Preventing Childhood Asthma: the Neglected Impact of Existing Public Health Interventions

About this Research Topic

Background

Increasing evidence, mainly in high income settings where data are often more readily available, is showing that antibiotic exposure in early life increases the risk of developing asthma and other allergic conditions, likely due to disturbances in the infant’s gut microbiome during a foundational time of immunological development, thereby predisposing the infant to hyperreactive immunological responses. The method of infant feeding in these first few months of life is a crucial factor to consider as early evidence shows not only that breastmilk is optimal for growth, lung development and passive immunological protection, it also can act to restore healthy microbial growth in the infant’s gut, potentially reversing the risk of atopic disease. While indoor and outdoor air pollution is a known trigger for asthmatic episodes in children, its role extends to also disrupting the gut microbiome in the first months of life, predisposing infants to asthma and allergy later in childhood.

Strong antibiotic stewardship, promotion of and support for breastfeeding and improved air quality inside and outside of the home are each vital public health efforts in and of themselves to reduce the urgent problem of antibiotic resistance, promote healthy development and immunological protection in children and reduce respiratory and cardiovascular disease in the general population, respectively. However, the additional benefit that they could confer in infants, by protecting a healthy and diverse gut microbiome, could contribute to reversing the asthma and allergy epidemic seen globally in the last several decades. This reversal is starting to be seen in high-income settings, however, the causal link is not conclusive and more research in animal models and at the population level needs to be done to understand these complex and interplaying early determinants of health. The context-specific challenges related to settings where antibiotic stewardship is less apparent, breastfeeding is not well supported and/or air quality is poor need to be understood. And the policy and cost implications of realizing a potentially enormous additional benefit to existing public health programs need to be analyzed in order to make the case for public health investment where it will be most meaningful.

Suitable themes for manuscripts include, but are not limited to:
1. The changing epidemiology of paediatric childhood asthma and allergy in different regions of the world
2. Pre and perinatal factors associated with asthma risk (C/S, pre and perinatal antibiotics)
3. Population-based studies of antibiotic exposure in infancy on childhood asthma and allergy – why antibiotics are used globally
4. The impact of infant antibiotics on gut microflora
5. The role of breastmilk exposure overall and on gut microflora in antibiotic-exposed children
6. Review of the known health benefits of breast milk in relation to atopic disease
7. The impact of differences in indoor and outdoor air quality in infancy on childhood asthma
8. Experimental models of antibiotic exposure and atopic disease
9. Metabolomics: How is the microflora connected to immunological development
10. Immunology of atopic asthma
11. Future opportunities for prebiotic/probiotic supplementation or “rescue”
12. Modelling the opportunity for leveraging existing public health interventions in different contexts to prevent childhood asthma and allergy (population-attributable risk)
13. Costing these opportunities and what this would mean for policy and public health investment
14. Understanding the context-specific challenges and competing risks in resource limited settings
15. Quantifying neonatal antibiotic use in resource-limited settings and opportunities for reduction in unnecessary use

The following article types are welcome: Original Research, Systematic Review, Policy and Practice Review, Perspective, Policy Brief.

Conflict of interest declaration: Meghan B Azad holds a Tier 2 Canada Research Chair in the Developmental Origins of Chronic Disease at the University of Manitoba and is a Fellow in the Canadian Institutes for Advanced Research (CIFAR) Humans and the Microbiome Program. She receives research funding from the Canadian Institutes of Health Research, Research Manitoba, the Canada Foundation for Innovation, the Bill and Melinda Gates Foundation, the National Institutes of Health, the Manitoba Children’s Hospital Foundation, Mitacs, CIFAR, the Garfield Weston Foundation, Health Data Research UK, and Canadian COVID Immunity Task Force. She has received speaking honoraria from Medela, Prolacta Biosciences, AstraZeneca, BabyFriendly UK, and the Institute for the Advancement of Breastfeeding & Lactation Education. She has consulted for DSM Nutritional Products and serves on the Malaika Vx and Tiny Health Scientific Advisory Boards.

We acknowledge the funding of the manuscripts published in this Research Topic by the University of British Columbia, with funds received from the Community Antimicrobial Stewardship Program at the BC Centre for Disease Control and the BCCDC Foundation for Public Health. We hereby state publicly that the University of British Columbia, with funds originally received from the Community Antimicrobial Stewardship Program at the BC Centre for Disease Control and the BCCDC Foundation for Public Health has had no editorial input in articles included in this Research Topic, thus ensuring that all aspects of this Research Topic are evaluated objectively, unbiased by any specific policy or opinion of University of British Columbia, with funds received from the Community Antimicrobial Stewardship Program at the BC Centre for Disease Control and the BCCDC Foundation for Public Health.

Please find the website for each sponsor below:
BCCDC Foundation for Public Health
Community Antimicrobial Stewardship at BC Centre for Disease Control
The University of British Columbia

Keywords: Paediatrics; Asthma; Atopic disease; Antibiotic stewardship; Breastfeeding; Air Quality; Gut microbiome; Immunology; Metabolomics; Public Health; Policy

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