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Bowman WS, Schmidt RJ, Sanghar GK, Thompson Iii GR, Ji H, Zeki AA, Haczku A. "Air That Once Was Breath" Part 2: Wildfire Smoke and Airway Disease - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023. Int Arch Allergy Immunol 2024; 185:617-630. [PMID: 38527432 DOI: 10.1159/000536576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Population growth and climate change have led to more frequent and larger wildfires, increasing the exposure of individuals to wildfire smoke. Notably, asthma exacerbations and allergic airway sensitization are prominent outcomes of such exposure. SUMMARY Key research questions relate to determining the precise impact on individuals with asthma, including the severity, duration, and long-term consequences of exacerbations. Identifying specific risk factors contributing to vulnerability, such as age, genetics, comorbidities, or environmental factors, is crucial. Additionally, reliable biomarkers for predicting severe exacerbations need exploration. Understanding the long-term health effects of repeated wildfire smoke exposures in individuals with asthma and addressing healthcare disparities are important research areas. KEY MESSAGES This review discusses the need for comprehensive research efforts to better grasp wildfire smoke-induced respiratory health, particularly in vulnerable populations such as farmworkers, firefighters, pregnant women, children, the elderly, and marginalized communities. Effective mitigation would require addressing the current limitations we face by supporting research aimed at a better understanding of wildfire smoke-induced airway disease.
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Bowman WS, Schmidt RJ, Sanghar GK, Thompson Iii GR, Ji H, Zeki AA, Haczku A. "Air That Once Was Breath" Part 1: Wildfire-Smoke-Induced Mechanisms of Airway Inflammation - "Climate Change, Allergy and Immunology" Special IAAI Article Collection: Collegium Internationale Allergologicum Update 2023. Int Arch Allergy Immunol 2024; 185:600-616. [PMID: 38452750 DOI: 10.1159/000536578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/23/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Wildfires are a global concern due to their wide-ranging environmental, economic, and public health impacts. Climate change contributes to an increase in the frequency and intensity of wildfires making smoke exposure a more significant and recurring health concern for individuals with airway diseases. Some of the most prominent effects of wildfire smoke exposure are asthma exacerbations and allergic airway sensitization. Likely due to the delayed recognition of its health impacts in comparison with cigarette smoke and industrial or traffic-related air pollution, research on the composition, the mechanisms of toxicity, and the cellular/molecular pathways involved is poor or non-existent. SUMMARY This review discusses potential underlying pathological mechanisms of wildfire-smoke-related allergic airway disease and asthma. We focused on major gaps in understanding the role of wildfire smoke composition in the development of airway disease and the known and potential mechanisms involving cellular and molecular players of oxidative injury at the epithelial barrier in airway inflammation. We examine how PM2.5, VOCs, O3, endotoxin, microbes, and toxic gases may affect oxidative stress and inflammation in the respiratory mucosal barrier. We discuss the role of AhR in mediating smoke's effects in alarmin release and IL-17A production and how glucocorticoid responsiveness may be impaired by IL-17A-induced signaling and epigenetic changes leading to steroid-resistant severe airway inflammation. KEY MESSAGE Effective mitigation of wildfire-smoke-related respiratory health effects would require comprehensive research efforts aimed at a better understanding of the immune regulatory effects of wildfire smoke in respiratory health and disease.
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Affiliation(s)
- Willis S Bowman
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Sacramento, California, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences, School of Medicine, Sacramento, California, USA
| | - Gursharan K Sanghar
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Sacramento, California, USA
| | - George R Thompson Iii
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Sacramento, California, USA
| | - Hong Ji
- UC Davis Lung Center, University of California, Davis, California, USA
- Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, Davis, California, USA
| | - Amir A Zeki
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Sacramento, California, USA
| | - Angela Haczku
- UC Davis Lung Center, University of California, Davis, California, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine, Sacramento, California, USA
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Wan W, Qiu Y, Huang X, Ren Y, Peng A, Yang C. Causal relationship between Butyricimonas and allergic asthma: a two-sample Mendelian randomization study. Front Microbiol 2023; 14:1190765. [PMID: 37869656 PMCID: PMC10587591 DOI: 10.3389/fmicb.2023.1190765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023] Open
Abstract
Background Growing evidence has well documented the close association between the gut microbiome and allergic respiratory disease, which has been notably represented by allergic asthma. However, it is unclear whether this association is a causal link. Therefore, we investigated the potential causal associations between the gut microbiome and allergic asthma or other allergic diseases. Methods In this study, we performed two-sample Mendelian randomization (MR) analyses by using the publicly available genome-wide association study (GWAS) summary data. Single-nucleotide polymorphisms (SNPs) that significantly correlated were selected as instrumental variables. The inverse variance weighted (IVW) method was used to examine the potential causal gut microbial genera for allergic asthma and other allergic diseases. The robustness of the primary findings of the MR analyses was ensured by using different sensitivity analyses. Results Combining the findings from multiple analyses, the host genetic-driven increases in Butyricimonas at the genus level were positively correlated with the risk of allergic asthma. In addition, phylum Bacteroidetes and class Bacteroidia were also found to have negative associations with the risk of allergic asthma; genus Slackia was identified as having potential causal effects with allergic asthma. No clear evidence of pleiotropy and heterogeneity was observed in genus Butyricimonas. Butyricimonas was also found to have an association with allergic rhinitis, but not with other allergic diseases. Conclusion Our findings indicate that there are new gut microbial genera that were causally associated with the risk of allergic asthma and other allergic diseases, and offer novel insights into the pathogenesis of allergic respiratory diseases.
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Affiliation(s)
| | | | | | | | | | - Chunping Yang
- Department of Otorhinolaryngology Head and Neck Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Uvelli A, Duranti C, Salvo G, Coluccia A, Gualtieri G, Ferretti F. The Risk Factors of Chronic Pain in Victims of Violence: A Scoping Review. Healthcare (Basel) 2023; 11:2421. [PMID: 37685455 PMCID: PMC10486711 DOI: 10.3390/healthcare11172421] [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: 07/18/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/10/2023] Open
Abstract
Violent situations are unfortunately very frequent in women and children all over the world. These experiences have long-term consequences for adult physical and psychological health. One of the most reported is chronic pain, defined in various sub-diagnoses and present in all types of violence. Unfortunately, the etiology of this condition is not clear and neither are the predisposing factors. The aim of this scoping review is to examine the literature trends about the probable risk factors of chronic pain in violence victims. Considering a bio-psycho-social model, it is possible to hypothesize the presence of all these aspects. The results will be discussed in the present article.
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Affiliation(s)
- Allison Uvelli
- Department of Medical Science, Surgery, and Neurosciences, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Cristina Duranti
- Department of Medical Science, Surgery, and Neurosciences, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Giulia Salvo
- Department of Medical Science, Surgery, and Neurosciences, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Anna Coluccia
- Department of Medical Science, Surgery, and Neurosciences, University of Siena, Viale Bracci, 53100 Siena, Italy
| | - Giacomo Gualtieri
- Azienda Ospedaliero-Universitaria Senese (AOUS), Viale Bracci, 53100 Siena, Italy
| | - Fabio Ferretti
- Department of Medical Science, Surgery, and Neurosciences, University of Siena, Viale Bracci, 53100 Siena, Italy
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Lima VBD, Vazquez VS, Campos ACP, Santos LMD, Cruz ÁA. Exposure to intimate partner violence and lack of asthma control in adults: a cross-sectional study. SAO PAULO MED J 2023; 141:e2022336. [PMID: 37311135 DOI: 10.1590/1516-3180.2022.0336.r2.30032023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 03/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Asthma is a chronic airway disease that affects 339 million people worldwide. It is a heterogeneous disease with different risks, including in family environments, where intimate partner violence occurs. OBJECTIVE This study aimed to investigate the possible association between psychosocial factors and asthma control in adults exposed to intimate partner violence. DESIGN AND SETTING This cross-sectional study was conducted at a Brazilian public higher education institution in Salvador, Bahia, Brazil. METHODS The study population consisted of adults clinically diagnosed with severe asthma and those with mild/moderate asthma identified at an asthma referral outpatient clinic. The sample comprised 492 participants who underwent clinical evaluation and completed questionnaires to assess asthma control, depression, stress, and resilience. The Conflict Tactics Scale, which measures tactics for managing marital conflicts, was used to estimate the level of intimate partner violence. RESULTS Of the 492 participants, 76.2% were women and 91% self-referenced color black/brown, 37.8% reported low family income, 87.4% reported low education level, 71.7% reported high stress, 32.5% reported low resilience, 18.5% reported moderate or severe depression, 83.3% reported resolute negotiation, 49.4% reported major psychological aggression, 19.6% reported major physical aggression, 15.5% reported major injury, and 7.3% reported major sexual coercion. Regression analysis revealed that sex was an effect modifier. CONCLUSION Women in situations of social vulnerability, with low income and poor education, with depression, severe asthma, and those who used aggression to resolve marital conflicts had a profile associated with a lack of asthma control.
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Affiliation(s)
- Valmar Bião de Lima
- BSc. Statistician and Researcher, Programa de Controle da Asma na Bahia (ProAR), Salvador (BA), Brazil; and Doctoral Student, Postgraduate Program in Medicine and Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Vanessa Serva Vazquez
- PhD. Psychologist and Researcher, Programa de Controle da Asma na Bahia (ProAR),, Salvador (BA), Brazil
| | - Ana Clara Paixão Campos
- PhD. Doctoral Student, Centro de Integração de Dados e Conhecimentos para Saúde (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (FIOCRUZ), Salvador, Brazil
| | - Letícia Marques Dos Santos
- PhD. Psychologist, Postgraduate Program in Collective Health, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil; and Associate Professor, Instituto de Humanidades Artes e Ciências (IHCA), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Álvaro Augusto Cruz
- PhD. Physician, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil; CNPq Researcher 1 B, founder of the Program for the Control of Asthma in Bahia (ProAR) and Executive Director of the ProAR Foundation, Salvador (BA), Brazil
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Mainardi AS, Harris D, Rosenthal A, Redlich CA, Hu B, Fenick AM. Reducing asthma exacerbations in vulnerable children through a medical-legal partnership. J Asthma 2023; 60:262-269. [PMID: 35188437 DOI: 10.1080/02770903.2022.2045307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Asthma health disparities are widely recognized, with worse outcomes in children from low income families. In a Medical-Legal Partnership (MLP), an attorney is embedded in a healthcare setting to address social determinants of health. We studied whether an MLP could impact asthma exacerbation rates in a vulnerable urban population at an academic children's hospital. METHODS The study population comprised children with asthma who were referred to the MLP between 2013 and 2017. We compared healthcare utilization for asthma exacerbations managed in primary care, emergency department and inpatient settings in the year before and year after MLP intervention. RESULTS 98 children with asthma were included in the study. The mean total encounters per person per year decreased from 1.16 to 0.66 (relative reduction 44.2%, p < 0.01). The largest effect was on hospitalizations, with a reduction from 0.33 to 0.10 hospitalizations per patient per year (relative reduction 69.7%, p < 0.01). Encounters for asthma exacerbations in the primary care office and emergency department also decreased but these changes did not meet statistical significance. CONCLUSION In a pediatric population with asthma, an MLP intervention was associated with a significant reduction in asthma exacerbation encounters and hospitalizations comparing the year before and after MLP intervention. Further studies are needed to better understand which interventions are most effective, and for which patient groups MLP referral would be particularly useful. MLPs may be an important way to reduce health disparities in patients with asthma and other chronic illnesses.
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Affiliation(s)
- Anne S Mainardi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of MedicineNew Haven, CT
| | - Drew Harris
- Division of Pulmonary and Critical Care, University of Virginia School of Medicine, Charlottesville, VR
| | - Alice Rosenthal
- Center for Children's Advocacy at Yale, New Haven Hospital, New Haven, CT
| | - Carrie A Redlich
- Occupational and Environmental Medicine Program, Yale University School of MedicineNew HavenCT
| | - Buqu Hu
- Division of Pulmonary and Critical Care, Yale University School of Medicine, New Haven, CT
| | - Ada M Fenick
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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Martinez A, Thakur N. Structural Racism and the Social Determinants of Health in Asthma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:101-115. [PMID: 37464118 DOI: 10.1007/978-3-031-32259-4_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma prevalence and morbidity are disproportionately higher among minoritized communities in the United States. Racial and ethnic disparities in asthma result from complex interactions across biological, environmental, and social factors. Asthma is considered a complex heterogeneous disease consisting of different phenotypes, some of which may be more common in individuals impacted by the downstream effects of structural racism and lack of access to the social determinants of health. Structural racism across generations has created and reinforced inequitable systems through policies and practices which are embedded in the economic, educational, health care, and justice systems (Bailey et al., N Engl J Med 384(8):768-773, 2021; Bailey et al., Lancet 389:1453-1463, 2017; Williams et al., Annu Rev Public Health 40:105-125, 2019). This manifests in an inequitable distribution of resources and the social determinants of health affecting an individual's physical and social environment (Bailey et al., Lancet 389:1453-1463, 2017; Thakur et al., Am J Respir Crit Care Med 202:943-949, 2020; Martinez et al., J Allergy Clin Immunol 148(5):1112-1120, 2021). In this chapter, we outline how inequity in housing, zoning laws, urban planning, education, employment, healthcare access, and healthcare delivery is linked to higher asthma prevalence and morbidity. We also describe the role that chronic physiologic stress has on asthma by enhancing neuroimmune and immunologic responses to environmental exposures. Interventions aimed at addressing the physical or social environment of an individual or community have been shown to improve asthma outcomes in patients at higher risk of severe disease.
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Affiliation(s)
- Adali Martinez
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neeta Thakur
- Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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Alcala CS, Orozco Scott P, Tamayo‐Ortiz M, Hernández Chávez MDC, Schnaas L, Carroll KN, Niedzwiecki MM, Wright RO, Téllez‐Rojo MM, Wright RJ, Hsu HL, Rosa MJ. Longitudinal assessment of maternal depression and early childhood asthma and wheeze: Effect modification by child sex. Pediatr Pulmonol 2023; 58:98-106. [PMID: 36128727 PMCID: PMC9771993 DOI: 10.1002/ppul.26164] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Studies report associations between maternal mental health and adverse respiratory outcomes in children; however, the impact of timing and duration of maternal distress remains understudied. We sought to longitudinally examine associations between maternal depression and childhood asthma and wheeze, and explore sex differences. METHODS Maternal depression (n = 601) was assessed using the Edinburgh Depression Scale questionnaire, dichotomized at a clinically relevant cutoff (>12) (a) during pregnancy, (b) postpartum, and (c) postpartum and subsequent time points postnatally (recurrent depression). Report of wheeze in the past 12 months (current wheeze) and asthma were obtained using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire at 48 and 72 months. Associations were analyzed using a modified Poisson regression adjusted for covariates, and in interaction models. RESULTS Both postpartum and recurrent depression were associated with higher risk of current wheeze (relative risk [RR]: 1.87, 95% confidence interval [CI]: 1.21, 2.90; RR: 2.41, 95% CI: 1.53, 3.79) and asthma at 48 months (RR: 2.42, 95% CI: 1.01, 5.84; RR: 2.45, 95% CI: 1.02, 5.84). In interaction analyses, associations were stronger in females. Recurrent depression was associated with a higher risk of current wheeze at 48 months in females (RR: 4.34, 95% CI: 2.02, 9.32) when compared to males (RR: 1.89, 95% CI: 1.05, 3.39). CONCLUSIONS Postpartum and recurrent depression were associated with a higher risk of wheeze and asthma in children. Understanding the temporal- and sex-specific effects of maternal depression may better inform prevention strategies.
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Affiliation(s)
- Cecilia S. Alcala
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Paloma Orozco Scott
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Marcela Tamayo‐Ortiz
- Occupational Health Research UnitMexican Social Security InstituteMexico CityMexico
| | | | - Lourdes Schnaas
- Department of Developmental NeurobiologyNational Institute of PerinatologyMexico CityMexico
| | - Kecia N. Carroll
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Pediatrics, Icahn School of Medicine at Mount SinaiKravis Children's HospitalNew YorkNew YorkUSA
| | - Megan M. Niedzwiecki
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Robert O. Wright
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Institute for Exposomic ResearchIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Martha Maria Téllez‐Rojo
- Center for Nutrition and Health ResearchNational Institute of Public HealthCuernavaca, MorelosMexico
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Pediatrics, Icahn School of Medicine at Mount SinaiKravis Children's HospitalNew YorkNew YorkUSA
- Institute for Exposomic ResearchIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Hsiao‐Hsien Leon Hsu
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Maria José Rosa
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Association of the 5HTR2C gene Ser23 variation with childhood allergic asthma. THE EUROBIOTECH JOURNAL 2022. [DOI: 10.2478/ebtj-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: Allergic asthma is the most frequently observed subtype of individuals with asthma. The effects of serotonin plays in the pathophysiology of asthma has not been clearly determined. Thus, this study aimed to investigate the association between the 5HTR2C gene rs 6318 G>C polymorphism and allergic asthma in pediatric patients in Cyprus.
Methods: This study included total number of 177 individuals with 118 control and 59 pediatric patients (43 atopic and 16 non-atopic asthma patient). A skin prick test was performed for each patient to confirm asthma diagnosis and to evaluate atopic status. Genotyping for the 5HTR2C was completed by Real Time-PCR analysis.
Results: The genotype distribution frequencies were not in agreement with the Hardy-Weinberg Equilibrium in the patients’ group (p<0.00001). The frequency of the risk allele (allele C) was not significantly different between the patient and control groups (p=0.255). The genotypic distribution between atopic asthma and non-atopic asthma within the patientsts groups was not in agreement with the Hardy-Weinberg Equilibrium (p=0.006). However, risk allele presence showed a statistically significant association with atopy-related asthma (p=0.037).
Discussion & Conclusion: Overall, despite the finding of no association between the 5HTR2C rs6318 C allele and childhood asthma, the current results indicated that there is a strong association between the 5HTR2C rs6318 C variant and childhood atopic asthma.
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Hoque S, Goulding M, Hazeltine M, Ferrucci KA, Trivedi M, Liu SH. Caregiver-perceived neighborhood safety and pediatric asthma severity: 2017-2018 National Survey of Children's Health. Pediatr Pulmonol 2022; 57:376-385. [PMID: 34796705 PMCID: PMC8792337 DOI: 10.1002/ppul.25762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine the association between caregiver-perceived neighborhood safety and pediatric asthma severity using a cross-sectional, nationally representative sample. STUDY DESIGN Using data from the 2017-2018 National Survey of Children's Health, children aged 6-17 years with primary caregiver report of a current asthma diagnosis were included (unweighted N = 3209; weighted N = 3,909,178). Perceived neighborhood safety, asthma severity (mild vs. moderate/severe), demographic, household, and health/behavioral covariate data were collected from primary caregiver report. Poisson regression with robust error variance was used to estimate the association between perceived neighborhood safety and caregiver-reported pediatric asthma severity. RESULTS Approximately one-third of children studied had moderate/severe asthma. A total of 42% of children with mild asthma and 52% of children with moderate/severe asthma identified as Hispanic or non-Hispanic Black. Nearly 20% of children with mild asthma and 40% of children with moderate/severe asthma were from families living below the federal poverty level (FPL). Children living in neighborhoods perceived by their caregiver to be unsafe had higher prevalence of moderate/severe asthma compared to those in the safest neighborhoods (adjusted prevalence ratio: 1.34; 95% confidence interval: 1.04-1.74). This association was found to be independent of race/ethnicity, household FPL, household smoking, and child's physical activity level after adjusting for covariates. CONCLUSIONS Children living in neighborhoods perceived by their caregiver to be unsafe have higher prevalence of moderate or severe asthma. Further investigation of geographic context and neighborhood characteristics that influence childhood asthma severity may inform public health strategies to reduce asthma burden and improve disease outcomes.
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Affiliation(s)
- Shushmita Hoque
- University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
| | - Melissa Goulding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
| | - Max Hazeltine
- Department of Surgery, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
| | - Katarina A. Ferrucci
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
| | - Michelle Trivedi
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
- Department of Pediatric Pulmonology, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA
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Rosenkranz MA, Esnault S, Gresham L, Davidson RJ, Christian BT, Jarjour NN, Busse WW. Role of amygdala in stress-induced upregulation of airway IL-1 signaling in asthma. Biol Psychol 2022; 167:108226. [PMID: 34800561 PMCID: PMC9426565 DOI: 10.1016/j.biopsycho.2021.108226] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/02/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023]
Abstract
Psychological stress, an important contributor to asthma morbidity, potentiates the immune response to allergen, but the brain mechanisms mediating this response are not fully understood. The amygdala is likely to play an important role, given its sensitivity to threat and connectivity with descending immune modulatory pathways. In this study, we recruited thirty asthmatic participants and examined glucose metabolism in the amygdala, using [F-18]fluorodeoxyglucose positron emission tomography, during a laboratory stressor. Stress hormone and airway inflammatory measurements were also acquired. Results showed that activity in the amygdala was significantly increased during the stressor, compared to a matched control task (p < .05 corrected). Moreover, the increase in amygdala activity was associated with a greater increase in sputum IL-1R1 mRNA and alpha amylase response (p < .05 corrected), which were also positively correlated (p = .01). These findings suggest that heightened amygdala reactivity may contribute to asthma morbidity via descending proinflammatory sympathetic signaling pathways.
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Affiliation(s)
- Melissa A Rosenkranz
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA; Center for Healthy Minds, University of Wisconsin-Madison, 625 W. Washington Ave., Madison, WI 53703, USA.
| | - Stephane Esnault
- Department of Medicine, University of Wisconsin School of Medicine and Public Health-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - Lauren Gresham
- Center for Healthy Minds, University of Wisconsin-Madison, 625 W. Washington Ave., Madison, WI 53703, USA
| | - Richard J Davidson
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA; Center for Healthy Minds, University of Wisconsin-Madison, 625 W. Washington Ave., Madison, WI 53703, USA; Department of Psychology, University of Wisconsin-Madison, 1202 W. Johnson St., Madison, WI 53706, USA
| | - Bradley T Christian
- Department of Psychiatry, University of Wisconsin-Madison, 6001 Research Park Blvd, Madison, WI 53719, USA; Department of Medical Physics, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA; Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI 53792, USA
| | - Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine and Public Health-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health-Madison, 600 Highland Ave, Madison, WI 53792, USA
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Royer C, Miller LA, Haczku A. A Novel Nonhuman Primate Model of Nonatopic Asthma. Methods Mol Biol 2022; 2506:83-94. [PMID: 35771465 PMCID: PMC11069454 DOI: 10.1007/978-1-0716-2364-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Nonhuman primate models have an essential role in understanding progressive respiratory disease pathogenesis. Immune and physiologic parameters in the nonhuman primate closely reflect the complexity of human systems and provide an exceptional translational impact for the investigation of the mucosal immune changes in response to environmental exposures. This potential warrants the development of novel models that will clarify the interaction of respiratory disease and the inhalable environment and the potential of novel therapies to alleviate the untoward results of these interactions. Nonhuman primate models of asthma can be spontaneous, induced, or experimentally manipulated by various exposures. Here we describe a model of exacerbation of airway hyperreactivity induced by exposure to an air pollutant, ozone, in a cohort of young adult asthmatic rhesus macaques.
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13
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Johnson E, J M, I L, R S. Asthma and posttraumatic stress disorder (PTSD): Emerging links, potential models and mechanisms. Brain Behav Immun 2021; 97:275-285. [PMID: 34107349 PMCID: PMC8453093 DOI: 10.1016/j.bbi.2021.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/16/2021] [Accepted: 06/04/2021] [Indexed: 12/31/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a highly prevalent, debilitating mental health condition. A better understanding of contributory neurobiological mechanisms will lead to effective treatments, improving quality of life for patients. Given that not all trauma-exposed individuals develop PTSD, identification of pre-trauma susceptibility factors that can modulate posttraumatic outcomes is important. Recent clinical evidence supports a strong link between inflammatory conditions and PTSD. A particularly strong association has been reported between asthma and PTSD prevalence and severity. Unlike many other PTSD-comorbid inflammatory conditions, asthma often develops in children, sensitizing them to subsequent posttraumatic pathology throughout their lifetime. Currently, there is a significant need to understand the neurobiology, shared mechanisms, and inflammatory mediators that may contribute to comorbid asthma and PTSD. Here, we provide a translational perspective of asthma and PTSD risk and comorbidity, focusing on clinical associations, relevant rodent paradigms and potential mechanisms that may translate asthma-associated inflammation to PTSD development.
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Affiliation(s)
- Emily Johnson
- Dept. of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati OH, 45220,Neuroscience Graduate Program, University of Cincinnati, Cincinnati OH, 45220
| | - McAlees J
- Division of Immunobiology, Children’s Hospital Medical Center, Cincinnati OH, 45220
| | - Lewkowich I
- Division of Immunobiology, Children’s Hospital Medical Center, Cincinnati OH, 45220,Department of Pediatrics, University of Cincinnati, Cincinnati OH, 45220
| | - Sah R
- Dept. of Pharmacology & Systems Physiology, University of Cincinnati, Cincinnati OH, 45220,Neuroscience Graduate Program, University of Cincinnati, Cincinnati OH, 45220,VA Medical Center, Cincinnati, OH, 45220
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14
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An Overview of Health Disparities in Asthma. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:497-507. [PMID: 34602887 PMCID: PMC8461584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Asthma is a heterogeneous disease characterized by inflammation in the respiratory airways which manifests clinically with wheezing, cough, and episodic periods of chest tightness; if left untreated it can lead to permanent obstruction or death. In the US, asthma affects all ages and genders, and individuals from racial and ethnic minority groups are disproportionately burdened by this disease. The financial cost of asthma exceeds $81 billion every year and despite all the resources invested, asthma is responsible for over 3,500 deaths annually in the nation. In this overview, we highlight important factors associated with health disparities in asthma. While they are complex and overlap, we group these factors in five domains: biological, behavioral, socio-cultural, built environment, and health systems. We review the biological domain in detail, which traditionally has been best studied. We also acknowledge that implicit and explicit racism is an important contributor to asthma disparities and responsible for many of the socio-environmental factors that worsen outcomes in this disease.
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15
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Jiang Y, Farrell AK, Tobin ET, Mair-Meijers H, Wildman DE, Luca F, Slatcher RB, Zilioli S. Socioeconomic status, financial stress, and glucocorticoid resistance among youth with asthma: Testing the moderation effects of maternal involvement and warmth. Brain Behav Immun 2021; 96:92-99. [PMID: 34015429 PMCID: PMC8319072 DOI: 10.1016/j.bbi.2021.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Children who grow up in more socioeconomically disadvantaged homes experience greater levels of inflammation and worse asthma symptoms than children from more advantaged families. However, recent evidence suggests that certain family-level factors can mitigate health disparities associated with socioeconomic status (SES). In a sample of youth with asthma, we investigated the potential buffering effects of maternal involvement and warmth on SES disparities in asthma-related immune responses, assessed via glucocorticoid resistance (GR) of immune cells. METHODS One hundred and forty-three youth (10-16 years of age) with asthma completed measures of maternal involvement and warmth, and their primary caregivers reported their levels of education, income, and financial stress. Peripheral blood mononuclear cells from youth's blood were isolated, cultured, and assayed to determine mitogen-stimulated (PMA/INO + Etho) and mitogen/hydrocortisone-stimulated (PMA/INO + Cort) levels of two Th-2 cytokines (i.e., interleukin-5, interleukin-13) and one Th-1 cytokine (i.e., interferon-γ). GR was calculated by subtracting log-transformed cytokine concentration in the PMA/INO + Etho samples from log-transformed cytokine concentration in the PMA/INO + Cort samples. RESULTS Both maternal involvement and warmth moderated the indirect pathway from family SES to GR of Th-2 cytokines via financial stress. Specifically, we found that low family SES was associated with elevated GR of Th-2 cytokines via increased financial stress among youth reporting low levels of maternal involvement and warmth, but not among those reporting high levels of maternal involvement or warmth. CONCLUSIONS These results highlight the protective role of maternal involvement and warmth in health-related biological processes modulated by family SES among youth with asthma.
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Affiliation(s)
- Yanping Jiang
- Department of Psychology, Wayne State University, United States.
| | | | - Erin T. Tobin
- Behavioral Health and General Internal Medicine, Henry Ford Health System
| | | | - Derek E. Wildman
- Genomics Program, College of Public Health, University of South Florida
| | - Francesca Luca
- Center for Molecular Medicine and Genetics, Wayne State University,Department of Obstetrics and Gynecology, Wayne State University
| | | | - Samuele Zilioli
- Department of Psychology, Wayne State University, United States; Department of Family Medicine and Public Health Sciences, Wayne State University, United States.
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16
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Balmes JR. Place Matters: Residential Racial Segregation and COPD. Am J Respir Crit Care Med 2021; 204:496-498. [PMID: 34138685 PMCID: PMC8491254 DOI: 10.1164/rccm.202105-1209ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- John R Balmes
- University of California Berkeley, 1438, Environmental Health Sciences, School of Public Health, Berkeley, California, United States.,University of California San Francisco, 8785, Department of Medicine, San Francisco, California, United States;
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17
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Enweasor C, Flayer CH, Haczku A. Ozone-Induced Oxidative Stress, Neutrophilic Airway Inflammation, and Glucocorticoid Resistance in Asthma. Front Immunol 2021; 12:631092. [PMID: 33717165 PMCID: PMC7952990 DOI: 10.3389/fimmu.2021.631092] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
Despite recent advances in using biologicals that target Th2 pathways, glucocorticoids form the mainstay of asthma treatment. Asthma morbidity and mortality remain high due to the wide variability of treatment responsiveness and complex clinical phenotypes driven by distinct underlying mechanisms. Emerging evidence suggests that inhalation of the toxic air pollutant, ozone, worsens asthma by impairing glucocorticoid responsiveness. This review discusses the role of oxidative stress in glucocorticoid resistance in asthma. The underlying mechanisms point to a central role of oxidative stress pathways. The primary data source for this review consisted of peer-reviewed publications on the impact of ozone on airway inflammation and glucocorticoid responsiveness indexed in PubMed. Our main search strategy focused on cross-referencing "asthma and glucocorticoid resistance" against "ozone, oxidative stress, alarmins, innate lymphoid, NK and γδ T cells, dendritic cells and alveolar type II epithelial cells, glucocorticoid receptor and transcription factors". Recent work was placed in the context from articles in the last 10 years and older seminal research papers and comprehensive reviews. We excluded papers that did not focus on respiratory injury in the setting of oxidative stress. The pathways discussed here have however wide clinical implications to pathologies associated with inflammation and oxidative stress and in which glucocorticoid treatment is essential.
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Affiliation(s)
- Chioma Enweasor
- UC Davis Lung Center, University of California, Davis, CA, United States
| | - Cameron H. Flayer
- Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Angela Haczku
- UC Davis Lung Center, University of California, Davis, CA, United States
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18
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Venckunas T, Balsys D. Pulmonary function as a limiting factor of middle distance race performance. J Sports Med Phys Fitness 2021; 62:1-8. [PMID: 33565755 DOI: 10.23736/s0022-4707.21.12042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Exercise induced bronchoconstriction (EIB) is common and underdiagnosed phenomenon of yet largely unknown etiology. This study aimed to estimate prevalence of EIB in response to highly demanding skyscraper race and to test its association with race performance and hypothetical predisposing factors. Healthy participants (26 males, 8 females; 31.5 +/- 6.3 years) from mostly running-based amateur sports were measured for forced expiratory volume in first 1 s (FEV1) before and then repeatedly within 10 min after the completion of the 114 m skyscraper upstairs race. Allergy questionnaire (AQUA) data were collected and post-exercise blood lactate was measured. Over 40% of the participants developed >10% decrement in FEV1 shortly after all-out exercise. While EIB response was not associated with questionnaire-based atopic status, training background, gender, age, anthropometrics, pacing and exertion (estimated from the accumulated blood lactate values), participants exhibiting <10% decrement in FEV1 were faster, especially over the later stages of the race. In conclusion, nearly every other participant of the skyscraper race develops EIB not associated with training, demographic, anthropometric and atopic status, pacing and exertion (estimated from postexercise blood lactate), but the responders (FEV1 decrement >10%) were slower indicative of poorer fitness due to EIB developing during the exercise already.
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Affiliation(s)
- Tomas Venckunas
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania -
| | - Domantas Balsys
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
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19
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Han CH, Chung JH, Lee SJ. Association between Asthma and Internet Addiction Status in Korean Adolescents. J Thorac Dis 2021; 13:968-976. [PMID: 33717569 PMCID: PMC7947535 DOI: 10.21037/jtd-20-2342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Problematic Internet addiction (IA) has been shown to be associated with a variety of psychological comorbidities, but its relationship with adolescent asthma has not yet been investigated in detail. Methods We analyzed 18,473 adolescent patients with physician-diagnosed asthma and 205,069 non-asthmatic adolescent patients from the Korean Youth Risk Behavior Web-based Survey. Socioeconomic factors, health behavior factors, psychological factors, and IA status were assessed using the Korean Internet Addiction Proneness Scale. Multiple logistic regression analysis was performed, with adjustment for multiple cofounders, to explore the association between IA and adolescent asthma. Results Comparison between the adolescent asthma group and non-adolescent asthma group indicated higher rates of probable IA (13.7% vs. 12.1%, respectively, P<0.001), IA (4.8% vs. 3.1%, respectively, P<0.001), and problematic IA (18.5% vs. 15.2%, respectively, P<0.001) in the adolescent asthma group. After adjustment for multiple confounders, probable IA [odds ratio (OR): 1.16, 95% confidence interval (CI): 1.08–1.26] and IA (OR: 1.07, 95% CI: 1.02–1.12) were significantly associated with increased risk of adolescent asthma, compared to non-problematic Internet use. Conclusions IA is associated with an increased rate of asthma in Korean adolescents. So, IA has attracted minimal attention in relation to the treatment of asthma.
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Affiliation(s)
- Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jae Ho Chung
- Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Su Jin Lee
- Department of Neurology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
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20
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Rengarajan S, Knoop KA, Rengarajan A, Chai JN, Grajales-Reyes JG, Samineni VK, Russler-Germain EV, Ranganathan P, Fasano A, Sayuk GS, Gereau RW, Kau AL, Knights D, Kashyap PC, Ciorba MA, Newberry RD, Hsieh CS. A Potential Role for Stress-Induced Microbial Alterations in IgA-Associated Irritable Bowel Syndrome with Diarrhea. CELL REPORTS MEDICINE 2020; 1. [PMID: 33196055 PMCID: PMC7659537 DOI: 10.1016/j.xcrm.2020.100124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Stress is a known trigger for flares of inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS); however, this process is not well understood. Here, we find that restraint stress in mice leads to signs of diarrhea, fecal dysbiosis, and a barrier defect via the opening of goblet-cell associated passages. Notably, stress increases host immunity to gut bacteria as assessed by immunoglobulin A (IgA)-bound gut bacteria. Stress-induced microbial changes are necessary and sufficient to elicit these effects. Moreover, similar to mice, many diarrhea-predominant IBS (IBS-D) patients from two cohorts display increased antibacterial immunity as assessed by IgA-bound fecal bacteria. This antibacterial IgA response in IBS-D correlates with somatic symptom severity and was distinct from healthy controls or IBD patients. These findings suggest that stress may play an important role in patients with IgA-associated IBS-D by disrupting the intestinal microbial community that alters gastrointestinal function and host immunity to commensal bacteria. Stress in mice causes diarrhea, dysbiosis, barrier defect, increased antibacterial IgA Stress-induced microbial changes are sufficient to elicit the above effects IBS-D patients from two cohorts display increased and unique antibacterial IgA Antibacterial IgA in IBS-D correlates with patient symptom severity
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Affiliation(s)
- Sunaina Rengarajan
- Department of Internal Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kathryn A Knoop
- Department of Internal Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Arvind Rengarajan
- Department of Internal Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jiani N Chai
- Department of Internal Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jose G Grajales-Reyes
- Washington University Pain Center and Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Vijay K Samineni
- Washington University Pain Center and Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Emilie V Russler-Germain
- Department of Internal Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Prabha Ranganathan
- Department of Internal Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alessio Fasano
- Center for Celiac Research and Treatment and Division of Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gregory S Sayuk
- Department of Internal Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA.,Gastroenterology Section, John Cochran Veterans Affairs Medical Center, St. Louis, MO 63125, USA
| | - Robert W Gereau
- Washington University Pain Center and Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Andrew L Kau
- Center for Women's Infectious Disease Research and Department of Internal Medicine, Division of Allergy and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Dan Knights
- Biomedical Informatics and Computational Biology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Purna C Kashyap
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA
| | - Matthew A Ciorba
- Department of Internal Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Rodney D Newberry
- Department of Internal Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Chyi-Song Hsieh
- Department of Internal Medicine, Division of Rheumatology, Washington University School of Medicine, St. Louis, MO 63110, USA.,Lead Contact
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21
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Abstract
PURPOSE OF REVIEW In asthma, there is an increasing focus on personalizing treatment by targeting treatable traits. Ethnicity has effects on many biological and behavioural traits, and so is an important consideration when personalizing asthma care. This review has particular relevance in light of current patterns of international migration, which are leading to unprecedented levels of ethnic heterogeneity in many geographic regions. RECENT FINDINGS This review examines the effect of ethnicity on three key domains - biological traits, behavioural traits and health system behaviour. Ethnicity influences asthma biology by affecting biomarker reference ranges, response to drug therapy and asthma phenotypes. Ethnicity impacts behavioural traits through its effects on psychosocial well being, adherence and asthma self-management. Ethnic minorities are often disadvantaged with regards to healthcare access and healthcare interactions. SUMMARY Concerted action is needed to address current issues around behavioural traits and healthcare behaviour, which are influenced by ethnicity. More research is required to understand the impact of ethnicity on asthma biology, especially the interplay between genetic and environmental influences on asthma, and the differential response to asthma therapies.
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22
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Cameron L, Palikhe NS, Laratta C, Vliagoftis H. Elevated Circulating Th2 Cells in Women With Asthma and Psychological Morbidity: A New Asthma Endotype? Clin Ther 2020; 42:1015-1031. [PMID: 32482491 DOI: 10.1016/j.clinthera.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Psychological stress shifts the immune system toward the production of T-helper (Th)-2-mediated cytokines and eosinophilia, increases the risks for both asthma and depression, and can precipitate asthma exacerbations. Th2-mediated inflammation is a characteristic of allergic asthma. We have shown that the levels of CD4+ Th2 cells in the peripheral blood of patients with asthma are associated with severity and/or control of the disease. To improve our understanding of the interactions between stress and asthma symptoms, we evaluated the effects of psychological comorbidity on Th2-mediated inflammation in patients with asthma. METHODS Sixty-six asthmatic patients were recruited from the University of Alberta Asthma Clinic after they gave informed consent. Stress-related effects on asthma and psychological morbidity were assessed using the Asthma Control Questionnaire, completed by the patients at recruitment. Venous blood was collected at recruitment and Th2-mediated immunity evaluated by flow cytometry, quantitative real-time reverse-transcription polymerase chain reaction and enzyme-linked immunosorbent assay. FINDINGS Patients with stress-triggered asthma (n = 12) had higher percentage of CD4+ T cells (P = 0.006) and Th2 cells (CD4+CRTh2+ T cells; P = 0.002) in peripheral blood compared to patients with asthma who did not experience stress-related worsening of disease (n = 54). The same was true when we analyzed patients with any form of psychological comorbidity (n = 19) compared to those without psychological comorbidities (n = 47). These differences were evident among women, but not among men. Women with psychological comorbidity also required higher doses of inhaled and oral corticosteroids compared to those without psychological comorbidity. IMPLICATIONS Asthma involving psychological morbidity associates with an elevated level of circulating Th2 cells and increased corticosteroid usage, and may be more prevalent in women. Larger-scale prospective studies are required for assessing whether these women constitute a new endotype of Th2-high asthma responsive to treatments aimed to improve psychological comorbidities.
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Affiliation(s)
- Lisa Cameron
- Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada.
| | - Nami Shrestha Palikhe
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Cheryl Laratta
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Harissios Vliagoftis
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Alberta Respiratory Centre, University of Alberta, Edmonton, Alberta, Canada
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23
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Lan Y, Li S, Yang D, Zhou J, Wang Y, Wang J, Xu Y, Chen Z. Clinical characteristics of Kawasaki disease complicated with Mycoplasma pneumoniae pneumonia: A retrospective study. Medicine (Baltimore) 2020; 99:e19987. [PMID: 32384451 PMCID: PMC7220055 DOI: 10.1097/md.0000000000019987] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This study aimed to investigate the inner linkage and mechanism of Mycoplasma pneumoniae (MP) infection and Kawasaki disease (KD), as well as the risk factors of outcome in this cohort of patients.A retrospective study was performed in 210 patients diagnosed with KD complicated with community acquired pneumonia (CAP) in Children's Hospital, Zhejiang University School of Medicine from January 2014 to December 2017. They were divided into two groups based on MP infection: MP infection group (n = 97) and non-MP infection group (n = 113). We compared the variables of these two groups based on medical records.The MP infection group had higher ESR than the non-MP infection group. During hospitalization, the non-MP infection group had higher levels of WBC during hospital, LDH, PCT, and lower HB when compared to the MP infection group. No differences were found in the hs-CRP level, N%, PLT, ALT, CKMB, and cytokine levels (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) between MP and non-MP infection group. Likewise, no difference was found in fever duration or hospital stays between them. Totally 19 patients in the infection group had CAA with a rate of 19.59%; and 27 (23.89%) patients had CAA in the non-MP infection group. Unfortunately, no difference was found in CAA rate between the two groups.MP infection may occur simultaneously in children with Kawasaki disease. KD patients with MP infection tended to occur in older population. MP infection may not increase the risk of CAA, which still needs further large-scaled studies to confirm. Clinicians should be alert to KD patients with high level of ESR. MP should be screened and early treatment with macrolides should be given timely.
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Affiliation(s)
- Yinle Lan
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Shuxian Li
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Dehua Yang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Junfen Zhou
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
- Department of Pediatrics, Wenling Maternal and Child Health Care Hospital, Wenling, Zhejiang, China
| | - Yingshuo Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Jianhua Wang
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Yingchun Xu
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
| | - Zhimin Chen
- Department of Pulmonology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang
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24
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Ramadan AA, Gaffin JM, Israel E, Phipatanakul W. Asthma and Corticosteroid Responses in Childhood and Adult Asthma. Clin Chest Med 2020; 40:163-177. [PMID: 30691710 DOI: 10.1016/j.ccm.2018.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Corticosteroids are the most effective treatment for asthma; inhaled corticosteroids (ICSs) are the first-line treatment for children and adults with persistent symptoms. ICSs are associated with significant improvements in lung function. The anti-inflammatory effects of corticosteroids are mediated by both genomic and nongenomic factors. Variation in the response to corticosteroids has been observed. Patient characteristics, biomarkers, and genetic features may be used to predict response to ICSs. The existence of multiple mechanisms underlying glucocorticoid insensitivity raises the possibility that this might indeed reflect different diseases with a common phenotype.
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Affiliation(s)
- Amira Ali Ramadan
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Beth Israel Deaconess Center, Cardiovascular institute, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Elliot Israel
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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25
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Flayer CH, Larson ED, Joseph A, Kao S, Qu W, Van Haren A, Royer CM, Miller LA, Capitanio JP, Sielecki T, Christofidou-Solomidou M, Haczku A. Ozone-induced enhancement of airway hyperreactivity in rhesus macaques: Effects of antioxidant treatment. J Allergy Clin Immunol 2020; 145:312-323. [PMID: 31627909 PMCID: PMC6949398 DOI: 10.1016/j.jaci.2019.08.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 07/18/2019] [Accepted: 08/30/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ozone (O3) inhalation elicits airway inflammation and impairs treatment responsiveness in asthmatic patients. The underlying immune mechanisms have been difficult to study because of the lack of relevant experimental models. Rhesus macaques spontaneously have asthma and have a similar immune system to human subjects. OBJECTIVES We sought to investigate mucosal immune changes after O3 inhalation in a clinically relevant nonhuman primate asthma model and to study the effects of an antioxidant synthetic lignan (synthetic secoisolariciresinol diglucoside [LGM2605]). METHODS A cohort of macaques (n = 17) previously characterized with airway hyperreactivity (AHR) to methacholine was assessed (day 1). Macaques were treated (orally) with LGM2605 (25 mg/kg) or placebo twice per day for 7 days, exposed to 0.3 ppm O3 or air for 6 hours (on day 7), and studied 12 hours later (day 8). Lung function, blood and bronchoalveolar lavage (BAL) fluid immune cell profile, and bronchial brushing and blood cell mRNA expression were assessed. RESULTS O3 induced significant BAL fluid neutrophilia and eosinophilia and increased AHR and expression of IL6 and IL25 mRNA in the airway epithelium together with increased BAL fluid group 2 innate lymphoid cell (ILC2s), CD1c+ myeloid dendritic cell, and CD4+ T-cell counts and diminished surfactant protein D expression. Although LGM2605 attenuated some of the immune and inflammatory changes, it completely abolished O3-induced AHR. CONCLUSION ILC2s, CD1c+ myeloid dendritic cells, and CD4+ T cells are selectively involved in O3-induced asthma exacerbation. The inflammatory changes were partially prevented by antioxidant pretreatment with LGM2605, which had an unexpectedly disproportionate protective effect on AHR.
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Affiliation(s)
- Cameron H Flayer
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, UC Davis School of Medicine, Davis, Calif
| | - Erik D Larson
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, UC Davis School of Medicine, Davis, Calif
| | - Anjali Joseph
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, UC Davis School of Medicine, Davis, Calif
| | - Sean Kao
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, UC Davis School of Medicine, Davis, Calif
| | - Wenxiu Qu
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, UC Davis School of Medicine, Davis, Calif; Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Austin Van Haren
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, UC Davis School of Medicine, Davis, Calif
| | | | - Lisa A Miller
- UC Davis California National Primate Research Center, Davis, Calif
| | - John P Capitanio
- UC Davis California National Primate Research Center, Davis, Calif
| | | | - Melpo Christofidou-Solomidou
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Angela Haczku
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, UC Davis School of Medicine, Davis, Calif.
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Michael KC, Bonneau RH, Bourne RA, Godbolt L, Caruso MJ, Hohmann C, Cavigelli SA. Divergent immune responses in behaviorally-inhibited vs. non-inhibited male rats. Physiol Behav 2019; 213:112693. [PMID: 31629765 PMCID: PMC6934092 DOI: 10.1016/j.physbeh.2019.112693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 02/06/2023]
Abstract
Stable behavioral traits (temperament, personality) often predict health outcomes. Temperament-specific differences in immune function could explain temperament-specific health outcomes, however, we have limited information on whether immune function varies by personality. In the present study, we examined the relationship between a basic behavioral trait (behavioral-inhibition vs. non-inhibition) and two immune responses (innate inflammation and delayed-type hypersensitivity, DTH) in a rodent model. In humans, behavioral inhibition (fearful temperament) is associated with altered stress physiology and allergies. In laboratory rats, the trait is associated with elevated glucocorticoid production. We hypothesized that behavioral inhibition is associated with glucocorticoid resistance and dampened T-helper 1 cell responses often associated with chronic stress and allergies. Further, this immune profile would predict poorly-regulated innate inflammation and dampened DTH. In male Sprague-Dawley rats, we quantified consistent behavioral phenotypes by measuring latency to contact two kinds of novelty (object vs. social), then measured lipopolysaccharide(LPS)-induced innate inflammation or keyhole limpet hemocyanin(KLH)-induced DTH. Behaviorally-inhibited rats had heightened glucocorticoid and interleukin-6 responses to a low/moderate dose of LPS and reduced DTH swelling to KLH re-exposure compared to non-inhibited rats. These results suggest that behavioral inhibition is associated with a glucocorticoid resistant state with poorly regulated innate inflammation and dampened cell-mediated immune responses. This immune profile may be associated with exaggerated T-helper 2 responses, which could set the stage for an allergic/asthmatic/atopic predisposition in inhibited individuals. Human and animal models of temperament-specific immune responses represent an area for further exploration of mechanisms involved in individual differences in health.
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Affiliation(s)
- Kerry C Michael
- Department of Psychology, University of Minnesota, Morris, USA
| | - Robert H Bonneau
- Department of Microbiology and Immunology and Department of Pediatrics, The Pennsylvania State University Hershey Medical Center, USA
| | - Rebecca A Bourne
- Department of Biobehavioral Health, The Pennsylvania State University, USA
| | | | - Michael J Caruso
- Department of Biobehavioral Health, The Pennsylvania State University, USA; Center for Brain, Behavior, and Cognition, The Pennsylvania State University, USA
| | | | - Sonia A Cavigelli
- Department of Biobehavioral Health, The Pennsylvania State University, USA; Center for Brain, Behavior, and Cognition, The Pennsylvania State University, USA; Huck Institutes of the Life Sciences, The Pennsylvania State University, USA.
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Saxer S, Schneider SR, Appenzeller P, Bader PR, Lichtblau M, Furian M, Sheraliev U, Estebesova B, Emilov B, Sooronbaev T, Bloch KE, Ulrich S. Asthma rehabilitation at high vs. low altitude: randomized parallel-group trial. BMC Pulm Med 2019; 19:134. [PMID: 31340793 PMCID: PMC6657156 DOI: 10.1186/s12890-019-0890-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 07/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background To investigate the effect of asthma rehabilitation at high altitude (3100 m, HA) compared to low altitude (760 m, LA). Methods For this randomized parallel-group trial insufficiently controlled asthmatics (Asthma Control Questionnaire (ACQ) > 0.75) were randomly assigned to 3-week in-hospital rehabilitation comprising education, physical-&breathing-exercises at LA or HA. Co-primary outcomes assessed at 760 m were between group changes in peak expiratory flow (PEF)-variability, and ACQ) from baseline to end-rehabilitation and 3 months thereafter. Results 50 asthmatics were randomized [median (quartiles) LA: ACQ 2.7(1.7;3.2), PEF-variability 19%(14;33); HA: ACQ 2.0(1.6;3.0), PEF-variability 17%(12;32)]. The LA-group improved PEF-variability by median(95%CI) -7%(− 14 to 0, p = 0.033), ACQ − 1.4(− 2.2 to − 0.9, p < 0.001), and after 3 months by − 3%(− 18 to 2, p = 0.103) and − 0.9(− 1.3 to − 0.3, p = 0.002). The HA-group improved PEF-variability by − 10%(− 21 to − 3, p = 0.004), ACQ − 1.1(− 1.3 to − 0.7, p < 0.001), and after 3 months by − 9%(− 10 to − 3, p = 0.003) and − 0.2(− 0.9 to 0.4, p = 0.177). The additive effect of HA vs. LA directly after the rehabilitation on PEF-variability was − 6%(− 14 to 2), on ACQ 0.3(− 0.4 to 1.1) and after 3 months − 5%(− 14 to 5) respectively 0.4(− 0.4 to 1.1), all p = NS. Conclusion Asthma rehabilitation is highly effective in improving asthma control in terms of PEF-variability and symptoms, both at LA and HA similarly. Trial registration Clinicaltrials.gov: NCT02741583, Registered April 18, 2016. Electronic supplementary material The online version of this article (10.1186/s12890-019-0890-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stéphanie Saxer
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland.,Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Simon R Schneider
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Paula Appenzeller
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Patrick R Bader
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Ulan Sheraliev
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Bermet Estebesova
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Berik Emilov
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Talant Sooronbaev
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Konrad E Bloch
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland.
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Jiang Y, Peng T, Gaur U, Silva M, Little P, Chen Z, Qiu W, Zhang Y, Zheng W. Role of Corticotropin Releasing Factor in the Neuroimmune Mechanisms of Depression: Examination of Current Pharmaceutical and Herbal Therapies. Front Cell Neurosci 2019; 13:290. [PMID: 31312123 PMCID: PMC6614517 DOI: 10.3389/fncel.2019.00290] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/14/2019] [Indexed: 12/17/2022] Open
Abstract
Approximately 3% of the world population suffers from depression, which is one of the most common form of mental disorder. Recent findings suggest that an interaction between the nervous system and immune system might be behind the pathophysiology of various neurological and psychiatric disorders, including depression. Neuropeptides have been shown to play a major role in mediating response to stress and inducing immune activation or suppression. Corticotropin releasing factor (CRF) is a major regulator of the hypothalamic pituitary adrenal (HPA) axis response. CRF is a stress-related neuropeptide whose dysregulation has been associated with depression. In this review, we summarized the role of CRF in the neuroimmune mechanisms of depression, and the potential therapeutic effects of Chinese herbal medicines (CHM) as well as other agents. Studying the network of CRF and immune responses will help to enhance our understanding of the pathogenesis of depression. Additionally, targeting this important network may aid in developing novel treatments for this debilitating psychiatric disorder.
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Affiliation(s)
- Yizhou Jiang
- Center of Reproduction, Development and Aging and Institute of Translation Medicine, Faculty of Health Sciences, University of Macau, Macau, China.,Department of Biology, Southern University of Science and Technology, Shenzhen, China
| | - Tangming Peng
- Center of Reproduction, Development and Aging and Institute of Translation Medicine, Faculty of Health Sciences, University of Macau, Macau, China.,Department of Neurosurgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgical Clinical Research Center of Sichuan Province, Luzhou, China
| | - Uma Gaur
- Center of Reproduction, Development and Aging and Institute of Translation Medicine, Faculty of Health Sciences, University of Macau, Macau, China
| | - Marta Silva
- Center of Reproduction, Development and Aging and Institute of Translation Medicine, Faculty of Health Sciences, University of Macau, Macau, China
| | - Peter Little
- School of Pharmacy, Pharmacy Australia Centre of Excellence, The University of Queensland, Woolloongabba, QLD, Australia
| | - Zhong Chen
- Key Laboratory of Medical Neurobiology of the Ministry of Health of China, College of Pharmaceutical Sciences, Institute of Pharmacology and Toxicology, Zhejiang University, Hangzhou, China
| | - Wei Qiu
- The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yandong Zhang
- Department of Biology, Southern University of Science and Technology, Shenzhen, China
| | - Wenhua Zheng
- Center of Reproduction, Development and Aging and Institute of Translation Medicine, Faculty of Health Sciences, University of Macau, Macau, China
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Heinrichs K, Hummel S, Gholami J, Schultz K, Li J, Sheikh A, Loerbroks A. Psychosocial working conditions, asthma self-management at work and asthma morbidity: a cross-sectional study. Clin Transl Allergy 2019; 9:25. [PMID: 31168356 PMCID: PMC6509772 DOI: 10.1186/s13601-019-0264-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022] Open
Abstract
Background Adverse psychosocial working conditions—in particular poor job decision latitude and poor social support at work—may impair the effective implementation of asthma self-management behaviour at work and may be associated with increased asthma morbidity. In this study, we investigate for the first time the association of job decision latitude and social support at work with (1) four asthma-specific self-management behaviours at work (i.e., physical activity, trigger avoidance, acute symptom management, and communication) and with (2) asthma morbidity.
Methods A total of 221 employees with asthma recruited through three rehabilitation clinics completed questionnaires (response rate = 29.3%). Job decision latitude and social support were measured using items from the Copenhagen Psychosocial Questionnaire. The four asthma self-management behaviours were mainly assessed by self-developed items. We used the Asthma Control Test and the Marks Asthma Quality of Life Questionnaire to measure asthma morbidity. We dichotomized all variables and conducted logistic regression analyses to calculate odds ratios with 95% CIs. Results Low job decision latitude and low social support were significantly associated with poorer trigger avoidance (odds ratios ≥ 2.09) and poorer acute symptom management (odds ratios ≥ 2.29); low social support was further related to significantly less communication (odds ratio = 2.82). Low job decision latitude and low social support were also associated with significantly poorer asthma control (odds ratios ≥ 1.95) and poorer asthma-specific quality of life (odds ratios ≥ 2.05). The relationships with asthma morbidity were attenuated after adjustment for the four asthma self-management behaviours (odds ratios ranging from 1.1 to 1.9). Conclusions Adverse psychosocial working conditions are associated with poorer asthma self-management behaviour at work and with increased asthma morbidity. The latter association may be mediated by asthma self-management behaviour. Trial registration German Clinical Trials Register, registration number: DRK S00011309, date of registration: 22.12.2016. Electronic supplementary material The online version of this article (10.1186/s13601-019-0264-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katherina Heinrichs
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Stefan Hummel
- MEDIAN Klinik Heiligendamm, Kinderstrand 1, 18209 Bad Doberan, Germany
| | - Jalal Gholami
- Nordseeklinik Borkum der DRV Rheinland, Bubertstraße 4, 26757 Borkum, Germany
| | - Konrad Schultz
- 4Klinik Bad Reichenhall der DRV Bayern Süd, Salzburger Str. 8, 83435 Bad Reichenhall, Germany
| | - Jian Li
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany.,5Department of Environmental Health Sciences, Fielding School of Public Health, Los Angeles, CA 90095-1772 USA.,6School of Nursing, University of California Los Angeles, Los Angeles, CA 90095-1772 USA
| | - Aziz Sheikh
- 7Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Adrian Loerbroks
- 1Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Universitätsstraße 1, 40225 Düsseldorf, Germany
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Duerson W, Lafer M, Ahmed O, Bandler I, Wang B, Lieberman S, Lebowitz R. Health Care Disparities in Patients Undergoing Endoscopic Sinus Surgery for Chronic Rhinosinusitis: Differences in Disease Presentation and Access to Care. Ann Otol Rhinol Laryngol 2019; 128:608-613. [PMID: 30832483 DOI: 10.1177/0003489419834947] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Data on health care disparities by socioeconomic status for chronic rhinosinusitis (CRS) are lacking, and the available literature shows mixed results. The aim of this study was to evaluate several indicators of disease complexity in patients with CRS undergoing endoscopic sinus surgery between a private and a public hospital to determine if there are any disparities in the severity of disease presentation or in access to care. METHODS Two hundred patients with CRS who underwent endoscopic sinus surgery from 2015 to 2017 were retrospectively reviewed. Demographics, disease-specific data, and pre- and postoperative management were collected. RESULTS Public hospital patients (n = 100) were significantly more likely to be non-Caucasian (73.0% vs 25.0%, P < .0001) and to have Medicaid or no insurance (86.0% vs 4.0%, P < .0001). Patients from the public hospital were more likely to have CRS with nasal polyposis (85.0% vs 60.0%, P < .0001) and to have longer wait times for surgery (68 vs 45 days, P < .0001) and were more likely to be lost to follow-up (26.0% vs 16.0%, P = .031). Patients at the public hospital had CRS symptoms 21% longer ( P = .0206), and if a patient carried a diagnosis of asthma, he or she had on average more severe asthma ( P = .0021). CONCLUSIONS This study suggests that patients of lower socioeconomic status had a longer duration of disease prior to surgery, more often had nasal polyposis, and had decreased access to care, as indicated by increased surgical wait times and being lost to follow-up. Acting as a foundation for further investigation, the ultimate intent of this study is to improve care for all patients.
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Affiliation(s)
- Wes Duerson
- 1 Department of Otolaryngology Head Neck Surg., Division of Rhinology and Skull Base Surgery, New York University School of Medicine, New York, NY, USA
| | - Marissa Lafer
- 1 Department of Otolaryngology Head Neck Surg., Division of Rhinology and Skull Base Surgery, New York University School of Medicine, New York, NY, USA
| | - Omar Ahmed
- 1 Department of Otolaryngology Head Neck Surg., Division of Rhinology and Skull Base Surgery, New York University School of Medicine, New York, NY, USA
| | - Ilana Bandler
- 1 Department of Otolaryngology Head Neck Surg., Division of Rhinology and Skull Base Surgery, New York University School of Medicine, New York, NY, USA
| | - Binhuan Wang
- 2 Department of Population Health, Division of Biostatistics, New York University School of Medicine, New York, NY, USA
| | - Seth Lieberman
- 1 Department of Otolaryngology Head Neck Surg., Division of Rhinology and Skull Base Surgery, New York University School of Medicine, New York, NY, USA
| | - Richard Lebowitz
- 1 Department of Otolaryngology Head Neck Surg., Division of Rhinology and Skull Base Surgery, New York University School of Medicine, New York, NY, USA
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Chronic psychological stress impairs germinal center response by repressing miR-155. Brain Behav Immun 2019; 76:48-60. [PMID: 30414952 DOI: 10.1016/j.bbi.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 12/25/2022] Open
Abstract
Germinal centers (GC) are vital to adaptive immunity. BCL6 and miR-155 are implicated in control of GC reaction and lymphomagenesis. FBXO11 causes BCL6 degradation through ubiquitination in B-cell lymphomas. Chronic psychological stress is known to drive immunosuppression. Corticosterone (CORT) is an adrenal hormone expressed in response to stress and can similarly impair immune functions. However, whether GC formation is disrupted by chronic psychological stress and its molecular mechanism remain to be elucidated. To address this issue, we established a GC formation model in vivo, and a GC B cell differentiation model in vitro. Comparing Naive B cells to GC B cells in vivo and in vitro, the differences of BCL6 and FBXO11 mRNA do not match the changes at the protein level and miR-155 levels that were observed. Next we demonstrated that CORT increase, induced by chronic psychological stress, reduced GC response, IgG1 antibody production and miR-155 level in vivo. The effect of chronic psychological stress can be blocked by a glucocorticoid receptor (GR) antagonist. Similarly, impaired GC B cell generation and isotope class switching were observed. Furthermore, we found that miR-155 and BCL6 expression were downregulated, but FBXO11 expression was upregulated in GC B cells treated with CORT in vitro. In addition, we demonstrated that miR-155 directly down-regulated FBXO11 expression by binding to its 3́-untranslated region. The subsequent overexpression of miR-155 significantly blocked the stress-induced impairment of GC response, due to changes in FBXO11 and BCL6 expression, as well as increased apoptosis in B cells both in vivo and in vitro. Our findings suggest perturbation of GC reaction may play a role in chronic psychological stress-induced immunosuppression through a glucocorticoid pathway, and miR-155-mediated post-transcriptional regulation of FBXO11 and BCL6 expression may contribute to the impaired GC response.
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New-Onset Asthma in Adults: What Does the Trigger History Tell Us? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:898-905.e1. [PMID: 30240884 DOI: 10.1016/j.jaip.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/21/2018] [Accepted: 09/05/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Adult-onset asthma is an important asthma phenotype and, in contrast to childhood asthma, is often associated with specific triggers of onset. It is unknown whether these triggers correspond with specific phenotypic characteristics or predict a specific asthma outcome. OBJECTIVE To compare clinical, functional, and inflammatory characteristics between patients with different triggers of asthma onset, and relate these triggers to asthma outcome. METHODS Two hundred adults with recently diagnosed (<1 year) asthma were prospectively followed for 5 years. The trigger of asthma onset was patient reported and defined by the question: "What, in your opinion, elicited your asthma?" Asthma remission was defined as no asthma symptoms and no asthma medication use for ≥1 year. Kruskal-Wallis and Fisher's exact test were used to compare categories containing >10 patients. RESULTS Ten categories of triggers were identified, of which 5 contained >10 patients. Clinical and inflammatory characteristics and remission rates differed significantly between categories. "New allergic sensitization" (11%) was associated with mild atopic asthma and a relatively young age at onset; "pneumonia" (8%) with previous smoking, low IgE, and the highest remission rates (one third); "upper respiratory symptoms" (22%) with high exhaled NO and eosinophilia; "no trigger identified" (38%) did not show any specific characteristics; and "stressful life event" (7%) with high medication usage, low type 2 markers, and no disease remission. CONCLUSIONS Patients with adult-onset asthma can be characterized by the trigger that seemingly incited their asthma. These triggers might represent underlying mechanisms and may be important to phenotype patients and predict disease outcome.
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Gimsa U, Tuchscherer M, Kanitz E. Psychosocial Stress and Immunity-What Can We Learn From Pig Studies? Front Behav Neurosci 2018; 12:64. [PMID: 29666573 PMCID: PMC5891618 DOI: 10.3389/fnbeh.2018.00064] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/16/2018] [Indexed: 12/14/2022] Open
Abstract
Psychosocial stress may impair immune functions and provoke the development of pathologies. The underlying communication between the brain and the immune system is being studied predominantly in rodents. However, pigs offer several advantages as preclinical models for humans because pigs are more similar to humans than rodents in many anatomical and physiological characteristics. Unlike in rodents, the main stress-induced glucocorticoid in humans and pigs is cortisol with a similar circadian rhythm. In this study, we summarize data on short-term and long-term effects of social stress in pigs for their immunity and neuroendocrine regulation with consequences for their health and well-being. As typical social stressors, regrouping, crowding, social isolation, and maternal deprivation have been studied. Psychosocial stress in pigs may affect various reactions of innate and adaptive immunity, such as leukocyte distribution, cytokine secretion, lymphocyte proliferation, and antibody production as well as immune responses to viral infection or vaccination. Furthermore, social stress may induce or promote gastrointestinal diseases through dysregulation of inflammatory processes. In piglets, psychosocial stress may also result in glucocorticoid resistance of lymphocytes, which has been discussed as a cause of allergic asthma in humans. Stress-related neuroendocrine alterations in the cortico-limbic structures, such as the prefrontal cortex, amygdala, hippocampus and hypothalamus, have been demonstrated in pigs at different ages. Based on these data, we propose using pigs as models for psychosocial stress in humans to study the mechanisms of brain-to-immune and immune-to-brain communication from the systemic level down to the cellular and subcellular levels.
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Affiliation(s)
- Ulrike Gimsa
- Psychophysiology Unit, Institute of Behavioural Physiology, Leibniz Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
| | - Margret Tuchscherer
- Psychophysiology Unit, Institute of Behavioural Physiology, Leibniz Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
| | - Ellen Kanitz
- Psychophysiology Unit, Institute of Behavioural Physiology, Leibniz Institute for Farm Animal Biology (FBN), Dummerstorf, Germany
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Cazzola M, Calzetta L, Matera MG, Hanania NA, Rogliani P. How does race/ethnicity influence pharmacological response to asthma therapies? Expert Opin Drug Metab Toxicol 2018. [DOI: 10.1080/17425255.2018.1449833] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mario Cazzola
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Luigino Calzetta
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Maria Gabriella Matera
- Department of Experimental Medicine, Unit of Pharmacology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Paola Rogliani
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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35
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Miyasaka T, Dobashi-Okuyama K, Takahashi T, Takayanagi M, Ohno I. The interplay between neuroendocrine activity and psychological stress-induced exacerbation of allergic asthma. Allergol Int 2018; 67:32-42. [PMID: 28539203 DOI: 10.1016/j.alit.2017.04.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/04/2017] [Accepted: 04/16/2017] [Indexed: 12/27/2022] Open
Abstract
Psychological stress is recognized as a key factor in the exacerbation of allergic asthma, whereby brain responses to stress act as immunomodulators for asthma. In particular, stress-induced enhanced type 2 T-helper (Th2)-type lung inflammation is strongly associated with asthma pathogenesis. Psychological stress leads to eosinophilic airway inflammation through activation of the hypothalamic-pituitary-adrenal pathway and autonomic nervous system. This is followed by the secretion of stress hormones into the blood, including glucocorticoids, epinephrine, and norepinephrine, which enhance Th2 and type 17 T-helper (Th17)-type asthma profiles in humans and rodents. Recent evidence has shown that a defect of the μ-opioid receptor in the brain along with a defect of the peripheral glucocorticoid receptor signaling completely disrupted stress-induced airway inflammation in mice. This suggests that the stress response facilitates events in the central nervous and endocrine systems, thus exacerbating asthma. In this review, we outline the recent findings on the interplay between stress and neuroendocrine activities followed by stress-induced enhanced Th2 and Th17 immune responses and attenuated regulatory T (Treg) cell responses that are closely linked with asthma exacerbation. We will place a special focus on our own data that has emphasized the continuity from central sensing of psychological stress to enhanced eosinophilic airway inflammation. The mechanism that modulates psychological stress-induced exacerbation of allergic asthma through neuroendocrine activities is thought to involve a series of consecutive pathological events from the brain to the lung, which implies there to be a "neuropsychiatry phenotype" in asthma.
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Affiliation(s)
- Tomomitsu Miyasaka
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kaori Dobashi-Okuyama
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoko Takahashi
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Motoaki Takayanagi
- Division of Pathophysiology, Department of Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Isao Ohno
- Center for Medical Education, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
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Mark JD. Asthma. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Alcala E, Cisneros R, Capitman JA. Health care access, concentrated poverty, and pediatric asthma hospital care use in California's San Joaquin Valley: A multilevel approach. J Asthma 2017; 55:1253-1261. [PMID: 29261336 DOI: 10.1080/02770903.2017.1409234] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations. OBJECTIVE The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access. METHODS This was a retrospective study based on secondary data from California hospital and ED records 2007-2012. Children who used services for asthma-related conditions, were aged 0-14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors. RESULTS The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01-1.02; RR = 1.03, 95% CI = 1.02-1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty. CONCLUSIONS Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.
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Affiliation(s)
- Emanuel Alcala
- a Department of Public Health, School of Social Sciences, Humanities, and Arts , University of California, Merced , California , USA.,b College of Health and Human Services , Central Valley Health Policy Institute, California State University , Fresno , California , USA
| | - Ricardo Cisneros
- a Department of Public Health, School of Social Sciences, Humanities, and Arts , University of California, Merced , California , USA
| | - John A Capitman
- b College of Health and Human Services , Central Valley Health Policy Institute, California State University , Fresno , California , USA
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Corticotropin-releasing hormone modulates airway vagal preganglionic neurons of Sprague–Dawley rats at multiple synaptic sites via activation of its type 1 receptors: Implications for stress-associated airway vagal excitation. Neuroscience 2017; 355:101-112. [DOI: 10.1016/j.neuroscience.2017.04.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/13/2017] [Accepted: 04/29/2017] [Indexed: 01/24/2023]
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Carlson S, Borrell LN, Eng C, Nguyen M, Thyne S, LeNoir MA, Burke-Harris N, Burchard EG, Thakur N. Self-reported racial/ethnic discrimination and bronchodilator response in African American youth with asthma. PLoS One 2017; 12:e0179091. [PMID: 28609485 PMCID: PMC5469454 DOI: 10.1371/journal.pone.0179091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/23/2017] [Indexed: 01/23/2023] Open
Abstract
IMPORTANCE Asthma is a multifactorial disease composed of endotypes with varying risk profiles and outcomes. African Americans experience a high burden of asthma and of psychosocial stress, including racial discrimination. It is unknown which endotypes of asthma are vulnerable to racial/ethnic discrimination. OBJECTIVE We examined the association between self-reported racial/ethnic discrimination and bronchodilator response (BDR) among African American youth with asthma ages 8 to 21 years (n = 576) and whether this association varies with tumor necrosis factor alpha (TNF-α) level. MATERIALS AND METHODS Self-reported racial/ethnic discrimination was assessed by a modified Experiences of Discrimination questionnaire as none or any. Using spirometry, BDR was specified as the mean percentage change in forced expiratory volume in one second before and after albuterol administration. TNF-α was specified as high/low levels based on our study population mean. Linear regression was used to examine the association between self-reported racial/ethnic discrimination and BDR adjusted for selected characteristics. An interaction term between TNF-α levels and self-reported racial/ethnic discrimination was tested in the final model. RESULTS Almost half of participants (48.8%) reported racial/ethnic discrimination. The mean percent BDR was higher among participants reporting racial/ethnic discrimination than among those who did not (10.8 versus 8.9, p = 0.006). After adjustment, participants reporting racial/ethnic discrimination had a 1.7 (95% CI: 0.36-3.03) higher BDR mean than those not reporting racial/ethnic discrimination. However, we found heterogeneity of this association according to TNF-α levels (p-interaction = 0.040): Among individuals with TNF-α high level only, we observed a 2.78 higher BDR mean among those reporting racial/ethnic discrimination compared with those not reporting racial/ethnic discrimination (95%CI: 0.79-4.77). CONCLUSIONS We found BDR to be increased in participants reporting racial/ethnic discrimination and this association was limited to African American youth with TNF-α high asthma, an endotype thought to be resistant to traditional asthma medications. These results support screening for racial/ethnic discrimination in those with asthma as it may reclassify disease pathogenesis.
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Affiliation(s)
- Sonia Carlson
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Luisa N. Borrell
- Department of Epidemiology & Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, United States of America
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Myngoc Nguyen
- Department of Allergy and Immunology, Kaiser Permanente-Oakland Medical Center, Oakland, California, United States of America
| | - Shannon Thyne
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, California, United States of America
| | | | - Nadine Burke-Harris
- The Center for Youth Wellness, San Francisco, California, United States of America
| | - Esteban G. Burchard
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | - Neeta Thakur
- Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Sato S, Yanagawa Y, Hiraide S, Iizuka K. Cyclic AMP signaling enhances lipopolysaccharide sensitivity and interleukin-33 production in RAW264.7 macrophages. Microbiol Immunol 2017; 60:382-9. [PMID: 27059942 DOI: 10.1111/1348-0421.12381] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/17/2016] [Accepted: 04/01/2016] [Indexed: 12/28/2022]
Abstract
While it has been suggested that IL-33 plays pathogenic roles in various disorders, the factors that stimulate IL-33 production are poorly characterized. In the present study, the effect of cyclic adenosine monophosphate (cAMP) signaling on IL-33 production in RAW264.7 macrophages in response to various doses of LPS was examined. High-dose LPS treatment induced IL-33 and TNF protein production in RAW264.7 macrophages. In contrast, low-dose LPS failed to induce IL-33 production while significantly inducing TNF production. In the presence of the membrane-permeable cAMP analog 8-Br-cAMP, low-dose LPS induced vigorous IL-33 production. This phenomenon was consistent with amounts of mRNA. Similarly, the cAMP-increasing agent adrenaline also enhanced the sensitivity of RAW264.7 macrophages to LPS as demonstrated by IL-33 production. The protein kinase A (PKA) inhibitor H89 blocked the effects of 8-Br-cAMP and adrenaline on IL-33 production, suggesting that PKA is involved in IL-33 induction. Taken together, cAMP-mediated signaling pathway appears to enhance the sensitivity of RAW264.7 macrophages to LPS with respect to IL-33 production. Our findings suggest that stress events and the subsequent secretion of adrenaline enhance macrophage production via IL-33; this process may be associated with the pathogenesis of various disorders involving IL-33.
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Affiliation(s)
- Shizuka Sato
- Department of Pharmacology, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Kanazawa 1757, Ishikari-Tobetsu 061-0293, Japan
| | - Yoshiki Yanagawa
- Department of Pharmacology, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Kanazawa 1757, Ishikari-Tobetsu 061-0293, Japan
| | - Sachiko Hiraide
- Department of Pharmacology, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Kanazawa 1757, Ishikari-Tobetsu 061-0293, Japan
| | - Kenji Iizuka
- Department of Pharmacology, School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, Kanazawa 1757, Ishikari-Tobetsu 061-0293, Japan
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Loerbroks A, Ding H, Han W, Wang H, Wu JP, Yang L, Angerer P, Li J. Work stress, family stress and asthma: a cross-sectional study among women in China. Int Arch Occup Environ Health 2017; 90:349-356. [PMID: 28220243 DOI: 10.1007/s00420-017-1201-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/12/2017] [Indexed: 01/05/2023]
Abstract
PURPOSE Research addressing links of work stress or family stress with asthma is constrained by (1) inconsistent evidence, (2) failure to consider the combined exposure to work stress and family stress, and (3) its primary focus on Western study populations. We aimed to address these knowledge gaps. METHODS We used cross-sectional data collected in 2015 among 7816 women from five professional groups in five Chinese cities. Work stress was measured by the 10-item effort-reward imbalance (ERI) questionnaire. Family stress was assessed by a psychometrically evaluated instrument comprising five items on, e.g., familial conflicts or domestic workload. Asthma was operationalized by self-reports of a physician diagnosis. Associations were examined by multivariable logistic regression estimating odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Both high work stress (i.e., ERI score >1) and high family stress (i.e., score above the median) were associated with asthma (OR 1.66, 95% CI 1.22-2.27 and OR 1.48, 95% CI 1.10-1.99, respectively). Women with combined exposure (versus none) had somewhat higher odds of asthma (OR 2.13, 95% CI 1.42-3.19) than those with sole exposure to either work stress (OR 1.89, 95% CI 1.20-2.96) or family stress (OR 1.71, 95% CI 1.03-2.84). Interaction terms were significant for continuous variables (p = 0.046), but not for dichotomized variables (p = 0.199). CONCLUSIONS The present study suggests that both work stress and family stress are positively associated with asthma in women in China. Further, the combined exposure may be associated with a further excess of asthma occurrence. Longitudinal studies are needed to confirm our findings and to explore potential temporal relationships.
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Affiliation(s)
- Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Hui Ding
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojiayuan Road, 100026, Beijing, People's Republic of China. .,School of Public Health, Capital Medical University, Beijing, People's Republic of China.
| | - Wei Han
- Shaanxi Provincial People's Hospital, Xi'an, People's Republic of China
| | - Hong Wang
- Shenzhen Maternity and Child Health Care Hospital, Shenzhen, People's Republic of China
| | - Jiang-Ping Wu
- Nanjing Maternity and Child Health Care Hospital, Nanjing, People's Republic of China
| | - Liu Yang
- Shenyang Women and Children Health Care Center, Shenyang, People's Republic of China
| | - Peter Angerer
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Jian Li
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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Brumpton B, Mai XM, Langhammer A, Laugsand LE, Janszky I, Strand LB. Prospective study of insomnia and incident asthma in adults: the HUNT study. Eur Respir J 2017; 49:49/2/1601327. [PMID: 28153868 DOI: 10.1183/13993003.01327-2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 11/07/2016] [Indexed: 01/20/2023]
Abstract
Insomnia is highly prevalent among asthmatics; however, few studies have investigated insomnia symptoms and asthma development. We aimed to investigate the association between insomnia and the risk of incident asthma in a population-based cohort.Among 17 927 participants free from asthma at baseline we calculated odds ratios and 95% confidence intervals for the risk of incident asthma among those with insomnia compared to those without. Participants reported sleep initiation problems, sleep maintenance problems and nonrestorative sleep. Chronic insomnia was defined as those reporting one or more insomnia symptom at baseline and 10 years earlier. Incident asthma was defined by questions on asthma at baseline and follow-up (average 11 years).The prevalence of sleep initiation problems, sleep maintenance problems and nonrestorative sleep were 1%, 1% and 5%, respectively. The multi-adjusted odds ratios were 1.18 (95% CI 0.97-1.44), 1.30 (95% CI 1.03-1.64) and 1.70 (95% CI 1.37-2.11) for people with one, two and three insomnia symptoms, respectively, compared with people without symptoms (p<0.01 for trend). The risk of developing asthma in those with chronic insomnia was three times higher (adjusted OR 3.16, 95% CI 1.37-6.40) than those without.Insomnia symptoms were associated with increased risk of incident asthma in this study.
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Affiliation(s)
- Ben Brumpton
- Dept of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway .,Dept of Thoracic and Occupational Medicine, Trondheim University Hospital, Trondheim, Norway
| | - Xiao-Mei Mai
- Dept of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Arnulf Langhammer
- Dept of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Lars Erik Laugsand
- Dept of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | - Imre Janszky
- Dept of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway.,Regional Center for Health Care Improvement, St Olav Hospital, Trondheim, Norway
| | - Linn Beate Strand
- Dept of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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Association of neighborhood crime with asthma and asthma morbidity among Mexican American children in Chicago, Illinois. Ann Allergy Asthma Immunol 2016; 117:502-507.e1. [PMID: 27788879 DOI: 10.1016/j.anai.2016.09.429] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is increasing evidence that neighborhood-level factors, in addition to individual-level factors, may contribute directly or indirectly to childhood asthma by affecting environmental and lifestyle factors. Exposure to neighborhood crime and violence has been associated with poor health outcomes, especially among underserved and minority populations, and its effect on respiratory health is an area of active research. OBJECTIVE To examine the association of residential neighborhood crime with asthma and asthma-related outcomes among Mexican American children. METHODS This cross-sectional study was conducted with parents of 2,023 Mexican American children. We derived measures of neighborhood (census tract) violent, property, and drug abuse crime and used multilevel generalized estimating equations to test associations of neighborhood crime counts with respiratory conditions. RESULTS In multiple regression models, a 1-SD increase in neighborhood property crimes significantly increased the odds of lifetime asthma, lifetime wheezing, lifetime emergency department (ED) visits attributable to asthma or wheezing, and lifetime hospitalization attributable to asthma or wheezing by 25%, 18%, 44%, and 62%, respectively. A 1-SD elevation in neighborhood violent crime was positively and significantly associated with 21% and 57% higher odds of lifetime wheezing and ED visits, respectively. We also observed 13% and 44% significantly increased odds of lifetime wheezing and ED visits, respectively, for a 1-SD increase in drug abuse crime. These findings were not explained or modified by individual- and neighborhood-level covariates. CONCLUSION Higher neighborhood crime was associated with greater odds of asthma and asthma morbidity in Mexican American children.
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Vo P, Bair-Merritt M, Camargo CA, Eisenberg S, Long W. Individual factors, neighborhood social context and asthma at age 5 years. J Asthma 2016; 54:265-272. [PMID: 27485524 DOI: 10.1080/02770903.2016.1216563] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Childhood asthma is a major public health problem and its development is multifactorial. We examined whether neighborhood cohesion and disorder were associated with caregiver-report of asthma at age 5 years. METHODS This study is a secondary data analysis of the 2011-2012 United States National Survey of Children's Health. Data were available for 4680 children, age 5 years old born at term or preterm with birthweight >2500 g. Neighborhood disorder and cohesion were assessed based on caregivers' responses to validated questionnaires. Child asthma diagnosis was reported by the caregiver. Multivariable logistic regression was used to examine the relationship between these neighborhood factors and caregiver-report of child asthma, while accounting for individual level covariates. RESULTS Approximately two-thirds of the 4680 children were White and lived in households with income >400% of federal poverty line. Asthma was present in 399 (9%) children. Child female sex was associated with reduced risk of caregiver-reported asthma while non-Hispanic Black race and having smokers in the household were independently associated with increased risk in multivariable models. In these models, neighborhood disorder was significantly associated with asthma (adjusted Odds Ratio [aOR] 1.70, 95% Confidence Interval [CI] 1.04-2.78), while neighborhood cohesion was not (aOR 0.93, 95% CI 0.51-1.68). CONCLUSION Even after adjustment for several individual level factors, neighborhood disorder was associated with caregiver-report of asthma in this nationally representative sample of 5-year-old children. Further research is needed to better understand how risk factors at different levels of the socio-ecological framework may interact to affect childhood asthma development.
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Affiliation(s)
- Phuong Vo
- a Department of Pediatrics , Boston Medical Center , Boston , MA , USA
| | | | - Carlos A Camargo
- b Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA
| | - Staci Eisenberg
- c Departments of Pediatrics and Medicine , Brown University/Hasboro , Providence , RI , USA
| | - Webb Long
- d Child Health Associates , Auburn , MA , USA
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Hartmann B, Leucht V, Loerbroks A. Work stress, asthma control and asthma-specific quality of life: Initial evidence from a cross-sectional study. J Asthma 2016; 54:210-216. [PMID: 27328314 DOI: 10.1080/02770903.2016.1201836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Research has suggested that psychological stress is positively associated with asthma morbidity. One major source of stress in adulthood is one's occupation. However, to date, potential links of work stress with asthma control or asthma-specific quality of life have not been examined. We aimed to address this knowledge gap. METHODS In 2014/2015, we conducted a cross-sectional study among adults with asthma in Germany (n = 362). For the current analyses that sample was restricted to participants in employment and reporting to have never been diagnosed with chronic obstructive pulmonary disease (n = 94). Work stress was operationalized by the 16-item effort-reward-imbalance (ERI) questionnaire, which measures the subcomponents "effort", "reward" and "overcommitment." Participants further completed the Asthma Control Test and the Asthma Quality of Life Questionnaire-Sydney. Multivariable associations were quantified by linear regression and logistic regression. RESULTS Effort, reward and their ratio (i.e. ERI ratio) did not show meaningful associations with asthma morbidity. By contrast, increasing levels of overcommitment were associated with poorer asthma control and worse quality of life in both linear regression (ß = -0.26, p = 0.01 and ß = 0.44, p < 0.01, respectively) and logistic regression (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.14-3.07 and OR = 2.34, 95% CI = 1.32-4.15, respectively). CONCLUSIONS The present study provides initial evidence of a positive relationship of work-related overcommitment with asthma control and asthma-specific quality of life. Longitudinal studies with larger samples are needed to confirm our findings and to disentangle the potential causality of associations.
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Affiliation(s)
- Bettina Hartmann
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
| | - Verena Leucht
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
| | - Adrian Loerbroks
- a Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf , Düsseldorf , Germany
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Feitosa CA, Santos DN, Barreto ML, Rodrigues LC. The effect of internalization and other psychologic factors on the remission and severity of wheeze in children. Pediatr Allergy Immunol 2016; 27:398-403. [PMID: 26843104 DOI: 10.1111/pai.12545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Asthma prevalence in Latin America is high and continues to increase. There is evidence that the psychologic characteristics of the child are associated with greater asthma morbidity. This study aimed to investigate the independent effect of internalizing/externalizing problems on two asthma/wheeze outcomes: (i) remission and (ii) progression to severity on Latin American children with mild asthma symptoms at baseline. METHODS This was a prospective study in a cohort of 371 asthmatic children living in a poor urban area in Salvador, Brazil. The psychologic characteristics of the child were assessed using the Child Behavior Checklist (CBCL), and wheezing was defined using the ISAAC questionnaire at the start and end of follow-up. A multiple logistic regression model with random effects was used to examine the association between the psychologic components and both outcomes. RESULTS Remission of symptoms of wheeze was observed among 229 (61.73%) children. Remission was 56% lower among children with internalizing problems (OR = 0.54, 95% CI 0.33-0.87, p = 0.01). In addition, we found that 19 (8.76%) of the children acquired severe symptoms during follow-up and there was strong evidence of the effect of internalizing problems in increasing the risk of progression to severe wheeze symptoms (OR = 4.03, 95% CI 1.39-11.70, p = 0.01). CONCLUSIONS Children with internalizing problems but not externalizing had less remission of wheezing, and a higher risk of acquiring severe symptoms. These results highlight the importance of psychologic care for children with asthma, to improve the prognosis of this condition.
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Affiliation(s)
- Caroline A Feitosa
- Institute of Collective Health, Federal University of Bahia - ISC/UFBA, Salvador, Brazil
| | - Darci N Santos
- Institute of Collective Health, Federal University of Bahia - ISC/UFBA, Salvador, Brazil
| | - Maurício L Barreto
- Institute of Collective Health, Federal University of Bahia - ISC/UFBA, Salvador, Brazil
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Bulcun E, Turkel Y, Oguztürk O, Dag E, Visal Buturak S, Ekici A, Ekici M. Psychological characteristics of patients with asthma. CLINICAL RESPIRATORY JOURNAL 2016; 12:113-118. [PMID: 27149073 DOI: 10.1111/crj.12494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 12/14/2015] [Accepted: 04/19/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Psychological distress of patients with asthma may be reduced when they learned to live with their illness. Asthma can change the psychological and personality characteristics. We aim to investigate the psychological and personality characteristics of patients with asthma using MMPI (Minnesota Multiphasic Personality Inventory). METHODS Thirty-three adult patients with asthma (23 female and 10 male) and 20 healthy controls (14 females and 6 males) were enrolled in this study. Psychometric evaluation was made with the Turkish version of the MMPI. The patients were separated into two groups according to the duration of symptoms (recent-onset asthma < 10 years, long-standing asthma ≥10 years). RESULTS Patients with asthma compared with control group had significantly higher the rate of clinical elevation on depression, hysteria, psychasthenia and social introversion. Patients with recent-onset asthma compared with long-standing asthma have significantly higher the rate of clinical elevation on depression, hysteria, psychopathic deviate, psychasthenia and social introversion. MMPI mean t score in patients with recent-onset asthma was higher than patients with long-standing asthma. MMPI mean t score in patients with asthma was negatively associated with the symptom duration in multivariate model. CONCLUSIONS Patients with asthma have relatively more inactivity, anergia, guilt, pessimism, nonspecific physical complaints, irrational fears and introvert. Patients with long-standing asthma have less psychological distress, suggesting that learned to cope with his illness.
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Affiliation(s)
- Emel Bulcun
- Faculty of Medicine, Department of Pulmonary Diseases, Kirikkale University, Kirikkale, Turkey
| | - Yakup Turkel
- Faculty of Medicine, Department of Neurology, Kirikkale University, Kirikkale, Turkey
| | - Omer Oguztürk
- Faculty of Medicine, Department of Psychiatry, Kirikkale University, Kirikkale, Turkey
| | - Ersel Dag
- Faculty of Medicine, Department of Neurology, Kirikkale University, Kirikkale, Turkey
| | - S Visal Buturak
- Faculty of Medicine, Department of Psychiatry, Kirikkale University, Kirikkale, Turkey
| | - Aydanur Ekici
- Faculty of Medicine, Department of Pulmonary Diseases, Kirikkale University, Kirikkale, Turkey
| | - Mehmet Ekici
- Faculty of Medicine, Department of Pulmonary Diseases, Kirikkale University, Kirikkale, Turkey
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48
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Tuchscherer M, Kanitz E, Tuchscherer A, Puppe B. Effects of social support on glucocorticoid sensitivity of lymphocytes in socially deprived piglets. Stress 2016; 19:325-32. [PMID: 27160343 DOI: 10.1080/10253890.2016.1179276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
There is growing evidence that social support given by a conspecific attenuates stress responses of a socially deprived animal. We hypothesized that the presence of a familiar social partner modulates the effectiveness of social buffering as assessed by an altered glucocorticoid sensitivity of immune cells. The current study investigated the effects of a 4-h social deprivation procedure on stress hormone responses and immune cell functions in 7-, 21- and 35-day-old piglets (52 males and 56 females). Within each of the three age categories, nine piglets were deprived of their mother and littermates either alone or with a familiar or unfamiliar age-matched piglet. Compared to non-deprived controls, piglets that were alone displayed significant increases in plasma adrenocorticotropic hormone and cortisol concentrations, and all socially deprived piglets showed a greater in vitro proliferative response of peripheral blood mononuclear cells (PBMCs) to lipopolysaccharide (LPS)-stimulation than controls. Concanavalin A (ConA)-induced in vitro proliferation was not affected by social treatment. Additionally, both the ConA- and LPS-stimulated PBMCs from piglets that experienced any of the deprivation treatments were more resistant to the inhibitory effects of cortisol than PBMCs from the controls in each of the three age categories. Irrespective of the mitogen used, the presence of an age-matched conspecific during deprivation attenuated the dose-dependent cortisol resistance. Here, familiarity between the piglets clearly improved the effectiveness of social support in an age-dependent manner. Collectively, our findings emphasize the benefits of social partners regarding stress coping abilities, with positive implications for animal welfare and health.
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Affiliation(s)
- Margret Tuchscherer
- a Institute of Behavioural Physiology, Leibniz Institute for Farm Animal Biology (FBN) , Dummerstorf , Germany
| | - Ellen Kanitz
- a Institute of Behavioural Physiology, Leibniz Institute for Farm Animal Biology (FBN) , Dummerstorf , Germany
| | - Armin Tuchscherer
- b Institute of Genetics and Biometry, Leibniz Institute for Farm Animal Biology (FBN) , Dummerstorf , Germany
| | - Birger Puppe
- a Institute of Behavioural Physiology, Leibniz Institute for Farm Animal Biology (FBN) , Dummerstorf , Germany
- c Behavioural Sciences, Faculty of Agricultural and Environmental Sciences , University of Rostock , Rostock , Germany
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49
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Abstract
Corticosteroids are the most effective treatment for asthma, but the therapeutic response varies markedly between individuals, with up to one third of patients showing evidence of insensitivity to corticosteroids. This article summarizes information on genetic, environmental and asthma-related factors as well as demographic and pharmacokinetic variables associated with corticosteroid insensitivity in asthma. Molecular mechanisms proposed to explain corticosteroid insensitivity are reviewed including alterations in glucocorticoid receptor subtype, binding and nuclear translocation, increased proinflammatory transcription factors and defective histone acetylation. Current therapies and future interventions that may restore corticosteroid sensitivity in asthma are discussed, including small molecule drugs and biological agents. In the future, biomarkers may be used in the clinic to predict corticosteroid sensitivity in patients with poorly controlled asthma.
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Affiliation(s)
- Neil C Thomson
- a Institute of Infection, Immunity & Inflammation , University of Glasgow , Glasgow , UK
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50
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Dunton G, Dzubur E, Li M, Huh J, Intille S, McConnell R. Momentary Assessment of Psychosocial Stressors, Context, and Asthma Symptoms in Hispanic Adolescents. Behav Modif 2015; 40:257-80. [PMID: 26438664 DOI: 10.1177/0145445515608145] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The current study used a novel real-time data capture strategy, ecological momentary assessment (EMA), to examine whether within-day variability in stress and context leads to exacerbations in asthma symptomatology in the everyday lives of ethnic minority adolescents. Low-income Hispanic adolescents (N = 20; 7th-12th grade; 54% male) with chronic asthma completed 7 days of EMA on smartphones, with an average of five assessments per day during non-school time. EMA surveys queried about where (e.g., home, outdoors) and with whom (e.g., alone, with friends) participants were at the time of the prompt. EMA surveys also assessed over the past few hours whether participants had experienced specific stressors (e.g., being teased, arguing with anyone), asthma symptoms (e.g., wheezing, coughing), or used an asthma inhaler. Multilevel models tested the independent relations of specific stressors and context to subsequent asthma symptoms adjusting for age, gender, and chronological day in the study. Being outdoors, experiencing disagreements with parents, teasing, and arguing were associated with more severe self-reported asthma symptoms in the next few hours (ps < .05). Being alone and having too much to do were unrelated to the experience of subsequent self-reported asthma symptoms. Using a novel real-time data capture strategy, results provide preliminary evidence that being outdoors and experiencing social stressors may induce asthma symptoms in low-income Hispanic children and adolescents with chronic asthma. The results of this preliminary study can serve as a basis for larger epidemiological and intervention studies.
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Affiliation(s)
| | - Eldin Dzubur
- University of Southern California, Los Angeles, USA
| | - Marilyn Li
- University of Southern California, Los Angeles, USA
| | - Jimi Huh
- University of Southern California, Los Angeles, USA
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