Early wheeze as reported by mothers and lung function in 4-year-olds. Prospective cohort study in Krakow

Asthma, bronchial hyperresponsiveness, allergy and lung function development until early adulthood: A systematic literature review

BACKGROUND

It is unclear in which periods of life lung function deficits develop, and whether these are affected by risk factors such as asthma, bronchial hyper-responsiveness (BHR) and allergic comorbidity. The goal of this systematic review was to identify temporal associations of asthma, BHR and allergic comorbidity with large and small lung function development from birth until peak function in early adulthood.

METHODS

We searched MEDLINE, EMBASE, Web of Science and CINAHL for papers published before 01.01.2020 on risk factors and lung function measurements of large and small airways. Studies were required to report lung function at any time point or interval from birth until peak lung function (age 21-26) and include at least one candidate risk factor.

RESULTS

Of the 45 papers identified, 44 investigated cohorts and one was a clinical trial with follow-up. Asthma, wheezing, BHR and allergic sensitization early in life and to multiple allergens were associated with a lower lung function growth of large and small airways during early childhood compared with the control populations. Lung function development after childhood in subjects with asthma or persistent wheeze, although continuing to grow at a lower level, largely tracked parallel to non-affected individuals until peak function was attained.

CLINICAL IMPLICATIONS AND FUTURE RESEARCH

Deficits in lung function growth develop in early childhood, and children with asthma, BHR and early-life IgE (poly)sensitization are at risk. This period is possibly a critical window of opportunity to identify at-risk subjects and provide treatment aimed at preventing long-term sequelae of lung function.

[Exposure to nitrogen dioxide and respiratory health at 2 years in the INMA-Valencia cohort]

OBJECTIVE

To analyze the association between exposure to nitrogen dioxide (NO₂) during pregnancy and the postnatal period up to the age of 2 years old and the incidence of respiratory problems in children from the INMA-Valencia cohort.

METHODS

The study population included 624 children from the INMA-Valencia cohort. Individual exposure to NO₂ was estimated in different environments outside the home during pregnancy and up to the age of 2 using empirical measurement and data from geo-statistical methods. Respiratory symptoms were obtained from a questionnaire applied at the age of two. The association between NO₂ exposure and respiratory symptoms was performed using multivariate logistic regression.

RESULTS

The cumulative incidence was 16.3% for persistent cough, 34.9% for wheezing and 27.6% for lower respiratory tract infections. No association was found between respiratory symptoms and exposure to NO₂ in any of the children. However an association between NO₂ exposure and persistent cough was found at two years of life in the children with a parental history of allergy.

CONCLUSION

NO₂ exposure would lead to persistent cough in children with a parental history of allergies.

Intraurban and longitudinal variability of classical pollutants in Kraków, Poland, 2000-2010

In spite of a dramatic decrease in anthropogenic emissions, ambient concentrations of major pollutants have not changed within many urban locations. To clarify the relationship between ambient air quality trend and the population exposures, we compared the intraurban versus temporal variability of the collocated measurements of five major air pollutants including particulate matter (PM) with an aerodynamic diameter <10 µm (PM₁₀), < 2.5 µm (PM₂.₅), tropospheric ozone (O₃), sulfur dioxide (SO₂), and nitrogen dioxide (NO₂), in Kraków, Poland, during the 2000-2010 period. Strong seasonal trends and overall absence of spatial heterogeneity in PM₁₀ and PM₂.₅, except in the traffic monitoring site, were observed across the monitoring network. The range of median PM₂.₅ concentrations during winter (54-64 µg/m³) was 3- to 4-times higher than the summer medians (15-26 µg/m³) across the sites during 2009-2010. Furthermore, large proportion of PM₁₀ appears to be comprised of PM₂.₅ (PM₂.₅/PM₁₀ concentration ratios range, 0.5-0.7). At each monitoring site, the Pearson's correlation coefficients between PM₂.₅ and PM₁₀ ranged between 0.944 and 0.963, suggesting a health-relevance of PM10 monitoring. One ln-unit increase in PM₁₀ was associated with 92%-100% increase in PM₂.₅ concentrations in the same location. While PM₁₀ did not demonstrate a clear temporal trend, SO₂ concentrations steadily declined by 40% during the 2000-2010 period. Summertime median NO₂ concentration was acutely elevated ‎(70 mg/m³ vs. 22 mg/m³) at the traffic oriented site compared to the city's central monitoring site. The traffic and the industrial sites were associated with highest number of days during which 24-hour mean PM₁₀ and PM₂.₅ concentrations exceeded the European Union standard. Steadily growing contributions by vehicular emissions appear to be associated with the absence of clear trend in PM₁₀. Current practices of air quality control within Kraków may not be adequate for the protection of the public's health.

Pulmonary function testing in young children

Pulmonary function testing (PFT) is of great importance in the evaluation and treatment of respiratory diseases. Spirometry is simple, noninvasive, and has been the most commonly used technique in cooperative children, obtaining reliable data in only a few minutes. The development of commercially available equipment as well as the simplification of previous techniques that now require minimal patient cooperation applied during tidal breathing have significantly stimulated the use of PFT in younger children. Tidal breathing techniques such as impulse oscillometry, gas dilution, and plethysmography have permitted previously unobtainable PFT in children 2 to 5 years of age. The purpose of this review is to help clinicians become familiar with available PFT techniques used in young children by discussing their general principles, clinical applications, and limitations.

Outdoor, but not indoor, nitrogen dioxide exposure is associated with persistent cough during the first year of life

BACKGROUND AND AIMS

Because their lungs and immune system are not completely developed, children are more susceptible to respiratory disease and more vulnerable to ambient pollution. We assessed the relation between prenatal and postnatal nitrogen dioxide (NO(2)) levels and the development of lower respiratory tract infections (LRTI), wheezing and persistent cough during the first year of life.

METHODS

The study population consisted of 352 children from a birth cohort in Valencia, Spain. Prenatal exposure to NO(2), a marker of traffic related air pollution was measured at 93 sampling sites spread over the study area during four different sampling periods of 7 days each. It was modeled for each residential address through land use regression using the empirical measurements and data from geographic information systems. Postnatal exposure was measured once inside and outside each home using passive samplers for a period of 14 days. Outcomes studied were any episode of LRTI during the child's first year of life diagnosed by a doctor (bronchitis, bronchiolitis or pneumonia), wheezing (defined as whistling sounds coming from the chest), and persistent cough (more than three consecutive weeks). Outcomes and potential confounders were obtained from structured questionnaires. Multiple logistic regression was used to identify associations.

RESULTS

The cumulative incidence (CI) at first year of life was 30.4% for LRTI (23.0% bronchiolitis, 11.9% bronchitis and 1.4% pneumonia), 26.1% for wheezing and 6.3% for persistent cough. The adjusted odds ratio (95% confidence interval) per 10μg/m(3) increment in postnatal outdoor NO(2) concentration was 1.40 (1.02-1.92) for persistent cough. We also found some pattern of association with LRTI, bronchiolitis, bronchitis, wheezing and persistent cough in different prenatal periods, although it was not statistically significant.

CONCLUSIONS

Our results indicate that exposure to outdoor, but not indoor, NO(2) during the first year of life increases the risk of persistent cough.