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Ducharme FM, Dell SD, Radhakrishnan D, Grad RM, Watson WT, Yang CL, Zelman M. Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper. Paediatr Child Health 2015; 20:353-71. [PMID: 26526095 DOI: 10.1093/pch/20.7.353] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥8 days/month) asthma-like symptoms or recurrent (≥2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.
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Affiliation(s)
- Francine M Ducharme
- Departments of Pediatrics and of Social and Preventive Medicine, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Montreal, Quebec
| | - Sharon D Dell
- Department of Pediatrics and IHPME, The Hospital for Sick Children, University of Toronto, Toronto
| | - Dhenuka Radhakrishnan
- Department of Pediatrics, Children's Hospital, London Health Sciences, Western University, London, Ontario
| | - Roland M Grad
- Department of Family Medicine, Jewish General Hospital, McGill University, Montreal, Quebec
| | - Wade Ta Watson
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia
| | - Connie L Yang
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia
| | - Mitchell Zelman
- Department of Pediatrics, Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Dalhousie University, Halifax, Nova Scotia
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52
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Ducharme FM, Dell SD, Radhakrishnan D, Grad RM, Watson WTA, Yang CL, Zelman M. Le diagnostic et la prise en charge de l’asthme chez les enfants d’âge préscolaire : document de principes de la Société canadienne de thoracologie et de la Société canadienne de pédiatrie. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.7.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Francine M Ducharme
- Départements de pédiatrie et de médecine sociale et préventive, Centre hospitalier universitaire Sainte-Justine, Université de Montréal, Montréal (Québec)
| | - Sharon D Dell
- Département de pédiatrie, The Hospital for Sick Children et Institute of Health Policy, Management and Evaluation, université de Toronto, Toronto (Ontario)
| | - Dhenuka Radhakrishnan
- Département de pédiatrie, Children’s Hospital, London Health Sciences Centre, université de Western Ontario, London (Ontario)
| | - Roland M Grad
- Département de médecine de famille, Hôpital général juif, Université McGill, Montréal (Québec)
| | - Wade TA Watson
- Département de pédiatrie, IWK Health Centre, université Dalhousie, Halifax (Nouvelle-Écosse)
| | - Connie L Yang
- Département de pédiatrie, British Columbia Children’s Hospital, université de la Colombie-Britannique, Vancouver (Colombie-Britannique)
| | - Mitchell Zelman
- Département de pédiatrie, Queen Elizabeth Hospital, Charlottetown (Île-du-Prince-Édouard), université Dalhousie, Halifax (Nouvelle-Écosse)
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Chung HL, Lee EJ, Park HJ, Lee KH. Increased epidermal growth factor in nasopharyngeal aspirates from infants with recurrent wheeze. Pediatr Pulmonol 2015; 50:841-7. [PMID: 25044265 DOI: 10.1002/ppul.23083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 05/27/2014] [Indexed: 11/08/2022]
Abstract
Airway remodeling is known to be a consequence of repeated injury and thought to be involved in early stage of asthma. We aimed to investigate the mediators associated with airway remodeling in recurrent early wheezers. Thirty-three infants, aged 2 years or less, admitted with exacerbation of wheezing were enrolled. All of them had experienced three or more episodes of wheezing before admission. They were categorized into two groups: those who had been hospitalized two or more times for severe wheezing (N = 19) and those who had only once or never been hospitalized (N = 14). Epidermal growth factor (EGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF)-β1 levels in nasopharyngeal aspirates (NPA) collected on admission were measured. The difference between two patients groups divided based on their hospitalization history was assessed. We also examined these mediators in older asthmatic children (N = 15) admitted with exacerbation and their relationship with lung function parameters measured after stabilization. NPA EGF levels were significantly increased in recurrent early wheezers compared to controls. EGF, VEGF, and TGF-β1 levels were significantly higher in those with a previous history of multiple hospitalizations than in those without. In older asthmatic children, EGF levels were related with age and duration of asthma, but showed an inverse correlation with forced expiratory volume in 1 sec and forced expiratory flow between 25% and 75% of vital capacity. Our study shows that there might be significant damage during exacerbation in wheezy infants as levels of the mediators, EGF, VEGF, and TGF-β1 were higher in those who had been frequently hospitalized. It seems to suggest that those infants with severe recurrent wheezing might have chronic airway obstruction.
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Affiliation(s)
- Hai Lee Chung
- Department of Pediatrics, School of Medicine, Catholic University of Taegu, Taegu, Korea
| | - Eun Joo Lee
- Department of Pediatrics, School of Medicine, Catholic University of Taegu, Taegu, Korea
| | - Hye Jin Park
- Department of Pediatrics, School of Medicine, Catholic University of Taegu, Taegu, Korea
| | - Kye Hyang Lee
- Department of Pediatrics, School of Medicine, Catholic University of Taegu, Taegu, Korea
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Hallberg J, Thunqvist P, Schultz ES, Kull I, Bottai M, Merritt AS, Chiesa F, Gustafsson PM, Melén E. Asthma phenotypes and lung function up to 16 years of age-the BAMSE cohort. Allergy 2015; 70:667-73. [PMID: 25703776 DOI: 10.1111/all.12598] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Asthma is a disease affecting many locations throughout the airway. Most studies have used spirometry as the primary assessment of airway obstruction, a method that may be less sensitive in regard to peripheral airway obstruction. The aim of this study was to elucidate the associations between asthma phenotypes based on age of onset and duration of symptoms, and (i) spirometry and (ii) small airway involvement measured by impulse oscillometry (IOS) in adolescence. METHODS Children and adolescents taking part in BAMSE, a prospective birth cohort study, performed spirometry at 8 and 16 years and IOS at 16 years of age. Based on data collected in questionnaires, children were categorized into the following groups: 'never asthma', 'early transient asthma', 'early persistent asthma', and 'late onset asthma'. RESULTS Compared with the never asthma group, all asthma groups were associated with lower FEV1 at 16 years of age (early transient-119 ml, 95% confidence interval -204 to -34; early persistent-410 ml, 95%CI -533; -287; and late onset-148 ml, 95%CI -237; -58). Between 8 and 16 years, significantly less increase in FEV1 was observed in the early persistent and late onset groups. The small airway index 'R5-20 ' was significantly associated with active asthma at 16 years, but not transient asthma. CONCLUSIONS All asthma phenotypes studied were negatively associated with FEV1 in adolescence. IOS measurements indicated that active asthma could be associated with small airway impairments. These results provide new insights into the physiology underlying wheezing phenotypes based on age of onset and duration of disease.
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Affiliation(s)
- J. Hallberg
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs' Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
| | - P. Thunqvist
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs' Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - E. S. Schultz
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - I. Kull
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs' Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Department of Clinical Science and Education; Södersjukhuset; Karolinska Institutet; Stockholm Sweden
| | - M. Bottai
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
| | - A.-S. Merritt
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for occupational and environmental medicine; Stockholm County Council; Stockholm Sweden
| | - F. Chiesa
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - P. M. Gustafsson
- The Sahlgrenska Academy at the University of Gothenburg; Gothenburg Sweden
- Department of Pediatrics; Central Hospital; Skövde Sweden
| | - E. Melén
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs' Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
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55
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Diagnosis and management of asthma in preschoolers: A Canadian Thoracic Society and Canadian Paediatric Society position paper. Can Respir J 2015; 22:135-43. [PMID: 25893310 DOI: 10.1155/2015/101572] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥ 8 days/month) asthma-like symptoms or recurrent (≥ 2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.
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56
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Thomsen SF. Epidemiology and natural history of atopic diseases. Eur Clin Respir J 2015; 2:24642. [PMID: 26557262 PMCID: PMC4629767 DOI: 10.3402/ecrj.v2.24642] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 02/01/2015] [Indexed: 01/17/2023] Open
Abstract
The atopic diseases – atopic dermatitis, asthma, and hay fever – pose a great burden to the individual and society, not least, since these diseases have reached epidemic proportions during the past decades in industrialized and, more recently, in developing countries. Whereas the prevalence of the atopic diseases now seems to have reached a plateau in many Western countries, they are still on the increase in the developing world. This emphasizes continuing research aimed at identifying the causes, risk factors, and natural history of these diseases. Herein, the fundamental aspects of the natural history and epidemiology of the atopic diseases are reviewed.
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Affiliation(s)
- Simon F Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
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57
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Karvonen AM, Hyvärinen A, Korppi M, Haverinen-Shaughnessy U, Renz H, Pfefferle PI, Remes S, Genuneit J, Pekkanen J. Moisture damage and asthma: a birth cohort study. Pediatrics 2015; 135:e598-606. [PMID: 25687143 DOI: 10.1542/peds.2014-1239] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Excess moisture and visible mold are associated with increased risk of asthma. Only a few studies have performed detailed home visits to characterize the extent and location of moisture damage and mold growth. METHODS Structured home inspections were performed in a birth cohort study when the children were 5 months old (on average). Children (N = 398) were followed up to the age of 6 years. Specific immunoglobulin E concentrations were determined at 6 years. RESULTS Moisture damage and mold at an early age in the child's main living areas (but not in bathrooms or other interior spaces) were associated with the risk of developing physician-diagnosed asthma ever, persistent asthma, and respiratory symptoms during the first 6 years. Associations with asthma ever were strongest for moisture damage with visible mold in the child's bedroom (adjusted odds ratio: 4.82 [95% confidence interval: 1.29-18.02]) and in the living room (adjusted odds ratio: 7.51 [95% confidence interval: 1.49-37.83]). Associations with asthma ever were stronger in the earlier part of the follow-up and among atopic children. No consistent associations were found between moisture damage with or without visible mold and atopic sensitization. CONCLUSIONS Moisture damage and mold in early infancy in the child's main living areas were associated with asthma development. Atopic children may be more susceptible to the effects of moisture damage and mold.
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Affiliation(s)
- Anne M Karvonen
- Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland;
| | - Anne Hyvärinen
- Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland
| | - Matti Korppi
- Pediatric Research Center, Tampere University and University Hospital, University of Tampere, Tampere, Finland
| | | | - Harald Renz
- Institute for Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-University Marburg, Marburg, Germany
| | - Petra I Pfefferle
- Institute for Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps-University Marburg, Marburg, Germany
| | - Sami Remes
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany; and
| | - Juha Pekkanen
- Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on childhood asthma specifically related to the underlying genetic background and pathophysiology of asthma and their interaction with environmental stimuli. We will also discuss emerging data in the field of disease phenotyping. RECENT FINDINGS The field of genetics is continuously evolving to expand our knowledge on the cause of disease. Childhood onset asthma has been related to atopy and exposure to early-life infections. More recently, phenotypes have been used to classify asthma as transient and persistent, but the association of each phenotype with the genetic origin of asthma is not clearly understood. SUMMARY This review covers the topics of genetics, epigenetics, pathophysiology, phenotypes and treatment as they relate to childhood asthma. Overall, it provides a basis for the future of asthma treatment through description of the current research.
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Ferry OR, Duffy DL, Ferreira MAR. Early life environmental predictors of asthma age-of-onset. IMMUNITY INFLAMMATION AND DISEASE 2014; 2:141-51. [PMID: 25505548 PMCID: PMC4257759 DOI: 10.1002/iid3.27] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 01/20/2023]
Abstract
Prevention strategies that delay the onset of asthma may improve clinical outcomes. To identify early life environmental exposures associated with asthma age-of-onset and potential genetic modifiers of these exposures, we studied 1085 subjects with physician-diagnosed asthma and disease onset at or after age two. Subjects reported retrospectively on their exposure to 17 environmental factors before the age of two. The presence of individual or combinations of these early life exposures was then tested for association with variation in asthma age-of-onset. For exposures significantly associated with age-of-onset, we tested if 26 single nucleotide polymorphisms (SNP) with an established association with allergic disease significantly modified the effect of the exposure. Five environmental exposures were significantly associated with variation in asthma age-of-onset after correction for multiple testing: carpet at home (P = 6 × 10−5), a serious chest illness (P = 10−4), father a cigarette smoker (P = 6 × 10−4) and direct exposure to father's smoking (P = 3 × 10−4). Individuals with early childhood asthma onset, between the ages of two and six, were 1.4-fold (CI 1.1–1.9) more likely to report having lived in a house with carpet and 2.1-fold (CI 1.3–3.5) more likely to report suffering a serious chest illness before the age of two, than asthmatics with later disease onset. We further found these individual risks to increase to 3.2-fold (CI 1.7–6.0) if carpet exposure and suffering a serious chest illness co-occurred before age two. Paternal smoking exposures were less likely to be reported by asthmatics with early when compared to later disease onset (OR 0.5, CI 0.3–0.7). There were no significant SNP interactions with these environmental exposures after correction for multiple testing. Our results suggest that disease onset in individuals at a high-risk of developing asthma can potentially be delayed by avoiding exposure to carpet at home and preventing serious chest illnesses during the first 2 years of life.
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Affiliation(s)
- Olivia R Ferry
- QIMR-Berghofer Medical Research Institute Brisbane, Australia
| | - David L Duffy
- QIMR-Berghofer Medical Research Institute Brisbane, Australia
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60
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Abstract
Preschool children (ie, those aged 5 years or younger) with wheeze consume a disproportionately high amount of health-care resources compared with older children and adults with wheeze or asthma, representing a diagnostic challenge. Although several phenotype classifications have been described, none have been validated to identify individuals responding to specific therapeutic approaches. Several risk factors related to genetic, prenatal, and postnatal environment are associated with preschool wheezing. Findings from several cohort studies have shown that preschool children with wheeze have deficits in lung function at 6 years of age that persisted until early and middle adulthood, suggesting increased susceptibility in the first years of life that might lead to persistent sequelae. Daily inhaled corticosteroids seem to be the most effective therapy for recurrent wheezing in trials of children with interim symptoms or atopy; intermittent high-dose inhaled corticosteroids are effective in moderate-to-severe viral-induced wheezing without interim symptoms. The role of leukotriene receptor antagonist is less clear. Interventions to modify the short-term and long-term outcomes of preschool wheeze should be a research priority.
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Affiliation(s)
- Francine M Ducharme
- Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada; Department of Paediatrics, University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.
| | - Sze M Tse
- Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada; Department of Paediatrics, University of Montreal, Montreal, QC, Canada
| | - Bhupendrasinh Chauhan
- Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada
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Been JV, Nurmatov UB, Cox B, Nawrot TS, van Schayck CP, Sheikh A. Effect of smoke-free legislation on perinatal and child health: a systematic review and meta-analysis. Lancet 2014; 383:1549-60. [PMID: 24680633 DOI: 10.1016/s0140-6736(14)60082-9] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Smoke-free legislation has the potential to reduce the substantive disease burden associated with second-hand smoke exposure, particularly in children. We investigated the effect of smoke-free legislation on perinatal and child health. METHODS We searched 14 online databases from January, 1975 to May, 2013, with no language restrictions, for published studies, and the WHO International Clinical Trials Registry Platform for unpublished studies. Citations and reference lists of articles of interest were screened and an international expert panel was contacted to identify additional studies. We included studies undertaken with designs approved by the Cochrane Effective Practice and Organisation of Care that reported associations between smoking bans in workplaces, public places, or both, and one or more predefined early-life health indicator. The primary outcomes were preterm birth, low birthweight, and hospital attendances for asthma. Effect estimates were pooled with random-effects meta-analysis. This study is registered with PROSPERO, number CRD42013003522. FINDINGS We identified 11 eligible studies (published 2008-13), involving more than 2·5 million births and 247,168 asthma exacerbations. All studies used interrupted time-series designs. Five North American studies described local bans and six European studies described national bans. Risk of bias was high for one study, moderate for six studies, and low for four studies. Smoke-free legislation was associated with reductions in preterm birth (four studies, 1,366,862 individuals; -10·4% [95% CI -18·8 to -2·0]; p=0·016) and hospital attendances for asthma (three studies, 225,753 events: -10·1% [95% CI -15·2 to -5·0]; p=0·0001). No significant effect on low birthweight was identified (six studies, >1·9 million individuals: -1·7% [95% CI -5·1 to 1·6]; p=0·31). INTERPRETATION Smoke-free legislation is associated with substantial reductions in preterm births and hospital attendance for asthma. Together with the health benefits in adults, this study provides strong support for WHO recommendations to create smoke-free environments. FUNDING Thrasher Fund, Lung Foundation Netherlands, International Paediatric Research Foundation, Maastricht University, Commonwealth Fund.
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Affiliation(s)
- Jasper V Been
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK; Department of Paediatrics, Maastricht University Medical Centre, Maastricht, Netherlands.
| | - Ulugbek B Nurmatov
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Bianca Cox
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Department of Public Health, University of Leuven, Leuven, Belgium
| | - Constant P van Schayck
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands; Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
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62
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Bousquet J, Gern JE, Martinez FD, Anto JM, Johnson CC, Holt PG, Lemanske RF, Le Souëf PN, Tepper RS, von Mutius ERM, Arshad SH, Bacharier LB, Becker A, Belanger K, Bergström A, Bernstein DI, Cabana MD, Carroll KN, Castro M, Cooper PJ, Gillman MW, Gold DR, Henderson J, Heinrich J, Hong SJ, Jackson DJ, Keil T, Kozyrskyj AL, Lødrup Carlsen KC, Miller RL, Momas I, Morgan WJ, Noel P, Ownby DR, Pinart M, Ryan PH, Schwaninger JM, Sears MR, Simpson A, Smit HA, Stern DA, Subbarao P, Valenta R, Wang X, Weiss ST, Wood R, Wright AL, Wright RJ, Togias A, Gergen PJ. Birth cohorts in asthma and allergic diseases: report of a NIAID/NHLBI/MeDALL joint workshop. J Allergy Clin Immunol 2014; 133:1535-46. [PMID: 24636091 DOI: 10.1016/j.jaci.2014.01.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/16/2014] [Accepted: 01/21/2014] [Indexed: 11/30/2022]
Abstract
Population-based birth cohorts on asthma and allergies increasingly provide new insights into the development and natural history of the diseases. More than 130 birth cohorts focusing on asthma and allergy have been initiated in the last 30 years. A National Institute of Allergy and Infectious Diseases; National Heart, Lung, and Blood Institute; Mechanisms of the Development of Allergy (MeDALL; Framework Programme 7 of the European Commission) joint workshop was held in Bethesda, Maryland, on September 11-12, 2012, with 3 objectives: (1) documenting the knowledge that asthma/allergy birth cohorts have provided, (2) identifying the knowledge gaps and inconsistencies, and (3) developing strategies for moving forward, including potential new study designs and the harmonization of existing asthma birth cohort data. The meeting was organized around the presentations of 5 distinct workgroups: (1) clinical phenotypes, (2) risk factors, (3) immune development of asthma and allergy, (4) pulmonary development, and (5) harmonization of existing birth cohorts. This article presents the workgroup reports and provides Web links (AsthmaBirthCohorts.niaid.nih.gov or www.medall-fp7.eu), where the reader will find tables describing the characteristics of the birth cohorts included in this report, the type of data collected at differing ages, and a selected bibliography provided by the participating birth cohorts.
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Affiliation(s)
- Jean Bousquet
- University Hospital, Montpellier and INSERM U1018, Villejuif, France.
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - Josep M Anto
- Centre for Research in Environmental Epidemiology (CREAL) and IMIM (Hospital del Mar Research Institute) and CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Pompeu Fabra, Departament de Ciències Experimentals i de la Salut, Barcelona, Spain
| | - Christine C Johnson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich
| | - Patrick G Holt
- Telethon Institute for Child Health Research, University of Western Australia, and Queensland Children's Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Robert F Lemanske
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Peter N Le Souëf
- School of Paediatrics and Child Health, Princess Margaret Hospital for Children, University of Western Australia, Perth, Australia
| | - Robert S Tepper
- Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Indianapolis, Ind
| | | | - S Hasan Arshad
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and the David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| | | | - Allan Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathleen Belanger
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, School of Medicine, New Haven, Conn
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David I Bernstein
- Division of Immunology, Allergy and Rheumatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael D Cabana
- Departments of Pediatrics, Epidemiology & Biostatistics, the University of California, San Francisco, Calif
| | - Kecia N Carroll
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Mo
| | - Philip J Cooper
- Liverpool School of Tropical Medicine, Liverpool, and Escuela de Biologia, Pontificia Universidad Catolica del Ecuador, Quito, Ecuador
| | - Matthew W Gillman
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, and Harvard School of Public Health, Department of Environmental Health, Boston, Mass
| | - John Henderson
- School of Social & Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Joachim Heinrich
- Helmholtz Zentrum, Muenchen, German Center for Environmental Health, Institute of Epidemiology I, Munich, Germany
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitaetsmedizin Berlin, Berlin, and Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rachel L Miller
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University, New York, NY
| | - Isabelle Momas
- Department of Public Health and Biostatistics, Paris Descartes University, Sorbonne, and Paris Municipal Department of Social Action, Childhood, and Health, Paris, France
| | - Wayne J Morgan
- Department of Pediatrics, University of Arizona, Tucson, Ariz
| | - Patricia Noel
- Division of Lung Diseases, National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health, Bethesda, Md
| | | | - Mariona Pinart
- Centre for Research in Environmental Epidemiology (CREAL) and IMIM (Hospital del Mar Research Institute) and CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Patrick H Ryan
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Julie M Schwaninger
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Malcolm R Sears
- Department of Medicine, AstraZeneca Chair in Respiratory Epidemiology, McMaster University, Hamilton, Ontario, Canada
| | - Angela Simpson
- Centre for Respiratory and Allergy, Institute of Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester and University Hospital of South Manchester, Manchester, United Kingdom
| | - Henriette A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Debra A Stern
- Arizona Respiratory Center, University of Arizona, Tucson, Ariz
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Xiaobin Wang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Scott T Weiss
- Harvard Medical School, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Robert Wood
- Department of Pediatrics, Division of Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Anne L Wright
- Arizona Respiratory Center and the Department of Pediatrics, University of Arizona College of Medicine, Tucson, Ariz
| | - Rosalind J Wright
- Department of Pediatrics and Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Peter J Gergen
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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Yang HJ, Kim BS, Kim WK, Kim J, Kim JT, Suh DI, Koh YY, Shin YH, Lee SY, Lim DH, Choung JT, Kim HB. Phenotype and endotype in pediatric asthma. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.2.85] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Hyeon-Jong Yang
- Department of Pediatrics, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Bong-Seong Kim
- Department of Pediatrics, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jakyoung Kim
- Department of Pediatrics, Kangwon National University School of Medicine, Chunchon, Korea
| | - Jin Tack Kim
- Department of Pediatrics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Yull Koh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Youn Ho Shin
- Department of Pediatrics, CHA University College of Medicine, Pocheon, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Korea
- Environmental Health Center for Allergic Rhinitis, Inha University Hospital, Ministry of Environment, Incheon, Korea
| | - Ji Tae Choung
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
- Environmental Health Center for Asthma, Korea University Anam Hospital, Ministry of Environment, Seoul, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Mirabelli MC, Beavers SF, Chatterjee AB, Moorman JE. Age at asthma onset and subsequent asthma outcomes among adults with active asthma. Respir Med 2013; 107:1829-36. [PMID: 24139624 PMCID: PMC4512733 DOI: 10.1016/j.rmed.2013.09.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/24/2013] [Accepted: 09/26/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Little is known about the extent to which the age at which asthma first began influences respiratory health later in life. We conducted these analyses to examine the relationship between age at asthma onset and subsequent asthma-related outcomes. METHODS We used data from 12,216 adults with asthma who participated in the 2010 Behavioral Risk Factor Surveillance System Asthma Call-back Survey to describe the distribution of age at asthma onset. Linear regression was used to estimate associations of age at asthma onset with asthma-related outcomes, including symptoms in the past 30 days and asthma-related emergency visits. RESULTS Asthma onset before age 16 was reported by an estimated 42% of adults with active asthma, including 14% with onset at 5-9 years of age who reported experiencing any asthma symptoms on 21% of days in the past month. Compared to this group, the percentage of days in the past month with any asthma symptoms was 14.8% higher (95% confidence interval (CI): 5.4, 24.1) among those whose asthma onset occurred at <1 year. When age at onset occurred at 10 years or older there was little change in the prevalence of asthma-related emergency visits across age at onset categories. CONCLUSION Age at asthma onset may affect subsequent asthma-related outcomes.
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Affiliation(s)
- Maria C Mirabelli
- Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-60, Atlanta, GA 30341, USA.
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Örtqvist AK, Lundholm C, Wettermark B, Ludvigsson JF, Ye W, Almqvist C. Validation of asthma and eczema in population-based Swedish drug and patient registers. Pharmacoepidemiol Drug Saf 2013; 22:850-60. [PMID: 23754713 DOI: 10.1002/pds.3465] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/02/2013] [Accepted: 04/29/2013] [Indexed: 11/08/2022]
Abstract
PURPOSE Validated measures of asthma and eczema at the population level remain a challenge. Our aim was to ascertain if register-based information on asthma/eczema medication can function as a proxy for an asthma/eczema diagnosis and to validate register-based asthma diagnoses. METHODS Information was requested on all 0-45-year-old individuals with reported asthma/eczema medication and/or diagnoses in the Swedish Prescribed Drug Register and National Patient Register, between July 2005 and December 2009 (N = 250 691). Medical records for 1952 randomly selected individuals were reviewed to estimate the proportion of individuals with the following: (1) asthma/eczema medication that fulfilled predefined criteria of asthma/eczema (positive predictive value (PPV)) and (2) a register-based asthma diagnosis verified as asthma by predefined criteria. RESULTS Positive predictive value for asthma by predefined criteria ranged between 0.75 (95%CI: 0.70-0.78) to 0.94 (95%CI: 0.91-0.96), depending on age group. In pre-school children, PPV for asthma in combination with obstructive bronchitis was 0.87 (95%CI: 0.83-0.90), and PPV for eczema was estimated to 0.45 (95%CI: 0.38-0.51). Eighty percent of children 0-4.5 years and 99% of children >4.5-17 years with a register-based diagnosis of asthma were verified as asthmatics. CONCLUSION Asthma medication is a suitable proxy for asthma in older children and adults; the same approach is insufficient for eczema. This validation study of two Swedish registers opens for future large nation-wide register-based studies on asthma.
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Affiliation(s)
- Anne K Örtqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Bochner BS, Rothenberg ME, Boyce JA, Finkelman F. Advances in mechanisms of allergy and clinical immunology in 2012. J Allergy Clin Immunol 2013; 131:661-7. [PMID: 23352632 DOI: 10.1016/j.jaci.2012.12.676] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
Manuscripts published in the "Mechanisms of allergy and clinical immunology" section of the Journal of Allergy and Clinical Immunology during 2012 enhanced our knowledge of the involvement of cytokines and other mediators in allergic disorders and described novel approaches for understanding mechanisms of allergic and immunologic diseases. Also published were articles focused on mechanisms of allergen-specific immunotherapy and the development of novel antiallergic treatments, as well as strategies to achieve tolerance to allergens. The highlights of these studies and their potential clinical implications are summarized in this review.
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Affiliation(s)
- Bruce S Bochner
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Abstract
Last year's "Advances in pediatric asthma: moving forward" concluded the following: "Now is also the time to utilize information recorded in electronic medical records to develop innovative disease management plans that will track asthma over time and enable timely decisions on interventions in order to maintain control that can lead to disease remission and prevention." This year's summary will focus on recent advances in pediatric asthma on modifying disease activity, preventing asthma exacerbations, managing severe asthma, and risk factors for predicting and managing early asthma, as indicated in Journal of Allergy and Clinical Immunology publications in 2012. Recent reports continue to shed light on methods to improve asthma management through steps to assess disease activity, tools to standardize outcome measures in asthma, genetic markers that predict risk for asthma and appropriate treatment, and interventions that alter the early presentation of asthma to prevent progression. We are well on our way to creating a pathway around wellness in asthma care and also to use new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.
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Affiliation(s)
- Stanley J Szefler
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, National Jewish Health, Denver, CO 80206, USA.
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Early asthma: stepping closer to primary prevention. J Allergy Clin Immunol 2012; 130:308-10. [PMID: 22846745 DOI: 10.1016/j.jaci.2012.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 02/07/2023]
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