Elizabeth C Matsui

• Johns Hopkins Medicine

Background Asthma-related emergency department (ED) visit rates among children in a typical year closely follow the school calendar, with a sharp increase in rates when students return to school. The well-known increase in asthma exacerbations at the start of the school year is largely attributable to increases in respiratory viral infection. Becau...

A growing literature within the field of air pollution exposure assessment addresses the issue of environmental justice. Leveraging the increasing availability of exposure datasets with broad spatial coverage and high spatial resolution, a number of works have assessed inequalities in exposure across racial/ethnic and other socioeconomic groupings....

Background Latinx children in the United States experience disparities in asthma control and asthma-related functional outcomes compared to non-Latinx White children, including more school absences, emergency department visits, and hospitalizations for asthma. Stress appears to play a role in asthma control, but interventions designed to address th...

Background In the United States, Black and Latino children with asthma are more likely than White children with asthma to require emergency department visits or hospitalizations because of an asthma exacerbation. Although many cite patient-level socioeconomic status and access to health care as primary drivers of disparities, there is an emerging f...

Background Emerging studies suggest that endocrine disrupting chemicals (EDCs) in personal care and other consumer products are linked with various adverse health effects, including respiratory and reproductive effects. Despite Black persons using more personal care products than other demographic groups and having a high asthma burden, little is k...

OBJECTIVES/GOALS: There is an excess risk of upper respiratory infection (URI) among Black and Mexican-American children in the US. Factors that underpin these disparities are largely unknown. We evaluated the extent to which socioeconomic status (SES), serum cotinine, obesity, and household size explained the association between race/ethnicity and...

Rationale: The share of Black or Latinx residents in a census tract remains associated with asthma-related Emergency Department visit rates after controlling for socioeconomic factors. The extent to which evident disparities relate to within-city heterogeneity of long-term air pollution exposure remains unclear. Objectives: To investigate the ro...

Background There is excess risk of upper respiratory infection (URI) among Black and Mexican American children in the US. Evidence suggests that obesity and exposure to nicotine may impair host-pathogen defense mechanisms, increasing susceptibility to URI. Low socioeconomic status (SES) is also linked to a higher risk of URI. Obesity, nicotine expo...

Background: It is unclear whether there are racial and/or ethnic disparities in the risk of acquiring an upper respiratory infection (URI) and/or the risk of lower respiratory manifestations of a URI. Methods: We studied all children and children with asthma, 6-17 years of age in the National Health and Nutritional Examination Survey (2007-2012)...

Importance: Structural racism has been implicated in the disproportionally high asthma morbidity experienced by children living in disadvantaged, urban neighborhoods. Current approaches designed to reduce asthma triggers have modest impact. Objective: To examine whether participation in a housing mobility program that provided housing vouchers a...

Environmental justice is the concept that all people have the right to live in a healthy environment, to be protected against environmental hazards, and to participate in decisions affecting their communities. Communities of color and low-income populations live, work and play in environments with disproportionate exposure to hazards associated wit...

Background Air trapping is an obstructive phenotype that has been associated with more severe and unstable asthma in children. Recently, air trapping has been defined using pre- and post-bronchodilator spirometry. The causes of air trapping are not completely understood. It is possible that environmental exposures could be implicated in air trappin...

Background There are marked disparities in asthma-related emergency department (ED) visit rates among children by race and ethnicity. Following the implementation of COVID-19 prevention measures, asthma-related ED visits rates declined substantially. The decline has been attributed to the reduced circulation of upper respiratory viruses, a common t...

Objective: To determine if the addition of home environmental control strategies (ECSs) to controller medication titration reduces asthma controller medication requirements and in-home allergen concentrations among children with persistent asthma in Baltimore City. Methods: 155 children ages 5-17 with allergen-sensitized asthma were enrolled in...

Youths who are negatively affected by social determinants of health suffer adverse effects like increased risks of chronic health conditions and mental health issues. Part 3 of this series describes ways pediatricians can help fight these social determinants to promote health equity for our most vulnerable children. Available for purchase at https:...

Introduction: Atopic dermatitis (AD) is a common chronic childhood illness. It is often treated by primary care providers (PCPs) though it may require referral to a dermatology specialist. Method: We administered an exploratory survey to 50 caregivers of children aged 0-17 years with AD to assess their preferences and barriers toward accessing d...

Background/objectives: We sought to quantify the reliability and validity of remote atopic dermatitis (AD) severity assessment using the Eczema Area and Severity Index (EASI) applied to caregiver-provided photos (p-EASI) and videos (v-EASI). Methods: Children (0-17 years) with a physician diagnosis of AD were recruited. Caregivers took photos an...

Background Phthalates are synthetic chemicals present in building materials, personal care products and other consumer goods. Limited studies link phthalates to pediatric asthma incidence; however, their effects on respiratory-related outcomes among those with pre-existing asthma remains unclear. Objective We examined associations between phthalat...

Objective: To assess depression, anxiety, and burnout among health care workers using well-established validated scales and to examine associations of these mental health outcomes with personal protective equipment (PPE) and high-risk patient contact. Methods: This prospective survey was conducted between August and October 2020 among 970 essentia...

Rationale Environmental exposures have been associated with adverse outcomes in COPD. Approximately one third of individuals with COPD have allergic sensitization, but it is unknown whether exposure to allergens in the home are associated with outcomes. Objectives To determine the prevalence and associations of allergen sensitization with exposure...

BACKGROUND Neighborhood and caregiver characteristics have each been linked to children’s asthma outcomes, but less is known about how caregiver psychosocial functioning may explain the link between neighborhood characteristics and asthma outcomes. OBJECTIVE To examine associations between neighborhood safety, caregiver stress and depressive sympt...

Objective To synthesize the growing body of literature on the role of social determinants of health (SDoH) in asthma and asthma disparities. Data Sources A pubmed.gov search was performed to identify published literature on SDoH, asthma, asthma disparities, and race and ethnicity. Current asthma statistics of the Centers for Disease Control and Pr...

Background Whether concomitant home exposures modify the effectiveness of mouse allergen reduction among mouse-sensitized children with asthma is unknown. Objective To determine whether lower baseline home mouse allergen level, lower PM10, and absence of sensitization and exposure to other indoor allergens are associated with greater improvements...

Black people in the United States experience greater atopic dermatitis (AD) prevalence, severity, and persistence when compared with White people. Although very little published literature describes AD in the Latinx population, additional differences in severity, persistence, and age of onset exist in contrast to White people. Thus far, genetic pol...

There is an evolving body of literature that links chemicals commonly found in personal care products (PCPs) to an increased risk of both developing asthma and worsening existing asthma. Phthalates, parabens, environmental phenols, such as triclosan and bisphenol A (BPA), and other endocrine disrupting compounds (EDCs) have been implicated in asthm...

Background: African-American and Latinx children suffer from higher rates of uncontrolled asthma and poorer outcomes compared to white children. Sociocultural factors play a prominent role in how caregivers navigate asthma control for their children. Objectives: 1) Explore the knowledge, perceptions and behaviors of Latinx and African-American c...

Heat exposure of a population is often estimated by applying temperatures from outdoor monitoring stations. However, this can lead to exposure misclassification if residents do not live close to the monitoring station and temperature varies over small spatial scales due to land use/built environment variability, or if residents generally spend more...

Traditional measures of socioeconomic status (SES) are associated with asthma morbidity, but their specific contributions are unclear. Increased exposure to indoor allergens among low SES children is an important consideration. Material hardship, a concept describing poor access to basic goods and services, may explain the relationship between low...

Insulin-like growth factors (IGFs), and their binding proteins (IGFBPs), play a significant role in cardiovascular function and may influence the pathobiology of PAH. We determined the diagnostic and prognostic value of IGF1 and IGFBP2 in pediatric PAH. Serum was analyzed by ELISA for IGF1 and IGFBP2 in pediatric PAH subjects from the NHLBI PAH Bio...

Background Bisphenol A (BPA) has been linked with pediatric asthma development and allergic airway inflammation in animal models. Whether exposure to BPA or its structural analogs bisphenol S (BPS) and bisphenol F (BPF) is associated with asthma morbidity remains unknown. Objective We examined associations between bisphenols and morbidity due to p...

Background Little is known about the concordance of atopy with asthma COPD overlap (ACO). Among individuals with COPD, a better understanding of the phenotypes characterized by asthma overlap and atopy is needed to better target therapies. Research Question What is the overlap between atopy and asthma status among individuals with COPD, and how ar...

Background: Current childhood asthma therapies have little effect on lung function trajectory. Objective: We sought to determine whether mouse allergen exposure reduction is associated with lung function growth in mouse-sensitized/exposed asthmatic children. Methods: Three hundred fifty mouse-sensitized/exposed asthmatic children (5-17 years o...

Asthma impacts children, particularly in inner‐city populations.1 A recent US population‐based study identified that dog allergen exposure was associated with worse asthma among sensitized children.2 While this helped clarify prior inconsistent findings regarding the effect of dog allergen,3 their study population consisted of more affluent non‐His...

Background: Mouse allergen reduction is associated with improvements in asthma among sensitized and exposed children, but whether clinical characteristics predict responsiveness to allergen reduction is unclear. Objective: To examine the effects of clinical characteristics on relationships between mouse allergen reduction and asthma outcomes. M...

Background: Studies on the association between folate/folic acid exposure and the development of allergic disease have yielded inconsistent results, which may be due, in part, to lack of data distinguishing folate from folic acid exposure. Objective: To examine the association between total folate, 5-methyltetrahydrofolate (5-MTHF), and unmetabo...

Background: It is unknown whether caregiver perception of a child's asthma control, independent of guideline-based asthma control assessment, is a predictor of future acute visits. Objective: To determine whether caregiver-reported asthma control is an indicator of future risk of acute visit. Methods: Two study populations of low-income, minor...

Purpose of Review To review current indoor allergen sampling devices, including devices to measure allergen in reservoir and airborne dust, and personal sampling devices, with attention to sampling rationale and major indoor allergen size and characteristics. Recent Findings While reservoir dust vacuuming samples and airborne dust volumetric air s...

Background Upper respiratory tract colonization with a number of bacterial pathogens has been associated with significant respiratory disease and asthma in children. As part of a larger study to evaluate microbial contributions from animals to children with asthma, we tested the hypothesis that mammalian pets could harbor respiratory pathogens of r...

Rationale: In developing countries, poor and rural areas have a high burden of chronic obstructive pulmonary disease (COPD), and environmental pollutants and indoor burning of biomass have been implicated as potential causal exposures. Less is known about the prevalence of COPD in the United States with respect to urban-rural distribution, poverty...

Background: Parabens are synthetic preservatives present in many consumer products. Their antimicrobial and endocrine disrupting properties have raised concerns that they may play a role in respiratory and allergic diseases; however, studies exploring these associations are scarce. Objective: We examined the cross-sectional association between p...

Background: The disrupted skin barrier in eczema has been associated with an increased risk of immunoglobulin E (IgE) sensitization in childhood. However, it is unclear whether eczema, independent of atopy, is a risk factor for the development of allergic sensitization in adulthood. Objective: To determine if skin barrier dysfunction, independen...

Background: Urban minority children are at risk for poor asthma outcomes and may not receive appropriate primary or subspecialty care. Objective: We hypothesized that preschool children with asthma whose caregivers reported more barriers to care would be less likely to have seen their primary care provider (PCP) or an asthma subspecialist and mo...

Background: Exposure to endotoxin is known to trigger airway inflammation and symptoms, and atopy may modify the relationship between endotoxin exposure and symptom development. Objective: To test the a priori hypothesis that atopic status modifies the relationship between endotoxin exposure and respiratory symptom development. Methods: A pros...

Rationale Evidence from observational studies and to a lesser extent clinical trials suggest that a healthy diet may improve symptoms and lung function in patients with asthma. We conducted a pilot study to determine the feasibility of conducting a larger scale dietary trial and to provide preliminary evidence on the impact of a healthy diet on ast...

Table A. Sample Weekly Menu; Table B. Data: Serum Markers of Adherence; Table C. Data: Asthma Morbidity Outcomes; Table D. Data: Reported Dietary Intake in Foods; Table E. Data: Reported Dietary Intake in Nutrients; Table F. Change in Serum Markers of Adherence at 2 Weeks; Table G. Change in Asthma Morbidity Outcomes at 2 Weeks; Appendix A. Study P...

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African Americans have higher rates of asthma prevalence, morbidity, and mortality in comparison with other racial groups. We sought to characterize endotypes of childhood asthma severity in African American patients in an inner-city pediatric asthma population. Baseline blood neutrophils, blood eosinophils, and 38 serum cytokine levels were measur...

Chronic exposure to mouse allergen may contribute greatly to the inner-city asthma burden. We hypothesized that reducing mouse allergen exposure may modulate the immunopathology underlying symptomatic pediatric allergic asthma, and that this occurs through epigenetic regulation. To test this hypothesis, we studied a cohort of mouse sensitized, pers...

Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Environmental Health Sciences (NIEHS), National Heart, Lung, and Blood Institute (NHLBI), and Merck Childho...

Evidence-based clinical practice guidelines and policy statements from the AAP! Clinical practice guidelines have long provided physicians with an evidence-based decision-making tool for managing common pediatric conditions. Policies issued and endorsed by the American Academy of Pediatrics (AAP) represent the AAP position on child health care issu...