Abstract
Background Exposure to violence has been associated with lower lung function in cross-sectional studies.
Methods We examined whether increasing violence-related distress over time is associated with worse lung function and worse asthma control or quality of life in a secondary analysis of a 48-week randomised clinical trial in 98 youth with asthma (aged 9–16 years) treated with low-dose inhaled corticosteroids (Vitamin D Kids Asthma Study (VDKA)). We then replicated our findings for lung function in a prospective study of 232 Puerto Rican youth followed for an average of 5.4 years. Violence-related distress was assessed using the Checklist of Children's Distress Symptoms (CCDS) scale. Our outcomes of interest were percent predicted lung function measures and (in VDKA only) asthma control (assessed using the Asthma Control Test) and asthma-related quality of life (assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ)).
Results In a multivariable analysis in VDKA, each 1-point increment in CCDS score was associated with decrements of 3.27% in forced expiratory volume in 1 s (FEV1) % pred (95% CI −6.44– −0.22%; p=0.04), 2.65% in forced vital capacity (FVC) % pred (95% CI −4.86– −0.45%; p=0.02) and 0.30 points in the overall PAQLQ score (95% CI −0.50– −0.10 points; p<0.01). Similar findings for FEV1 and FVC were obtained in the prospective study of Puerto Rican youth.
Conclusions Our findings suggest that violence-related distress may worsen lung function and quality of life in youth with asthma (even those treated with low-dose inhaled corticosteroids), and further support policies to reduce exposure to violence among children in the USA and Puerto Rico.
Abstract
Increasing violence-related distress over time was associated with worse lung function and worse asthma-related quality of life in youth with asthma despite treatment with low-dose inhaled corticosteroids https://bit.ly/3zL1vXM
Footnotes
Author contributions: K. Gaietto and Y-Y. Han participated in data analysis and wrote the initial draft of the manuscript. E. Forno, L.B. Bacharier, W. Phipatanakul, T.W. Guilbert, M.D. Cabana, K. Ross, J. Blatter, E. Acosta-Pérez, F.J. Rosser, S. Durrani and G. Canino participated in data collection, data management and study implementation. G.E. Miller, R.E. de la Hoz and S.R. Wisniewski participated in data analysis and interpretation. J.C. Celedón obtained funding and participated in study design and implementation. All authors reviewed the draft for intellectual content and approved submission of the final version of the manuscript.
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Conflict of interest: K. Gaietto has nothing to disclose.
Conflict of interest: Y-Y. Han has nothing to disclose.
Conflict of interest: E. Forno has nothing to disclose.
Conflict of interest: L.B. Bacharier has nothing to disclose.
Conflict of interest: W. Phipatanakul reports personal fees for consultancy from GlaxoSmithKline, Genentech, Novartis, Regeneron, Sanofi and Teva, grants from Genentech, Novartis, Regeneron, Sanofia, Circassia, Monaghen, Thermo Fisher, ALK-Abelló, Lincoln Diagnostics, GlaxoSmithKline, Kaleo and Merck, and institutional grants from Genentech, Regeneron, Novartis and the US National Institutes of Health, outside the submitted work.
Conflict of interest: T.W. Guilbert reports personal fees for consultancy from American Board of Pediatrics (Pediatric Pulmonary Sub-board), GlaxoSmithKline, Teva and Sanofi/Regeneron, grants from AstraZeneca, Novartis and Sanofi/Regeneron, nonfinancial support from Up To Date, outside the submitted work.
Conflict of interest: M.D. Cabana is a member of the US Preventive Services Task Force (USPSTF), outside the submitted work.
Conflict of interest: K. Ross has nothing to disclose.
Conflict of interest: J. Blatter has nothing to disclose.
Conflict of interest: E. Acosta-Pérez has nothing to disclose.
Conflict of interest: G.E. Miller has nothing to disclose.
Conflict of interest: R.E. de la Hoz has nothing to disclose.
Conflict of interest: F.J. Rosser has nothing to disclose.
Conflict of interest: S. Durrani has nothing to disclose.
Conflict of interest: G. Canino has nothing to disclose.
Conflict of interest: S.R. Wisniewski has nothing to disclose.
Conflict of interest: J.C. Celedón reports nonfinancial support (research materials) from Pharmavite and GlaxoSmithKline, during the conduct of the study; nonfinancial support (research materials) from Merck, outside the submitted work.
Support statement: This study was supported by grants HL119952, HL07966, HL117191 and MD011764 from the National Institutes of Health (NIH). The project was also supported by the Pediatric Clinical and Translational Research Center (PCTRC) at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh through NIH grant UL1 TR001857. F.J. Rosser's contribution was supported by grant KL2 TR001856 from the NIH. Pharmavite LLC provided the vitamin D and placebo capsules for the study, and GlaxoSmithKline provided the Flovent given to study participants. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received August 24, 2021.
- Accepted September 16, 2021.
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