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Stojchevski R, Chandrasekaran P, Hadzi-Petrushev N, Mladenov M, Avtanski D. Adipose Tissue Dysfunction Related to Climate Change and Air Pollution: Understanding the Metabolic Consequences. Int J Mol Sci 2024; 25:7849. [PMID: 39063092 PMCID: PMC11277516 DOI: 10.3390/ijms25147849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
Obesity, a global pandemic, poses a major threat to healthcare systems worldwide. Adipose tissue, the energy-storing organ during excessive energy intake, functions as a thermoregulator, interacting with other tissues to regulate systemic metabolism. Specifically, brown adipose tissue (BAT) is positively associated with an increased resistance to obesity, due to its thermogenic function in the presence of uncoupled protein 1 (UCP1). Recently, studies on climate change and the influence of environmental pollutants on energy homeostasis and obesity have drawn increasing attention. The reciprocal relationship between increasing adiposity and increasing temperatures results in reduced adaptive thermogenesis, decreased physical activity, and increased carbon footprint production. In addition, the impact of climate change makes obese individuals more prone to developing type 2 diabetes mellitus (T2DM). An impaired response to heat stress, compromised vasodilation, and sweating increase the risk of diabetes-related comorbidities. This comprehensive review provides information about the effects of climate change on obesity and adipose tissue, the risk of T2DM development, and insights into the environmental pollutants causing adipose tissue dysfunction and obesity. The effects of altered dietary patterns on adiposity and adaptation strategies to mitigate the detrimental effects of climate change are also discussed.
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Affiliation(s)
- Radoslav Stojchevski
- Friedman Diabetes Institute, Lenox Hill Hospital, Northwell Health, New York, NY 10003, USA;
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
| | | | - Nikola Hadzi-Petrushev
- Faculty of Natural Sciences and Mathematics, Institute of Biology, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia; (N.H.-P.); (M.M.)
| | - Mitko Mladenov
- Faculty of Natural Sciences and Mathematics, Institute of Biology, Ss. Cyril and Methodius University, 1000 Skopje, North Macedonia; (N.H.-P.); (M.M.)
| | - Dimiter Avtanski
- Friedman Diabetes Institute, Lenox Hill Hospital, Northwell Health, New York, NY 10003, USA;
- Feinstein Institutes for Medical Research, Manhasset, NY 11030, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
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2
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Bisoffi L, Sassudelli G, Agostinis F, Cogo A, Cutrera R, Dalpiaz I, Di Cicco ME, Guidi B, Grutta SL, Miceli A, Mori F, Piacentini G, Peroni D, Snjiders D, Giovannini M, Baldo E. Pediatric asthma and altitude: a complex interplay between different environmental factors. Ital J Pediatr 2024; 50:42. [PMID: 38448980 PMCID: PMC10918861 DOI: 10.1186/s13052-023-01492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/09/2023] [Indexed: 03/08/2024] Open
Abstract
Asthma is one of the most common non-communicable diseases, and its prevalence and morbidity are influenced by a wide array of factors that are only partially understood. In addition to individual predisposition linked to genetic background and early life infections, environmental factors are crucial in determining the impact of asthma both on an individual patient and on a population level.Several studies have examined the role of the environment where asthmatic subjects live in the pathogenesis of asthma. This review aims to investigate the differences in the prevalence and characteristics of asthma between the pediatric population residing at higher altitudes and children living at lower altitudes, trying to define factors that potentially determine such differences. For this purpose, we reviewed articles from the literature concerning observational studies assessing the prevalence of pediatric asthma in these populations and its characteristics, such as spirometric and laboratory parameters and associated sensitization to aeroallergens.Despite the heterogeneity of the environments examined, the hypothesis of a beneficial effect of residing at a higher altitude on the prevalence of pediatric asthma could be confirmed, as well as a good profile on airway inflammation in asthmatic children. However, the possibility of a higher hospitalization risk for asthma in children living at higher altitudes was demonstrated. Moreover, a positive association between residing at a higher altitude and sensitization to pollens and between lower altitude and sensitization to house dust mites could be confirmed in some pediatric patients, even if the results are not homogeneous, probably due to the different geographical and climatic regions considered. Nonetheless, further studies, e.g., extensive and international works, need to be conducted to better understand the complex interplay between different environmental factors, such as altitude, and the pathogenesis of asthma and how its prevalence and characteristics could vary due to climate change.
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Affiliation(s)
- Laura Bisoffi
- Department of Health Sciences, University of Florence, Florence, Italy
| | | | | | - Annalisa Cogo
- Center for Exercise and Sport Science, University of Ferrara, Ferrara, Italy
- Institute Pio XII, Misurina, Italy
| | - Renato Cutrera
- Pediatric Pulmonology Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Irene Dalpiaz
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Maria Elisa Di Cicco
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Battista Guidi
- Hospital and Territorial Pediatrics Unit, Pavullo Hospital, Pavullo nel Frignano, Italy
| | - Stefania La Grutta
- National Research Council, Institute of Translational Pharmacology (IFT), Palermo, Italy
| | - Andrea Miceli
- Hospital and Territorial Pediatrics Unit, Pavullo Hospital, Pavullo nel Frignano, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | | | - Diego Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Deborah Snjiders
- Department of Woman and Child Health (SDB), University of Padova, Padua, Italy
| | - Mattia Giovannini
- Department of Health Sciences, University of Florence, Florence, Italy.
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
| | - Ermanno Baldo
- "Giovan Battista Mattei" Research Institute, Stenico, Italy
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3
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Climate Change Factors and the Aerobiology Effect. Immunol Allergy Clin North Am 2022; 42:771-786. [DOI: 10.1016/j.iac.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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4
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Subiza J, Cabrera M, Jm CR, Jc C, Mj N. Influence of climate change on airborne pollen concentrations in Madrid, 1979-2018. Clin Exp Allergy 2021; 52:574-577. [PMID: 34918414 DOI: 10.1111/cea.14082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/03/2021] [Accepted: 12/12/2021] [Indexed: 12/12/2022]
Affiliation(s)
| | - Martha Cabrera
- Allergy Department, Hospital Los Madroños, Madrid, Spain
| | - Cárdenas-Rebollo Jm
- Department of Applied Mathematics and Statistics, CEU San Pablo University, Madrid, Spain
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5
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Pathak N, McKinney A. Planetary Health, Climate Change, and Lifestyle Medicine: Threats and Opportunities. Am J Lifestyle Med 2021; 15:541-552. [PMID: 34646104 PMCID: PMC8504332 DOI: 10.1177/15598276211008127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Global environmental degradation and climate change threaten the foundation of human health and well-being. In a confluence of crises, the accelerating pace of climate change and other environmental disruptions pose an additional, preventable danger to a global population that is both aging and carrying a growing burden of noncommunicable diseases (NCDs). Climate change and environmental disruption function as "threat multipliers," especially for those with NCDs, worsening the potential health impacts on those with suboptimal health. At the same time, these environmental factors threaten the basic pillars of health and prevention, increasing the risk of developing chronic disease. In the face of these threats, the core competencies of lifestyle medicine (LM) present crucial opportunities to mitigate climate change and human health impacts while also allowing individuals and communities to build resilience. LM health professionals are uniquely positioned to coach patients toward climate-healthy behavior changes that heal both people and the planet.
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Affiliation(s)
- Neha Pathak
- American College of Lifestyle Medicine, Global Sustainability Committee, Atlanta, Georgia
| | - Amanda McKinney
- Institute for Human and Planetary Health-Doane University, Crete, Nebraska
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Koch CA, Sharda P, Patel J, Gubbi S, Bansal R, Bartel MJ. Climate Change and Obesity. Horm Metab Res 2021; 53:575-587. [PMID: 34496408 PMCID: PMC8440046 DOI: 10.1055/a-1533-2861] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023]
Abstract
Global warming and the rising prevalence of obesity are well described challenges of current mankind. Most recently, the COVID-19 pandemic arose as a new challenge. We here attempt to delineate their relationship with each other from our perspective. Global greenhouse gas emissions from the burning of fossil fuels have exponentially increased since 1950. The main contributors to such greenhouse gas emissions are manufacturing and construction, transport, residential, commercial, agriculture, and land use change and forestry, combined with an increasing global population growth from 1 billion in 1800 to 7.8 billion in 2020 along with rising obesity rates since the 1980s. The current Covid-19 pandemic has caused some decline in greenhouse gas emissions by limiting mobility globally via repetitive lockdowns. Following multiple lockdowns, there was further increase in obesity in wealthier populations, malnutrition from hunger in poor populations and death from severe infection with Covid-19 and its virus variants. There is a bidirectional relationship between adiposity and global warming. With rising atmospheric air temperatures, people typically will have less adaptive thermogenesis and become less physically active, while they are producing a higher carbon footprint. To reduce obesity rates, one should be willing to learn more about the environmental impact, how to minimize consumption of energy generating carbon dioxide and other greenhouse gas emissions, and to reduce food waste. Diets lower in meat such as a Mediterranean diet, have been estimated to reduce greenhouse gas emissions by 72%, land use by 58%, and energy consumption by 52%.
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Affiliation(s)
- Christian A. Koch
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA,
USA
- Department of Medicine, The University of Tennessee Health Science
Center, Memphis, TN, USA
| | - Pankaj Sharda
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA,
USA
| | - Jay Patel
- Department of Medicine, The University of Tennessee Health Science
Center, Memphis, TN, USA
| | - Sriram Gubbi
- National Institutes of Health, Bethesda, MD, USA
| | | | - Michael J. Bartel
- Department of Medicine, Fox Chase Cancer Center, Philadelphia, PA,
USA
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7
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Plaza MP, Alcázar P, Oteros J, Galán C. Atmospheric pollutants and their association with olive and grass aeroallergen concentrations in Córdoba (Spain). ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:45447-45459. [PMID: 32789634 PMCID: PMC8197725 DOI: 10.1007/s11356-020-10422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/06/2020] [Indexed: 05/07/2023]
Abstract
Cumulative data indicate that pollen grains and air pollution reciprocally interact. Climate changes seem also to influence pollen allergenicity. Depending on the plant species and on the pollutant type and concentration, this interaction may modify the features and metabolism of the pollen grain. Previous results revealed a significant positive correlation between pollen and aeroallergen, even using two different samplers. However, some discrepancy days have been also detected with low pollen but high aeroallergen concentrations. The main aim of the present paper is to find how the environmental factors, and specially pollutants, could affect the amount of allergens from olive and grass airborne pollen. Pollen grains were collected by a Hirst-type volumetric spore trap. Aeroallergen was simultaneously sampled by a low-volume Cyclone Burkard sampler. Phl p 5 and Ole e 1 aeroallergen were quantified by double-sandwich ELISA test. The data related to air pollutants, pollen grains, and aeroallergens were analyzed with descriptive statistic. Spearman's correlation test was used to identify potential correlations between these variables. There is a significant positive correlation between aeroallergens and airborne pollen concentrations, in both studied pollen types, so allergen concentrations could be explained with the pollen concentration. The days with unlinked events coincide between olive and grass allergens. Nevertheless, concerning to our results, pollutants do not affect the amount of allergens per pollen. Even if diverse pollutants show an unclear relationship with the allergen concentration, this association seems to be a casual effect of the leading role of some meteorological parameters.
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Affiliation(s)
- Maria Pilar Plaza
- Chair and Institute of Environmental Medicine, UNIKA-T, University of Augsburg - Technical University of Munich (TUM) and Helmholtz Zentrum München, Neusässer Str. 47, 86156, Augsburg, Germany.
- Department of Botany, Ecology and Plant Physiology, University of Córdoba (UCO), Córdoba, Spain.
| | - Purificación Alcázar
- Department of Botany, Ecology and Plant Physiology, University of Córdoba (UCO), Córdoba, Spain
| | - José Oteros
- Department of Botany, Ecology and Plant Physiology, University of Córdoba (UCO), Córdoba, Spain
- Center of Allergy & Environment (ZAUM), Member of the German Center for Lung Research (DZL), Technische Universität München/Helmholtz Center, Munich, Germany
| | - Carmen Galán
- Department of Botany, Ecology and Plant Physiology, University of Córdoba (UCO), Córdoba, Spain
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Patterson BD, Mo F, Borgschulte A, Hillestad M, Joos F, Kristiansen T, Sunde S, van Bokhoven JA. Renewable CO 2 recycling and synthetic fuel production in a marine environment. Proc Natl Acad Sci U S A 2019; 116:12212-12219. [PMID: 31160448 PMCID: PMC6589678 DOI: 10.1073/pnas.1902335116] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A massive reduction in CO2 emissions from fossil fuel burning is required to limit the extent of global warming. However, carbon-based liquid fuels will in the foreseeable future continue to be important energy storage media. We propose a combination of largely existing technologies to use solar energy to recycle atmospheric CO2 into a liquid fuel. Our concept is clusters of marine-based floating islands, on which photovoltaic cells convert sunlight into electrical energy to produce H2 and to extract CO2 from seawater, where it is in equilibrium with the atmosphere. These gases are then reacted to form the energy carrier methanol, which is conveniently shipped to the end consumer. The present work initiates the development of this concept and highlights relevant questions in physics, chemistry, and mechanics.
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Affiliation(s)
- Bruce D Patterson
- Laboratory for Advanced Analytical Technologies, Swiss Federal Laboratories for Materials Science and Technology, CH-8600 Dübendorf, Switzerland
- Department of Physics, University of Zürich, CH-8057 Zürich, Switzerland
| | - Frode Mo
- Department of Physics, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Andreas Borgschulte
- Laboratory for Advanced Analytical Technologies, Swiss Federal Laboratories for Materials Science and Technology, CH-8600 Dübendorf, Switzerland;
| | - Magne Hillestad
- Department of Chemical Engineering, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Fortunat Joos
- Climate and Environmental Physics, Physics Institute, University of Bern, CH-3012 Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, CH-3012 Bern, Switzerland
| | - Trygve Kristiansen
- Department of Marine Technology, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Svein Sunde
- Department of Materials Science and Engineering, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | - Jeroen A van Bokhoven
- Department of Chemistry and Bioengineering, ETH Zurich, CH-8093 Zurich, Switzerland
- Laboratory for Catalysis and Sustainable Chemistry, Paul Scherrer Institut, CH-5232 Villigen, Switzerland
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9
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Akdis CA, Byrne J, Ballas ZK. The Journal of Allergy and Clinical Immunology: An update on style and substance. J Allergy Clin Immunol 2019; 140:60-62. [PMID: 28673404 DOI: 10.1016/j.jaci.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
| | - Justin Byrne
- Journal of Allergy Clinical Immunology, American Academy of Allergy Asthma and Immunology, Milwaukee, Wis
| | - Zuhair K Ballas
- University of Iowa and Iowa City VA Medical Center, Iowa City, Iowa
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10
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Research Needs on Respiratory Health in Migrant and Refugee Populations. An Official American Thoracic Society and European Respiratory Society Workshop Report. Ann Am Thorac Soc 2018; 15:1247-1255. [DOI: 10.1513/annalsats.201807-478st] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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11
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The Association Between Ambient Air Pollution and Allergic Rhinitis Inception and Control. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0162-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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13
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Advances in environmental and occupational disorders in 2016. J Allergy Clin Immunol 2017; 140:1683-1692. [PMID: 29080787 DOI: 10.1016/j.jaci.2017.09.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/06/2017] [Accepted: 09/28/2017] [Indexed: 12/29/2022]
Abstract
In this review we highlight recent studies that advance the knowledge and understanding of the effects of various environmental factors and associated immune responses in patients with allergic diseases. This review will focus on new literature regarding allergic and immune responses to a variety of environmental factors, including aeroallergens, stinging insects, fungi, pollutants, viral respiratory tract infections, climate change, and microbial exposures.
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Barry M, Annesi-Maesano I. Ten principles for climate, environment and respiratory health. Eur Respir J 2017; 50:50/6/1701912. [DOI: 10.1183/13993003.01912-2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/03/2017] [Indexed: 11/05/2022]
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Anderson WC, Apter AJ, Dutmer CM, Searing DA, Szefler SJ. Advances in asthma in 2016: Designing individualized approaches to management. J Allergy Clin Immunol 2017; 140:671-680. [PMID: 28709967 DOI: 10.1016/j.jaci.2017.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022]
Abstract
In this year's Advances in Asthma review, we discuss viral infections in asthmatic patients and potential therapeutic agents, the microbiome, novel genetic associations with asthma, air quality and climate effects on asthma, exposures during development and long-term sequelae of childhood asthma, patient-centered outcomes research, and precision medicine. In addition, we discuss application of biomarkers to precision medicine and new information on asthma medications. New evidence indicates that rhinovirus-triggered asthma exacerbations become more severe as the degree of sensitization to dust mite and mouse increase. The 2 biggest drivers of asthma severity are an allergy pathway starting with allergic sensitization and an environmental tobacco smoke pathway. In addition, allergic sensitization and blood eosinophils can be used to select medications for management of early asthma in young children. These current findings, among others covered in this review, represent significant steps toward addressing rapidly advancing areas of knowledge that have implications for asthma management.
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Affiliation(s)
- William C Anderson
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Andrea J Apter
- Section of Allergy & Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Cullen M Dutmer
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Daniel A Searing
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Stanley J Szefler
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
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Outdoor Environment and Pediatric Asthma: An Update on the Evidence from North America. Can Respir J 2017; 2017:8921917. [PMID: 28239256 PMCID: PMC5292365 DOI: 10.1155/2017/8921917] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/09/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction. The evidence about the association between asthma and outdoor environmental factors has been inadequate for certain allergens. Even less is known about how these associations vary across seasons and climate regions. We reviewed recent literature from North America for research related to outdoor environmental factors and pediatric asthma, with attention to spatial-temporal variations of these associations. Method. We included indexed literature between years 2010 and 2015 on outdoor environmental factors and pediatric asthma, by searching PubMed. Results. Our search resulted in 33 manuscripts. Studies about the link between pediatric asthma and traffic-related air pollutants (TRAP) consistently confirmed the correlation between TRAP and asthma. For general air pollution, the roles of PM2.5 and CO were consistent across studies. The link between asthma and O3 varied across seasons. Regional variation exists in the role of SO2. The impact of pollen was consistent across seasons, whereas the role of polycyclic aromatic hydrocarbon was less consistent. Discussion. Recent studies strengthened the evidence about the roles of PM2.5, TRAP, CO, and pollen in asthma, while the evidence for roles of PM10-2.5, PM10, O3, NO2, SO2, and polycyclic aromatic hydrocarbon in asthma was less consistent. Spatial-temporal details of the environment are needed in future studies of asthma and environment.
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