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Makrinioti H, Fainardi V, Bonnelykke K, Custovic A, Cicutto L, Coleman C, Eiwegger T, Kuehni C, Moeller A, Pedersen E, Pijnenburg M, Pinnock H, Ranganathan S, Tonia T, Subbarao P, Saglani S. European Respiratory Society statement on preschool wheezing disorders: updated definitions, knowledge gaps and proposed future research directions. Eur Respir J 2024; 64:2400624. [PMID: 38843917 DOI: 10.1183/13993003.00624-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/05/2024] [Indexed: 07/28/2024]
Abstract
Since the publication of the European Respiratory Society (ERS) task force reports on the management of preschool wheezing in 2008 and 2014, a large body of evidence has accumulated suggesting that the clinical phenotypes that were proposed (episodic (viral) wheezing and multiple-trigger wheezing) do not relate to underlying airway pathology and may not help determine response to treatment. Specifically, using clinical phenotypes alone may no longer be appropriate, and new approaches that can be used to inform clinical care are needed for future research. This ERS task force reviewed the literature published after 2008 related to preschool wheezing and has suggested that the criteria used to define wheezing disorders in preschool children should include age of diagnosis (0 to <6 years), confirmation of wheezing on at least one occasion, and more than one episode of wheezing ever. Furthermore, diagnosis and management may be improved by identifying treatable traits, including inflammatory biomarkers (blood eosinophils, aeroallergen sensitisation) associated with type-2 immunity and differential response to inhaled corticosteroids, lung function parameters and airway infection. However, more comprehensive use of biomarkers/treatable traits in predicting the response to treatment requires prospective validation. There is evidence that specific genetic traits may help guide management, but these must be adequately tested. In addition, the task force identified an absence of caregiver-reported outcomes, caregiver/self-management options and features that should prompt specialist referral for this age group. Priorities for future research include a focus on identifying 1) mechanisms driving preschool wheezing; 2) biomarkers of treatable traits and efficacy of interventions in those without allergic sensitisation/eosinophilia; 3) the need to include both objective outcomes and caregiver-reported outcomes in clinical trials; 4) the need for a suitable action plan for children with preschool wheezing; and 5) a definition of severe/difficult-to-treat preschool wheezing.
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Affiliation(s)
- Heidi Makrinioti
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- H. Makrinioti and V. Fainardi contributed equally to the manuscript
| | - Valentina Fainardi
- Department of Medicine and Surgery, Paediatric Clinic, University of Parma, Parma, Italy
- H. Makrinioti and V. Fainardi contributed equally to the manuscript
| | - Klaus Bonnelykke
- Department of Pediatrics, University of Copenhagen, Copenhagen, Denmark
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, Imperial NIHR Biomedical Research Centre, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
| | - Lisa Cicutto
- Community Research Department, National Jewish Health, University of Colorado, Denver, CO, USA
| | - Courtney Coleman
- Patient Involvement and Engagement, European Lung Foundation, Sheffield, UK
| | - Thomas Eiwegger
- Department of Pediatric and Adolescent Medicine, University Hospital St Pölten, St Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Department of Immunology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claudia Kuehni
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Alexander Moeller
- Department of Respiratory Medicine, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eva Pedersen
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Marielle Pijnenburg
- Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Thomy Tonia
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | - Padmaja Subbarao
- SickKids Research Institute, Toronto, ON, Canada
- S. Saglani and P. Subbarao contributed equally to the manuscript
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College London, Imperial NIHR Biomedical Research Centre, and Centre for Paediatrics and Child Health, Imperial College London, London, UK
- S. Saglani and P. Subbarao contributed equally to the manuscript
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Hara A, Sato T, Kress S, Suzuki K, Pham KO, Tajima A, Schikowski T, Nakamura H. Sex-specific associations between air pollutants and asthma prevalence in Japanese adults: a population-based study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-9. [PMID: 38741239 DOI: 10.1080/09603123.2024.2352597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024]
Abstract
This study investigated the association between air pollutants and asthma prevalence in male and female Japanese adults. In this retrospective cross-sectional analysis, annual mean exposure levels of air pollutants, specifically nitrogen dioxide (NO2) and particulate matter with a median aerodynamic diameter ≤2.5 μm (PM2.5), were assessed at a local monitoring site. Multivariable logistic regression models, adjusted for genetic and/or lifestyle factors, were used to explore the association between air pollutants and asthma, with stratification by sex. A total of 1,497 participants aged ≥40 years were included. Their mean age was 65.9 ± 12.4 years, with 847 being women. Overall, 91 participants were diagnosed with asthma. In the multivariable model, ambient exposure levels of NO2 and PM2.5 were significantly associated with asthma in women but not in men. This study highlights sex as a significant determinant of the link between air pollutants and asthma exacerbation, particularly among female Japanese adults.
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Affiliation(s)
- Akinori Hara
- Department of Hygiene and Public Health, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Takehiro Sato
- Department of Bioinformatics and Genomics, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
- Department of Human Biology and Anatomy, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Sara Kress
- Working group: Environmental epidemiology of lung, brain and skin aging, IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Keita Suzuki
- Department of Public Health, Advanced Preventive Medical Sciences Research Center, Kanazawa University, Kanazawa, Japan
| | - Kim-Oanh Pham
- Department of Hygiene and Public Health, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Atsushi Tajima
- Department of Bioinformatics and Genomics, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Tamara Schikowski
- Working group: Environmental epidemiology of lung, brain and skin aging, IUF - Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Hiroyuki Nakamura
- Department of Hygiene and Public Health, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Kim BE, Hui-Beckman JW, Nevid MZ, Goleva E, Leung DYM. Air pollutants contribute to epithelial barrier dysfunction and allergic diseases. Ann Allergy Asthma Immunol 2024; 132:433-439. [PMID: 38006973 DOI: 10.1016/j.anai.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
Air pollution is a global problem associated with various health conditions, causing elevated rates of morbidity and mortality. Major sources of air pollutants include industrial emissions, traffic-related pollutants, and household biomass combustion, in addition to indoor pollutants from chemicals and tobacco. Various types of air pollutants originate from both human activities and natural sources. These include particulate matter, pollen, greenhouse gases, and other harmful gases. Air pollution is linked to allergic diseases, including atopic dermatitis, allergic rhinitis, allergic conjunctivitis, food allergy, and bronchial asthma. These pollutants lead to epithelial barrier dysfunction, dysbiosis, and immune dysregulation. In addition, climate change and global warming may contribute to the exacerbation and the development of allergic diseases related to air pollutants. Epigenetic changes associated with air pollutants have also been connected to the onset of allergic diseases. Furthermore, these changes can be passed down through subsequent generations, causing a higher prevalence of allergic diseases in offspring. Modulation of the aryl hydrocarbon receptor could be a valuable strategy for alleviating air pollutant-induced epidermal barrier dysfunction and atopic dermatitis. A more effective approach to preventing allergic diseases triggered by air pollutants is to reduce exposure to them. Implementing public policies aimed at safeguarding individuals from air pollutant exposure may prove to be the most efficient solution. A pressing need exists for global policy initiatives that prioritize efforts to reduce the production of air pollutants.
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Affiliation(s)
- Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | | | | | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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Zanobetti A, Ryan PH, Coull BA, Luttmann-Gibson H, Datta S, Blossom J, Brokamp C, Lothrop N, Miller RL, Beamer PI, Visness CM, Andrews H, Bacharier LB, Hartert T, Johnson CC, Ownby DR, Khurana Hershey GK, Joseph CL, Mendonça EA, Jackson DJ, Zoratti EM, Wright AL, Martinez FD, Seroogy CM, Ramratnam SK, Calatroni A, Gern JE, Gold DR. Early-Life Exposure to Air Pollution and Childhood Asthma Cumulative Incidence in the ECHO CREW Consortium. JAMA Netw Open 2024; 7:e240535. [PMID: 38416497 PMCID: PMC10902721 DOI: 10.1001/jamanetworkopen.2024.0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/31/2023] [Indexed: 02/29/2024] Open
Abstract
Importance Exposure to outdoor air pollution contributes to childhood asthma development, but many studies lack the geographic, racial and ethnic, and socioeconomic diversity to evaluate susceptibility by individual-level and community-level contextual factors. Objective To examine early life exposure to fine particulate matter (PM2.5) and nitrogen oxide (NO2) air pollution and asthma risk by early and middle childhood, and whether individual and community-level characteristics modify associations between air pollution exposure and asthma. Design, Setting, and Participants This cohort study included children enrolled in cohorts participating in the Children's Respiratory and Environmental Workgroup consortium. The birth cohorts were located throughout the US, recruited between 1987 and 2007, and followed up through age 11 years. The survival analysis was adjusted for mother's education, parental asthma, smoking during pregnancy, child's race and ethnicity, sex, neighborhood characteristics, and cohort. Statistical analysis was performed from February 2022 to December 2023. Exposure Early-life exposures to PM2.5 and NO2 according to participants' birth address. Main Outcomes and Measures Caregiver report of physician-diagnosed asthma through early (age 4 years) and middle (age 11 years) childhood. Results Among 5279 children included, 1659 (31.4%) were Black, 835 (15.8%) were Hispanic, 2555 (48.4%) where White, and 229 (4.3%) were other race or ethnicity; 2721 (51.5%) were male and 2596 (49.2%) were female; 1305 children (24.7%) had asthma by 11 years of age and 954 (18.1%) had asthma by 4 years of age. Mean values of pollutants over the first 3 years of life were associated with asthma incidence. A 1 IQR increase in NO2 (6.1 μg/m3) was associated with increased asthma incidence among children younger than 5 years (HR, 1.25 [95% CI, 1.03-1.52]) and children younger than 11 years (HR, 1.22 [95% CI, 1.04-1.44]). A 1 IQR increase in PM2.5 (3.4 μg/m3) was associated with increased asthma incidence among children younger than 5 years (HR, 1.31 [95% CI, 1.04-1.66]) and children younger than 11 years (OR, 1.23 [95% CI, 1.01-1.50]). Associations of PM2.5 or NO2 with asthma were increased when mothers had less than a high school diploma, among Black children, in communities with fewer child opportunities, and in census tracts with higher percentage Black population and population density; for example, there was a significantly higher association between PM2.5 and asthma incidence by younger than 5 years of age in Black children (HR, 1.60 [95% CI, 1.15-2.22]) compared with White children (HR, 1.17 [95% CI, 0.90-1.52]). Conclusions and Relevance In this cohort study, early life air pollution was associated with increased asthma incidence by early and middle childhood, with higher risk among minoritized families living in urban communities characterized by fewer opportunities and resources and multiple environmental coexposures. Reducing asthma risk in the US requires air pollution regulation and reduction combined with greater environmental, educational, and health equity at the community level.
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Affiliation(s)
- Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Patrick H. Ryan
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Brent A. Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Heike Luttmann-Gibson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Soma Datta
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Blossom
- Center for Geographic Analysis, Harvard University, Cambridge, Massachusetts
| | - Cole Brokamp
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Nathan Lothrop
- Asthma and Airways Disease Research Center, University of Arizona, Tucson
- Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | - Rachel L. Miller
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paloma I. Beamer
- Asthma and Airways Disease Research Center, University of Arizona, Tucson
- Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | | | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Leonard B. Bacharier
- Monroe Carell Jr Children’s Hospital at Vanderbilt, Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Nashville, Tennessee
| | - Tina Hartert
- Vanderbilt University School of Medicine, Division of Allergy, Pulmonary, and Critical Care Medicine, Nashville, Tennessee
| | | | - Dennis R. Ownby
- Division of Allergy and Immunology, Augusta University, Augusta, Georgia
| | | | | | | | - Daniel J. Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Anne L. Wright
- Asthma and Airways Disease Research Center, University of Arizona, Tucson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, College of Medicine, University of Arizona, Tucson
| | - Fernando D. Martinez
- Asthma and Airways Disease Research Center, University of Arizona, Tucson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, College of Medicine, University of Arizona, Tucson
| | - Christine M. Seroogy
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Sima K. Ramratnam
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Diane R. Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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de Lira-Quezada CE, González-Díaz SN, Cotera-de Lira AG, Macouzet-Sánchez C, Acuña-Ortega N, Guzman-Avilán RI, Macías-Weinmann A. The association of air pollution in respiratory allergy: Its impact in an industrial city. World Allergy Organ J 2024; 17:100867. [PMID: 38370131 PMCID: PMC10869943 DOI: 10.1016/j.waojou.2023.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/23/2023] [Accepted: 12/29/2023] [Indexed: 02/20/2024] Open
Abstract
Background Asthma and allergic diseases have increased in recent decades and are more common in industrialized countries. Industrial areas with a considerably high number of inhabitants and vehicles can favor the presence of serious air pollution and therefore the appearance and exacerbation of respiratory allergy symptoms. The objective of this study was to determine the relationship between exposure to environmental pollutants with exacerbation of respiratory allergy. Methods A total of 240 subjects above 6 years old who lived in the metropolitan area of Monterrey, Nuevo León, Mexico, with diagnosis of allergic rhinitis and/or asthma, were included. The subject's address was registered in the database and the rhinitis control assessment test (RCAT) and the asthma control test (ACT) were applied. Environmental data were obtained from the Environmental Monitoring System (SIMA) of Nuevo León. Geolocation of industries and avenues in proximity of subject's addresses and SIMA stations were obtained through geographic information systems using ArcGis software. Results The relation between pollutants and subjects' RCAT, ACT, and spirometry results in the 14 stations was established. PM10 and forced vital capacity (FVC) had an r = 0.074 with p = 0.005, PM10 and absolute FEV1/FVC ratio presented an r = -0.102 with a p = 0.000; The distance found to be associated with a worsening of respiratory symptoms was living 165 m from a main road or 241 m from an industrial establishment. Conclusions Exposure to pollutants present in the environment are factors associated with increased symptoms in subjects with respiratory allergies.
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Affiliation(s)
- Cindy Elizabeth de Lira-Quezada
- Universidad Autónoma de Nuevo León, Faculty of Medicine and Hospital Universitario "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, Nuevo León, CP 64460, Mexico
| | - Sandra Nora González-Díaz
- Universidad Autónoma de Nuevo León, Faculty of Medicine and Hospital Universitario "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, Nuevo León, CP 64460, Mexico
| | | | - Carlos Macouzet-Sánchez
- Universidad Autónoma de Nuevo León, Faculty of Medicine and Hospital Universitario "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, Nuevo León, CP 64460, Mexico
| | - Natalhie Acuña-Ortega
- Universidad Autónoma de Nuevo León, Faculty of Medicine and Hospital Universitario "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, Nuevo León, CP 64460, Mexico
| | - Rosa Ivett Guzman-Avilán
- Universidad Autónoma de Nuevo León, Faculty of Medicine and Hospital Universitario "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, Nuevo León, CP 64460, Mexico
| | - Alejandra Macías-Weinmann
- Universidad Autónoma de Nuevo León, Faculty of Medicine and Hospital Universitario "Dr. José Eleuterio González", Regional Center of Allergy and Clinical Immunology, Gonzalitos y Madero s/n Colonia Mitras Centro, Monterrey, Nuevo León, CP 64460, Mexico
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Hu Q, Chen X, Fu W, Fu Y, He K, Huang H, Jia N, Jin M, Liu E, Shi X, Song C, Su N, Tan W, Tang W, Wu Y, Xie H, Zhang M, Zou M, Shen K, Cai S, Li J. Chinese expert consensus on the diagnosis, treatment, and management of asthma in women across life. J Thorac Dis 2024; 16:773-797. [PMID: 38410605 PMCID: PMC10894401 DOI: 10.21037/jtd-23-1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/10/2023] [Indexed: 02/28/2024]
Abstract
Background The epidemiology and severity of asthma vary by sex and age. The diagnosis, treatment, and management of asthma in female patients are quite challenging. However, there is hitherto no comprehensive and standardized guidance for female patients with asthma. Methods Corresponding search strategies were determined based on clinical concerns regarding female asthma. Search terms included "sex hormones and lung development", "sex hormone changes and asthma", "hormones and asthma immune response", "women, asthma", "children, asthma", "puberty, asthma", "menstruation, asthma", "pregnancy, asthma", "lactation, asthma", "menopause, asthma", "obesity, asthma", and "women, refractory, severe asthma". Literature was retrieved from PubMed/Medline, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Data with the search date of July 30, 2022 as the last day. This consensus used the Grading of Recommendations Assessment, Development, and Evaluation to evaluate the strength of recommendation and quality of evidence. Results We collected basic research results and clinical evidence-based medical data and reviewed the effects of sex hormones, classical genetics, and epigenetics on the clinical presentation and treatment response of female patients with asthma under different environmental effects. Based on that, we formulated this expert consensus on the management of female asthma throughout the life cycle. Conclusions This expert consensus on the management of asthma in women throughout the life cycle provides diagnosis, treatment, and research reference for clinical and basic medical practitioners.
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Affiliation(s)
- Qiurong Hu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoyan Chen
- Department of Endocrinology and Metabolism, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wanyi Fu
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingyun Fu
- Department of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen People’s Hospital, Shenzhen, China
| | - Ke He
- Department of Obstetric and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huaqiong Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Nan Jia
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Meiling Jin
- Department of Allergy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Enmei Liu
- Department of Respiratory Medicine Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xu Shi
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Cui Song
- Department of Endocrinology and Genetic Metabolism disease, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Nan Su
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Weiping Tan
- Department of Pediatrics, Sun Yat-Sen Memorial Hospital Sun Yat-Sen University, Guangzhou, China
| | - Wei Tang
- Department of Pulmonary and Critical Care Medicine, Shanghai Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanxin Wu
- Department of Obstetric and Gynecology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hua Xie
- Department of Respiratory Medicine, General Hospital of Northern Theater Command, Shenyang, China
| | - Min Zhang
- Department of Pulmonary and Critical Care Medicine, Shanghai General Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mengchen Zou
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kunling Shen
- Respiratory Department, Beijing Children’s Hospital, Capital Medical University, China National Clinical Research Center of Respiratory Diseases, National Center for Children’s Health, Beijing, China
| | - Shaoxi Cai
- Department of Respiratory and Critical Care Medicine, Chronic Airways Diseases Laboratory, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jing Li
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Noël A, Harmon AC, Subramanian B, Perveen Z, Aryal A, Legendre K, Zaman H, Paulsen DB, Varner KJ, Dugas TR, Penn AL. Adjuvant effect of inhaled particulate matter containing free radicals following house-dust mite induction of asthma in mice. Inhal Toxicol 2023; 35:333-349. [PMID: 38060410 PMCID: PMC10903547 DOI: 10.1080/08958378.2023.2289024] [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: 08/31/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Exposures to particulate matter (PM) from combustion sources can exacerbate preexisting asthma. However, the cellular and molecular mechanisms by which PM promotes the exacerbation of asthma remain elusive. We used a house dust mite (HDM)-induced mouse model of asthma to test the hypothesis that inhaled DCB230, which are PM containing environmentally persistent free radicals (EPFRs), will aggravate asthmatic responses. METHODS Groups of 8-10-week-old C57BL/6 male mice were exposed to either air or DCB230 aerosols at a concentration of 1.5 mg/m3 4 h/day for 10 days with or without prior HDM-induction of asthma. RESULTS Aerosolized DCB230 particles formed small aggregates (30-150 nm). Mice exposed to DCB230 alone showed significantly reduced lung tidal volume, overexpression of the Muc5ac gene, and dysregulation of 4 inflammation related genes, Ccl11, Ccl24, Il-10, and Tpsb2. This suggests DCB230 particles interacted with the lung epithelium inducing mucous hypersecretion and restricting lung volume. In addition to reduced lung tidal volume, compared to respective controls, the HDM + DCB230-exposed group exhibited significantly increased lung tissue damping and up-regulated expression of Muc5ac, indicating that in this model, mucous hypersecretion may be central to pulmonary dysfunction. This group also showed augmented lung eosinophilic inflammation accompanied by an up-regulation of 36 asthma related genes. Twelve of these genes are part of IL-17 signaling, suggesting that this pathway is critical for DCB230 induced toxicity and adjuvant effects in lungs previously exposed to HDM. CONCLUSION Our data indicate that inhaled DCB230 can act as an adjuvant, exacerbating asthma through IL-17-mediated responses in a HDM mouse model.
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Affiliation(s)
- Alexandra Noël
- Department of Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, LA
| | - Ashlyn C. Harmon
- Department of Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, LA
| | | | - Zakia Perveen
- Department of Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, LA
| | - Ankit Aryal
- Department of Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, LA
| | - Kelsey Legendre
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, LA
| | - Hasan Zaman
- Department of Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, LA
| | - Daniel B. Paulsen
- Department of Pathobiological Sciences, Louisiana State University, Baton Rouge, LA
| | - Kurt J. Varner
- Department of Pharmacology and Experimental Therapeutics, LSU Health Sciences Center, New Orleans, LA
| | - Tammy R. Dugas
- Department of Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, LA
| | - Arthur L. Penn
- Department of Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, LA
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Fiter RJ, Murphy LJ, Gong MN, Cleven KL. The impact of air pollution on asthma: clinical outcomes, current epidemiology, and health disparities. Expert Rev Respir Med 2023; 17:1237-1247. [PMID: 38247719 DOI: 10.1080/17476348.2024.2307545] [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: 10/05/2023] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Air pollution has been shown to have a significant impact on morbidity and mortality of respiratory illnesses including asthma. AREAS COVERED Outdoor air pollution consists of a mixture of individual pollutants including vehicle traffic and industrial pollution. Studies have implicated an array of individual components of air pollution, with PM2.5, NO2, SO2, and ozone being the most classically described, and newer literature implicating other pollutants such as black carbon and volatile organic compounds. Epidemiological and cohort studies have described incidence and prevalence of pollution-related asthma and investigated both acute and chronic air pollution exposure as they relate to asthma outcomes. There is an increasing body of literature tying disparities in pollution exposure to clinical outcomes. In this narrative review, we assessed the published research investigating the association of pollution with asthma outcomes, focusing on the adult population and health care disparities. EXPERT OPINION Pollution has multiple deleterious effects on respiratory health but there is a lack of data on individualized pollution monitoring, making it difficult to establish a temporal relationship between exposure and symptoms, thereby limiting our understanding of safe exposure levels. Future research should focus on more personalized monitoring and treatment plans for mitigating exposure.
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Affiliation(s)
- Ryan J Fiter
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Lila J Murphy
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Michelle N Gong
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Krystal L Cleven
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Celebi Sozener Z, Özbey Yücel Ü, Altiner S, Ozdel Oztürk B, Cerci P, Türk M, Gorgülü Akin B, Akdis M, Yilmaz I, Ozdemir C, Mungan D, Akdis CA. The External Exposome and Allergies: From the Perspective of the Epithelial Barrier Hypothesis. FRONTIERS IN ALLERGY 2022; 3:887672. [PMID: 35873598 PMCID: PMC9304993 DOI: 10.3389/falgy.2022.887672] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction In the last decades, we have seen a rapid increase in the prevalence of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis, and food allergies. The environmental changes caused by industrialization, urbanization and modernization, including dramatic increases in air pollutants such as particulate matter (PM), diesel exhaust, nitrogen dioxide (NO2), ozone (O3), alarming effects of global warming, change and loss of biodiversity, affect both human health and the entire ecosystem. Objective In this review, we aimed to discuss the effects of the external exposome on epithelial barriers and its relationship with the development of allergic diseases by considering the changes in all stakeholders of the outer exposome together, in the light of the recently proposed epithelial barrier hypothesis. Method To reach current, prominent, and comprehensive studies on the subject, PubMed databases were searched. We included the more resounding articles with reliable and strong results. Results Exposure to altered environmental factors such as increased pollution, microplastics, nanoparticles, tobacco smoke, food emulsifiers, detergents, and household cleaners, and climate change, loss and change in microbial biodiversity, modifications in the consumption of dietary fatty acids, the use of emulsifiers, preservatives and the decrease in the antioxidant content of the widely consumed western diet may disrupt the epithelial barriers of the skin, respiratory and gastrointestinal tracts, making us more vulnerable to exogeneous allergens and microbes. Epithelial cell activation, microbial dysbiosis and bacterial translocation disrupt the immune balance and a chronic Th2 inflammation ensues. Conclusion Dramatic increases in air pollution, worrisome effects of global warming, dysbiosis, changing dietary habits and the complex interactions of all these factors affect the epithelial barriers and local and systemic inflammation. We want to draw attention to the emerging health effects of environmental changes and to motivate the public to influence government policies for the well-being of humans and the nature of the earth and the well-being of future generations.
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Affiliation(s)
- Zeynep Celebi Sozener
- Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara, Turkey
- *Correspondence: Zeynep Celebi Sozener ; orcid.org/0000-0003-4188-0959
| | - Ümüs Özbey Yücel
- Department of Nutrition and Diet, Ankara University, Ankara, Turkey
| | - Seda Altiner
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, School of Medicine, Ankara University, Ankara, Turkey
| | - Betül Ozdel Oztürk
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic Diseases, Eskisehir City Hospital, Eskisehir, Turkey
| | - Murat Türk
- Clinic of Immunology and Allergic Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Begüm Gorgülü Akin
- Clinic of Immunology and Allergic Diseases, Ankara City Hospital, Ankara, Turkey
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Insu Yilmaz
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, Erciyes University, Kayseri, Turkey
| | - Cevdet Ozdemir
- Department of Pediatric Basic Sciences, Institute of Child Health, Istanbul University, Istanbul, Turkey
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Dilsad Mungan
- Division of Immunology and Allergic Diseases, Department of Chest Diseases, School of Medicine, Ankara University, Ankara, Turkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Cezmi A. Akdis ; orcid.org/0000-0001-8020-019X
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10
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Celebi Sozener Z, Ozdel Ozturk B, Cerci P, Turk M, Gorgulu Akin B, Akdis M, Altiner S, Ozbey U, Ogulur I, Mitamura Y, Yilmaz I, Nadeau K, Ozdemir C, Mungan D, Akdis CA. Epithelial barrier hypothesis: Effect of the external exposome on the microbiome and epithelial barriers in allergic disease. Allergy 2022; 77:1418-1449. [PMID: 35108405 PMCID: PMC9306534 DOI: 10.1111/all.15240] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/25/2022] [Accepted: 01/29/2022] [Indexed: 12/11/2022]
Abstract
Environmental exposure plays a major role in the development of allergic diseases. The exposome can be classified into internal (e.g., aging, hormones, and metabolic processes), specific external (e.g., chemical pollutants or lifestyle factors), and general external (e.g., broader socioeconomic and psychological contexts) domains, all of which are interrelated. All the factors we are exposed to, from the moment of conception to death, are part of the external exposome. Several hundreds of thousands of new chemicals have been introduced in modern life without our having a full understanding of their toxic health effects and ways to mitigate these effects. Climate change, air pollution, microplastics, tobacco smoke, changes and loss of biodiversity, alterations in dietary habits, and the microbiome due to modernization, urbanization, and globalization constitute our surrounding environment and external exposome. Some of these factors disrupt the epithelial barriers of the skin and mucosal surfaces, and these disruptions have been linked in the last few decades to the increasing prevalence and severity of allergic and inflammatory diseases such as atopic dermatitis, food allergy, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, and asthma. The epithelial barrier hypothesis provides a mechanistic explanation of how these factors can explain the rapid increase in allergic and autoimmune diseases. In this review, we discuss factors affecting the planet's health in the context of the 'epithelial barrier hypothesis,' including climate change, pollution, changes and loss of biodiversity, and emphasize the changes in the external exposome in the last few decades and their effects on allergic diseases. In addition, the roles of increased dietary fatty acid consumption and environmental substances (detergents, airborne pollen, ozone, microplastics, nanoparticles, and tobacco) affecting epithelial barriers are discussed. Considering the emerging data from recent studies, we suggest stringent governmental regulations, global policy adjustments, patient education, and the establishment of individualized control measures to mitigate environmental threats and decrease allergic disease.
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Affiliation(s)
| | - Betul Ozdel Ozturk
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Pamir Cerci
- Clinic of Immunology and Allergic DiseasesEskisehir City HospitalEskisehirTurkey
| | - Murat Turk
- Clinic of Immunology and Allergic DiseasesKayseri City HospitalKayseriTurkey
| | - Begum Gorgulu Akin
- Clinic of Immunology and Allergic DiseasesAnkara City HospitalAnkaraTurkey
| | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Seda Altiner
- Clinic of Internal Medicine Division of Immunology and Allergic DiseasesKahramanmaras Necip Fazil City HospitalKahramanmarasTurkey
| | - Umus Ozbey
- Department of Nutrition and DietAnkara UniversityAnkaraTurkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
| | - Insu Yilmaz
- Department of Chest DiseasesDivision of Immunology and Allergic DiseasesErciyes UniversityKayseriTurkey
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University School of MedicineDivision of Pulmonary and Critical Care MedicineDepartment of MedicineStanford UniversityStanfordCaliforniaUSA
| | - Cevdet Ozdemir
- Institute of Child HealthDepartment of Pediatric Basic SciencesIstanbul UniversityIstanbulTurkey
- Istanbul Faculty of MedicineDepartment of PediatricsDivision of Pediatric Allergy and ImmunologyIstanbul UniversityIstanbulTurkey
| | - Dilsad Mungan
- School of MedicineDepartment of Chest DiseasesDivision of Immunology and Allergic DiseasesAnkara UniversityAnkaraTurkey
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichDavosSwitzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE)DavosSwitzerland
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Matthaios VN, Kang CM, Wolfson JM, Greco KF, Gaffin JM, Hauptman M, Cunningham A, Petty CR, Lawrence J, Phipatanakul W, Gold DR, Koutrakis P. Factors Influencing Classroom Exposures to Fine Particles, Black Carbon, and Nitrogen Dioxide in Inner-City Schools and Their Implications for Indoor Air Quality. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:47005. [PMID: 35446676 PMCID: PMC9022782 DOI: 10.1289/ehp10007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 02/10/2022] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND School classrooms, where students spend the majority of their time during the day, are the second most important indoor microenvironment for children. OBJECTIVE We investigated factors influencing classroom exposures to fine particulate matter (PM2.5), black carbon (BC), and nitrogen dioxide (NO2) in urban schools in the northeast United States. METHODS Over the period of 10 y (2008-2013; 2015-2019) measurements were conducted in 309 classrooms of 74 inner-city schools during fall, winter, and spring of the academic period. The data were analyzed using adaptive mixed-effects least absolute shrinkage and selection operator (LASSO) regression models. The LASSO variables included meteorological-, school-, and classroom-based covariates. RESULTS LASSO identified 10, 10, and 11 significant factors (p<0.05) that were associated with indoor PM2.5, BC, and NO2 exposures, respectively. The overall variability explained by these models was R2=0.679, 0.687, and 0.621 for PM2.5, BC, and NO2, respectively. Of the model's explained variability, outdoor air pollution was the most important predictor, accounting for 53.9%, 63.4%, and 34.1% of the indoor PM2.5, BC, and NO2 concentrations. School-based predictors included furnace servicing, presence of a basement, annual income, building type, building year of construction, number of classrooms, number of students, and type of ventilation that, in combination, explained 18.6%, 26.1%, and 34.2% of PM2.5, BC, and NO2 levels, whereas classroom-based predictors included classroom floor level, classroom proximity to cafeteria, number of windows, frequency of cleaning, and windows facing the bus area and jointly explained 24.0%, 4.2%, and 29.3% of PM2.5, BC, and NO2 concentrations, respectively. DISCUSSION The adaptive LASSO technique identified significant regional-, school-, and classroom-based factors influencing classroom air pollutant levels and provided robust estimates that could potentially inform targeted interventions aiming at improving children's health and well-being during their early years of development. https://doi.org/10.1289/EHP10007.
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Affiliation(s)
- Vasileios N. Matthaios
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham, UK
| | - Choong-Min Kang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jack M. Wolfson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kimberly F. Greco
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Jonathan M. Gaffin
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Marissa Hauptman
- Harvard Medical School, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Amparito Cunningham
- Boston Children’s Hospital Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Carter R. Petty
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Joy Lawrence
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Massachusetts, USA
- Boston Children’s Hospital Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Diane R. Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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12
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Anderko L, Pennea E. Climate Changes Children’s Health: Improving Clinical Practice to Address Changing Health Needs. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Vanoli J, Coull BA, Ettinger de Cuba S, Fabian PM, Carnes F, Massaro MA, Poblacion A, Bellocco R, Kloog I, Schwartz J, Laden F, Zanobetti A. Postnatal exposure to PM 2.5 and weight trajectories in early childhood. Environ Epidemiol 2022; 6:e181. [PMID: 35169661 PMCID: PMC8835545 DOI: 10.1097/ee9.0000000000000181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inconsistent evidence has assessed the impact of air pollution exposure on children's growth trajectories. We investigated the role of 90-day average postnatal fine particulate matter (PM2.5) exposures by estimating the magnitude of effects at different ages, and the change in child weight trajectory by categories of exposure. METHODS We obtained weight values from electronic health records at each hospital visit (males = 1859, females = 1601) from birth to 6 years old children recruited into the Boston-based Children's HealthWatch cohort (2009-2014). We applied mixed models, adjusting for individual and maternal confounders using (1) varying-coefficient models allowing for smooth non-linear interaction between age and PM2.5, (2) factor-smooth interaction between age and PM2.5 quartiles. Additionally, we stratified by sex and low birthweight (LBW) status (≤2500 g). RESULTS Using varying-coefficient models, we found that PM2.5 significantly modified the association between age and weight in males, with a positive association in children younger than 3 years and a negative association afterwards. In boys, for each 10 µg/m3 increase in PM2.5 we found a 2.6% increase (95% confidence interval = 0.8, 4.6) in weight at 1 year of age and a -0.6% (95% confidence interval = -3.9, 2.9) at 5 years. We found similar but smaller changes in females, and no differences comparing growth trajectories across quartiles of PM2.5. Most of the effects were in LBW children and null for normal birthweight children. CONCLUSIONS This study suggests that medium-term postnatal PM2.5 may modify weight trajectories nonlinearly in young children, and that LBW babies are more susceptible than normal-weight infants.
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Affiliation(s)
- Jacopo Vanoli
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Statistics and Quantitative Methods, Universita degli Studi di Milano-Bicocca, Milan, Italy
| | - Brent A. Coull
- Department of Biostatistics, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Patricia M. Fabian
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Fei Carnes
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Marisa A. Massaro
- Department of Environmental Health, School of Public Health, Boston University, Boston, Massachusetts
| | - Ana Poblacion
- Department of Pediatrics, School of Medicine, Boston University, Boston, Massachusetts
| | - Rino Bellocco
- Department of Statistics and Quantitative Methods, Universita degli Studi di Milano-Bicocca, Milan, Italy
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Itai Kloog
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Joel Schwartz
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Francine Laden
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Antonella Zanobetti
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
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Thurston GD, Lee A. Evidence of air pollution exposure and new asthma onset: further justification for cleaner air. Eur Respir J 2021; 57:57/6/2100064. [PMID: 34088757 DOI: 10.1183/13993003.00064-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/04/2021] [Indexed: 11/05/2022]
Affiliation(s)
- George D Thurston
- Environmental Medicine and Population Health, New York University School of Medicine, New York, NY, USA
| | - Alison Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Asthma and air pollution: recent insights in pathogenesis and clinical implications. Curr Opin Pulm Med 2021; 26:10-19. [PMID: 31724961 DOI: 10.1097/mcp.0000000000000644] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Air pollution has adverse effects on the onset and morbidity of respiratory diseases, including asthma. In this review, we discuss recent insights into the effects of air pollution on the incidence and exacerbation of asthma. We focus on epidemiological studies that describe the association between air pollution exposure and development, mortality, persistence and exacerbations of asthma among different age groups. Moreover, we also provide an update on translational studies describing the mechanisms behind this association. RECENT FINDINGS Mechanisms linking air pollutants such as particulate matter, nitrogen dioxide (NO2) and ozone to the development and exacerbation of asthma include the induction of both eosinophilic and neutrophilic inflammation driven by stimulation of airway epithelium and increase of pro-inflammatory cytokine production, oxidative stress and DNA methylation changes. Although exposure during foetal development is often reported as a crucial timeframe, exposure to air pollution is detrimental in people of all ages, thus influencing asthma onset as well as increase in asthma prevalence, mortality, persistence and exacerbation. SUMMARY In conclusion, this review highlights the importance of reducing air pollution levels to avert the progressive increase in asthma incidence and morbidity.
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Chatkin J, Correa L, Santos U. External Environmental Pollution as a Risk Factor for Asthma. Clin Rev Allergy Immunol 2021; 62:72-89. [PMID: 33433826 PMCID: PMC7801569 DOI: 10.1007/s12016-020-08830-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/12/2022]
Abstract
Air pollution is a worrisome risk factor for global morbidity and mortality and plays a special role in many respiratory conditions. It contributes to around 8 million deaths/year, with outdoor exposure being responsible for more than 4.2 million deaths throughout the world, while more than 3.8 million die from situations related to indoor pollution. Pollutant agents induce several respiratory symptoms. In addition, there is a clear interference in numerous asthma outcomes, such as incidence, prevalence, hospital admission, visits to emergency departments, mortality, and asthma attacks, among others. The particulate matter group of pollutants includes coarse particles/PM10, fine particles/PM2.5, and ultrafine particles/PM0.1. The gaseous components include ground-level ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide. The timing, load, and route of allergen exposure are other items affecting allergic disease phenotypes. The complex interaction between pollutant exposures and human host factors has an implication in the development and rise of asthma as a public health problem. However, there are hiatuses in the understanding of the pathways in this disease. The routes through which pollutants induce asthma are multiple, and include the epigenetic changes that occur in the respiratory tract microbiome, oxidative stress, and immune dysregulation. In addition, the expansion of the modern Westernized lifestyle, which is characterized by intense urbanization and more time spent indoors, resulted in greater exposure to polluted air. Another point to consider is the different role of the environment according to age groups. Children growing up in economically disadvantaged neighborhoods suffer more important negative health impacts. This narrative review highlights the principal polluting agents, their sources of emission, epidemiological findings, and mechanistic evidence that links environmental exposures to asthma.
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Affiliation(s)
- Jose Chatkin
- Pulmonology Division, School of Medicine, Pontifical Catholic University Rio Grande Do Sul (PUCRS), Hospital São Lucas da PUCRS, Porto Alegre, Brazil.
| | - Liana Correa
- Health Sciences Doctorate Program, School of Medicine, Pontifical Catholic University Rio Grande Do Sul (PUCRS), Pulmonologist Hospital São Lucas da PUCRS, Porto Alegre, Brazil
| | - Ubiratan Santos
- Pulmonology Division of Instituto Do Coração, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Commodore S, Ferguson PL, Neelon B, Newman R, Grobman W, Tita A, Pearce J, Bloom MS, Svendsen E, Roberts J, Skupski D, Sciscione A, Palomares K, Miller R, Wapner R, Vena JE, Hunt KJ. Reported Neighborhood Traffic and the Odds of Asthma/Asthma-Like Symptoms: A Cross-Sectional Analysis of a Multi-Racial Cohort of Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E243. [PMID: 33396261 PMCID: PMC7794885 DOI: 10.3390/ijerph18010243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/11/2020] [Accepted: 12/25/2020] [Indexed: 11/16/2022]
Abstract
Asthma in children poses a significant clinical and public health burden. We examined the association between reported neighborhood traffic (a proxy for traffic-related air pollution) and asthma among 855 multi-racial children aged 4-8 years old who participated in the Environmental Influences on Child Health Outcomes (ECHO) cohort. We hypothesized that high neighborhood traffic density would be associated with the prevalence of asthma. Asthma/asthma-like symptoms (defined as current and/or past physician diagnosed asthma, past wheezing, or nighttime cough or wheezing in the past 12 months) was assessed by parental report. The relationship between neighborhood traffic and asthma/asthma-like symptoms was assessed using logistic regression. The prevalence of asthma/asthma-like symptoms among study participants was 23%, and 15% had high neighborhood traffic. Children with significant neighborhood traffic had a higher odds of having asthma/asthma-like symptoms than children without neighborhood traffic [adjusted OR = 2.01 (95% CI: 1.12, 3.62)] after controlling for child's race-ethnicity, age, sex, maternal education, family history of asthma, play equipment in the home environment, public parks, obesity and prescribed asthma medication. Further characterization of neighborhood traffic is needed since many children live near high traffic zones and significant racial/ethnic disparities exist.
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Affiliation(s)
- Sarah Commodore
- Department of Environmental and Occupational Health, Indiana University, Bloomington, IN 47405, USA
| | - Pamela L. Ferguson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - William Grobman
- Department of Obstetrics and Gynecology, Northwestern University, Chicago, IL 60611, USA;
| | - Alan Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
| | - John Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - Michael S. Bloom
- Department of Global and Community Health, George Mason University, Fairfax, VA 22030, USA;
| | - Erik Svendsen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - James Roberts
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Daniel Skupski
- Department of Obstetrics and Gynecology, New York-Presbyterian Queens Hospital, Queens, NY 11365, USA;
- Department of Obstetrics and Gynecology, Weill Cornell Graduate School of Medical Sciences, Cornell University, New York, NY 10021, USA
| | - Anthony Sciscione
- Department of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, DE 19899, USA;
| | - Kristy Palomares
- Department of Obstetrics and Gynecology, Saint Peter’s University Hospital, New Brunswick, NJ 08901, USA;
| | - Rachel Miller
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Ronald Wapner
- Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA;
| | - John E. Vena
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
| | - Kelly J. Hunt
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (P.L.F.); (B.N.); (J.P.); (E.S.); (J.E.V.); (K.J.H.)
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Khreis H, Alotaibi R, Horney J, McConnell R. The impact of baseline incidence rates on burden of disease assessment of air pollution and onset childhood asthma: analysis of data from the contiguous United States. Ann Epidemiol 2020; 53:76-88.e10. [PMID: 32956840 DOI: 10.1016/j.annepidem.2020.08.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Burden of disease (BoD) assessments typically rely on national-level incidence rates for the health outcomes of interest. The impact of using a constant national-level incidence rate, versus a more granular spatially varying rate, remains unknown and understudied in the literature. There has been an increasing number of publications estimating the BoD of childhood asthma attributable to air pollution, as emerging evidence demonstrates that traffic-related air pollution (TRAP) leads to onset of the disease. In this study, we estimated the burden of incident childhood asthma cases which may be attributable to nitrogen dioxide (NO2), a criteria pollutant and a good marker of TRAP, in the contiguous United States. We used both a national-level and newly generated state-specific asthma incidence rates and compared results from the two approaches. METHODS We estimated incident childhood asthma cases which may be attributable to NO2 using standard BoD assessment methods. We combined child (<18 years) counts with 2010 NO2 exposures at the census block level, concentration-response function, and state-specific asthma incidence rates. NO2 concentrations were obtained from a previously validated land-use regression model. We sourced the concentration-response function from a meta-analysis on TRAP and risk of childhood asthma. We estimated incidence rates using raw data collected in the 2006-2010 Behavioral Risk Factor Surveillance System and Asthma Call-back Surveys. We stratified the estimated BoD by urban versus rural status and by median household income, explored trends in BoD across 48 states and the District of Columbia, and compared our results with a published BoD analysis which used a constant national-level incidence rate across all states. RESULTS The overall mean (min-max) NO2 concentration(s) was 13.2 (1.5-58.3) ug/m3 and was highest in urbanized areas. The estimated national aggregate asthma incidence rate was 11.6 per 1000 at-risk children and ranged from 4.3 (Montana) to 17.7 (District of Columbia) per 1000 at-risk children. The 17 states that did not have data to estimate an incidence rate were assigned the national aggregate asthma incidence rate. Using the state-specific incidence rates, we estimated a total of 134,166 (95% confidence interval: 75,177-193,327) childhood asthma incident cases attributable to NO2, accounting for 17.6% of all childhood asthma incident cases. Using the national-level incidence rate, we estimated a total of 141,931 (95% confidence interval: 119,222-163,505) incident cases attributable to NO2, accounting for 17.9% of all childhood asthma incident cases. Using the state-specific incidence rates therefore reduced the attributable number of cases by 7,765 (5.5% relative reduction), compared with estimates using the national-level incidence rate. Across states, the change in the attributable number of cases ranged from -64.1% (Montana) to +33.8% (Texas). California had the largest absolute decrease (-6,190) in attributable cases, whereas Texas had the largest increase (+3,615). Stratifying by socioeconomic status and urban versus rural status produced new trends compared with the previously published BoD analysis showing high heterogeneity across the states. CONCLUSIONS We estimated new state-specific asthma incidence rates for the contiguous United States. Using state-specific incidence rates versus a constant national incidence rate resulted in a small change in the NO2 attributable BoD at the national level, but had a more prominent impact at the state level.
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Affiliation(s)
- Haneen Khreis
- Center for Advancing Research in Transportation, Emissions, Energy, and Health (CARTEEH), Texas A&M Transportation Institute (TTI), College Station, TX; ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.
| | - Raed Alotaibi
- Department of Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Texas A&M Health Science Center School of Public Health, TX
| | - Jennifer Horney
- Disaster Research Center, Program in Epidemiology, University of Delaware
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
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Thurston GD, Balmes JR, Garcia E, Gilliland FD, Rice MB, Schikowski T, Van Winkle LS, Annesi-Maesano I, Burchard EG, Carlsten C, Harkema JR, Khreis H, Kleeberger SR, Kodavanti UP, London SJ, McConnell R, Peden DB, Pinkerton KE, Reibman J, White CW. Outdoor Air Pollution and New-Onset Airway Disease. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2020; 17:387-398. [PMID: 32233861 PMCID: PMC7175976 DOI: 10.1513/annalsats.202001-046st] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although it is well accepted that air pollution exposure exacerbates preexisting airway disease, it has not been firmly established that long-term pollution exposure increases the risk of new-onset asthma or chronic obstruction pulmonary disease (COPD). This Workshop brought together experts on mechanistic, epidemiological, and clinical aspects of airway disease to review current knowledge regarding whether air pollution is a causal factor in the development of asthma and/or COPD. Speakers presented recent evidence in their respective areas of expertise related to air pollution and new airway disease incidence, followed by interactive discussions. A writing committee summarized their collective findings. The Epidemiology Group found that long-term exposure to air pollution, especially metrics of traffic-related air pollution such as nitrogen dioxide and black carbon, is associated with onset of childhood asthma. However, the evidence for a causal role in adult-onset asthma or COPD remains insufficient. The Mechanistic Group concluded that air pollution exposure can cause airway remodeling, which can lead to asthma or COPD, as well as asthma-like phenotypes that worsen with long-term exposure to air pollution, especially fine particulate matter and ozone. The Clinical Group concluded that air pollution is a plausible contributor to the onset of both asthma and COPD. Available evidence indicates that long-term exposure to air pollution is a cause of childhood asthma, but the evidence for a similar determination for adult asthma or COPD remains insufficient. Further research is needed to elucidate the exact biological mechanism underlying incident childhood asthma, and the specific air pollutant that causes it.
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Sordillo JE, Rifas-Shiman SL, Switkowski K, Coull B, Gibson H, Rice M, Platts-Mills TAE, Kloog I, Litonjua AA, Gold DR, Oken E. Prenatal oxidative balance and risk of asthma and allergic disease in adolescence. J Allergy Clin Immunol 2019; 144:1534-1541.e5. [PMID: 31437488 PMCID: PMC6900442 DOI: 10.1016/j.jaci.2019.07.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 07/10/2019] [Accepted: 07/12/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Fetal oxidative balance (achieved when protective prenatal factors counteract sources of oxidative stress) might be critical for preventing asthma and allergic disease. OBJECTIVE We examined prenatal intakes of hypothesized protective nutrients (including antioxidants) in conjunction with potential sources of oxidative stress in models of adolescent asthma and allergic disease. METHODS We used data from 996 mother-child pairs in Project Viva. Exposures of interest were maternal prepregnancy body mass index and prenatal nutrients (energy-adjusted intakes of vitamins D, C, and E; β-carotene; folate; choline; and n-3 and n-6 polyunsaturated fatty acids [PUFAs]), air pollutant exposures (residence-specific third-trimester black carbon or particulate matter with a diameter of less than 2.5 μm [PM2.5]), acetaminophen, and smoking. Outcomes were offspring's current asthma, allergic rhinitis, and allergen sensitization at a median age of 12.9 years. We performed logistic regression. Continuous exposures were log-transformed and modeled as z scores. RESULTS We observed protective associations for vitamin D (odds ratio [OR], 0.69 [95% CI, 0.53-0.89] for allergic rhinitis), the sum of the n-3 PUFAs eicosapentaenoic acid and docosahexaenoic acid (OR, 0.81 [95% CI, 0.66-0.99] for current asthma), and the n-3 PUFA α-linolenic acid (OR, 0.78 [95% CI, 0.64-0.95] for allergen sensitization and OR, 0.80 [95% CI 0.65-0.99] for current asthma). Black carbon and PM2.5 were associated with an approximately 30% increased risk for allergen sensitization. No multiplicative interactions were observed for protective nutrient intakes with sources of oxidative stress. CONCLUSIONS We identified potential protective prenatal nutrients (vitamin D and n-3 PUFAs), as well as adverse prenatal pro-oxidant exposures that might alter the risk of asthma and allergic disease into adolescence.
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Affiliation(s)
- Joanne E Sordillo
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Karen Switkowski
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Heike Gibson
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Mary Rice
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Thomas A E Platts-Mills
- Asthma and Allergic Diseases Center, University of Virginia Health System, Charlottesville, Va
| | - Itai Kloog
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, University of Rochester Medical Center, Rochester, NY
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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21
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Khreis H, Cirach M, Mueller N, de Hoogh K, Hoek G, Nieuwenhuijsen MJ, Rojas-Rueda D. Outdoor air pollution and the burden of childhood asthma across Europe. Eur Respir J 2019; 54:13993003.02194-2018. [PMID: 31391220 DOI: 10.1183/13993003.02194-2018] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 07/07/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Emerging evidence suggests that air pollution may contribute to childhood asthma development. We estimated the burden of incident childhood asthma that may be attributable to outdoor nitrogen dioxide (NO2), particulate matter ≤2.5 µm in diameter (PM2.5) and black carbon (BC) in Europe. METHODS We combined country-level childhood incidence rates and pooled exposure-response functions with childhood (age 1-14 years) population counts, and exposure estimates at 1 540 386 1 km×1 km cells, across 18 European countries and 63 442 419 children. Annual average pollutant concentrations were obtained from a validated and harmonised European land-use regression model. We investigated two exposure reduction scenarios. For the first, we used recommended annual World Health Organization (WHO) air quality guideline values. For the second, we used the minimum air pollution levels recorded across 41 studies in the underlying meta-analysis. RESULTS NO2 ranged from 1.4 to 70.0 µg·m-3, with a mean of 11.8 µg·m-3. PM2.5 ranged from 2.0 to 41.1 µg·m-3, with a mean of 11.6 µg·m-3. BC ranged from 0.003 to 3.7×10-5 m-1, with a mean of 1.0×10-5 m-1. Compliance with the NO2 and PM2.5 WHO guidelines was estimated to prevent 2434 (0.4%) and 66 567 (11%) incident cases, respectively. Meeting the minimum air pollution levels for NO2 (1.5 µg·m-3), PM2.5 (0.4 µg·m-3) and BC (0.4×10-5 m-1) was estimated to prevent 135 257 (23%), 191 883 (33%) and 89 191 (15%) incident cases, respectively. CONCLUSIONS A significant proportion of childhood asthma cases may be attributable to outdoor air pollution and these cases could be prevented. Our estimates underline an urgent need to reduce children's exposure to air pollution.
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Affiliation(s)
- Haneen Khreis
- Center for Advancing Research in Transportation Emissions, Energy, and Health (CARTEEH), Texas A&M Transportation Institute (TTI), College Station, TX, USA .,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.,These authors are joint lead authors of the study
| | - Marta Cirach
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Natalie Mueller
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Gerard Hoek
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Mark J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain
| | - David Rojas-Rueda
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA.,These authors are joint lead authors of the study
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22
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Bacharier LB, Mori A, Kita H. Advances in asthma, asthma-COPD overlap, and related biologics in 2018. J Allergy Clin Immunol 2019; 144:906-919. [PMID: 31476323 DOI: 10.1016/j.jaci.2019.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/23/2019] [Accepted: 08/26/2019] [Indexed: 01/14/2023]
Abstract
Over the past year, numerous important advances in our understanding of multiple aspects of asthma, ranging from disease pathogenesis to epidemiology to therapeutics, have been reported. This review is a compilation of highlights from articles published largely in the Journal of Allergy and Clinical Immunology and supplemented by articles published elsewhere that have substantially advanced the fields of asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap and biologic therapies for these disorders. The intention of this article is not to provide a comprehensive review but rather to focus on several areas that have developed quickly and/or received extensive attention from our readers.
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Affiliation(s)
- Leonard B Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo.
| | - Akio Mori
- Department of Advanced Medicine, Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Hirohito Kita
- Division of Allergic Diseases, Department of Medicine and Department of Immunology, Mayo Clinic, Rochester, Minn; Division of Allergic Diseases, Department of Medicine and Department of Immunology, Mayo Clinic, Scottsdale
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23
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Abstract
Asthma in inner-city children is often severe and difficult to control. Residence in poor and urban areas confers increased asthma morbidity even after adjusting for ethnicity, age, and gender. Higher exposure to household pests, such as cockroaches and mice, pollutants and tobacco smoke exposure, poverty, material hardship, poor-quality housing, differences in health care quality, medication compliance, and heath care access also contribute to increased asthma morbidity in this population. Since 1991, the National Institutes of Allergy and Infectious Diseases established research networks: the National Cooperative Inner-City Asthma Study (NCICAS), the Inner-City Asthma Study (ICAS), and the Inner-City Asthma Consortium (ICAC), to improve care for this at risk population. The most striking finding of the NCICAS is the link between asthma morbidity and the high incidence of allergen sensitization and exposure, particularly cockroach. The follow-up ICAS confirmed that reductions in household cockroach and dust mite were associated with reduction in the inner-city asthma morbidity. The ICAC studies have identified that omalizumab lowered fall inner-city asthma exacerbation rate; however, the relationship between inner-city asthma vs immune system dysfunction, respiratory tract infections, prenatal environment, and inner-city environment is still being investigated. Although challenging, certain interventions for inner-city asthma children have shown promising results. These interventions include family-based interventions such as partnering families with asthma-trained social workers, providing guidelines driven asthma care as well as assured access to controller medication, home-based interventions aim at elimination of indoor allergens and tobacco smoke exposure, school-based asthma programs, and computer/web-based asthma programs.
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24
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Thurston GD, Rice MB. Air Pollution Exposure and Asthma Incidence in Children: Demonstrating the Value of Air Quality Standards. JAMA 2019; 321:1875-1877. [PMID: 31112243 DOI: 10.1001/jama.2019.5343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- George D Thurston
- Department of Environmental Medicine, New York University School of Medicine, New York
| | - Mary B Rice
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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25
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Buters J, Behrendt H, Raulf M. Allergien und Umwelteinflüsse. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1835-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Yang M, Chu C, Bloom MS, Li S, Chen G, Heinrich J, Markevych I, Knibbs LD, Bowatte G, Dharmage SC, Komppula M, Leskinen A, Hirvonen MR, Roponen M, Jalava P, Wang SQ, Lin S, Zeng XW, Hu LW, Liu KK, Yang BY, Chen W, Guo Y, Dong GH. Is smaller worse? New insights about associations of PM 1 and respiratory health in children and adolescents. ENVIRONMENT INTERNATIONAL 2018; 120:516-524. [PMID: 30153645 DOI: 10.1016/j.envint.2018.08.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/27/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about PM1 effects on respiratory health, relative to larger size fractions (PM2.5). To address this literature gap, we assessed associations between PM1 exposure and asthmatic symptoms in Chinese children and adolescents, compared with PM2.5. METHODS A total of 59,754 children, aged 2-17 years, were recruited from 94 kindergartens, elementary and middle schools in the Seven Northeast Cities (SNEC) study, during 2012-2013. We obtained information on asthma and asthma-related symptoms including wheeze, persistent phlegm, and persistent cough using a standardized questionnaire developed by the American Thoracic Society. PM1 and PM2.5 concentrations were estimated using a spatial statistical model matched to the children's geocoded home addresses. To examine the associations, mixed models with school/kindergarten as random intercept were used, controlling for covariates. RESULTS Odds ratios (ORs) of doctor-diagnosed asthma associated with a 10-μg/m3 increase for PM1 and PM2.5 were 1.56 (95% CI: 1.46-1.66) and 1.50 (1.41-1.59), respectively, and similar pattern were observed for other outcomes. Interaction analyses indicated that boys and the individuals with an allergic predisposition may be vulnerable subgroups. For example, among children with allergic predisposition, the ORs for doctor diagnosed asthma per 10 μg/m3 increase in PM1 was 1.71 (95% CI: 1.60-1.83), which was stronger than in their counterparts (1.46; 1.37-1.56) (pfor interaction < 0.05). CONCLUSIONS This study indicated that long-term exposure to PM1 may increase the risk of asthma and asthma-related symptoms, especially among boys and those with allergic predisposition. Furthermore, these positive associations for PM1 were very similar to those for PM2.5.
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Affiliation(s)
- Mo Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chu Chu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Gongbo Chen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilian-University, Munich 80336, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilian-University, Munich 80336, Germany
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Mika Komppula
- Finnish Meteorological Institute, Kuopio 70211, Finland
| | - Ari Leskinen
- Finnish Meteorological Institute, Kuopio 70211, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio 70211, Finland
| | - Maija-Riitta Hirvonen
- Department of Environmental and Biological Science, University of Eastern Finland, Kuopio 70211, Finland
| | - Marjut Roponen
- Department of Environmental and Biological Science, University of Eastern Finland, Kuopio 70211, Finland
| | - Pasi Jalava
- Department of Environmental and Biological Science, University of Eastern Finland, Kuopio 70211, Finland
| | - Si-Quan Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Shao Lin
- Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Kang-Kang Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Abstract
Abstract
Background
Air pollutants such as particulate matter (PM2.5) and nitrogen dioxide (NO2) in outdoor air have long been suspected of causing the development of asthma and allergic rhinitis. However, a variety of systematic reviews have reached different conclusions in the last 15 years on whether these air pollutants do in actual fact play a causal role in the onset of asthma, allergic rhinitis, and eczema.
Methods
Based on published systematic reviews and the most recent publications, the current state of knowledge on epidemiological evidence is presented and the potential for primary prevention of these allergic diseases by reducing or avoiding exposure to these air pollutants evaluated.
Results
Despite conducting an extensive literature search, analyzing the most recent results, and focusing on the birth cohort studies most relevant to the question in hand, epidemiological results do not adequately support the concept of a causal relationship between the two air pollutants in question, PM2.5 and NO2, and asthma. Epidemiological studies predominantly show no effect of these air pollutants on allergic sensitization and the onset of allergic rhinitis. The small number of studies that have investigated the link between air pollutants and eczema largely revealed there to be no link.
Conclusion
If the evidence for the causal role of air pollutants in the onset of allergies is inconclusive, one must assume that it is probably not possible to achieve primary prevention of allergies by improving air quality. However, there is sufficient evidence to show that air pollutants can trigger exacerbations of allergic diseases. This alone justifies ensuring that the existing threshold values for air pollutants are adhered to, in order to protect particularly allergy sufferers from health impairments.
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Liou CJ, Cheng CY, Yeh KW, Wu YH, Huang WC. Protective Effects of Casticin From Vitex trifolia Alleviate Eosinophilic Airway Inflammation and Oxidative Stress in a Murine Asthma Model. Front Pharmacol 2018; 9:635. [PMID: 29962952 PMCID: PMC6010522 DOI: 10.3389/fphar.2018.00635] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 05/29/2018] [Indexed: 01/09/2023] Open
Abstract
Casticin has been isolated from Vitex trifolia and found to have anti-inflammatory and anti-tumor properties. We also previously discovered that casticin can reduce pro-inflammatory cytokines and ICAM-1 expression in inflammatory pulmonary epithelial cells. In the present study, we evaluated whether casticin reduced airway hyper-responsiveness (AHR), airway inflammation, and oxidative stress in the lungs of a murine asthma model and alleviated inflammatory and oxidative responses in tracheal epithelial cells. Female BALB/c mice were randomly divided into five groups: normal controls, ovalbumin (OVA)-induced asthma, and OVA-induced asthma treated with intraperitoneal injection of casticin (5 or 10 mg/kg) or prednisolone (5 mg/kg). Casticin reduced AHR, goblet cell hyperplasia, and oxidative responses in the lungs of mice with asthma. Mechanistic studies revealed that casticin attenuated the levels of Th2 cytokine in bronchoalveolar lavage fluids and regulated the expression of Th2 cytokine and chemokine genes in the lung. Casticin also significantly regulated oxidative stress and reduced inflammation in the lungs of mice with asthma. Consequently, inflammatory tracheal epithelial BEAS-2B cells treated with casticin had significantly suppressed levels of pro-inflammatory cytokines and eotaxin, and reduced THP-1 monocyte cell adherence to BEAS-2B cells via suppressed ICAM-1 expression. Thus, casticin is a powerful immunomodulator, ameliorating pathological changes by suppressing Th2 cytokine expression in mice with asthma.
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Affiliation(s)
- Chian-Jiun Liou
- Division of Basic Medical Sciences, Department of Nursing, Research Center for Chinese Herbal Medicine, Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ching-Yi Cheng
- Graduate Institute of Health Industry Technology, Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuo-Wei Yeh
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yi-Hong Wu
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Wen-Chung Huang
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Health Industry Technology, Research Center for Food and Cosmetic Safety, Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
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