10.1007/s40262-023-01285-9

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published: August 30, 2023

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How much vitamin D do children with asthma and increased body weight need to correct low vitamin D levels?

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What Are factors That Affect the Incidence Rate of Asthma With Recurrent Exacerbations in Children?

Authors: Rachel L. Miller; Christine C. Johnson, et al.

A Nationwide Study on How Childhood Asthma Relates to Obesity Development

Authors: Nikos Stratakis and Erika Garcia

General health and life satisfaction in children with chronic illness

Author(s): Courtney K. Blackwell, et al

ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Authors: Izzuddin Aris, et al.

Can Neighborhood Conditions Throughout Childhood Shape the Risk of Developing Asthma?

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Authors: Izzuddin Aris, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Neighborhood conditions, such as access to housing, healthy food, transportation, and education centers, can contribute to the development of childhood asthma. Researchers often measure these conditions using the Child Opportunity Index and the Social Vulnerability Index, which link residential addresses at birth, infancy (age 0.5‒1.5 years), and early childhood (age 2.0‒4.8 years) to census-tract data about the opportunities and resources available in the surrounding neighborhood. Previous studies looking into this topic lacked geographic diversity or considered only specific socioeconomic aspects of neighborhood disadvantage, which may not fully capture the role of early-life experiences on health outcomes. This study examines the association of conditions and resources available in neighborhoods during different developmental stages with childhood asthma incidence.

What were the study results?

Living in a neighborhood with higher opportunity at birth, infancy, or early childhood was associated with lower asthma incidence when compared to living in a neighborhood with lower opportunity. Differences in sociodemographic characteristics, parental asthma history, or the number of births a mother had did not explain this effect.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the impact?

Neighborhood conditions could help researchers identify vulnerable children who are at high risk for developing asthma. Policymakers, researchers, and community groups can use this information to guide decisions and interventions to improve the health of children and promote equitable opportunities across neighborhoods.

Who was involved?

This study used data from 10,516 children at 46 research sites participating in ECHO. The participants have at least one residential address from birth and a parent or caregiver report of a physician’s diagnosis of asthma.

What happened during the study?

Researchers linked participants’ residential addresses to the Child Opportunity Index and Social Vulnerability Index. They estimated asthma incidence rates associated with Child Opportunity Index or Social Vulnerability Index data for a child’s neighborhood at each life stage, adjusting for sociodemographic characteristics, maternal and paternal history of asthma, and the number of births a mother had.

What happens next?

Future studies can explore the impact of investing in early life health and environmental, social, and economic resources on improving health outcomes for children in disadvantaged neighborhoods. Follow-up studies can also focus on how these neighborhood-level factors are affecting asthma rates and how moving may alter asthma development.

Where can I learn more?

Access the full journal article, titled “Associations of Neighborhood Opportunity and Vulnerability with Incident Asthma Among U.S. Children in the ECHO cohorts,” in JAMA Pediatrics.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 28, 2023

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ECHO Study Suggests Neighborhood Conditions Throughout Childhood May Shape Risk of Developing Asthma

Different Viruses that Cause Wheezing Illnesses Provide Limited Protection Against Each Other

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Different Viruses that Cause Wheezing Illnesses Provide Limited Protection Against Each Other

Authors: Yury Bochkov, James Gern, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Rhinovirus (RV) is the most common virus detected in both mild and acute respiratory illnesses, such as the common cold and wheezing. While three species of rhinoviruses (A, B, and C) can cause upper respiratory illnesses, RV-A and RV-C are more likely to cause wheezing illnesses in preschoolers and in children and adults who have asthma. No specific vaccines for these viruses exist yet, in part because the large range of rhinovirus strains makes vaccine development difficult.

After a natural infection, neutralizing antibody responses develop in infected persons that help reduce the risk of illness on a second exposure. The goal of this study was to test whether RV-C infections are more likely than RV-A infections to induce long-lasting antibodies that can protect against other RV-C strains.

What were the study results?

Both RV-A and RV-C infections induced neutralizing antibody responses of similarly long durations but did not provide strong protection against each other. The researcher’s data analysis suggests that RV-C types are less likely than RV-A types to create a strong immune response against different virus strains. Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should always consult with a qualified healthcare provider for diagnosis and for answers to your personal questions.

What was the study's impact?

The results showed that while protective antibody responses to RV-C last for several years, they have only modest cross-protection that is limited to genetically similar viruses. These findings suggest that vaccines against RV-C might need to include many of the most common RV-C types to offer broad protection.

Who was involved?

Over 4,000 children were enrolled in 14 independent studies across Australia, Finland, and the United States. Study participants varied in age from 0 to 19 years and had RV-induced illnesses of varying severity. Some studies included participants with asthma, in addition to healthy participants.

What happened during the study?

Researchers tested whether RV-C infections cause protection against multiple RV-C types. Researchers analyzed samples collected between 1998 and 2019. Each of the 14 sites collected nasal samples that were analyzed for RV species and type. Data from 11 studies and 3,199 children included serial sampling for analysis across more than one RV illness. Many children in this study contracted a series of illnesses caused by various RV-A and RV-C types. The investigators examined the sequence of illnesses that children had experienced to understand which kinds of rhinovirus might provide protection against which other kinds of rhinovirus. Researchers also analyzed blood specimens to see whether RV-C infections are more likely to create antibodies to fight other rhinoviruses or produce antibody responses of longer duration than RV-A infections do.

What happens next?

Researchers want to determine why RV-C infections occur so frequently in preschool children, and why they are more likely to cause wheezing illnesses. These studies aim to help researchers design a practical RV-C vaccine that could protect high-risk children.

Where can I learn more?

Access the full journal article, titled “Rhinoviruses A and C Elicit Long-lasting Antibody Responses with Limited Cross-neutralization,” in the Journal of Medical Virology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published August 28, 2023

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ECHO Researchers Find Different Rhinoviruses Can Provide Limited Protection Against Each Other