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Beasley R, Hughes R, Agusti A, Calverley P, Chipps B, del Olmo R, Papi A, Price D, Reddel H, Müllerová H, Rapsomaniki E. Prevalence, Diagnostic Utility and Associated Characteristics of Bronchodilator Responsiveness. Am J Respir Crit Care Med 2024; 209:390-401. [PMID: 38029294 PMCID: PMC10878375 DOI: 10.1164/rccm.202308-1436oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/29/2023] [Indexed: 12/01/2023] Open
Abstract
Rationale: The prevalence and diagnostic utility of bronchodilator responsiveness (BDR) in a real-life setting is unclear. Objective: To explore this uncertainty in patients aged ⩾12 years with physician-assigned diagnoses of asthma, asthma and chronic obstructive pulmonary disease (COPD), or COPD in NOVELTY, a prospective cohort study in primary and secondary care in 18 countries. Methods: The proportion of patients with a positive BDR test in each diagnostic category was calculated using 2005 (ΔFEV1 or ΔFVC ⩾12% and ⩾200 ml) and 2021 (ΔFEV1 or ΔFVC >10% predicted) European Respiratory Society/American Thoracic Society criteria. Measurements and Main Results: We studied 3,519 patients with a physician-assigned diagnosis of asthma, 833 with a diagnosis of asthma + COPD, and 2,436 with a diagnosis of COPD. The prevalence of BDR was 19.7% (asthma), 29.6% (asthma + COPD), and 24.7% (COPD) using 2005 criteria and 18.1%, 23.3%, and 18.0%, respectively, using 2021 criteria. Using 2021 criteria in patients diagnosed with asthma, BDR was associated with higher fractional exhaled nitric oxide; lower lung function; higher symptom burden; more frequent hospital admissions; and greater use of triple therapy, oral corticosteroids, or biologics. In patients diagnosed with COPD, BDR (2021) was associated with lower lung function and higher symptom burden. Conclusions: BDR prevalence in patients with chronic airway diseases receiving treatment ranges from 18% to 30%, being modestly lower with the 2021 than with the 2005 European Respiratory Society/American Thoracic Society criteria, and it is associated with lower lung function and greater symptom burden. These observations question the validity of BDR as a key diagnostic tool for asthma managed in clinical practice or as a standard inclusion criterion for clinical trials of asthma and instead suggest that BDR be considered a treatable trait for chronic airway disease.
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Affiliation(s)
- Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Rod Hughes
- Research and Early Development, Respiratory and Immunology, Clinical, AstraZeneca, Cambridge, United Kingdom
| | - Alvar Agusti
- University of Barcelona, Respiratory Institute, Clinic Barcelona, IDIBAPS, and CIBERES, Barcelona, Spain
| | - Peter Calverley
- University of Liverpool Institute of Life Course and Medical Sciences, Liverpool, United Kingdom
| | - Bradley Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, California
| | - Ricardo del Olmo
- Diagnostic and Treatment Department of María Ferrer Hospital & IDIM CR, Buenos Aires, Argentina
| | - Alberto Papi
- Research Centre on Asthma and Chronic Obstructive Pulmonary Disease, University of Ferrara, Ferrara, Italy
| | - David Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Helen Reddel
- Woolcock Institute of Medical Research, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University
- Sydney Local Health District, Sydney, Australia; and
| | - Hana Müllerová
- BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
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2
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Lazarusic NK, Kasap EB, Tolic E, Dokoza M, Pavlisa G. Value of Fractional Exhaled Nitric Oxide in Diagnosing Mild Asthma Responsive to Inhaled Corticosteroids. J Clin Med 2023; 12:jcm12093330. [PMID: 37176770 PMCID: PMC10179178 DOI: 10.3390/jcm12093330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Mild asthma is often characterized by normal spirometric values and a negative bronchodilation test (BDT), which makes accurate diagnosis challenging. The aim of our study was to evaluate the diagnostic accuracy of fractional exhaled nitric oxide (FeNO) in mild asthma. METHODS In adults with symptoms suggestive of asthma and normal spirometry values, BDT, FeNO, BPT and skin prick testing were performed. Patients with positive BPT started inhaled corticosteroid (ICS) therapy. Those with positive response to ICS were considered asthmatics. RESULTS There were 142 asthmatics and 140 non-asthmatics. No significant difference was found in BDT between the groups, p = 0.233. Median FeNO levels were significantly higher in the asthma group (49.5 ppb) than in the non-asthma group (23 ppb), p < 0.001. BPT was positive in 145 (51.42%) and negative in 137 (48.58%) patients. Positive response to ICS treatment was recorded in 142/145 (97.9%) patients. In diagnosing asthma, FeNO ≥ 25 ppb had a sensitivity of 75.4% and specificity of 47.9%. CONCLUSIONS FeNO has insufficient sensitivity and specificity in mild asthma and the application of BPT is often necessary to establish an accurate diagnosis.
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Affiliation(s)
| | | | - Ena Tolic
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Martina Dokoza
- Department of Pulmonology, General Hospital, 23000 Zadar, Croatia
| | - Gordana Pavlisa
- Clinic for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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3
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Tuomisto LE, Ilmarinen P, Lehtimäki L, Niemelä O, Tommola M, Kankaanranta H. Clinical value of bronchodilator response for diagnosing asthma in steroid-naïve adults. ERJ Open Res 2021; 7:00293-2021. [PMID: 34912880 PMCID: PMC8666574 DOI: 10.1183/23120541.00293-2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/24/2021] [Indexed: 11/05/2022] Open
Abstract
Spirometry and testing for bronchodilator response have been recommended to detect asthma, and a bronchodilator response (BDR) of ≥12% and ≥200 mL has been suggested to confirm asthma. However, the clinical value of bronchodilation tests in newly diagnosed steroid-naïve adult patients with asthma remains unknown. We evaluated the sensitivity of BDR in forced expiratory volume in 1 s (FEV1) as a diagnostic test for asthma in a real-life cohort of participants in the Seinäjoki Adult Asthma Study. In the diagnostic phase, 369 spirometry tests with bronchodilation were performed for 219 steroid-naïve patients. The fulfilment of each test threshold was assessed. According to the algorithm of the National Institute for Health and Care Excellence, we divided the patients into obstructive (FEV1/forced vital capacity (FVC) <0.70) and non-obstructive (FEV1/FVC ≥0.70) groups. Of the overall cohort, 35.6% fulfilled ΔFEV1 ≥12% and ≥200 mL for the initial FEV1, 18.3% fulfilled ΔFEV1 ≥15% and ≥400 mL for the initial FEV1, and 36.1% fulfilled ΔFEV1 ≥9% of predicted FEV1 at least once. One-third (31%) of these steroid-naïve patients was obstructive (pre-bronchodilator FEV1/FVC <0.7). Of the obstructive patients, 55.9%, 26.5% and 48.5%, respectively, met the same thresholds. In multivariate logistic regression analysis, different thresholds recognised different kinds of asthma patients. In steroid-naïve adult patients, the current BDR threshold (ΔFEV1 ≥12% and ≥200 mL) has low diagnostic sensitivity (36%) for asthma. In obstructive patients, sensitivity is somewhat higher (56%) but far from optimal. If the first spirometry test with bronchodilation is not diagnostic but asthma is suspected, spirometry should be repeated, and other lung function tests should be used to confirm the diagnosis.
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Affiliation(s)
- Leena E Tuomisto
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pinja Ilmarinen
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Dept of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Minna Tommola
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Dept of Respiratory Medicine, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannu Kankaanranta
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Centre, Dept of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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4
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Louis R, Louis G, Bonhomme O. NOVELTY: a landmark study in phenotyping and endotyping chronic obstructive airway diseases in real clinical practice. Eur Respir J 2021; 58:58/3/2100627. [PMID: 34556532 DOI: 10.1183/13993003.00627-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/05/2022]
Affiliation(s)
| | - Gilles Louis
- Dept of Public Health, University of Liege, Liege, Belgium
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5
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Vempilly JJ, Rashidian A, Jain VV, Abejie BA, Bhakta N. Residual Volume Responsiveness Testing May Improve the Detection of Reversible Airway Obstruction in Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:250-256. [PMID: 34536615 DOI: 10.1016/j.jaip.2021.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 08/07/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Residual volume responsiveness to bronchodilator administration has been observed in subjects with chronic obstructive pulmonary disease. However, the prevalence of residual volume (RV) responsiveness has not been formally studied in asthma. OBJECTIVE To identify the prevalence and magnitude of RV responsiveness in asthma. METHODS Physician-diagnosed adult subjects with asthma on treatment for >12 months were prospectively recruited to perform spirometry and measurement of lung volumes using body plethysmography before and after administration of 360 μg of albuterol. RESULTS Among 120 subjects, 76% were women. The ethnic composition was 64% Caucasian, 32% Hispanic, and 13% African American. The mean age was 52 ± 15 years. The mean duration of asthma was 16 ± 15 years. The mean RV% responsiveness was -7.74 ± 14. Whereas patients with the lowest baseline forced expiratory volume in 1 second (FEV1) value showed the highest mean responsiveness (P = .001), the baseline RV value had minimal influence on RV responsiveness. Using -7.74% to define significant RV responsiveness, and ≥12% and ≥200 mL to define significant FEV1 responsiveness, more subjects showed isolated RV responsiveness (37%) compared with 6% with isolated FEV1 responsiveness and 14% with both FEV1 and RV responsiveness (P = .04). There was a minimal correlation between FEV1 responsiveness and RV responsiveness (r = 0.17, P = .06). The RV responsiveness was significantly associated with the wheeze score (P = .006) and dyspnea score (P = .029). CONCLUSION The addition of RV responsiveness testing to spirometry based responsiveness testing can improve the identification of reversible airway obstruction in asthma. RV responsiveness may be useful in monitoring symptoms associated with air trapping in asthma.
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Affiliation(s)
- Jose J Vempilly
- Division of Pulmonary and Critical Care, University of California San Francisco, Fresno, Calif.
| | - Ali Rashidian
- Division of Pulmonary and Critical Care, University of California San Francisco, Fresno, Calif
| | - Vipul V Jain
- Division of Pulmonary and Critical Care, University of California San Francisco, Fresno, Calif
| | - Belayneh A Abejie
- Division of Occupational Medicine, University of California San Francisco, Fresno, Calif
| | - Nirav Bhakta
- Division of Pulmonary and Critical Care, University of California San Francisco, Fresno, Calif
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6
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Tan DJ, Lodge CJ, Lowe AJ, Bui DS, Bowatte G, Johns DP, Hamilton GS, Thomas PS, Abramson MJ, Walters EH, Perret JL, Dharmage SC. Bronchodilator reversibility as a diagnostic test for adult asthma: findings from the population-based Tasmanian Longitudinal Health Study. ERJ Open Res 2021; 7:00042-2020. [PMID: 33585659 PMCID: PMC7869605 DOI: 10.1183/23120541.00042-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Bronchodilator reversibility (BDR) is often used as a diagnostic test for adult asthma. However, there has been limited assessment of its diagnostic utility. We aimed to determine the discriminatory accuracy of common BDR cut-offs in the context of current asthma and asthma–COPD overlap (ACO) in a middle-aged community sample. The Tasmanian Longitudinal Health Study is a population-based cohort first studied in 1968 (n=8583). In 2012, participants completed respiratory questionnaires and spirometry (n=3609; mean age 53 years). Receiver operating characteristic (ROC) curves were fitted for current asthma and ACO using continuous BDR measurements. Diagnostic parameters were calculated for different categorical cut-offs. Area under the ROC curve (AUC) was highest when BDR was expressed as change in forced expiratory volume in 1 s (FEV1) as a percentage of initial FEV1, as compared with predicted FEV1. The corresponding AUC was 59% (95% CI 54–64%) for current asthma and 87% (95% CI 81–93%) for ACO. Of the categorical cut-offs examined, the European Respiratory Society/American Thoracic Society threshold (≥12% from baseline and ≥200 mL) was assessed as providing the best balance between positive and negative likelihood ratios (LR+ and LR−, respectively), with corresponding sensitivities and specificities of 9% and 97%, respectively, for current asthma (LR+ 3.26, LR− 0.93), and 47% and 97%, respectively, for ACO (LR+ 16.05, LR− 0.55). With a threshold of ≥12% and ≥200 mL from baseline, a positive BDR test provided a clinically meaningful change in the post-test probability of disease, whereas a negative test did not. BDR was more useful as a diagnostic test in those with co-existent post-bronchodilator airflow obstruction (ACO). Using the commonly adopted threshold, a positive BDR test provides a meaningful change in post-test probability of adult asthma, whereas a negative test does not. Discriminatory accuracy is much greater in those with coexistent post-BD airflow obstruction.https://bit.ly/3gPvlm8
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Affiliation(s)
- Daniel J Tan
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Dept of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka.,National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - David P Johns
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Garun S Hamilton
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Paul S Thomas
- Prince of Wales' Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - E Haydn Walters
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Melbourne, Victoria, Australia.,These authors contributed equally
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,These authors contributed equally
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7
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Tommola M, Won HK, Ilmarinen P, Jung H, Tuomisto LE, Lehtimäki L, Niemelä O, Kim TB, Kankaanranta H. Relationship between age and bronchodilator response at diagnosis in adult-onset asthma. Respir Res 2020; 21:179. [PMID: 32660470 PMCID: PMC7359254 DOI: 10.1186/s12931-020-01441-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Possible variation in bronchodilator response (BDR) according to age at the diagnosis of adult-onset asthma is unknown. Our aim was to assess if BDR in FEV1 is related to age at diagnosis of adult-onset asthma and how many subjects fulfill the 400 mL criterion of BDR, the suggested cut-off for asthma-like reversibility in asthma-COPD overlap (ACO). METHODS A total of 1030 patients with adult-onset asthma were included; 245 from SAAS (Seinäjoki Adult Asthma Study, Finland) and 785 from COREA (Cohort for Reality and Evolution of Adult Asthma in Korea) cohorts. BDR in FEV1 at the diagnosis of asthma was assessed. Patients were divided into groups based on age at asthma diagnosis: < 40, 40-59.9, and ≥ 60 years. The cohorts were analyzed separately. RESULTS BDR % in FEV1 did not differ between the groups of different age at asthma diagnosis and no correlation between BDR and age was found. Of patients aged ≥40 years, only 18% (SAAS-cohort) and 5% (COREA-cohort) reached the 400 mL BDR in FEV1. After exclusion of possible ACO patients, the results remained similar. CONCLUSION By using two large cohorts of steroid-naive patients with asthma, we have shown that BDR at diagnosis of asthma is constant over large age span range, and the limit of 400 mL in BDR in FEV1 is rarely reached. TRIAL REGISTRATION Seinäjoki Adult Asthma Study is registered at ClinicalTrials.gov with identifier number NCT02733016 .
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Affiliation(s)
- Minna Tommola
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Ha-Kyeong Won
- Department of Internal Medicine, VHS Medical Center, Seoul, South Korea
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Heewon Jung
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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8
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Dai X, Dharmage SC, Abramson MJ, Erbas B, Bennett CM, Svanes C, Hui J, Axelrad C, Lowe AJ, Lodge CJ. Early life acetaminophen exposure, glutathione S-transferase genes, and development of adolescent asthma in a high-risk birth cohort. J Allergy Clin Immunol 2020; 146:1035-1044.e12. [PMID: 32289338 DOI: 10.1016/j.jaci.2020.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Although the impact of early life acetaminophen on asthma risk is still not clear, potential interactions with glutathione S-transferase (GST) genes due to reduced antioxidant function in particular polymorphisms, and possible impact on lung function, have never been investigated in adolescents. OBJECTIVE We aimed to investigate associations between early life acetaminophen use and adolescent asthma and lung function and to assess potential interactions by GST polymorphisms. METHODS Acetaminophen use was recorded 18 times up to age 2 years (n = 575 [92.7%]). Participants were genotyped for GST polymorphisms (GSTM1/T1/P1) (n = 429 [69.2%]). Asthma and lung function were measured at 12 (n = 365 [58.9%]) and 18 years (n = 413 [66.6%]). Regression models assessed associations and interactions. RESULTS Doubling of days of acetaminophen use was associated with reduced prebronchodilator FEV1/forced vital capacity (β coefficient, -0.10; 95% CI, -0.19 to -0.01) and midexpiratory flow (-0.09; 95% CI, -0.18 to 0) at 18 years, but this association was not found when restricted for nonrespiratory reasons, suggesting confounding by indication. However, in children with GSTM1 null and GSTT1 present, increasing acetaminophen use for nonrespiratory reasons was associated with reduced FEV1 and midexpiratory flow at 18 years (interaction between GSTM1/T1 and acetaminophen P < .05). Increased acetaminophen use was associated with asthma at 18 years for children with GSTP1 Ile/Ile (odds ratio, 1.66; 95% CI, 1.07 to 2.57), but not other GSTP1 genotypes. CONCLUSIONS These novel findings need to be investigated for consistency in other studies but suggest that children carrying risk genotypes may be susceptible to respiratory consequences from acetaminophen use.
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Affiliation(s)
- Xin Dai
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Catherine M Bennett
- Institute for Health Transformation, Deakin University, Melbourne, Australia
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jennie Hui
- Pathwest Laboratory Medicine of West Australia, Perth, Australia; School of Population and Global Health and School of Pathology and Laboratory Medicine, the University of Western Australia, Crawley, Australia
| | - Christine Axelrad
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Melbourne, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Melbourne, Australia
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9
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Dai X, Dharmage SC, Bowatte G, Waidyatillake NT, Perret JL, Hui J, Erbas B, Abramson MJ, Lowe AJ, Burgess JA, Svanes C, Lodge CJ. Interaction of Glutathione S-Transferase M1, T1, and P1 Genes With Early Life Tobacco Smoke Exposure on Lung Function in Adolescents. Chest 2019; 155:94-102. [PMID: 30616740 DOI: 10.1016/j.chest.2018.08.1079] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/14/2018] [Accepted: 08/24/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Glutathione S-transferase (GST) genes are involved in the management of oxidative stress in the lungs. We aimed to determine whether they modify the associations between early life smoke exposure and adverse lung health outcomes. METHODS The Melbourne Atopy Cohort study (a high-risk birth cohort) enrolled 620 children and followed them prospectively from birth. We recorded perinatal tobacco smoke exposure, asthma, and lung function at 12 (59%) and 18 years (66%) and genotyped for GSTM1, GSTT1, and GSTP1 (69%). RESULTS GST genotypes were found to interact with tobacco smoke exposure on lung function outcomes (P interaction ≤ .05). Only among children with GSTT1 null genotypes was exposure to mother's, father's, or parental tobacco smoke in early life associated with an increased risk of reductions in prebronchodilator (BD) FEV1 and FVC at both 12 and 18 years. These associations were not seen in children with GSTT1 present. Similarly, only among children with GSTM1 null genotypes was exposure to father's or parental smoking associated with reductions in pre- and post-BD FEV1 and FVC at 18 years. Only among children with Ile/Ile genotypes of GSTP1 was exposure to mother's smoking associated with increased risk of reduced FEV1 at 18 years, but this was not the case among children with Val/Val or Ile/Val genotypes. CONCLUSIONS Our study provides evidence of interaction between early tobacco smoke exposure and GST genotypes on lung function. Carriers of GST null mutations and GSTP1 Ile/Ile alleles may be more susceptible when exposed to tobacco smoke in early life. These findings support stronger recommendations to protect all infants from tobacco smoke exposure. TRIAL REGISTRY Australian and New Zealand Clinical Trials Registry; No.: ACTRN12609000734268; URL: http://www.anzctr.org.au/.
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Affiliation(s)
- Xin Dai
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, VIC, Australia.
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Nilakshi T Waidyatillake
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennie Hui
- PathWest Laboratory Medicine of West Australia, Perth, WA, Australia; School of Population and Global Health and School of Pathology and Laboratory Medicine, The University of Western Australia, WA, Australia; Busselton Population Medical Research Institute, WA, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia; Centre for International Health, University of Bergen, Bergen, Norway
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Louis R, Bougard N, Guissard F, Paulus V, Henket M, Schleich F. Bronchodilation Test with Inhaled Salbutamol Versus Bronchial Methacholine Challenge to Make an Asthma Diagnosis: Do They Provide the Same Information? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:618-625.e8. [PMID: 31541767 DOI: 10.1016/j.jaip.2019.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Methacholine bronchial challenge and bronchodilation to salbutamol are key tests in clinical practice to make asthma diagnosis. OBJECTIVE To assess the concordance between the 2 tests and to see whether they actually identify the same population of asthmatics. METHOD We conducted a retrospective study using our asthma clinic database to see how methacholine bronchial challenge compared to bronchodilation to salbutamol in untreated patients with recurrent or chronic symptoms suspicious of asthma. We identified 194 untreated patients with baseline forced expiratory volume in 1 second (FEV1) ≥70% predicted who had both a bronchodilation test with salbutamol and a methacholine bronchial challenge 7 to 14 days apart. A positive bronchial challenge was a provocative concentration of methacholine causing a 20% fall in FEV1 ≤16 mg/mL, whereas a positive bronchodilation test was a reversibility to 400 μg inhaled salbutamol ≥12% from baseline and 200 mL. RESULTS Overall, asthma diagnosis was confirmed in 91% of cases leaving 9% of subjects with double negative tests. Isolated positive methacholine challenge was found in 71% of subjects, double positive tests in 17%, whereas isolated significant bronchodilation to salbutamol was rare (3%). There was no correlation between provocative concentration of methacholine causing a fall in FEV1 of 20% (PC20M) and the magnitude of salbutamol reversibility (P = .10). Baseline FEV1/forced vital capacity ratio inversely correlated with reversibility to salbutamol (P < .001) but not with PC20M (P = .1). No difference was found between the groups regarding demographic and immunoinflammatory features, including the proportion of eosinophilic asthma. CONCLUSION We conclude that methacholine challenge outperforms reversibility to salbutamol to diagnose asthma without selecting patients with distinct inflammatory profile. Baseline airway obstruction predicts magnitude of reversibility but not hyperresponsiveness.
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Affiliation(s)
- Renaud Louis
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium.
| | - Nicolas Bougard
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
| | - Françoise Guissard
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
| | - Virginie Paulus
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
| | - Monique Henket
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
| | - Florence Schleich
- Department of Pneumology, CHU Liege, GIGA I(3) Research Group, University of Liege, Liege, Belgium
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Melaku YA, Gill TK, Appleton SL, Hill C, Boyd MA, Adams RJ. Sociodemographic, lifestyle and metabolic predictors of all-cause mortality in a cohort of community-dwelling population: an 18-year follow-up of the North West Adelaide Health Study. BMJ Open 2019; 9:e030079. [PMID: 31446418 PMCID: PMC6720239 DOI: 10.1136/bmjopen-2019-030079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Studies examining potential factors of all-cause mortality comprehensively at community level are rare. Using long-term community-based follow-up study, we examined the association of sociodemographic and behavioural characteristics, metabolic and chronic conditions, and medication and health service utilisation with all-cause mortality. METHODS We followed 4056 participants, aged 18-90 years, for 18 years in the North West Adelaide Health Study (NWAHS). Mortality data were obtained from South Australian (SA) public hospitals and registries including SA births, deaths and marriages, the National Death Index and the NWAHS follow-up. Predictors of all-cause mortality were explored using Cox proportional hazard model, adjusting for potential confounders. We performed subgroup analyses by sex and age. RESULTS Mean (SD) age at baseline was 50.4 (16.4) years. Less than half (47.8%) of the participants were men. A total of 64 689.7 person-years from 4033 participants with 18.7 years of follow-up were generated. The median follow-up time was 17.7 years; 614 deaths were recorded. The overall crude death rate was 9.6 (95% CI 8.9 to 10.4) per 1000 person-years. After adjusting for potential confounders, a reduced risk of mortality was significantly associated with being separated or divorced, being in the highest Socioeconomic Indexes for Areas quintile, engaging in moderate exercise, being overweight (body mass index: 25.0-29.9 kg/m2) and per 10% increase in per cent predicted forced expiratory volume in 1 s. We found that the most important predictors of all-cause mortality were sociodemographic and behavioural characteristics. Sociodemographic factors were more important predictors of all-cause mortality in young age bracket compared with older people. CONCLUSIONS Socioeconomic factors were found to be the most important predictors of all-cause mortality. The study highlights the need to address the social inequalities and strengthen behavioural interventions for different subgroups of population to prevent premature deaths.
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Affiliation(s)
- Yohannes Adama Melaku
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tiffany K Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Sarah L Appleton
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Adelaide, South Australia, Australia
- Freemason's Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Catherine Hill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Rheumatology Unit, The Queen Elizabeth and Royal Adelaide Hospitals, Adelaide, South Australia, Australia
| | - Mark A Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
- Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Robert J Adams
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Adelaide, South Australia, Australia
- Freemason's Centre for Men's Health, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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12
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Tuomisto LE, Ilmarinen P, Lehtimäki L, Tommola M, Kankaanranta H. Immediate bronchodilator response in FEV 1 as a diagnostic criterion for adult asthma. Eur Respir J 2019; 53:13993003.00904-2018. [PMID: 30464017 DOI: 10.1183/13993003.00904-2018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/12/2018] [Indexed: 12/20/2022]
Abstract
Asthma is characterised by variable and reversible expiratory airflow limitations. Thus, it is logical to use the change in forced expiratory volume in 1 s (FEV1) in response to a bronchodilator (ΔFEV1BDR) as a diagnostic tool; increases of ≥12% and ≥200 mL from the baseline FEV1 are commonly used values. We aimed to evaluate the historical development of diagnostic cut-off levels for the ΔFEV1BDR for adults and the evidence behind these recommendations.We searched for studies from the reference lists of all the main statements, reports and guidelines concerning the interpretation of spirometry and diagnostics for asthma and conducted a literature search.A limited amount of evidence regarding the ΔFEV1BDR in healthy populations was found, and even fewer patient studies were found. In healthy persons, the upper 95th percentile for the absolute ΔFEV1BDR ranges between 240 mL and 320 mL, the relative ΔFEV1BDR calculated from the initial FEV1 ranges from 5.9% to 13.3% and the ΔFEV1BDR calculated from the predicted FEV1 ranges from 8.7% to 11.6%. However, the absolute and percentage ΔFEV1BDR values calculated from the initial FEV1 are dependent on age, sex, height and the degree of airway obstruction. Thus, the use of the ΔFEV1BDR calculated from the predicted FEV1 might be more appropriate.Not enough data exist to assess the sensitivity of any of the cut-off levels for the ΔFEV1BDR to differentiate asthma patients from healthy subjects. Further studies in newly diagnosed asthma patients are needed.
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Affiliation(s)
- Leena E Tuomisto
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pinja Ilmarinen
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Minna Tommola
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Hannu Kankaanranta
- Dept of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Diagnostic Accuracy of Bronchodilator Response for Asthma in a Population of South China. Adv Ther 2018; 35:1578-1584. [PMID: 30209751 DOI: 10.1007/s12325-018-0783-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION A significant bronchodilator response is commonly defined as a 12% or greater and 200 ml or greater change in FEV1 from baseline according to the 2005 American Thoracic Society (ATS)/European Respiratory Society (ERS) criterion. A number of studies have shown that the ATS/ERS criterion has limitations in asthma diagnosis, and some experts have argued for correcting the criteria. The aim of this study is to investigate the diagnostic value of acute bronchodilator response for asthma in a Southern Chinese population. METHODS We prospectively evaluated 805 patients with obstructive lung disease (309 for asthma, 496 for non-asthma). Spirometry was performed according to the ATS/ERS guidelines. Data were analyzed by SPSS 18.0. The receiver-operating characteristic (ROC) curve was drawn to assess the diagnostic accuracy of the ATS/ERS criterion based on FEV1. Linear regression was used to analyze the factors of FEV1 change. RESULTS The sensitivity and specificity of the acute bronchodilator test when judged by the ATS/ERS criteria (200 ml or higher and 12% improvement) were 68.6% and 78.2%, respectively. For the ATS/ERS criteria, the Youden Index, which comprehensively reflects the authenticity of a diagnostic test, was 46.8%. The absolute change of FEV1 positively correlated with baseline FEV1 and weight and negatively with age, while the percentage change of FEV1 was negatively correlated with baseline FEV1, age and height and positively with weight. Compared with the different diagnostic values, when ∆FEV1 was 195 ml and ∆FEV1i% was 14%, the Youden Index was the largest (48.2%) and the diagnostic capability of the test the biggest. CONCLUSIONS The ATS/ERS criterion for acute bronchodilator response might not be completely suitable for asthma in the Chinese population. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registry ID: ChiCTR-DDT-14004976). FUNDING This work was supported by the National Natural Science Foundation of China (grant nos. 81670027, 81270080).
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14
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Dai X, Dharmage SC, Lowe AJ, Allen KJ, Thomas PS, Perret J, Waidyatillake N, Matheson MC, Svanes C, Welsh L, Abramson MJ, Lodge CJ. Early smoke exposure is associated with asthma and lung function deficits in adolescents. J Asthma 2016; 54:662-669. [PMID: 27791435 DOI: 10.1080/02770903.2016.1253730] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Early life tobacco smoke exposure may influence asthma, lung function and lung function growth into adolescence. We aimed to determine the associations between perinatal smoke exposure and asthma and lung function up to 18 years of age. METHODS We prospectively recorded perinatal parental smoking and measured respiratory outcomes at 12 and 18 years in the Melbourne Atopy Cohort Study (MACS), a longitudinal birth cohort. Multiple logistic regression was used to analyse the associations between perinatal smoke exposure and asthma at 12 (n = 370) and 18 years (n = 411). Multiple linear regression was used to investigate the relationship between perinatal smoking and: lung function (12 and 18 years) and lung function growth (between 12 and 18 years). RESULTS At 18 years, girls exposed to parental smoking during the perinatal period had increased odds of asthma (OR: 3.45, 95%CI: 1.36, 8.77), reduced pre-bronchodilator Forced expiratory volume in one-second (FEV1) (-272 ml/s; -438, -107); FEV1/ forced vital capacity (FVC) (-0.038; -0.065, -0.010); mid expiratory flow (MEF25-75) (-430 ml/s; -798, -61), and reduced post-bronchodilator FEV1/FVC (-0.028, -0.053, -0.004). No associations were found for boys (pre-bronchodilator FEV1 26ml/s; -202, 255; FEV1/FVC 0.018; -0.013, 0.049). CONCLUSIONS Perinatal smoke may affect risk of asthma, reduce lung function and lung function growth in adolescence. Girls appear to be more susceptible than boys.
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Affiliation(s)
- Xin Dai
- a Centre for Epidemiology and Biostatistics, Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , Australia
| | - Shyamali C Dharmage
- a Centre for Epidemiology and Biostatistics, Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , Australia.,b Center for Food and Allergy Research, Murdoch Children's Research Institute , Victoria , Australia
| | - Adrian J Lowe
- a Centre for Epidemiology and Biostatistics, Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , Australia.,b Center for Food and Allergy Research, Murdoch Children's Research Institute , Victoria , Australia
| | - Katrina J Allen
- b Center for Food and Allergy Research, Murdoch Children's Research Institute , Victoria , Australia.,c Department of Allergy and Clinical Immunology at Royal Children's Hospital , Parkeville , Victoria , Australia.,d The department of Paedriatics , University of Melbourne , Parkeville , Victoria , Canada.,e School of Inflammation and Repair, University of Manchester , Manchester , United Kingdom
| | - Paul S Thomas
- f Inflammation and Infection Research Centre, UNSW, and Respiratory Medicine, Prince of Wales Hospital , Sydney , Australia
| | - Jennifer Perret
- a Centre for Epidemiology and Biostatistics, Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , Australia
| | - Nilakshi Waidyatillake
- a Centre for Epidemiology and Biostatistics, Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , Australia
| | - Melanie C Matheson
- a Centre for Epidemiology and Biostatistics, Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , Australia
| | - Cecilie Svanes
- g Bergen Respiratory Research Group, Centre for International Health, University of Bergen , Bergen , Norway.,h Department of Occupational Medicine, Haukeland University Hospital , Bergen , Norway
| | - Liam Welsh
- b Center for Food and Allergy Research, Murdoch Children's Research Institute , Victoria , Australia.,i Respiratory Medicine, Royal Children's Hospital , Parkeville , Victoria , Australia
| | - Michael J Abramson
- j School of Public Health & Preventative Medicine, Monash University , Melbourne , Australia
| | - Caroline J Lodge
- a Centre for Epidemiology and Biostatistics, Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne , Melbourne , Australia
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15
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Abstract
Many chronic pulmonary diseases, including those that are not primarily infectious in etiology, have some aspects of their pathogenesis that are influenced by infectious organisms. Microorganisms may contribute to chronic lung diseases, either directly (i.e., overt infection) or indirectly, via the amplification of inflammatory pathways that are critical to host defense. As techniques for detecting and characterizing microorganisms have advanced, investigations of both infecting and colonizing organisms have yielded new insights into mechanisms of pulmonary disease. In addition, changes in patterns of infection and microbial resistance have important implications for treatment. Examples of these infectious-pulmonary associations, including Haemophilus influenzae infection and chronic obstructive pulmonary disease, nontuberculous mycobacteria and bronchiectasis, and human immunodeficiency virus and obstructive lung disease, are reviewed.
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16
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Does guideline knowledge affect treatment compliance among emergency doctors? Am J Med Sci 2015; 348:357-61. [PMID: 25118657 DOI: 10.1097/maj.0000000000000269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The insufficient adoption of internationally accepted clinical guidelines may lead to less than adequate patient care of patients with asthma. OBJECTIVE To evaluate the knowledge and treatment compliance with Global Initiative of Asthma (GINA, 2011) asthma treatment guidelines among emergency physicians (EPs) at a referral hospital in northern Malaysia. METHODS A cross-sectional study was designed in the territory-level referral hospital in northern Malaysia. Twenty-seven EPs were asked to complete an asthma guideline questionnaire to assess their knowledge regarding GINA 2011 asthma treatment guidelines. A total of 810 patients were enrolled, and 30 patients were selected per physician. The authors evaluated the physicians' compliance with GINA 2011 asthma treatment guidelines. RESULTS Of 27 EPs, 20 (74.1%) had adequate knowledge of GINA 2011 asthma treatment guidelines. A total of 615 (75.9%) patients received guideline-recommended emergency treatment. Shortness of breath (n = 436, 53.8%) was the most frequently reported chief complaint. Furthermore, there was a significant but weak association between knowledge of the guideline and treatment compliance among emergency doctors (P = 0.003, φ = 0.110). Moreover, there was no significant change in therapy for patients with comorbid conditions. The mean age of respondents was 27.3 years. CONCLUSIONS Overall, a fair level of guideline knowledge and treatment compliance was noted among EPs. Doctors with adequate guideline knowledge were more likely to comply with GINA 2011 asthma treatment guidelines.
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17
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Understanding the evolution of multimorbidity: evidences from the North West Adelaide Health Longitudinal Study (NWAHS). PLoS One 2014; 9:e96291. [PMID: 24798485 PMCID: PMC4010459 DOI: 10.1371/journal.pone.0096291] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/07/2014] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The aim of this study is to describe the evolution of multimorbidity. STUDY DESIGN AND SETTING Data from 1854 South Australians who participated in the North West Adelaide longitudinal Health Study (NWAHS) was collected between baseline (2000-2002) and follow-up (2008-2010). Status for eight chronic diseases (CDs) was determined by biomedical measurement or self-report. Chronic disease (CD) mean age of occurrence and order of appearance was investigated. RESULTS The prevalence of multimorbidity increased from 32% to 64% during the 7.8±1.1 years of follow-up. The estimated mean age of onset of a new CD was significantly older for hypertension, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) and younger for hypercholesterolemia, asthma and other mental problem. Hypercholesterolemia was more likely to develop as a first than as a subsequent CD (39%vs.16%, p<0.0001) while CVD (1%vs.5%, p<0.0001), diabetes (5%vs.11%, p<0.001) and COPD (6%vs.16%, p<0.0001) were less likely. The presence of mood disorders at baseline was associated with an increased risk of developing other mental disorders (36%vs.12%, p<0.0001), diabetes (18%vs.9%, p<0.01) and asthma (30%vs.21%, p<0.05). CONCLUSION Longitudinal data could be used to study the evolution of multimorbidity and could provide information on CDs mean age of occurrence, order of appearance and impact on the development of future CDs.
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18
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Asthma is associated with cardiovascular disease in a representative population sample. Obes Res Clin Pract 2013; 2:71-142. [PMID: 24351727 DOI: 10.1016/j.orcp.2008.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 04/22/2008] [Accepted: 04/22/2008] [Indexed: 11/22/2022]
Abstract
SUMMARY RATIONALE People with asthma may have an increased risk of cardiovascular disease (CVD) and metabolic disorders due to the direct involvement of common inflammatory mediators in the pathogenesis of CVD and insulin resistance. The aim of this study was to determine whether asthma was associated with an increased prevalence of CVD/stroke, and diabetes in a cross-sectional population study and whether the relationship was modified by obesity. METHODS The North West Adelaide Health Study (NWAHS) (n = 4060, age ≥18 years) clinical assessment included spirometry, anthropometry, blood pressure, fasting lipids, glucose and HbA1c. Questionnaires assessed doctor diagnosed asthma, diabetes, CVD (myocardial infarction, angina)/stroke, smoking status, and demographics. Asthma was identified by self-report or significant bronchodilator reversibility of lung function. RESULTS After adjustment for known risk factors and confounders, asthma was not associated with diabetes (odds ratio (OR) = 1.06, 95% confidence interval (CI): 0.45-2.49, p = .91) yet remained positively associated with CVD/stroke (OR = 1.82, 95% CI: 1.20-2.73, p < 0.01) independent of the level of BMI (p for interaction between asthma and BMI = .22), smoking and lung function. Asthma was not positively associated with CVD risk factors or the metabolic syndrome. CONCLUSIONS In a representative population sample, asthma was associated with CVD/stroke after adjustment for traditional risk factors and lung function. Asthma may lead to CVD events via pathways unrelated to traditional risk factors and this requires further investigation. No significant effect modification by BMI was observed in relation to CVD, or diabetes.
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Abstract
In the era of effective antiretroviral therapy (ART), epidemiologic studies have found that persons infected with human immunodeficiency virus (HIV) have a higher prevalence and incidence of chronic obstructive pulmonary disease than HIV-uninfected persons. In comparison with HIV-uninfected persons and those with well-controlled HIV disease, HIV-infected persons with poor viral control or lower CD4 cell count have more airflow obstruction, a greater decline in lung function, and possibly more severe diffusing impairment. This article reviews the evidence linking HIV infection to obstructive lung disease, and discusses management issues related to the treatment of obstructive lung disease in HIV-infected patients.
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Affiliation(s)
- Matthew R. Gingo
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Alison Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Kristina Crothers
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA
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20
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Abstract
Antiretroviral therapy has improved longevity for HIV-infected persons, but long-term HIV infection is now complicated by increased rates of chronic medical conditions including pulmonary disorders. Chronic obstructive pulmonary disease, lung cancer, asthma, and pulmonary hypertension are becoming common comorbidities of HIV infection, and these diseases may develop as a result of HIV-related risk factors, such as antiretroviral drug toxicities, colonization by infectious organisms, HIV viremia, immune activation, or immune dysfunction. It also appears that the ability to control HIV infection does not completely eliminate the risk for infectious complications, such as bacterial pneumonia and tuberculosis. The effect of HIV infection on lung-specific immune responses is being elucidated to help develop better prevention and treatment strategies in HIV-infected persons.
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Affiliation(s)
- Matthew R. Gingo
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Alison Morris
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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21
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Price D, Chisholm A, van der Molen T, Roche N, Hillyer EV, Bousquet J. Reassessing the evidence hierarchy in asthma: evaluating comparative effectiveness. Curr Allergy Asthma Rep 2011; 11:526-38. [PMID: 21927929 PMCID: PMC3208109 DOI: 10.1007/s11882-011-0222-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Classical randomized controlled trials are the gold standard in medical evidence because of their high internal validity. However, their necessarily strict design can limit their external validity and the ability to extrapolate these data to real world patients. Therefore, alternatively designed studies may play a complementary role in evaluating the comparative effectiveness of therapies in nonidealized patients in more naturalistic, real world settings. Observational studies have high external validity and can evaluate real world outcomes. Their strength lies in hypothesis generation and testing and in identifying areas in which further clinical trials may be required. Pragmatic trials are designed to maximize applicability of trial results to usual care settings by relying on clinically important outcomes and enrolling a wide range of participants. A combination of these approaches is preferable and necessary.
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Affiliation(s)
- David Price
- Academic Centre of Primary Care, University of Aberdeen, Foresterhill Health Centre, UK.
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22
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Taylor AW, Price K, Gill TK, Adams R, Pilkington R, Carrangis N, Shi Z, Wilson D. RETRACTED ARTICLE: Multimorbidity: not just an older person's issue. Results from an Australian biomedical study. Soc Psychiatry Psychiatr Epidemiol 2011; 46:351. [PMID: 21076915 DOI: 10.1007/s00127-010-0309-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 10/18/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Anne W Taylor
- South Australian Department of Health, Population Research and Outcome Studies, PO Box 287, Rundle Mall, Adelaide, SA, 5000, Australia.
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23
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Taylor AW, Price K, Gill TK, Adams R, Pilkington R, Carrangis N, Shi Z, Wilson D. Multimorbidity - not just an older person's issue. Results from an Australian biomedical study. BMC Public Health 2010; 10:718. [PMID: 21092218 PMCID: PMC3001730 DOI: 10.1186/1471-2458-10-718] [Citation(s) in RCA: 169] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 11/22/2010] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity, the simultaneous occurrence of two or more chronic conditions, is usually associated with older persons. This research assessed multimorbidity across a range of ages so that planners are informed and appropriate prevention programs, management strategies and health service/health care planning can be implemented. METHODS Multimorbidity was assessed across three age groups from data collected in a major biomedical cohort study (North West Adelaide Health Study). Using randomly selected adults, diabetes, asthma, and chronic obstructive pulmonary disease were determined clinically and cardio-vascular disease, osteoporosis, arthritis and mental health by self-report (ever been told by a doctor). A range of demographic, social, risk and protective factors including high blood pressure and high cholesterol (assessed bio-medically), health service use, quality of life and medication use (linked to government records) were included in the multivariate modelling. RESULTS Overall 4.4% of the 20-39 year age group, 15.0% of the 40-59 age group and 39.2% of those aged 60 years of age or older had multimorbidity (17.1% of the total). Of those with multimorbidity, 42.1% were aged less than 60 years of age. A variety of variables were included in the final logistic regression models for the three age groups including family structure, marital status, education attainment, country of birth, smoking status, obesity measurements, medication use, health service utilisation and overall health status. CONCLUSIONS Multimorbidity is not just associated with older persons and flexible care management support systems, appropriate guidelines and care-coordination programs are required across a broader age range. Issues such as health literacy and polypharamacy are also important considerations. Future research is required into assessing multimorbidity across the life course, prevention of complications and assessment of appropriate self-care strategies.
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Affiliation(s)
- Anne W Taylor
- Population Research & Outcome Studies, South Australian Department of Health, Adelaide, Australia
- Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Kay Price
- School of Nursing & Midwifery, University of South Australia, Adelaide, Australia
| | - Tiffany K Gill
- Population Research & Outcome Studies, South Australian Department of Health, Adelaide, Australia
- Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Robert Adams
- Health Observatory, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Rhiannon Pilkington
- Population Research & Outcome Studies, South Australian Department of Health, Adelaide, Australia
| | - Natalie Carrangis
- Health Promotion, South Australian Department of Health, Adelaide, Australia
| | - Zumin Shi
- Population Research & Outcome Studies, South Australian Department of Health, Adelaide, Australia
- Department of Medicine, University of Adelaide, Adelaide, Australia
| | - David Wilson
- Health Observatory, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
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Adams RJ, Appleton SL, Cole A, Gill TK, Taylor AW, Hill CL. Oral complementary medicine and alternative practitioner use varies across chronic conditions and attitudes to risk. Clin Epidemiol 2010; 2:251-60. [PMID: 21152252 PMCID: PMC2998815 DOI: 10.2147/clep.s12741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine whether chronic conditions and patient factors, such as risk perception and decision-making preferences, are associated with complementary medicine and alternative practitioner use in a representative longitudinal population cohort. PARTICIPANTS AND SETTING Analysis of data from Stage 2 of the North West Adelaide Health Study of 3161 adults who attended a study clinic visit in 2004-2006. The main outcome measures were the medications brought by participants to the study clinic visit, chronic health conditions, attitudes to risk, levels of satisfaction with conventional medicine, and preferred decision-making style. RESULTS At least one oral complementary medicine was used by 27.9% of participants, and 7.3% were visiting alternative practitioners (naturopath, osteopath). Oral complementary medicine use was significantly associated with arthritis, osteoporosis, and mental health conditions, but not with other chronic conditions. Any pattern of complementary medicine use was generally significantly associated with female gender, age at least 45 years, patient-driven decision-making preferences (odds ratio [OR] 1.38, 95% confidence interval [CI]: 1.08-1.77), and frequent general practitioner visits (>five per year; OR 3.62, 95% CI: 2.13-6.17). Alternative practitioner visitors were younger, with higher levels of education (diploma/trade [OR 1.88, 95% CI: 1.28-2.76], bachelor's degree [OR 1.77, 95% CI: 1.11-2.82], income >$80,000 (OR 2.28, 95% CI: 1.26-4.11), female gender (OR 3.15, 95% CI: 2.19-4.52), joint pain not diagnosed as arthritis (OR 1.68, 95% CI: 1.17-2.41), moderate to severe depressive symptoms (OR 2.15, 95% CI: 1.04-4.46), and risk-taking behavior (3.26, 1.80-5.92), or low-to-moderate risk aversion (OR 2.08, 95% CI: 1.26-4.11). CONCLUSION Although there is widespread use of complementary medicines in the Australian community, there are differing patterns of use between those using oral complementary medicines and those using alternative practitioners.
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Affiliation(s)
| | | | | | - Tiffany K Gill
- Population Research and Outcomes Unit, SA Health, The University of Adelaide Discipline of Medicine, Queen Elizabeth Hospital, Woodville, Australia
| | - Anne W Taylor
- Population Research and Outcomes Unit, SA Health, The University of Adelaide Discipline of Medicine, Queen Elizabeth Hospital, Woodville, Australia
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Adams RJ, Appleton SL, Wilson DH, Taylor AW, Ruffin RE. Associations of physical and mental health problems with chronic cough in a representative population cohort. Cough 2009; 5:10. [PMID: 20003540 PMCID: PMC2804566 DOI: 10.1186/1745-9974-5-10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 12/16/2009] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Although chronic cough is a common problem in clinical practice, data on the prevalence and characteristics of cough in the general population are scarce. Our aim was to determine the prevalence of chronic cough that is not associated with diagnosed respiratory conditions and examine the impact on health status and psychological health, in a representative adult population cohort METHODS North West Adelaide Health Study (n stage 1 = 4060, stage 2 = 3160) is a representative population adult cohort. Clinical assessment included spirometry, anthropometry and skin tests. Questionnaires assessed demographics, lifestyle risk factors, quality of life, mental health and respiratory symptoms, doctor diagnosed conditions and medication use. RESULTS Of the 3355 people without identified lung disease at baseline, 18.2% reported chronic cough. In multiple logistic regression models, at follow-up, dry chronic cough without sputum production was significantly more common in males (OR 1.5, 95% CI 1.1, 1.9), current smokers (OR 4.9, 95% CI 3.4, 7.2), obesity (OR 1.9, 95% CI 1.3, 2.9), use of ACE inhibitors (OR 1.8, 95% CI 1.1, 2.9), severe mental health disturbance (OR 2.1, 95% CI 1.4, 3.1) and older age (40-59 years OR 1.7 95% CI 1.2, 2.4; > or = 60 years OR 2.1 95% CI 1.3, 3.5). Among non-smokers only, all cough was significantly more common in men, those with severe mental health disturbance and obesity. CONCLUSIONS Chronic cough is a major cause of morbidity. Attention to cough is indicated in patients with obesity, psychological symptoms or smokers. Inquiring about cough in those with mental health problems may identify reversible morbidity.
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Affiliation(s)
- Robert J Adams
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, 5011, Australia
| | - Sarah L Appleton
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, 5011, Australia
| | - David H Wilson
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, 5011, Australia
| | - Anne W Taylor
- Population Research and Outcome Studies Unit, South Australian Department of Health, Adelaide, South Australia, 5000, Australia
| | - Richard E Ruffin
- The Health Observatory, Discipline of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, South Australia, 5011, Australia
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Urso DL. Asthma in the elderly. Curr Gerontol Geriatr Res 2009; 2009:858415. [PMID: 19888424 PMCID: PMC2771152 DOI: 10.1155/2009/858415] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 07/08/2009] [Accepted: 09/10/2009] [Indexed: 11/17/2022] Open
Abstract
Bronchial asthma is a common problem with enormous medical and economics impacts. It is an inflammatory disease of the airways associated with intermittent episodes of bronchospasm. Asthma is not uncommon in the elderly patients. Prevalence of asthma is similar in older and younger adults. Asthma in the elderly patient is underdiagnosed because of false perceptions by both patient and physician. The high incidence of comorbid conditions in the elderly patient makes the diagnosis and management more difficult. Correct diagnosis is demonstrated with spirometry. The goals of asthma treatment are to achieve and maintain control of symptoms and to prevent development of irreversible airflow limitation. Asthma drugs are preferably inhaled because this route minimizes systemic absorption and, thus, improves the ratio of the therapeutic benefit to the potential side-effects in elderly patients.
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Chittleborough CR, Taylor AW, Dal Grande E, Gill TK, Grant JF, Adams RJ, Wilson DH, Ruffin RE. Gender differences in asthma prevalence: variations with socioeconomic disadvantage. Respirology 2009; 15:107-14. [PMID: 19849810 DOI: 10.1111/j.1440-1843.2009.01638.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Socioeconomic inequalities in health have been shown to vary for different diseases and by gender. This study aimed to examine gender differences in associations between asthma and socioeconomic disadvantage. METHODS Socioeconomic variables were assessed among men and women in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Asthma was determined from spirometry and self-reported doctor diagnosis. RESULTS The prevalence of asthma was 12.0% (95% CI: 11.1-13.1), and was significantly higher among women (13.5%) than men (10.5%). For participants aged 18-64 years a higher prevalence of asthma was associated with an education level of secondary school or lower, or not being in the paid labour force among men, and with a gross annual household income of $20,000 or less among women. Among socioeconomically advantaged groups, the prevalence of asthma was significantly higher among women than men. CONCLUSIONS Socioeconomic disadvantage was associated with higher asthma prevalence, although this varied by gender depending on the indicator of socioeconomic position used. Men with low education or those not employed in the paid labour force had higher asthma prevalence than more socioeconomically advantaged men. Women with low income had higher asthma prevalence than those with higher income. Among all socioeconomically advantaged groups, and also the low-income group, women experienced a higher prevalence of asthma than men.
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Affiliation(s)
- Catherine R Chittleborough
- Population Research and Outcome Studies Unit, South Australian Department of Health, SA 5000 Adelaide, South Australia, Australia.
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Liu CL, Wu CL, Lu YT. Effects of Age on 1-Second Forced Expiratory Volume Response to Bronchodilation. INT J GERONTOL 2009. [DOI: 10.1016/s1873-9598(09)70040-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Appleton SL, Ruffin RE, Wilson DH, Taylor AW, Adams RJ. Cardiovascular disease risk associated with asthma and respiratory morbidity might be mediated by short-acting beta2-agonists. J Allergy Clin Immunol 2009; 123:124-130.e1. [PMID: 19130933 DOI: 10.1016/j.jaci.2008.10.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Revised: 10/16/2008] [Accepted: 10/21/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Studies examining the asthma-related risks of cardiovascular disease (CVD) events have generally used selected samples or did not control for the effects of beta(2)-agonist use, itself associated with CVD events. OBJECTIVES We assessed the relationship between incident CVD/stroke and asthma and the effect of atopy while controlling for beta(2)-agonist use in a representative adult population cohort free of CVD at baseline. METHODS The North West Adelaide Health Study (stage 1, n = 3812; stage 2, n = 3113) assessed spirometry, anthropometry, atopy, blood pressure, and lipid levels. Questionnaires assessed doctor-diagnosed asthma and CVD (myocardial infarction and angina)/stroke, smoking status, and demographics. Asthma was defined by self-report or FEV(1) reversibility. Current short- and long-acting beta(2)-agonist use was identified at follow-up. RESULTS Results are expressed as odds ratios (ORs) and 95% CIs. By using multivariable logistic regression, after adjustment for risk factors, in female subjects incident CVD/stroke events were associated with asthma (OR, 3.24; 95% CI, 1.55-6.78), with no effect modification by atopy (P for interaction = .61), and with as-required short-acting beta(2)-agonist use (OR, 2.66; 95% CI, 1.06-6.61). In male subjects events were associated with daily cough/sputum (OR, 1.92; 95% CI, 1.05-3.50) and FEV(1) of less than 80% of predicted value but an FEV(1)/forced vital capacity ratio of greater than 0.70 (OR, 2.15; 95% CI, 0.91-5.09; P = .08). Although few CVD/stroke events occurred in male subjects with asthma, a significant interaction with atopic status was found (P = .05). CONCLUSIONS Studies are required to elucidate how asthma exposes older women to excess macrovascular risk and prospectively determine the short-acting beta(2)-agonist-related risk in persons without existing CVD. CVD risk in relation to atopic status of asthma also requires further investigation.
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Affiliation(s)
- Sarah L Appleton
- The Health Observatory, Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia.
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Lehmann S, Bakke PS, Eide GE, Gulsvik A. Bronchodilator response to adrenergic beta2-agonists: relationship to symptoms in an adult community. Respir Med 2006; 101:1183-90. [PMID: 17188486 DOI: 10.1016/j.rmed.2006.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Revised: 11/09/2006] [Accepted: 11/09/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Wheeze and chest tightness has traditionally been associated with enhanced bronchial responsiveness. However, no community studies are available on the associations between bronchodilator response and respiratory symptoms among adults. AIM To examine how respiratory symptoms predict bronchodilator response. METHODS An age and gender stratified random sample of all adults aged 47-48 and 71-73 years in Bergen, Norway, were invited. The 3506 participants (69%) filled in questionnaires including nine symptoms and performed bronchodilator reversibility tests. Subjects without current anti-asthmatic medication performing acceptable reversibility tests were included in the analyses (n=3088). RESULTS A reversibility with FEV(1) increase 12% and 200 ml was obtained in 2% of middle-aged and 4% of elderly subjects (p=0.001). In multiple linear regression analysis bronchodilatation was positively associated with wheezing without cold (FEV(1) increase of 1.5%, 95% CI: (0.9, 2.2)% in all participants and 31 ml, 95% CI: (1, 61)ml in men only) and dyspnoea climbing two flights of stairs (0.9%, 95% CI: (0.5,1.4)% and 12 ml, 95% CI: (1,23)ml). Chronic cough predicted the response negatively (-0.7%, 95% CI: (-1.3,-0.1)% and -17 ml, 95% CI: (-32,-2)ml). In multiple logistic regression analysis morning cough predicted an FEV(1) increase 12% and 200 ml (OR: 1.8, 95% CI: (1.1,2.8)). CONCLUSIONS A small fraction of adults in a general population has bronchodilatation after salbutamol inhalation. "Wheezing without cold", "dyspnoea climbing two flights of stairs", and "morning cough" predict an increased bronchodilator response among subjects without current anti-asthmatic medications.
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Affiliation(s)
- Sverre Lehmann
- Section for Thoracic Medicine, Institute of Medicine, University of Bergen, 5021 Bergen, Norway.
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Travers J, Marsh S, Williams M, Weatherall M, Caldwell B, Shirtcliffe P, Aldington S, Beasley R. External validity of randomised controlled trials in asthma: to whom do the results of the trials apply? Thorax 2006; 62:219-23. [PMID: 17105779 PMCID: PMC2117157 DOI: 10.1136/thx.2006.066837] [Citation(s) in RCA: 218] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Asthma is a heterogeneous disease with a wide range of clinical phenotypes, not all of which may be encompassed in the subjects included in randomised controlled trials (RCTs). This makes it difficult for clinicians to know to what extent the evidence derived from RCTs applies to a given patient. AIM To calculate the proportion of individuals with asthma who would have been eligible for the major asthma RCTs from the data of a random community survey of respiratory health. METHODS A postal survey was sent to 3500 randomly selected individuals aged 25-75 years. Respondents were invited to complete a detailed respiratory questionnaire and pulmonary function testing. Participants with current asthma were assessed against the eligibility criteria of the 17 major asthma RCTs cited in the Global Initiative for Asthma (GINA) guidelines. FINDINGS A total of 749 participants completed the full survey, of whom 179 had current asthma. A median 4% of participants with current asthma (range 0-36%) met the eligibility criteria for the included RCTs. A median 6% (range 0-43%) of participants with current asthma on treatment met the eligibility criteria. INTERPRETATION This study shows that the major asthma RCTs on which the GINA guidelines are based may have limited external validity as they have been performed on highly selected patient populations. Most of the participants with current asthma on treatment in the community would not have been eligible for these RCTs.
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Affiliation(s)
- Justin Travers
- Medical Research Institute of New Zealand, PO Box 10055, Wellington, New Zealand
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Muñoz-López F. Asthma: objective assessment. Allergol Immunopathol (Madr) 2006; 34:231-3. [PMID: 17173838 DOI: 10.1157/13095868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Apter AJ, Szefler SJ. Advances in adult and pediatric asthma. J Allergy Clin Immunol 2006; 117:512-8. [PMID: 16522448 DOI: 10.1016/j.jaci.2005.12.1353] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 12/15/2005] [Accepted: 12/20/2005] [Indexed: 12/18/2022]
Abstract
This year we present updates on the management and therapeutics of asthma and research on the relationship of airway remodeling to clinically irreversible disease and continue a discussion about the origins of asthma. Significant advances are occurring in our understanding of the natural history of asthma, including the application of biomarkers and genetics. These tools should assist the clinician in defining patients at risk for significant morbidity related to asthma. Incorporating this knowledge will help prompt the development of more effective management techniques and new medications. Meanwhile, more effective health care strategies must be developed to reduce the reported disparities in asthma care noted in our patient populations.
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Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia 19104, USA.
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