Abstract
In an important study of how providers' prejudices influence practice, Harrington et al. in Birmingham, Alabama, demonstrate that a patient's race and education have a substantial influence on a healthcare provider's misperceptions of health literacy. When compared to a validated health literacy measurement tool (The Rapid Assessment of Health Literacy in Medicine), providers estimated parental health literacy concordantly with the validated tool 81% of the time when the parents were white, but only 45% of the time when the parents were black. Changes in treatment recommendation were more common when parents were perceived to have marginal health literacy. 2
Borowsky et al. describe an innovative approach to assessment of community childhood asthma burden by survey of school nurses. 3 As research funding becomes increasingly limited and as representative population surveys are becoming increasingly difficulty to conduct, this is an important demonstration of the ability to demonstrate respiratory disease burden and disease disparities by use of readily available data sources.
A provocative study by Foty et al. suggests that children in Toronto with asthma are less likely to walk to school. 4 In multivariate models, being driven by school bus had the strongest association with asthma. Associations do not prove causation. However, this leads to interesting speculation. Does the exercise of walking to school reduce risk for asthma? Are children with asthma (especially in northern climates) less likely to walk to school because cold air might trigger their asthma? Or does walking have nothing at all to do with it, but perhaps the observed associations reflect harm from exposure to diesel and other motor vehicle exhaust associated with bus or car travel to/from school?5,6
In looking back at the last 5 years of the Journal, much has been accomplished. The Journal name was changed from Pediatric Asthma, Allergy, and Immunolology to Pediatric Allergy, Immunology, and Pulmonology to acknowledge the important overlap and importance of cross-fertilization between these very closely related fields. We have focused on improving understanding of both common and uncommon respiratory diseases of children. We have not shied away from addressing issues relevant to community health, health disparities, and public policy. After all, respiratory health starts with what you breathe.
Among the most important original research articles published is a validation study of the Youth and Parent Versions of the Asthma-Related Anxiety Scale by Bruzesse et al. (Vol. 24, No. 2). This valuable tool enables assessment of an important potentially effect modifying variable in pediatric asthma research. A prospective cohort study by Ducharme et al. demonstrated that a short course of oral corticosteroids (as commonly prescribed for young children with asthma) impairs immune responses to new antigens (Vol. 23, No. 4). Using data from the Boston Birth Cohort study, Kumar et al. demonstrated that maternal obesity increases risk of wheezing in the first years of life of their offspring—independently of the child's weight status (Vol. 23, No. 3). Akinbami et al. demonstrated that presence of an adult household smoker was associated with an increased adjusted risk ratio for asthma-related school absence.
Canino et al. described how public health insurance policies in Puerto Rico created disincentives to the prescription of asthma controller medications, thereby impairing asthma care among this high-risk population (Vol. 23, No. 3). Sala et al. demonstrated that, among patients admitted to a pediatric intensive care unit for asthma, African Americans were more likely to be intubated than other ethnicities (Vol. 25, No. 4), further highlighting ethnic disparities in asthma. Lighter-Fisher documented that children who are tuberculin skin test positive (indicating the history of latent tuberculosis infection) were less likely to have asthma, providing further evidence in support of the hygiene hypothesis (Vol. 25, No. 2). And Ribeiro Silva demonstrated that Western diet patterns were associated with increased risk for wheezing among school age children in Bahia, Brazil (Vol. 26, No. 1), providing further insight to why asthma prevalence is higher in the Westernized world.
Smith et al. described how computed tomography findings can be used to diagnose bronchiolitis obliterans in children (Vol. 23, No. 4). Application of these findings can reduce the number of children who need lung biopsies to diagnose this condition. Bach et al. described their experience in the management of spinal muscular atrophy type I by noninvasive respiratory aids (Vol. 22, No. 4)—this is the group that pioneered this use of the technology in a congenital illness previously thought to be fatal.
Among the many excellent review articles published, community health was addressed by Wheeler et al. who summarized school-based strategies to improve asthma management (Vol. 22, No. 4). Pruitt et al. summarized an American Lung Association convened conference of policy leaders and asthma experts to identify public policies that, if implemented, would reduce asthma morbidity and mortality (Vol. 22, No. 4). Kelsey-Lamb et al. described describe the work of Regional Asthma Management and Prevention (RAMP), a model program of comprehensive community-based intervention to reduce asthma burden (Vol. 24, No. 3).
Management of severe asthma was addressed by Fitzpatrick et al. in a review of key findings on severe asthma in children from the Severe Asthma Research Program (Vol. 23, No. 2). Krieger reviewed the importance of improving the home environment in achieving asthma control (Vol. 23, No. 2). Morton et al. provided new insights into the assessment and role of the small airways in asthma (Vol. 25, No. 4). Nguyen et al. reviewed the opportunities and imperative of including diverse populations in asthma research—with a focus on the hazards of focusing on European ancestry populations when exploring the genetics of asthma (Vol. 25, No. 3).
In exploring the connections between respiratory and gastrointestinal diseases (really just different parts of the foregut), Lang reviewed the connections between obesity and asthma (Vol. 25, No. 2). Wallis and Ryan described the role of aspiration in pediatric lung disease (Vol. 25, No. 3). Gut and Sivan reviewed the infrequently recognized respiratory involvement in children with inflammatory bowel disease (Vol. 24, No. 4).
We featured several special collections to allow for more in-depth exploration of important and evolving areas. The “Children's Interstitial Lung Diseases” special issue (Vol. 23, No. 1) led the first issue of the Journal under its new name. Other special collections focused on evolution of lung disease in the premature infant (Vol. 24, Nos. 1 and 2), clinical applications of pediatric lung function testing (Vol. 24, Nos. 2 and 3), and food allergy (Vol. 23, No. 4). Pro-Con debates explored controversial areas including the role of inhaled corticosteroids in preschool children (Vol. 24, No. 1) and the role of thoracoscopy versus fibronolytics in the management of empyema (Vol. 25, No. 3).
As tobacco use and tobacco smoke exposure are among the most important preventable contributors to children's respiratory and allergic diseases, the Journal has included a special focus on tobacco. Kelly reviewed the effect of smoking on pharmacotherapeutic agents in asthma (Vol. 22, No. 4). Lando et al. discussed the international perspective on tobacco control and children (Vol. 23, No. 2). Ibrahim reviewed the importance of tobacco promotion to youth in maintaining the tobacco epidemic (Vol. 23, No. 2). Sawnani reviewed the impact of in utero smoke exposure on control of breathing, which is an important mechanism for the impact of maternal smoking on sudden infant death. Adams et al. reviewed the approaches to addressing tobacco dependence in prenatal and newborn care (Vol. 25, No. 1). DiFranza described new and important understandings of how tobacco dependence develops—understandings that have important implications for tobacco control and tobacco dependence treatment (Vol. 25 No. 2).
The Interview with the Expert section has helped to tell our current history. Over the last several years, we have featured interviews with important thought leaders, including Bettina Hilman, Sandra Wilson, Lynn Taussig, Claire Langston, LeRoy Graham, Max Klein, Robert E Wood, Michael Frank, George Mallory, Marianne Frieri, Bruce Rubin, Eduardo Lentini, Gregory Diette, and Petr Pohunek.
The Pharmacotherapy Update column, edited (and often written) by Hengameh Raissey and Kathryn Blake, has been a popular feature in each issue. The Clinical Case of the Month series, edited by Annabelle Quizon, has provided quality presentations accompanied by astute expert discussions of challenging and insightful clinical cases.
As I look back on the last 5 years, I am very pleased with what the Journal has accomplished. With this issue, I will be stepping down as editor of Pediatric Allergy, Immunology, and Pulmonology. Service as a journal editor is a privilege. I am honored to have followed in my mentor Bettina Hilman's footsteps. I have learned a great many things and developed many wonderful relationships from my role as editor. I am grateful for the many contributions of the pediatric pulmonary and allergy communities to this Journal both as authors and as reviewers. And I am most grateful to Dr. Mary Cataletto for being energized, excited, and passionate about taking over the helm of this Journal. I know that she will do excellent work in moving the Journal to the next level.