1
|
Wada T, Adachi Y, Murakami S, Ito Y, Itazawa T, Tsuchida A, Matsumura K, Hamazaki K, Inadera H. Maternal exposure to smoking and wheezing phenotypes in children: a cohort study of the Japan Environment and Children's Study. BMC Pediatr 2024; 24:624. [PMID: 39354379 PMCID: PMC11443675 DOI: 10.1186/s12887-024-05101-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/23/2024] [Indexed: 10/03/2024] Open
Abstract
BACKGROUND Previous studies have shown that prenatal maternal smoking and maternal secondhand smoke exposure during pregnancy were associated with an increased risk of wheezing and asthma development. However, few studies have examined the influence of different sources of tobacco exposure in different perinatal timeframes (preconception, prenatal, and postnatal) on wheezing phenotypes in children. Using national survey data from Japan, we investigated the effects of exposure to tobacco smoke during pregnancy on wheezing phenotypes in children before the age of 3 years. METHODS Pregnant women who lived in the 15 regional centers in the Japan Environment and Children's Study were recruited. We obtained information on prenatal and postnatal exposure to active and secondhand smoke (SHS) and wheeze development up to 3 years of age. Multiple logistic regression analysis was performed to determine the association between tobacco smoke exposure and wheezing phenotypes in children. RESULTS We analyzed 73,057 singleton births and identified four longitudinal wheezing phenotypes: never wheezing; early transient wheezing (wheezing by age 1 year but not thereafter); late-onset wheezing (wheezing by age 2-3 years but not beforehand); and persistent wheezing. Maternal smoking during pregnancy was significantly associated with early transient and persistent wheezing in children compared with no maternal smoking [early transient wheezing: 1-10 cigarettes per day, adjusted odds ratio (aOR) 1.43, 95% confidence interval (CI) 1.23-1.66; ≥ 11 cigarettes per day, aOR 1.67, 95% CI 1.27-2.20; persistent wheezing: 1-10 cigarettes per day, aOR 1.64, 95% CI 1.37-1.97; ≥ 11 cigarettes per day, aOR 2.32, 95% CI 1.70-3.19]. Smoking cessation even before pregnancy was also significantly associated with increased risk of early transient wheezing, late-onset wheezing, and persistent wheezing in children. Moreover, maternal exposure to SHS during pregnancy was significantly associated with increased risk of early transient and persistent wheezing compared with no such exposure. CONCLUSIONS Maternal smoking before and throughout pregnancy was associated with wheeze development in children up to 3 years of age. It appears that smoking is detrimental compared to never smoking, regardless of whether individuals quit smoking before or after becoming aware of the pregnancy.
Collapse
Affiliation(s)
- Takuya Wada
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan.
- Pediatric Allergy Center, Toyama Red Cross Hospital, 2-1-58 Ushijima-honmachi, Toyama, 930- 8562, Japan.
| | - Shokei Murakami
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Yasunori Ito
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Toshiko Itazawa
- Department of Pediatrics, Saitama Medical University, Saitama, Japan
| | - Akiko Tsuchida
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for Japan Environment and Children's Study (JECS), University of Toyama, Toyama, Japan
| | - Kenta Matsumura
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for Japan Environment and Children's Study (JECS), University of Toyama, Toyama, Japan
| | - Kei Hamazaki
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Department of Public Health, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Hidekuni Inadera
- Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan
- Toyama Regional Center for Japan Environment and Children's Study (JECS), University of Toyama, Toyama, Japan
| |
Collapse
|
2
|
Fitzpatrick AM, Grunwell JR, Gaur H, Kobara S, Kamaleswaran R. Plasma metabolomics identifies differing endotypes of recurrent wheezing in preschool children differentiated by symptoms and social disadvantage. Sci Rep 2024; 14:15813. [PMID: 38982241 PMCID: PMC11233605 DOI: 10.1038/s41598-024-66878-1] [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: 05/07/2024] [Accepted: 07/04/2024] [Indexed: 07/11/2024] Open
Abstract
Preschool children with recurrent wheezing are a heterogeneous population with many underlying biological pathways that contribute to clinical presentations. Although the morbidity of recurrent wheezing in preschool children is significant, biological studies in this population remain quite limited. To address this gap, this study performed untargeted plasma metabolomic analyses in 68 preschool children with recurrent wheezing to identify metabolomic endotypes of wheezing. K-means cluster analysis was performed on metabolomic dataset including a total of 1382 named and unnamed metabolites. We identified three metabolomic clusters which differed in symptom severity, exacerbation occurrence, and variables associated with social disadvantage. Metabolites that distinguished the clusters included those involved in fatty acid metabolism, fatty acids (long chain monounsaturated fatty acids, long chain polyunsaturated fatty acids, and long chain saturated fatty acids), lysophospholipids, phosphatidylcholines, and phosphatidylethanolamines. Pathway analyses identified pathways of interest in each cluster, including steroid metabolism, histidine metabolism, sphingomyelins, and sphingosines, among others. This study highlights the biologic complexity of recurrent wheezing in preschool children and offers novel metabolites and pathways that may be amenable to future study and intervention.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive Office #340, 30322, Atlanta, Georgia.
- Division of Pulmonary Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive Office #340, 30322, Atlanta, Georgia
- Division of Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Hina Gaur
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Seibi Kobara
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | | |
Collapse
|
3
|
Kyvsgaard JN, Brustad N, Hesselberg LM, Vahman N, Thorsen J, Schoos AMM, Bønnelykke K, Stokholm J, Chawes BL. Key risk factors of asthma-like symptoms are mediated through infection burden in early childhood. J Allergy Clin Immunol 2024; 153:684-694. [PMID: 37995855 DOI: 10.1016/j.jaci.2023.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Risk factors of asthma-like symptoms in childhood may act through an increased infection burden because infections often trigger these symptoms. OBJECTIVE We sought to investigate whether the effect of established risk factors of asthma-like episodes in early childhood is mediated through burden and subtypes of common infections. METHODS The study included 662 children from the Copenhagen Prospective Studies on Asthma in Childhood 2010 mother-child cohort, in which infections were registered prospectively in daily diaries from age 0 to 3 years. The association between established risk factors of asthma-like episodes and infection burden was analyzed by quasi-Poisson regressions, and mediation analyses were performed for significant risk factors. RESULTS In the first 3 years of life, the children experienced a median of 16 (interquartile range, 12-23) infectious episodes. We found that the infection burden significantly (PACME < .05) mediated the association of maternal asthma (36.6% mediated), antibiotics during pregnancy (47.3%), siblings at birth (57.7%), an asthma exacerbation polygenic risk score (30.6%), and a bacterial airway immune score (80.2%) with number of asthma-like episodes, whereas the higher number of episodes from male sex, low birth weight, low gestational age, and maternal antibiotic use after birth was not mediated through an increased infection burden. Subtypes of infections driving the mediation were primarily colds, pneumonia, gastroenteritis, and fever, but not acute otitis media or acute tonsillitis. CONCLUSIONS Several risk factors of asthma-like symptoms in early childhood act through an increased infection burden in the first 3 years of life. Prevention of infectious episodes may therefore be beneficial to reduce the burden of asthma-like symptoms in early childhood.
Collapse
Affiliation(s)
- Julie Nyholm Kyvsgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
| | - Nicklas Brustad
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Laura Marie Hesselberg
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nilo Vahman
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Thorsen
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Marie Malby Schoos
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark; Section of Microbiology and Fermentation, Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | - Bo Lund Chawes
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
4
|
Custovic D, Fontanella S, Custovic A. Understanding progression from pre-school wheezing to school-age asthma: Can modern data approaches help? Pediatr Allergy Immunol 2023; 34:e14062. [PMID: 38146116 DOI: 10.1111/pai.14062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023]
Abstract
Preschool wheezing and childhood asthma create a heavy disease burden which is only exacerbated by the complexity of the conditions. Preschool wheezing exhibits both "curricular" and "aetiological" heterogeneity: that is, heterogeneity across patients both in the time-course of its development and in its underpinning pathological mechanisms. Since these are not fully understood, but clinical presentations across patients may nonetheless be similar, current diagnostic labels are imprecise-not mapping cleanly onto underlying disease mechanisms-and prognoses uncertain. These uncertainties also make a identifying new targets for therapeutic intervention difficult. In the past few decades, carefully designed birth cohort studies have collected "big data" on a large scale, incorporating not only a wealth of longitudinal clinical data, but also detailed information from modalities as varied as imaging, multiomics, and blood biomarkers. The profusion of big data has seen the proliferation of what we term "modern data approaches" (MDAs)-grouping together machine learning, artificial intelligence, and data science-to make sense and make use of this data. In this review, we survey applications of MDAs (with an emphasis on machine learning) in childhood wheeze and asthma, highlighting the extent of their successes in providing tools for prognosis, unpicking the curricular heterogeneity of these conditions, clarifying the limitations of current diagnostic criteria, and indicating directions of research for uncovering the etiology of the diseases underlying these conditions. Specifically, we focus on the trajectories of childhood wheeze phenotypes. Further, we provide an explainer of the nature and potential use of MDAs and emphasize the scope of what we can hope to achieve with them.
Collapse
Affiliation(s)
- Darije Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Sara Fontanella
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
5
|
Grant TL, Wood RA, Chapman MD. Indoor Environmental Exposures and Their Relationship to Allergic Diseases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2963-2970. [PMID: 37652348 PMCID: PMC10927277 DOI: 10.1016/j.jaip.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
Cockroach, dust mite, cat, dog, mouse, and molds are major indoor allergens that have been associated with the development of allergic diseases and disease morbidity in allergen-sensitized individuals. Physical characteristics, such as allergen particle size, hydrophobicity, and charge, can determine an allergen's propensity to become airborne, location of respiratory tract penetration, and ability to elicit IgE responses in genetically predisposed individuals. Standardization and recent advancements in indoor allergen assessment serve to identify sources and distribution of allergens in a patient's home and public environment, inform public policy, and monitor the efficacy of allergen avoidance and therapeutics. Allergen exposure interventions have yielded mixed results with current US and international asthma guidelines differing on recommendations. A pragmatic, patient-centered approach to allergen avoidance includes: (1) tailoring intervention to the patient's sensitization and exposure status, (2) using a rigorous multifaceted intervention strategy to reduce allergen exposure as much as possible, and (3) beginning the intervention as soon as the patient is diagnosed. Further research into the risks/benefits of early allergen exposure, rapid and affordable in-home allergen assessment, and best practices for environmental control measures for asthma is needed.
Collapse
Affiliation(s)
- Torie L Grant
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | | |
Collapse
|
6
|
Chang CL, Ali GB, Pham J, Dharmage SC, Lodge CJ, Tang MLK, Lowe AJ. Childhood body mass index trajectories and asthma and allergies: A systematic review. Clin Exp Allergy 2023; 53:911-929. [PMID: 37401045 DOI: 10.1111/cea.14366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Previous systematic reviews have focused on associations between single time point measures of Body Mass Index (BMI) and asthma and allergic diseases. As BMI changes dynamically during childhood, examination of associations between longitudinal trajectories in BMI and allergic diseases is needed to fully understand the nature of these relationships. OBJECTIVE To systematically synthesise the association between BMI trajectories in childhood (0-18 years) and allergic diseases (asthma, eczema, allergic rhinitis, or food allergies outcomes). DESIGN We conducted a systematic review following the PRISMA guidelines, and two independent reviewers assessed the study quality using the ROBINS-E and GRADE tools. A narrative synthesis was performed as the statistical heterogeneity did not allow a meta-analysis. DATA SOURCES A search was performed on PubMed and EMBASE databases on 4th January 2023. ELIGIBILITY CRITERIA Longitudinal cohort studies assessing the associations between childhood BMI trajectories and allergic diseases were included. RESULTS Eleven studies met the inclusion criteria with a total of 37,690 participants between 0 and 53 years of age. Ten studies examined asthma outcomes, three assessed association with allergic rhinitis, two assessed eczema, and one assessed food allergy. High heterogeneity and high risk of bias were observed. Overall, the quality of evidence was very low. Nevertheless, two consistent findings were identified: (1) a persistently high BMI between 6 and 10 years of age may be associated with an increased risk of asthma at 18 years and (2) a rapid increase in BMI in the first 2 years of life may be associated with subsequent asthma. CONCLUSIONS Maintaining a normal BMI trajectory during childhood may reduce the risk of asthma. Future research that adequately addresses confounding and includes longer-term follow-up is needed. Moreover, additional studies examining potential associations with eczema, food allergies, and allergic rhinitis outcomes are needed.
Collapse
Affiliation(s)
- Chia-Lun Chang
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gulshan Bano Ali
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan Pham
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Asthma, Allergy and Clinical Immunology Service, Department of Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Allergy Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Kyvsgaard JN, Chawes BL, Horner DLG, Hesselberg LM, Melgaard ME, Jensen SK, Schoos AMM, Thorsen J, Pedersen CET, Brustad N, Bønnelykke K, Bisgaard H, Stokholm J. Risk Factors and Age-Related Patterns of Asthma-Like Symptoms in Early Childhood. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1773-1784.e10. [PMID: 36889671 DOI: 10.1016/j.jaip.2023.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/08/2023] [Accepted: 02/21/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Episodes of asthma-like symptoms in young children are common, but little is known about risk factors and their patterns for the daily symptom burden. OBJECTIVE We investigated a variety of possible risk factors and their age-related impact on the number of asthma-like episodes during age 0 to 3 years. METHODS The study population included 700 children from the Copenhagen Prospective Studies on Asthma in Childhood2010 mother-child cohort followed prospectively from birth. Asthma-like symptoms were recorded until age 3 by daily diaries. Risk factors were analyzed by quasi-Poisson regressions, and interaction with age was explored. RESULTS Diary data were available in 662 children. Male sex, maternal asthma, low birth weight, maternal antibiotic use, high asthma exacerbation polygenic risk score, and high airway immune score were associated with a higher number of episodes in a multivariable analysis. Maternal asthma, preterm birth, caesarean section, and low birth weight showed an increasing impact with age, whereas sibling(s) at birth showed a decreased association with age. The remaining risk factors had a stable pattern during age 0 to 3 years. For every additional clinical risk factor (male sex, low birth weight, and maternal asthma) a child had, we found 34% more episodes (incidence rate ratio: 1.34, 95% confidence interval: 1.21-1.48; P < .001). CONCLUSION Using unique day-to-day diary recordings, we identified risk factors for the burden of asthma-like symptoms in the first 3 years of life and described their unique age-related patterns. This provides novel insight into the origin of asthma-like symptoms in early childhood that potentially pave a path for personalized prognostics and treatment.
Collapse
Affiliation(s)
- Julie Nyholm Kyvsgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
| | - Bo Lund Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - David Lyle George Horner
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Laura Marie Hesselberg
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Elsner Melgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Signe Kjeldgaard Jensen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Marie M Schoos
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
| | - Jonathan Thorsen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Casper-Emil Tingskov Pedersen
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nicklas Brustad
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark; Section of Microbiology and Fermentation, Department of Food Science, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
8
|
Forster F, Heumann C, Schaub B, Böck A, Nowak D, Vogelberg C, Radon K. Parental occupational exposures prior to conception and offspring wheeze and eczema during first year of life. Ann Epidemiol 2023; 77:90-97. [PMID: 36476404 DOI: 10.1016/j.annepidem.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Parental exposures prior to conception might influence asthma and allergy risk in offspring. As occupational exposures are established risk factors for asthma and allergies, we investigated if parental occupational exposures prior to conception cause wheeze and eczema in offspring during the first year of life. METHODS We analysed data of 436 families from an offspring cohort based on a follow-up study of German participants of the International Study of Asthma and Allergies in Childhood (ISAAC). Offspring cohort data was collected between 2009 and 2019. Occupational exposures were based on participants' work histories and measured by a Job-Exposure-Matrix. We used Bayesian logistic regression models for analysis. Inference and confounder selection were based on directed acyclic graphs. RESULTS In mothers, for both allergic and irritative occupational exposures prior to conception suggestive effects on offspring eczema during the first year of life were found (allergens: odds ratio (OR) 1.22, 95% compatibility interval (CI) 0.92-1.57; irritants: OR 1.36, 95% CI 0.99-1.77), while no relation with wheeze was suggested. CONCLUSIONS Our results suggest that reduction of asthma-related occupational exposures might not only reduce the burden of disease for occupationally induced or aggravated asthma and allergies in employees but also in their children.
Collapse
Affiliation(s)
- Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.
| | | | - Bianca Schaub
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Andreas Böck
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), Munich, Germany
| | - Christian Vogelberg
- Department of Pediatrics, University Hospital Dresden, Technical University, Dresden, Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center (CPC) Munich, German Center for Lung Research (DZL), Munich, Germany
| |
Collapse
|
9
|
Grandinetti R, Fainardi V, Caffarelli C, Capoferri G, Lazzara A, Tornesello M, Meoli A, Bergamini BM, Bertelli L, Biserna L, Bottau P, Corinaldesi E, De Paulis N, Dondi A, Guidi B, Lombardi F, Magistrali MS, Marastoni E, Pastorelli S, Piccorossi A, Poloni M, Tagliati S, Vaienti F, Gregori G, Sacchetti R, Mari S, Musetti M, Antodaro F, Bergomi A, Reggiani L, Caramelli F, De Fanti A, Marchetti F, Ricci G, Esposito S. Risk Factors Affecting Development and Persistence of Preschool Wheezing: Consensus Document of the Emilia-Romagna Asthma (ERA) Study Group. J Clin Med 2022; 11:6558. [PMID: 36362786 PMCID: PMC9655250 DOI: 10.3390/jcm11216558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 07/30/2023] Open
Abstract
Wheezing at preschool age (i.e., before the age of six) is common, occurring in about 30% of children before the age of three. In terms of health care burden, preschool children with wheeze show double the rate of access to the emergency department and five times the rate of hospital admissions compared with school-age asthmatics. The consensus document aims to analyse the underlying mechanisms involved in the pathogenesis of preschool wheezing and define the risk factors (i.e., allergy, atopy, infection, bronchiolitis, genetics, indoor and outdoor pollution, tobacco smoke exposure, obesity, prematurity) and the protective factors (i.e., probiotics, breastfeeding, vitamin D, influenza vaccination, non-specific immunomodulators) associated with the development of the disease in the young child. A multidisciplinary panel of experts from the Emilia-Romagna Region, Italy, addressed twelve key questions regarding managing preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes). Systematic reviews have been conducted on PubMed to answer these specific questions and formulate recommendations. The GRADE approach has been used for each selected paper to assess the quality of the evidence and the degree of recommendations. Based on a panel of experts and extensive updated literature, this consensus document provides insight into the pathogenesis, risk and protective factors associated with the development and persistence of preschool wheezing. Undoubtedly, more research is needed to improve our understanding of the disease and confirm the associations between certain factors and the risk of wheezing in early life. In addition, preventive strategies must be promoted to avoid children's exposure to risk factors that may permanently affect respiratory health.
Collapse
Affiliation(s)
- Roberto Grandinetti
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Gaia Capoferri
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Angela Lazzara
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marco Tornesello
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Aniello Meoli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Barbara Maria Bergamini
- Paediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Luca Bertelli
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Loretta Biserna
- Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Paolo Bottau
- Paediatrics Unit, Imola Hospital, 40026 Imola, Italy
| | | | - Nicoletta De Paulis
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Arianna Dondi
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Battista Guidi
- Hospital and Territorial Paediatrics Unit, Pavullo, 41026 Pavullo Nel Frignano, Italy
| | | | - Maria Sole Magistrali
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Elisabetta Marastoni
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | | | - Alessandra Piccorossi
- Paediatrics and Paediatric Intensive Care Unit, Cesena Hospital, AUSL Romagna, 47521 Cesena, Italy
| | - Maurizio Poloni
- Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy
| | | | - Francesca Vaienti
- Paediatrics Unit, G.B. Morgagni—L. Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Giuseppe Gregori
- Primary Care Pediatricians, AUSL Piacenza, 29121 Piacenza, Italy
| | | | - Sandra Mari
- Primary Care Pediatricians, AUSL Parma, 43126 Parma, Italy
| | | | | | - Andrea Bergomi
- Primary Care Pediatricians, AUSL Modena, 41125 Modena, Italy
| | | | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Federico Marchetti
- Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Giampaolo Ricci
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | | |
Collapse
|
10
|
Peters RL, Eigenmann P. Editorial comment on "Phenotyping of immediate-type food allergies based on 10 years of research: A latent class analysis". Pediatr Allergy Immunol 2022; 33:e13875. [PMID: 36433850 DOI: 10.1111/pai.13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Rachel L Peters
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Philippe Eigenmann
- Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
| |
Collapse
|
11
|
Tischer C, Täubel M, Kirjavainen PV, Depner M, Hyvärinen A, Piippo-Savolainen E, Pekkanen J, Karvonen AM. Early-life residential exposure to moisture damage is associated with persistent wheezing in a Finnish birth cohort. Pediatr Allergy Immunol 2022; 33:e13864. [PMID: 36282133 PMCID: PMC9828426 DOI: 10.1111/pai.13864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND AIMS Moisture damage increases the risk for respiratory disorders in childhood. Our aim was to determine whether early age residential exposure to inspector-observed moisture damage or mold is associated with different wheezing phenotypes later in childhood. METHODS Building inspections were performed by civil engineers, in a standardized manner, in the children's homes-mostly single family and row houses (N = 344)-in the first year of life. The children were followed up with repeated questionnaires until the age of 6 years and wheezing phenotypes-never/infrequent, transient, intermediate, late onset, and persistent-were defined using latent class analyses. The multinomial logistic regression model was used for statistical analysis. RESULTS A total of 63% (n = 218) had infrequent or no wheeze, 23% (n = 80) had transient and 9.6% (n = 21) had a persistent wheeze. Due to the low prevalence, results for intermediate (3.8%, n = 13) and late-onset wheeze (3.5%, n = 12) were not further evaluated. Most consistent associations were observed with the persistent wheeze phenotype with an adjusted odds ratio (95% confidence intervals) 2.04 (0.67-6.18) for minor moisture damage with or without mold spots (present in 23.8% of homes) and 3.68 (1.04-13.05) for major damage or any moisture damage with visible mold in a child's main living areas (present in 13.4% of homes). Early-age moisture damage or mold in the kitchen was associated with transient wheezing. CONCLUSION At an early age, residential exposure to moisture damage or mold, can be dose-dependently associated especially with persistent wheezing phenotype later in childhood.
Collapse
Affiliation(s)
- Christina Tischer
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.,State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany.,Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland.,European Foundation for the Care of Newborn Infants (EFCNI), Munich, Germany
| | - Martin Täubel
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Pirkka V Kirjavainen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Martin Depner
- Institute for Asthma and Allergy Prevention (IAP), Helmholtz Zentrum München1, Neuherberg, Germany
| | - Anne Hyvärinen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Eija Piippo-Savolainen
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.,Department of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne M Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| |
Collapse
|
12
|
Forster F, Ege MJ, Gerlich J, Weinmann T, Kreißl S, Weinmayr G, Genuneit J, Nowak D, von Mutius E, Vogelberg C, Radon K. Trajectories of asthma and allergy symptoms from childhood to adulthood. Allergy 2022; 77:1192-1203. [PMID: 34473346 DOI: 10.1111/all.15075] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/14/2021] [Accepted: 07/27/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Phenotypes of asthma and allergic diseases are mainly studied separately for children and adults. To explore the role of adolescence and young adulthood, we investigated symptom trajectories at the transition from childhood into adulthood. METHODS Latent class analysis (LCA) was conducted in a population initially recruited for the German arm of Phase II of the International Study of Asthma and Allergies in Childhood and followed-up three times until their early 30s (N=2267). Indicators included in LCA were 12-month prevalences of symptoms of wheeze, rhinoconjunctivitis, and eczema. Latent classes were further characterised regarding important traits such as skin prick tests. Logistic regression models were used to investigate associations with environmental determinants such as smoking and occupational exposures. RESULTS Six latent classes were identified: an asymptomatic one as well as three with single and two with co-occurring symptoms. All trajectories essentially established between baseline assessment at around 10 years and the first follow-up at around 17 years. Probabilities for symptoms increased from childhood to adolescence, especially for wheeze-related latent classes, while they remained constant in adulthood. Wheeze-related latent classes were also positively associated with exposures during adolescence (e.g. active smoking). CONCLUSION Distinct trajectories of asthma and allergy symptoms establish from childhood through adolescence and stabilize during early adulthood. This pattern was most notable in wheeze-related latent classes which also showed the strongest positive associations with environmental exposures in adolescence/young adulthood. Therefore, not only childhood but also adolescence is relevant for disease development and offers considerable potential for prevention and health promotion.
Collapse
Affiliation(s)
- Felix Forster
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich Munich Germany
- Comprehensive Pneumology Center (CPC) Munich, member German Center for Lung Research (DZL) Munich Germany
| | - Markus Johannes Ege
- Comprehensive Pneumology Center (CPC) Munich, member German Center for Lung Research (DZL) Munich Germany
- Dr. v. Hauner Children’s Hospital University Hospital, LMU Munich Munich Germany
| | - Jessica Gerlich
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich Munich Germany
- Comprehensive Pneumology Center (CPC) Munich, member German Center for Lung Research (DZL) Munich Germany
| | - Tobias Weinmann
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich Munich Germany
- Comprehensive Pneumology Center (CPC) Munich, member German Center for Lung Research (DZL) Munich Germany
| | - Sylvia Kreißl
- Paediatric Department University Hospital Carl Gustav Carus Dresden, TU Dresden Dresden Germany
| | - Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry University of Ulm Ulm Germany
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry University of Ulm Ulm Germany
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty Leipzig University Leipzig Germany
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich Munich Germany
- Comprehensive Pneumology Center (CPC) Munich, member German Center for Lung Research (DZL) Munich Germany
| | - Erika von Mutius
- Comprehensive Pneumology Center (CPC) Munich, member German Center for Lung Research (DZL) Munich Germany
- Dr. v. Hauner Children’s Hospital University Hospital, LMU Munich Munich Germany
| | - Christian Vogelberg
- Paediatric Department University Hospital Carl Gustav Carus Dresden, TU Dresden Dresden Germany
| | - Katja Radon
- Institute and Clinic for Occupational, Social and Environmental Medicine University Hospital, LMU Munich Munich Germany
- Comprehensive Pneumology Center (CPC) Munich, member German Center for Lung Research (DZL) Munich Germany
| |
Collapse
|
13
|
Achten NB, van Rossum AMC, Bacharier LB, Fitzpatrick AM, Hartert TV. Long-Term Respiratory Consequences of Early-Life Respiratory Viral Infections: A Pragmatic Approach to Fundamental Questions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:664-670. [PMID: 34942383 DOI: 10.1016/j.jaip.2021.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
Early-life viral infection can have profound effects on the developing lung and immune systems, both important in asthma development. For decades, research has aimed to establish whether there is a causal link between these viral infections as an exposure and asthma later in childhood. Establishing causality will remain important, but new insights regarding early-life viral infection as an exposure, the recognition of asthma as a heterogeneous outcome, and the shared genetic susceptibility to both suggest a refocus from answering the theoretical question of causality toward additional pragmatic approaches focusing on improving patient outcomes across the spectrum of respiratory disease. This Clinical Commentary reviews the evidence on the consequences of early-life viral infection and aims to look beyond the question of causality, suggesting a research agenda specifically aimed at what matters for human development, and for the quality of life of current and future patients with wheezing disorders.
Collapse
Affiliation(s)
- Niek B Achten
- Department of Pediatrics, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - Annemarie M C van Rossum
- Department of Pediatrics, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Leonard B Bacharier
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Tina V Hartert
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| |
Collapse
|
14
|
Harvey SM, Murphy VE, Whalen OM, Gibson PG, Jensen ME. Breastfeeding and wheeze-related outcomes in high-risk infants: A systematic review and meta-analysis. Am J Clin Nutr 2021; 113:1609-1618. [PMID: 33826694 DOI: 10.1093/ajcn/nqaa442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The risk of wheezing is high in infancy and is heightened in infants with a family history of asthma/atopy. The role of breastfeeding in influencing respiratory health for these high-risk infants is unclear. OBJECTIVES To systematically appraise evidence for the association between breastfeeding and wheeze incidences and severity in high-risk infants. METHODS Studies identified through electronic databases and reference lists were eligible if they assessed breastfeeding and respiratory outcomes in infants with a family history of asthma/atopy. The primary outcome was wheeze incidences in the first year of life. Secondary outcomes were wheeze incidences in the first 6 months of life, indicators of wheeze severity (recurrent wheeze, health-care utilization, and medication use), and other wheeze-related outcomes [bronchiolitis, pneumonia, croup, and incidence of lower respiratory tract infection (LRTI)] up to 12 months old. Meta-analyses were conducted where possible. RESULTS Of 1843 articles screened, 15 observational studies met the inclusion criteria. Breastfeeding was associated with 32% reduced odds of wheezing during the first year of life (ever vs. never: OR, 0.68; 95% CI: 0.53, 0.88; n = 9 studies); this association was even stronger in the first 6 months (OR, 0.45; 95% CI: 0.27, 0.75; n = 5 studies). Breastfeeding for a "longer" versus "shorter" time (approximately longer vs. shorter than 3 months) was associated with 50% reduced odds of wheezing at the age of 6 months (OR, 0.50; 95% CI: 0.39, 0.64; n = 3 studies). CONCLUSIONS Breastfeeding was associated with reduced odds of wheezing in high-risk infants, with the strongest protection in the first 6 months. More research is needed to understand the impact of breastfeeding intensity on wheezing and to examine additional respiratory outcomes, including wheeze severity. This review was registered at PROSPERO as CRD42019118631.
Collapse
Affiliation(s)
- Soriah M Harvey
- Priority Research Centre Grow Up Well, University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre Grow Up Well, University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Olivia M Whalen
- Priority Research Centre Grow Up Well, University of Newcastle, Newcastle, NSW, Australia.,School of Psychology, University of Newcastle, Newcastle, NSW, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Megan E Jensen
- Priority Research Centre Grow Up Well, University of Newcastle, Newcastle, NSW, Australia.,School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
| |
Collapse
|
15
|
Owora AH, Zhang Y. Childhood wheeze trajectory-specific risk factors: A systematic review and meta-analysis. Pediatr Allergy Immunol 2021; 32:34-50. [PMID: 32668501 DOI: 10.1111/pai.13313] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is growing interest in the use of latent trajectory methodology to identify wheeze patterns in heterogeneous populations of children. This study systematically reviewed and meta-analyzed childhood wheeze trajectory studies to identify childhood wheeze trajectory group-specific risk factors among children from birth through to adolescence. METHODS We included studies that used latent trajectory methodology to identify wheeze trajectories and associated risk factors. We searched PubMed, EMBASE, and Google Scholar from 2000 through September 30, 2019, for relevant studies. The study was conducted according to the PRISMA recommendations. RESULTS Thirteen cohort studies conducted in eleven high-income countries were included in our meta-analysis with the length of follow-up ranging from 3 to 18 years. Five distinct latent wheeze trajectory groups were identified: Never/Infrequent, Early-Transient, Early-Persistent, Intermediate-Onset, and Late-Onset. We found moderate-to-strong evidence that family history of asthma predicted persistent childhood wheezing among male children but with lower risk among first-born children. There was weak-to-moderate evidence for childhood atopy, male sex, short duration of breastfeeding, tobacco exposure, daycare attendance, and having siblings as risk factors for Early-Transient wheezing; except for breastfeeding, these factors were also associated with intermediate and Late-Onset wheezing with varying effect sizes in high-risk vs general population cohorts. CONCLUSIONS Our findings confirm the consistency of wheeze trajectory groups defined by onset, peak prevalence, and duration; we also suggest a common nomenclature for future trajectory studies. With the exception of the relationship between a family history of asthma and persistent childhood wheezing, commonly suspected wheeze risk factors (childhood atopy, male sex, short duration of breastfeeding, tobacco exposure, daycare attendance, and having siblings) are not trajectory-specific and have varying effects in high-risk vs general population cohorts. Delineation of time-varying risk factor effects may be critical to the specificity of wheeze trajectory group prediction to better inform prognosis and targeted early preventive intervention among at-risk children.
Collapse
Affiliation(s)
- Arthur H Owora
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Yijia Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
| |
Collapse
|
16
|
Bui DS, Lodge CJ, Perret JL, Lowe A, Hamilton GS, Thompson B, Giles G, Tan D, Erbas B, Pirkis J, Cicuttini F, Cassim R, Bowatte G, Thomas P, Garcia-Aymerich J, Hopper J, Abramson MJ, Walters EH, Dharmage SC. Trajectories of asthma and allergies from 7 years to 53 years and associations with lung function and extrapulmonary comorbidity profiles: a prospective cohort study. THE LANCET RESPIRATORY MEDICINE 2020; 9:387-396. [PMID: 33217367 DOI: 10.1016/s2213-2600(20)30413-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Longitudinal trajectories of asthma and allergies from childhood to adulthood might be differentially associated with lung function and chronic obstructive pulmonary disease (COPD), but associations with extrapulmonary comorbidities have not been well investigated. We aimed to assess these trajectories and examine their associations with lung function outcomes and profiles of comorbidities. METHODS In this prospective cohort study, data for asthma and related allergic conditions (ie, eczema, hay fever, and food allergy) were prospectively collected from the Tasmanian Longitudinal Health Study for participants aged 7-53 years originally recruited in Tasmania, Australia. All surviving individuals in the database with contact details were invited in the most recent follow-up (mean age 53 years). There were no exclusion criteria. With use of latent class analysis, we identified longitudinal trajectories of asthma and allergic conditions from 7-53 years, and profiles of self-reported extrapulmonary conditions recorded at 53 years. The associations between asthma and allergy trajectories and morbidity profiles and lung function at 53 years were investigated with regression models. FINDINGS Between Sept 3, 2012, and Nov 8, 2016, of 6128 individuals invited, 3609 (58·9%) individuals were enrolled. We identified five asthma and allergy trajectories: minimal and least asthma and allergies (n= 1767 [49·0%]); late-onset hay fever, no asthma (n=1065 [29·5%]); early-onset remitted asthma and allergies (n=236 [6·5%]); late-onset asthma and allergies (n=317 [8·8%]); and early-onset persistent asthma and allergies (n=224 [6·2%]); and four profiles of extrapulmonary morbidities: minimal or least disease (n=2206 [61·1%]); dominant mental health disorders (n=861 [23·9%]); dominant cardiovascular diseases or risks (n=424 [11·7%]); and multiple disorders (n=117 [3·2%]). The late-onset asthma and allergies trajectory was predominantly associated with the multiple disorders profile (relative risk ratio 3·3 [95% CI 1·9-5·9]), whereas the other asthma and allergy trajectories were associated only with the dominant mental health disorders profile. Both spirometrically defined and clinical COPD were most strongly associated with the early-onset persistent asthma and allergies trajectory (odds ratio [OR] 5·3 [95% CI 3·2-8·6]) and also with the late-onset asthma and allergies trajectory (OR 3·8 [2·4-6·1]). INTERPRETATION Distinct longitudinal trajectories of asthma and allergic disease from childhood to 53 years are associated with different profiles of extrapulmonary comorbidities and varying risk of COPD. These findings can inform a personalised approach in clinical guidelines and management focusing on treatable traits. Comorbidity profiles are a new target for early identification and intervention. FUNDING National Health and Medical Research Council of Australia, EU's Horizon 2020, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, The Victorian, Queensland & Tasmanian Asthma Foundations, The Royal Hobart Hospital, Helen MacPherson Smith Trust, and GlaxoSmithKline.
Collapse
Affiliation(s)
- Dinh S Bui
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, Melbourne, VIC, Australia
| | - Adrian Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Garun S Hamilton
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Monash Lung and Sleep, Monash Health, Clayton, VIC, Australia
| | | | - Graham Giles
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Daniel Tan
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Flavia Cicuttini
- Musculoskeletal Unit, Monash University, Melbourne, VIC, Australia; Alfred Hospital, Melbourne, VIC, Australia
| | - Raisa Cassim
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Thomas
- Prince of Wales' Hospital Clinical School and School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica, Epidemiología y Salud Pública, Barcelona, Spain
| | - John Hopper
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Abramson
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eugene H Walters
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| |
Collapse
|
17
|
Lodge CJ, Lowe AJ, Abramson MJ, Svanes C, Zaloumis SG, Thomas PS, Dharmage SC. Transient childhood wheeze is associated with less atopy in adolescence. Pediatr Allergy Immunol 2020; 31:913-919. [PMID: 32519350 DOI: 10.1111/pai.13304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 05/08/2020] [Accepted: 06/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The relationships between childhood wheeze phenotypes and subsequent allergic conditions other than asthma, including hay fever, eczema and sensitization, have not been widely reported. We aimed to investigate this relationship up to late adolescence. METHODS Using five childhood wheeze phenotypes defined from 620 children in a high-atopy risk birth cohort (Melbourne Atopy Cohort Study), we investigated their relationships with sensitization, eczema, hay fever and fractional exhaled nitric oxide (FeNO) at ages 12 and/or 18 years using logistic and linear regression models. RESULTS 'Early Persistent wheeze' was associated with the increased risk of eczema (odds ratio: 3.69; 95% CI: 1.23, 11.12) and sensitization (4.52; 1.50, 13.64) at 12 years. 'Intermediate Onset wheeze' was associated with the increased risk of eczema at 12 years (2.57; 1.11, 5.97), hay fever at 12 (2.87; 1.44, 5.74) and 18 years (2.19; 1.20, 4.02), sensitization at 12 (2.25; 1.17, 4.34) and 18 years (2.46; 1.18, 5.12), and raised FeNO at 18 years. 'Late Onset wheeze' was associated with the increased risk of hay fever at 12 (5.18; 1.11, 24.20) and 18 years (4.20; 1.03, 17.11) and sensitization at 12 years (3.27; 0.81, 13.27). In contrast, 'Early Transient wheeze' was associated with the reduced risk of eczema (0.44; 0.20, 0.96), hay fever (0.57; 0.33, 0.99) and sensitization (0.59; 0.35, 0.99) at 18 years and a lower FeNO compared with 'Never/Infrequent wheezers'. CONCLUSIONS Persistent wheeze phenotypes were associated with allergic outcomes up to 18 years with 'Intermediate Onset wheeze' being the most atopic group. In contrast, 'Early Transient wheezers' had less risk of allergic outcomes at 18 years. This protective effect may reassure parents of wheezy infants and young children.
Collapse
Affiliation(s)
- Caroline Jane Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Adrian John Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Michael John Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Cecilie Svanes
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Sophie G Zaloumis
- Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Paul S Thomas
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Shyamali Chandrika Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| |
Collapse
|
18
|
Chan A, Yu JE. Food allergy and asthma. JOURNAL OF FOOD ALLERGY 2020; 2:44-47. [PMID: 39022141 PMCID: PMC11250426 DOI: 10.2500/jfa.2020.2.200003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Food allergies (FA) and asthma commonly coexist in patients, with asthma affecting 14% of school-age children and with FA affecting up to 8% of children in the United States. Compared with children without FA, children with FA are two to four times more likely to have asthma. The timings of food sensitization and FA seem to be strong predictors of asthma onset in childhood; results of studies show that food sensitization in the first few years of life is associated with increased odds of developing early wheeze. Having multiple FAs as opposed to a single FA further compounds the risk of asthma. Reciprocally, there is a strong association between the presence of food sensitization and/or FA and poor asthma control, including increased asthma-related healthcare utilization and emergency medication use. Asthma is a risk factor in ~75% of fatal food-related anaphylaxis cases. Therefore, besides FA education and management, patients with FA and with asthma should optimize medical therapy of their asthma and receive asthma education, including identifying possible asthma triggers. Furthermore, allergists should ensure that asthma must be well controlled before conducting oral food challenges. Timely administration of epinephrine is lifesaving and remains the firstline treatment during food-induced anaphylaxis, especially in patients with asthma. Among those biologic therapies that have been highly effective in treating asthma, omalizumab and dupilumab are now also being studied as treatments for FA.
Collapse
Affiliation(s)
- Angela Chan
- From the Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Joyce E. Yu
- From the Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| |
Collapse
|
19
|
Wadhwa V, Lodge CJ, Dharmage SC, Cassim R, Sly PD, Russell MA. The Association of Early Life Viral Respiratory Illness and Atopy on Asthma in Children: Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2663-2672.e7. [PMID: 32298852 DOI: 10.1016/j.jaip.2020.03.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 02/22/2020] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The interaction between early life viral respiratory illness and atopy in the genesis of asthma has been widely discussed in the literature as the "two-hit hypothesis." OBJECTIVE To synthesize evidence regarding the association of childhood viral respiratory illness and atopy in the development of persistent wheezing and asthma. METHODS A systematic review was performed, according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Human studies investigating early life associations between atopy and viral respiratory illness with outcomes of asthma and wheezing were included. Meta-analysis was performed to investigate the association of viral illness across atopic and nonatopic groups. Subgroup analysis was undertaken to investigate potential effect modification of age at outcome. RESULTS Nine cohort studies were included, with data available for meta-analysis in 4 birth cohort studies. There was a stronger association of viral respiratory illness with persistent asthma/wheeze in atopic (odds ratio [OR], 4.02; 95% CI, 1.46-11.06) compared with nonatopic (OR, 2.32; 95% CI, 1.22-4.40) individuals; however, the evidence for this was limited. In 3 studies amenable to subanalysis based on outcome age, a stronger effect was observed up to 7 years for those with atopy (OR, 7.27; 95% CI 4.65-11.36) compared with those without atopy (OR, 3.19; 95% CI, 2.09-4.87). CONCLUSIONS There was a stronger association between viral respiratory illness and asthma/wheeze outcomes in individuals with atopy as compared with those without atopy. When outcomes were considered at younger ages, a greater differential effect was observed. Within the limitations of the few available studies however, definite conclusions cannot be made. There was also insufficient evidence for differential effects of early versus late atopy. Further research, in particular regarding virus type, timing of atopy, and atopic phenotype, would contribute to untangling this complex association.
Collapse
Affiliation(s)
- Vikas Wadhwa
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Raisa Cassim
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Peter D Sly
- Centre for Children's Health Research, South Brisbane, QLD, Australia
| | - Melissa Anne Russell
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Murdoch Children's Research Institute, Parkville, VIC, Australia.
| |
Collapse
|
20
|
Fitzpatrick AM, Bacharier LB, Jackson DJ, Szefler SJ, Beigelman A, Cabana M, Covar R, Guilbert T, Holguin F, Lemanske RF, Martinez FD, Morgan W, Phipatanakul W, Pongracic JA, Raissy HH, Zeiger RS, Mauger DT. Heterogeneity of Mild to Moderate Persistent Asthma in Children: Confirmation by Latent Class Analysis and Association with 1-Year Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2617-2627.e4. [PMID: 32156610 DOI: 10.1016/j.jaip.2020.02.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Compared with adults, phenotypic characterization of children with asthma is still limited and it remains difficult to predict which children with asthma are at highest risk for poor outcomes. OBJECTIVE To identify latent classes in a large population of treatment-adherent children with mild to moderate asthma enrolled in clinical trials and determine whether latent class assignment predicts future lung function abnormalities and exacerbation rate. METHODS Latent class analysis was performed on 2593 children with mild to moderate asthma aged 5 18 years, with 19 variables encompassing demographic characteristics, medical history, symptoms, lung function, allergic sensitization, and type 2 inflammation. Outcomes included lung function and the annualized exacerbation rate at 12 months of follow-up. RESULTS Five latent classes were identified with differing demographic features, asthma control, sensitization, type 2 inflammatory markers, and lung function. Exacerbation rates were 1.30 ± 0.12 for class 1 (multiple sensitization with partially reversible airflow limitation), 0.90 ± 0.05 for class 2 (multiple sensitization with reversible airflow limitation), 0.87 ± 0.08 for class 3 (lesser sensitization with reversible airflow limitation), 0.87 ± 0.05 for class 4 (multiple sensitization with normal lung function), and 0.71 ± 0.06 for class 5 (lesser sensitization with normal lung function). Lung function abnormalities persisted in class 1 at 12 months. CONCLUSIONS Children with mild to moderate asthma are a heterogeneous group. Allergic sensitization and lung function may be particularly useful in identifying children at the greatest risk for future exacerbation. Additional studies are needed to determine whether latent classes correspond to meaningful phenotypes for the purpose of personalized treatment.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Ga.
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, Mo
| | - Daniel J Jackson
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Stanley J Szefler
- Children's Hospital Colorado and Department of Pediatrics, University of Colorado, Aurora, Colo
| | - Avraham Beigelman
- Department of Pediatrics, Washington University and St Louis Children's Hospital, St Louis, Mo
| | - Michael Cabana
- Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York, NY
| | - Ronina Covar
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Theresa Guilbert
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
| | | | - Robert F Lemanske
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - Wayne Morgan
- Department of Pediatrics, The University of Arizona, Tucson, Ariz
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital and Harvard Medical School Department of Pediatrics, Boston, Mass
| | | | | | - Robert S Zeiger
- Kaiser Permanente, Southern California Region and Department of Pediatrics, University of California San Diego, San Diego, Calif
| | - David T Mauger
- Department of Public Health Sciences, Penn State University, Hershey, Pa
| |
Collapse
|
21
|
Haataja P, Korhonen P, Ojala R, Hirvonen M, Korppi M, Gissler M, Luukkaala T, Tammela O. Hospital admissions for lower respiratory tract infections after early-, late-, and post-term birth. Paediatr Perinat Epidemiol 2020; 34:139-149. [PMID: 32010990 DOI: 10.1111/ppe.12631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 11/19/2019] [Accepted: 12/01/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent data suggest that early-term births are associated with later respiratory morbidity (LRTI), and post-term births may decrease this risk. OBJECTIVES The objective was to determine the impact of early-term, late-term, and post-term birth on hospital admission for LRTI up to the age of seven years. Additionally, we explored maternal and perinatal factors associated with the risk of admission for LRTIs. METHODS The association of early-term (37+0 -38+6 weeks), late-term (41+0 -41+6 weeks), and post-term (≥42 weeks) birth with hospital admissions for lower respiratory tract infections (LRTI) in comparison with infants born full-term (39+0 -40+6 weeks) was assessed and early predictors of LRTI were established. The register study included 948 695 infants born in Finland in 1991-2008. Data were analysed in four-term subgroups. Hospital admissions for bronchiolitis/bronchitis and pneumonia were collected up to 7 years of age. Adjusted Cox proportional hazards models were used to assess risk factors of LRTI admissions. RESULTS The rates of hospital admission in the early-, full-, late-, and post-term groups were 6.7%, 5.5%, 5.1%, and 4.8% for bronchiolitis/bronchitis, and 2.8%, 2.4%, 2.3%, and 2.3% for pneumonia. Early-term birth was associated with an increased risk of admission for bronchiolitis/bronchitis (hazard ratio HR 1.21, 95% confidence interval CI 1.18, 1.23) and pneumonia (HR 1.16, 95% CI 1.12, 1.20), while late-term (HR 0.93, 95% CI 0.91, 0.95) and post-term births (HR 0.89, 95% CI 0.85, 0.93) were associated with a decreased risk of bronchiolitis/bronchitis admission compared with the full-term group. Maternal age ≤ 20 years, smoking during pregnancy, male sex, caesarean delivery, small for gestational age, 1-minute Apgar score < 4, ventilator support, and neonatal antibiotic therapy were associated with an increased risk of LRTI admission, while being firstborn, born in a level-II hospital and in the Northern region was associated with decreased risk. CONCLUSION Early-term birth was associated with a higher risk of all LRTI admissions while late-term and post-term births were associated with lower risk of bronchiolitis/bronchitis admission. Modifiable risk factors of LRTIs were smoking during pregnancy, birth by elective caesarean delivery, neonatal ventilator support, and antibiotic therapy.
Collapse
Affiliation(s)
- Paula Haataja
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Päivi Korhonen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Riitta Ojala
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Mikko Hirvonen
- Tampere Center for Child Health Research, Tampere University, Tampere, Finland.,Central Finland Health Care District, Jyväskylä, Finland
| | - Matti Korppi
- Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tiina Luukkaala
- School of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Research, Innovation and Development Centre, Tampere University Hospital, Tampere, Finland
| | - Outi Tammela
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, Tampere University, Tampere, Finland
| |
Collapse
|
22
|
Mora AM, Hoppin JA, Córdoba L, Cano JC, Soto-Martínez M, Eskenazi B, Lindh CH, van Wendel de Joode B. Prenatal pesticide exposure and respiratory health outcomes in the first year of life: Results from the infants' Environmental Health (ISA) study. Int J Hyg Environ Health 2020; 225:113474. [PMID: 32066110 DOI: 10.1016/j.ijheh.2020.113474] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/18/2020] [Accepted: 01/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Growing evidence suggests that pesticide exposure may influence respiratory health, but data in young children are very limited. We examined the association of prenatal pesticide exposure with lower respiratory tract infections (LRTIs) and wheeze at one year of age in children from the Infants' Environmental Health (ISA) study in Costa Rica. METHODS We measured seven pesticide metabolites, including ethylenethiourea (ETU, metabolite of mancozeb), in maternal urine samples collected repeatedly during pregnancy. For each woman, we averaged pesticide concentrations during each half of pregnancy (≤20 and >20 weeks of gestation) and across repeated samples collected over the course of pregnancy. We collected information about LRTIs (n = 355) and wheezing (n = 272) during the first year of life from mothers when their children were 11-19 months old. We fit multivariable logistic regression models using high (quartile 4) vs. low (quartiles 1-3) urinary pesticide concentrations as exposures and adjusted models for maternal age, education, parity, gestational age at birth, and child sex. RESULTS Ten percent of the children had at least one LRTI and 39% had at least one episode of wheezing during their first year of life. Median (25-75th percentile) specific gravity-corrected urinary ETU concentrations during the first half, second half, and over the course of pregnancy were 3.4 (2.1-5.0), 3.3 (2.2-4.7), and 3.4 (2.4-5.0) ng/mL, respectively. We observed that high urinary ETU concentrations during the first half of pregnancy were associated with increased odds of LRTI (OR = 2.45; 95% CI: 0.96, 6.26), whereas high urinary ETU concentrations during the second half of pregnancy were associated with decreased odds of wheezing (OR = 0.50; 95% CI: 0.26, 0.96). We found that the association between high urinary ETU concentrations during the first half of pregnancy and LRTIs persisted among mother-child pairs with either high or low ETU concentrations during the second half. In contrast, the association of high urinary ETU concentrations during the second half of pregnancy with wheezing was attenuated when we simultaneously adjusted for urinary ETU concentrations during the first half. We observed null associations between other pesticide metabolites measured during pregnancy and respiratory outcomes. CONCLUSIONS Our data indicate that exposure to mancozeb/ETU during the first half of pregnancy may be associated with respiratory outcomes in the first year of life.
Collapse
Affiliation(s)
- Ana M Mora
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica; Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California at Berkeley, Berkeley, United States.
| | - Jane A Hoppin
- Department of Biological Sciences and Center for Human Health and the Environment, North Carolina State University, United States
| | - Leonel Córdoba
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Juan C Cano
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Manuel Soto-Martínez
- Respiratory Department, Hospital Nacional de Niños, Caja Costarricense del Seguro Social, Costa Rica
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California at Berkeley, Berkeley, United States
| | - Christian H Lindh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Berna van Wendel de Joode
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| |
Collapse
|
23
|
Tang HHF, Sly PD, Holt PG, Holt KE, Inouye M. Systems biology and big data in asthma and allergy: recent discoveries and emerging challenges. Eur Respir J 2020; 55:13993003.00844-2019. [PMID: 31619470 DOI: 10.1183/13993003.00844-2019] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022]
Abstract
Asthma is a common condition caused by immune and respiratory dysfunction, and it is often linked to allergy. A systems perspective may prove helpful in unravelling the complexity of asthma and allergy. Our aim is to give an overview of systems biology approaches used in allergy and asthma research. Specifically, we describe recent "omic"-level findings, and examine how these findings have been systematically integrated to generate further insight.Current research suggests that allergy is driven by genetic and epigenetic factors, in concert with environmental factors such as microbiome and diet, leading to early-life disturbance in immunological development and disruption of balance within key immuno-inflammatory pathways. Variation in inherited susceptibility and exposures causes heterogeneity in manifestations of asthma and other allergic diseases. Machine learning approaches are being used to explore this heterogeneity, and to probe the pathophysiological patterns or "endotypes" that correlate with subphenotypes of asthma and allergy. Mathematical models are being built based on genomic, transcriptomic and proteomic data to predict or discriminate disease phenotypes, and to describe the biomolecular networks behind asthma.The use of systems biology in allergy and asthma research is rapidly growing, and has so far yielded fruitful results. However, the scale and multidisciplinary nature of this research means that it is accompanied by new challenges. Ultimately, it is hoped that systems medicine, with its integration of omics data into clinical practice, can pave the way to more precise, personalised and effective management of asthma.
Collapse
Affiliation(s)
- Howard H F Tang
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Australia .,Cambridge Baker Systems Genomics Initiative, Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,School of BioSciences, The University of Melbourne, Parkville, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Patrick G Holt
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Kathryn E Holt
- Dept of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia.,London School of Hygiene and Tropical Medicine, London, UK
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, Australia.,Cambridge Baker Systems Genomics Initiative, Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,School of BioSciences, The University of Melbourne, Parkville, Australia.,The Alan Turing Institute, London, UK
| |
Collapse
|
24
|
Abstract
The premature neonate is at high risk for childhood airway hyperreactivity and episodes of wheezing. Intermittent hypoxic events are frequently observed during the first weeks and months of life in these infants. Intermittent hypoxemia has been associated with adverse outcomes in extremely premature infants; including the diagnosis of bronchopulmonary dysplasia, reported wheezing, and use of prescription asthma medications. We review the incidence of intermittent hypoxia, their potential role in short and longer term respiratory morbidity, and the translational newborn models now being used to investigate common pathways by which intermittent hypoxia contributes to respiratory disease.
Collapse
Affiliation(s)
- Thomas M. Raffay
- Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106-6010
| | - Richard J. Martin
- Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106-6010
| |
Collapse
|
25
|
Santos KD, Lodge CJ, Abramson MJ, Erbas B, Bennett CM, Hui J, Dharmage SC, Lowe AJ. Early-Life Exposure to Oral Antibiotics and Lung Function Into Early Adulthood. Chest 2019; 157:334-341. [PMID: 31669428 DOI: 10.1016/j.chest.2019.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/06/2019] [Accepted: 10/01/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although there is ongoing debate regarding the impact of early postnatal exposure to antibiotics on the development of asthma, the possibility that antibiotic exposure may impair lung function has not previously been examined. Furthermore, it is unclear if specific types of antibiotics may have a greater effect, or if children with genetic mutations in the oxidative stress response glutathione S-transferase (GST) superfamily may be at greater risk. METHODS Parent-reported data of childhood antibiotic use from birth to 2 years, including type and indication, were collected from a birth cohort of 620 infants with a family history of allergy. Spirometry was performed at age 12 and 18 years, and results are presented as z scores. Participants were genotyped for GST-P, GST-M, and GST-T polymorphisms. Linear regression models were used to investigate the associations while adjusting for confounding factors. RESULTS Neither increasing days of exposure nor earlier exposure to antibiotics was associated with reduced FEV1 (at 18 years, per doubling of days of exposure = -0.03 z score units; 95% CI, -0.11 to 0.04) or FVC (< 0.01; 95% CI, -0.08 to 0.07). There was no evidence that GST-risk polymorphisms (M1, P1, and T1) increased susceptibility, and specific types of antibiotics also did not increase risk of lung function deficits. CONCLUSIONS Increasing exposure to oral antibiotics in early postnatal life was not associated with reduced lung function in children with a family history of allergic diseases. Although unwarranted use of antibiotics in children should be minimized, concerns regarding long-term lung health should not be a driving influence for this rationalization of use.
Collapse
Affiliation(s)
- Karoliny Dos Santos
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, SC, Brazil; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Catherine M Bennett
- Institute for Health Transformation, Deakin University, Waurn Ponds, VIC, Australia
| | - Jennie Hui
- School of Population Health, the University of Western Australia, Perth, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| |
Collapse
|
26
|
Gabet S, Rancière F, Just J, de Blic J, Lezmi G, Amat F, Seta N, Momas I. Asthma and allergic rhinitis risk depends on house dust mite specific IgE levels in PARIS birth cohort children. World Allergy Organ J 2019; 12:100057. [PMID: 31641405 PMCID: PMC6796773 DOI: 10.1016/j.waojou.2019.100057] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/28/2019] [Accepted: 07/23/2019] [Indexed: 11/06/2022] Open
Abstract
Background The natural history of allergic sensitization in childhood, and its impact on allergic disease development, needs to be clarified. This study aims to identify allergic sensitization and morbidity patterns during the first 8 years of life. Methods The study was conducted in the on-going population-based prospective Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort. Sensitization profiles were identified by k-means clustering based upon allergen-specific IgE levels measured at 18 months and 8/9 years. Allergic morbidity profiles were identified by latent class analysis based on symptoms, symptom severity, treatments, and lifetime doctor-diagnoses of asthma, allergic rhinitis, and atopic dermatitis and on lower respiratory infections before 2 years. Results Five sensitization and 5 allergic morbidity patterns were established in 714 children. Children not sensitized or with isolated and low allergen-specific sensitization were grouped together (76.8%). A profile of early and transient sensitization to foods that increased the risk of asthma later in childhood was identified (4.9%). Children strongly sensitized (≥3.5 kUA/L) to house dust mite at 8/9 years (9.0%) had the highest risk of asthma and allergic rhinitis. Finally, timothy grass pollen at 8/9 years sensitization profile (5.3%) was related to respiratory allergic diseases, as was early onset and persistent sensitization profile (4.1%), this latter being also strongly associated with atopic dermatitis. Conclusions & Clinical Relevance We show that accurate assessment of the risk of allergic disease should rely on earliness and multiplicity of sensitization, involved allergens, and allergen-specific IgE levels, and not considering solely allergic sensitization as a dichotomous variable (allergen-specific IgE ≥0.35 kUA/L), as usually done. This is particularly striking for house dust mite. We are hopeful that, pending further confirmation in other populations, our findings will improve clinical practice as part of an approach to allergic disease prevention.
Collapse
Key Words
- AIC, Akaike Information Criteria
- Allergic morbidity
- BAMSE, Stockholm Children Allergy and Environmental Prospective Birth Cohort
- BIC, Bayesian Information Criteria
- BMI, body mass index
- Birth cohort
- COPSAC2000, Copenhagen Prospective Study on Asthma in Childhood 2000
- Cluster analysis
- ISAAC, International Study of Asthma and Allergies in Childhood
- IgE, Immunoglobulin E
- LCA, latent class analysis
- LRI, lower respiratory infections
- Latent class analysis
- MAS, Multicenter Allergy Study
- MeDALL, Mechanisms of the Development of ALLergy
- OR(a), (adjusted) odds ratio
- PARIS, Pollution and Asthma Risk: an Infant Study
- PASTURE, Protection Against Allergy: Study in Rural Environments
- SES, socio-economic status
- Specific IgE levels
Collapse
Affiliation(s)
- Stephan Gabet
- Université de Paris, Faculté de Pharmacie de Paris, Inserm UMR 1153, Centre of Research in Epidemiology and Statistics (CRESS), HERA team, Paris, France
| | - Fanny Rancière
- Université de Paris, Faculté de Pharmacie de Paris, Inserm UMR 1153, Centre of Research in Epidemiology and Statistics (CRESS), HERA team, Paris, France
| | - Jocelyne Just
- AP-HP, Hôpital d'Enfants Armand-Trousseau, Service d'Allergologie Pédiatrique, Paris, France
| | - Jacques de Blic
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France
| | - Guillaume Lezmi
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France
| | - Flore Amat
- AP-HP, Hôpital d'Enfants Armand-Trousseau, Service d'Allergologie Pédiatrique, Paris, France.,UPMC, Sorbonne Universités, Inserm UMR S1136, Paris, France
| | - Nathalie Seta
- Université de Paris, Faculté de Pharmacie de Paris, Inserm UMR 1153, Centre of Research in Epidemiology and Statistics (CRESS), HERA team, Paris, France
| | - Isabelle Momas
- Université de Paris, Faculté de Pharmacie de Paris, Inserm UMR 1153, Centre of Research in Epidemiology and Statistics (CRESS), HERA team, Paris, France.,Mairie de Paris, Direction de l'Action Sociale, de l'Enfance et de la Santé (DASES), Cellule Cohorte, Paris, France
| |
Collapse
|
27
|
Influence of Childhood Asthma and Allergies on Occupational Exposure in Early Adulthood: A Prospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16122163. [PMID: 31248069 PMCID: PMC6617119 DOI: 10.3390/ijerph16122163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/11/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
Abstract
We aimed to determine whether history of asthma/allergies in childhood was associated with avoidance of jobs with exposure to asthmagens in early adulthood. The Melbourne Atopic Cohort Study recruited 620 children at high risk of allergic diseases at birth (1990–1994). Asthma, hay fever and eczema were evaluated by questionnaires during childhood. A follow-up in early adulthood (mean age: 18 years) collected information on the current job. Occupational exposure to asthmagens/irritants was evaluated using a job-exposure matrix. The association between history of asthma/allergies in childhood and working in a job with exposure to asthmagens/irritants was evaluated by logistic regression, adjusted for age, sex and parental education. Among 363 participants followed-up until early adulthood, 17% worked in a job with exposure to asthmagens/irritants. History of asthma (35%) was not associated with working in an exposed job (adjusted OR: 1.16, 95% CI: 0.65–2.09). Subjects with history of hay fever (37%) and eczema (40%) were more likely to enter exposed jobs (significant for hay fever: 1.78, 1.00–3.17; but not eczema: 1.62, 0.91–2.87). In conclusion, young adults with history of allergies were more likely to enter exposed jobs, suggesting no avoidance of potentially hazardous exposures. Improved counselling against high risk jobs may be needed for young adults with these conditions.
Collapse
|
28
|
Oksel C, Granell R, Mahmoud O, Custovic A, Henderson AJ. Causes of variability in latent phenotypes of childhood wheeze. J Allergy Clin Immunol 2019; 143:1783-1790.e11. [PMID: 30528616 PMCID: PMC6505513 DOI: 10.1016/j.jaci.2018.10.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/29/2018] [Accepted: 10/12/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Latent class analysis (LCA) has been used extensively to identify (latent) phenotypes of childhood wheezing. However, the number and trajectory of discovered phenotypes differed substantially between studies. OBJECTIVE We sought to investigate sources of variability affecting the classification of phenotypes, identify key time points for data collection to understand wheeze heterogeneity, and ascertain the association of childhood wheeze phenotypes with asthma and lung function in adulthood. METHODS We used LCA to derive wheeze phenotypes among 3167 participants in the ALSPAC cohort who had complete information on current wheeze recorded at 14 time points from birth to age 16½ years. We examined the effects of sample size and data collection age and intervals on the results and identified time points. We examined the associations of derived phenotypes with asthma and lung function at age 23 to 24 years. RESULTS A relatively large sample size (>2000) underestimated the number of phenotypes under some conditions (eg, number of time points <11). Increasing the number of data points resulted in an increase in the optimal number of phenotypes, but an identical number of randomly selected follow-up points led to different solutions. A variable selection algorithm identified 8 informative time points (months 18, 42, 57, 81, 91, 140, 157, and 166). The proportion of asthmatic patients at age 23 to 24 years differed between phenotypes, whereas lung function was lower among persistent wheezers. CONCLUSIONS Sample size, frequency, and timing of data collection have a major influence on the number and type of wheeze phenotypes identified by using LCA in longitudinal data.
Collapse
Affiliation(s)
- Ceyda Oksel
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom
| | - Raquel Granell
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Osama Mahmoud
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Adnan Custovic
- Section of Paediatrics, Department of Medicine, Imperial College London, London, United Kingdom.
| | - A John Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
29
|
Dharmage SC, Perret JL, Custovic A. Epidemiology of Asthma in Children and Adults. Front Pediatr 2019; 7:246. [PMID: 31275909 PMCID: PMC6591438 DOI: 10.3389/fped.2019.00246] [Citation(s) in RCA: 558] [Impact Index Per Article: 111.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/29/2019] [Indexed: 11/23/2022] Open
Abstract
Asthma is a globally significant non-communicable disease with major public health consequences for both children and adults, including high morbidity, and mortality in severe cases. We have summarized the evidence on asthma trends, environmental determinants, and long-term impacts while comparing these epidemiological features across childhood asthma and adult asthma. While asthma incidence and prevalence are higher in children, morbidity, and mortality are higher in adults. Childhood asthma is more common in boys while adult asthma is more common in women, and the reversal of this sex difference in prevalence occurs around puberty suggesting sex hormones may play a role in the etiology of asthma. The global epidemic of asthma that has been observed in both children and adults is still continuing, especially in low to middle income countries, although it has subsided in some developed countries. As a heterogeneous disease, distinct asthma phenotypes, and endotypes need to be adequately characterized to develop more accurate and meaningful definitions for use in research and clinical settings. This may be facilitated by new clustering techniques such as latent class analysis, and computational phenotyping methods are being developed to retrieve information from electronic health records using natural language processing (NLP) algorithms to assist in the early diagnosis of asthma. While some important environmental determinants that trigger asthma are well-established, more work is needed to define the role of environmental exposures in the development of asthma in both children and adults. There is increasing evidence that investigation into possible gene-by-environment and environment-by-environment interactions may help to better uncover the determinants of asthma. Therefore, there is an urgent need to further investigate the interrelationship between environmental and genetic determinants to identify high risk groups and key modifiable exposures. For children, asthma may impair airway development and reduce maximally attained lung function, and these lung function deficits may persist into adulthood without additional progressive loss. Adult asthma may accelerate lung function decline and increase the risk of fixed airflow obstruction, with the effect of early onset asthma being greater than late onset asthma. Therefore, in managing asthma, our focus going forward should be firmly on improving not only short-term symptoms, but also the long-term respiratory and other health outcomes.
Collapse
Affiliation(s)
- Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, United Kingdom
| |
Collapse
|
30
|
Fitzpatrick AM, Bacharier LB, Guilbert TW, Jackson DJ, Szefler SJ, Beigelman A, Cabana MD, Covar R, Holguin F, Lemanske RF, Martinez FD, Morgan W, Phipatanakul W, Pongracic JA, Zeiger RS, Mauger DT. Phenotypes of Recurrent Wheezing in Preschool Children: Identification by Latent Class Analysis and Utility in Prediction of Future Exacerbation. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:915-924.e7. [PMID: 30267890 DOI: 10.1016/j.jaip.2018.09.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 09/11/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Recurrent preschool wheezing is a heterogeneous disorder with significant morbidity, yet little is known about phenotypic determinants and their impact on clinical outcomes. OBJECTIVE Latent class analysis (LCA) was used to identify latent classes of recurrent preschool wheeze and their association with future exacerbations and inhaled corticosteroid (ICS) treatment response. METHODS Data from 5 clinical trials of 1708 children aged 12 to 71 months with recurrent wheezing were merged. LCA was performed on 10 demographic, exposure, and sensitization variables to determine the optimal number of latent classes. The primary outcome was the annualized rate of wheezing exacerbations requiring systemic corticosteroids during the study intervention period; the secondary outcome was the time to first exacerbation. Exploratory analyses examined the effect of daily ICS treatment on exacerbation outcomes. RESULTS Four latent classes of recurrent wheezing were identified; these were not distinguished by current symptoms or historical exacerbations but differed with regard to allergen sensitization and/or exposures. Annualized exacerbation rates (mean ± SEM/year) were 0.65 ± 0.06 for class 1 ("minimal sensitization"), 0.93 ± 0.10 for class 2 ("sensitization with indoor pet exposure"), 0.60 ± 0.07 for class 3 ("sensitization with tobacco smoke exposure"), and 0.81 ± 0.10 for class 4 ("multiple sensitization and eczema") (P < .001). In a research setting of high adherence, daily ICS treatment improved exacerbation rates in classes 2 and 4 but not the other groups. CONCLUSIONS Sensitization and exposure assessments are useful in the prediction of future exacerbation and may identify children most likely to respond favorably to daily ICS treatment.
Collapse
Affiliation(s)
- Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
| | | | - Theresa W Guilbert
- Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | | | - Stanley J Szefler
- Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo
| | | | - Michael D Cabana
- Department of Pediatrics, University of California San Francisco, San Francisco, Calif
| | - Ronina Covar
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Fernando Holguin
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pa
| | | | | | - Wayne Morgan
- Department of Pediatrics, University of Arizona, Tucson, Ariz
| | - Wanda Phipatanakul
- Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | | | - Robert S Zeiger
- Kaiser Permanente, Southern California Region, San Diego, Calif; Department of Pediatrics, University of California San Diego, San Diego, Calif
| | - David T Mauger
- Department of Statistics, Pennsylvania State University, Hershey, Pa
| | | |
Collapse
|
31
|
Lowe AJ, Lodge CJ, Allen KJ, Abramson MJ, Matheson MC, Thomas PS, Barton CA, Bennett CM, Erbas B, Svanes C, Wjst M, Gómez Real F, Perret JL, Russell MA, Southey MC, Hopper JL, Gurrin LC, Axelrad CJ, Hill DJ, Dharmage SC. Cohort Profile: Melbourne Atopy Cohort study (MACS). Int J Epidemiol 2018; 46:25-26. [PMID: 27097746 DOI: 10.1093/ije/dyw011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Katrina J Allen
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Melanie C Matheson
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Paul S Thomas
- Inflammation and Infection Research Centre & Prince of Wales' Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Catherine M Bennett
- Centre for Population Health Research, Deakin University, Geelong, VIC, Australia
| | - Bircan Erbas
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mathias Wjst
- German Research Center for Environmental Health, Munich, Germany
| | | | - Jennifer L Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Melissa A Russell
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Melissa C Southey
- Department of Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - John L Hopper
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Lyle C Gurrin
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | - Christine J Axelrad
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - David J Hill
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.,Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| |
Collapse
|
32
|
Lodge CJ, Lowe AJ, Dharmage SC. EuroPrevall: insights into the allergic disease epidemic. Thorax 2018; 73:999-1000. [PMID: 30006450 DOI: 10.1136/thoraxjnl-2018-211660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia
| |
Collapse
|
33
|
Haataja P, Korhonen P, Ojala R, Hirvonen M, Korppi M, Gissler M, Luukkaala T, Tammela O. Hospital admissions for lower respiratory tract infections in children born moderately/late preterm. Pediatr Pulmonol 2018; 53:209-217. [PMID: 29193814 DOI: 10.1002/ppul.23908] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 10/17/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the frequency and predictors of hospital admissions for lower respiratory tract infections (LRTIs) in moderately preterm (MP, 32+0 to 33+6 weeks) and late preterm (LP, 34+0 to 36+6 weeks) infants compared to term (T ≥37 weeks) and very preterm (VP, <32+0 weeks) infants. STUDY DESIGN This national register-based study covered all infants born in Finland in 1991-2008. Data on 1 018 256 infants were analyzed in four gestational age-based groups: VP (n = 6329), MP (n = 6796), LP (n = 39 928), and T (n = 965 203) groups. Data on hospital admissions due to bronchiolitis/bronchitis and pneumonia were collected up to the age of 7 years. RESULTS Hospital admissions for LRTIs were more common in the MP and LP groups than in the T group but less frequent than in the VP group: bronchiolitis/bronchitis (VP 24.4%, MP 13.9%, LP 9.5%, and T 5.6%) and pneumonia (VP 8.8%, MP 4.5%, LP 3.3%, and T 2.4%). Compared to the term group, MP and LP birth predicted bronchiolitis/bronchitis (MP OR 1.89; 95%CI 1.75-2.03, LP 1.51; 1.45-1.56) and pneumonia (MP 1.49; 1.32-1.67, LP 1.25; 1.18-1.33) admissions. Statistically significant risk factors for LRTIs included maternal smoking, cesarean section, male sex, admission to a neonatal unit and ventilator therapy. In addition, being first-born, being born SGA and neonatal antibiotic therapy were associated with bronchiolitis/bronchitis. CONCLUSIONS MP and LP births, in addition to VP birth, have a significant impact on respiratory infectious morbidity and the need of hospital admissions for LRTIs.
Collapse
Affiliation(s)
- Paula Haataja
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Päivi Korhonen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Riitta Ojala
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Mikko Hirvonen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere, Tampere, Finland.,Central Finland Health Care District, Jyväskylä, Finland
| | - Matti Korppi
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere, Tampere, Finland
| | - Mika Gissler
- Information Services Department, THL National Institute for Health and Welfare, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
| | - Tiina Luukkaala
- Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland.,Research and Innovation Centre, Tampere University Hospital, Tampere, Finland
| | - Outi Tammela
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,Tampere Center for Child Health Research, University of Tampere, Tampere, Finland
| |
Collapse
|
34
|
Lodge CJ, Bråbäck L, Lowe AJ, Dharmage SC, Olsson D, Forsberg B. Grandmaternal smoking increases asthma risk in grandchildren: A nationwide Swedish cohort. Clin Exp Allergy 2017; 48:167-174. [PMID: 28925522 DOI: 10.1111/cea.13031] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/31/2017] [Accepted: 08/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is growing interest in exposures prior to conception as possible risk factors for offspring asthma. Although partially supported by evidence from limited human studies, current evidence is inconsistent and based on recall of exposure status. OBJECTIVE We aimed to investigate grandmaternal smoking during pregnancy and the risk of asthma in grandchildren using prospectively collected population-based data. METHODS Information on grandmaternal and maternal smoking during pregnancy and grandchild use of asthma medications was collected from national Swedish registries. Associations between grandmaternal smoking during pregnancy (10-12 weeks) and asthma medication use in grandchildren were investigated using generalized estimating equations. Ages at which asthma medications were prescribed classified childhood asthma into never, early transient (0-3 years), late onset (3-6 years) and early persistent (0-3 and 3-6 years) phenotypes. RESULTS From 1982 to 1986, 44 583 grandmothers gave birth to 46 197 mothers, who gave birth to 66 271 grandchildren (born 1996-2010). Children aged 1-6 years had an increased asthma risk if their grandmothers had smoked during pregnancy, with a higher risk for more exposure (10+ cigs/d; adjusted OR 1.23; 1.17, 1.30). Maternal smoking did not modify this relationship. CONCLUSIONS & CLINICAL RELEVANCE Children had an increased risk of asthma in the first 6 years of life if their grandmothers smoked during early pregnancy, independent of maternal smoking. Importantly, this exhibited a dose-response relationship and was associated with a persistent childhood asthma phenotype. These findings support possible epigenetic transmission of risk from environmental exposures in previous generations.
Collapse
Affiliation(s)
- C J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - L Bråbäck
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - A J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - S C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Melbourne, Vic., Australia
| | - D Olsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - B Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
35
|
Polymorphism in the gene encoding toll-like receptor 10 may be associated with asthma after bronchiolitis. Sci Rep 2017; 7:2956. [PMID: 28592890 PMCID: PMC5462783 DOI: 10.1038/s41598-017-03429-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/28/2017] [Indexed: 11/22/2022] Open
Abstract
Toll-like receptors (TLRs) recognise microbes that contribute to the severity of bronchiolitis and the subsequent risk of asthma. We evaluated whether post-bronchiolitis asthma was associated with polymorphisms in the TLR3 rs3775291, TLR4 rs4986790, TLR7 rs179008, TLR8 rs2407992, TLR9 rs187084, and TLR10 rs4129009 genes. The gene polymorphisms were studied at the age of 6.4 years (mean) in 135 children hospitalised for bronchiolitis in infancy. The outcome measure was current or previous asthma. Current asthma was more common (30%) in children with the variant AG or GG genotype in the TLR10 rs4129009 gene versus those who were homozygous for the major allele A (11%) (p = 0.03). The adjusted odds ratio (aOR) was 4.30 (95% CI 1.30–14.29). Asthma ever was more common (34.6%) in girls with the TLR7 variant AT or TT genotype versus those who were homozygous for the major allele A (12.5%) (p = 0.03). The adjusted OR was 3.93 (95% CI 1.06–14.58). Corresponding associations were not seen in boys. There were no significant associations between TLR3, TLR4, TLR8, or TLR9 polymorphisms and post-bronchiolitis asthma. Polymorphism in the TLR10 gene increases and in the TLR7 gene may increase the risk of asthma in preschool-aged children after infant bronchiolitis.
Collapse
|
36
|
Peters RL, Koplin JJ, Gurrin LC, Dharmage SC, Wake M, Ponsonby AL, Tang MLK, Lowe AJ, Matheson M, Dwyer T, Allen KJ. The prevalence of food allergy and other allergic diseases in early childhood in a population-based study: HealthNuts age 4-year follow-up. J Allergy Clin Immunol 2017; 140:145-153.e8. [PMID: 28514997 DOI: 10.1016/j.jaci.2017.02.019] [Citation(s) in RCA: 211] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The HealthNuts study previously reported interim prevalence data showing the highest prevalence of challenge-confirmed food allergy in infants internationally. However, population-derived prevalence data on challenge-confirmed food allergy and other allergic diseases in preschool-aged children remain sparse. OBJECTIVE This study aimed to report the updated prevalence of food allergy at age 1 year from the whole cohort, and to report the prevalence of food allergy, asthma, eczema, and allergic rhinitis at age 4 years. METHODS HealthNuts is a population-based cohort study with baseline recruitment of 5276 one-year-old children who underwent skin prick test (SPT) to 4 food allergens and those with detectable SPT results had formal food challenges. At age 4 years, parents completed a questionnaire (81.3% completed) and those who previously attended the HealthNuts clinic at age 1 year or reported symptoms of a new food allergy were invited for an assessment that included SPT and oral food challenges. Data on asthma, eczema, and allergic rhinitis were captured by validated International Study of Asthma and Allergies in Childhood questionnaires. RESULTS The prevalence of challenge-confirmed food allergy at age 1 and 4 years was 11.0% and 3.8%, respectively. At age 4 years, peanut allergy prevalence was 1.9% (95% CI, 1.6% to 2.3%), egg allergy was 1.2% (95% CI, 0.9% to 1.6%), and sesame allergy was 0.4% (95% CI, 0.3% to 0.6%). Late-onset peanut allergy at age 4 years was rare (0.2%). The prevalence of current asthma was 10.8% (95% CI, 9.7% to 12.1%), current eczema was 16.0% (95% CI, 14.7% to 17.4%), and current allergic rhinitis was 8.3% (95% CI, 7.2% to 9.4%). Forty percent to 50% of this population-based cohort experienced symptoms of an allergic disease in the first 4 years of their life. CONCLUSIONS Although the prevalence of food allergy decreased between age 1 year and age 4 years in this population-based cohort, the prevalence of any allergic disease among 4-year-old children in Melbourne, Australia, is remarkably high.
Collapse
Affiliation(s)
| | - Jennifer J Koplin
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Lyle C Gurrin
- School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Shyamali C Dharmage
- School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Melissa Wake
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Paediatrics and the Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Parkville, Australia; School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Mimi L K Tang
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia
| | - Adrian J Lowe
- School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Melanie Matheson
- School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Terence Dwyer
- Murdoch Childrens Research Institute, Parkville, Australia; George Institute for Global Health, University of Oxford, Oxford, United Kingdom
| | - Katrina J Allen
- Murdoch Childrens Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom.
| | | |
Collapse
|
37
|
Belgrave D, Henderson J, Simpson A, Buchan I, Bishop C, Custovic A. Disaggregating asthma: Big investigation versus big data. J Allergy Clin Immunol 2017; 139:400-407. [PMID: 27871876 PMCID: PMC5292995 DOI: 10.1016/j.jaci.2016.11.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022]
Abstract
We are facing a major challenge in bridging the gap between identifying subtypes of asthma to understand causal mechanisms and translating this knowledge into personalized prevention and management strategies. In recent years, "big data" has been sold as a panacea for generating hypotheses and driving new frontiers of health care; the idea that the data must and will speak for themselves is fast becoming a new dogma. One of the dangers of ready accessibility of health care data and computational tools for data analysis is that the process of data mining can become uncoupled from the scientific process of clinical interpretation, understanding the provenance of the data, and external validation. Although advances in computational methods can be valuable for using unexpected structure in data to generate hypotheses, there remains a need for testing hypotheses and interpreting results with scientific rigor. We argue for combining data- and hypothesis-driven methods in a careful synergy, and the importance of carefully characterized birth and patient cohorts with genetic, phenotypic, biological, and molecular data in this process cannot be overemphasized. The main challenge on the road ahead is to harness bigger health care data in ways that produce meaningful clinical interpretation and to translate this into better diagnoses and properly personalized prevention and treatment plans. There is a pressing need for cross-disciplinary research with an integrative approach to data science, whereby basic scientists, clinicians, data analysts, and epidemiologists work together to understand the heterogeneity of asthma.
Collapse
Affiliation(s)
| | - John Henderson
- School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Iain Buchan
- Health Informatics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Adnan Custovic
- Department of Paediatrics, Imperial College, London, United Kingdom.
| |
Collapse
|
38
|
Azad MB, Moyce BL, Guillemette L, Pascoe CD, Wicklow B, McGavock JM, Halayko AJ, Dolinsky VW. Diabetes in pregnancy and lung health in offspring: developmental origins of respiratory disease. Paediatr Respir Rev 2017; 21:19-26. [PMID: 27665512 DOI: 10.1016/j.prrv.2016.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/11/2016] [Indexed: 12/17/2022]
Abstract
Diabetes is an increasingly common complication of pregnancy. In parallel with this trend, a rise in chronic lung disease in children has been observed in recent decades. While several adverse health outcomes associated with exposure to diabetes in utero have been documented in epidemiological and experimental studies, few have examined the impact of diabetes in pregnancy on offspring lung health and respiratory disease. We provide a comprehensive overview of current literature on this topic, finding suggestive evidence that exposure to diabetes in utero may have adverse effects on lung development. Delayed lung maturation and increased risk of respiratory distress syndrome have been consistently observed among infants born to mothers with diabetes and these findings are also observed in some rodent models of diabetes in pregnancy. Further research is needed to confirm and characterize epidemiologic observations that diabetes in pregnancy may predispose offspring to childhood wheezing illness and asthma. Parallel translational studies in human pregnancy cohorts and experimental models are needed to explore the role of fetal programming and other potential biological mechanisms in this context.
Collapse
Affiliation(s)
- M B Azad
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
| | - B L Moyce
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Canada
| | - L Guillemette
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Applied Health Sciences, University of Manitoba, Winnipeg, Canada
| | - C D Pascoe
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
| | - B Wicklow
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - J M McGavock
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - A J Halayko
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
| | - V W Dolinsky
- Manitoba Developmental Origins of Chronic Diseases in Children Network (DEVOTION); Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
39
|
Tse SM, Rifas-Shiman SL, Coull BA, Litonjua AA, Oken E, Gold DR. Sex-specific risk factors for childhood wheeze and longitudinal phenotypes of wheeze. J Allergy Clin Immunol 2016; 138:1561-1568.e6. [PMID: 27246527 PMCID: PMC5083247 DOI: 10.1016/j.jaci.2016.04.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 04/05/2016] [Accepted: 04/13/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although sexual dimorphism in wheeze and asthma prevalence are well documented, sex-specific risk factors for wheeze and longitudinal wheeze phenotypes have not been well elucidated. OBJECTIVE By using a large prebirth cohort, this study aimed to identify sex-specific risk factors for wheeze from birth through midchildhood and identify distinct longitudinal wheeze phenotypes and the sex-specific risk factors associated with these phenotypes. METHODS Mothers reported child wheeze symptoms over the past year approximately yearly on 9 occasions starting at age 1 year. We identified sex-specific predictors of wheeze, wheeze phenotypes, and sex-specific predictors of these phenotypes by using generalized estimating equations, latent class mixed models, and multinomial logistic analysis, respectively. RESULTS A total of 1623 children had information on wheeze at 1 or more time points. Paternal asthma was a stronger predictor of ever wheezing in boys (odds ratio [OR], 2.15; 95% CI, 1.74-2.66) than in girls (OR, 1.53; 95% CI, 1.19-1.96; P for sex by paternal asthma interaction = .03), whereas being black or Hispanic, birth weight for gestational age z score, and breast-feeding duration had stronger associations among girls. We identified 3 longitudinal wheeze phenotypes: never/infrequent wheeze (74.1%), early transient wheeze (12.7%), and persistent wheeze (13.1%). Compared with never/infrequent wheeze, maternal asthma, infant bronchiolitis, and atopic dermatitis were associated with persistent wheeze in both sexes, but paternal asthma was associated with persistent wheeze in boys only (OR, 4.27; 95% CI, 2.33-7.83; P for sex by paternal asthma interaction = .02), whereas being black or Hispanic was a predictor for girls only. CONCLUSION We identified sex-specific predictors of wheeze and longitudinal wheeze patterns, which might have important prognostic value and allow for a more personalized approach to wheeze and asthma treatment.
Collapse
Affiliation(s)
- Sze Man Tse
- Division of Respiratory Medicine, Department of Pediatrics, Sainte-Justine University Hospital Center and University of Montreal, Montreal, Quebec, Canada.
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Brent A Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, Mass
| | - Augusto A Litonjua
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Diane R Gold
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| |
Collapse
|
40
|
Fuchs O, Bahmer T, Rabe KF, von Mutius E. Asthma transition from childhood into adulthood. THE LANCET RESPIRATORY MEDICINE 2016; 5:224-234. [PMID: 27666650 DOI: 10.1016/s2213-2600(16)30187-4] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 12/11/2022]
Abstract
Asthma is the most prevalent chronic respiratory disease both in children and adults and resembles a complex syndrome rather than a single disease. Different methods have been developed to better characterise distinct asthma phenotypes in childhood and adulthood. In studies of adults, most phenotyping relies on biomaterials from the lower airways; however, this information is missing in paediatric studies because of restricted accessibility. Few patients show symptoms throughout childhood, adolescence, and adulthood. Risk factors for this might be genetics, family history of asthma and atopy, infections early in life, allergic diseases, and lung function deficits. In turn, a large proportion of children with asthma lose their symptoms during school age and adolescence. This improved prognosis, which might also reflect a better treatment response, is associated with being male and with milder and less allergic disease. Importantly, whether clinical remission of symptoms equals the disappearance of underlying pathology is unknown. In fact, airway hyper-responsiveness and airway inflammation might remain despite the absence of overt symptoms. Additionally, a new-onset of asthma symptoms is apparent in adulthood, especially in women and in the case of impaired lung function. However, many patients do not remember childhood symptoms, which might reflect relapse rather than true initiation. Both relapse and adult-onset of asthma symptoms have been associated with allergic disease and sensitisation in addition to airway hyper-responsiveness. Thus, asthma symptoms beginning in adults might have originated in childhood. Equivocally, persistence into, relapse, and new-onset of symptoms in adulthood have all been related to active smoking. However, underlying mechanisms for the associations remain unclear, and future asthma research should therefore integrate standardised molecular approaches in identical ways in both paediatric and adult populations and in longitudinal studies.
Collapse
Affiliation(s)
- Oliver Fuchs
- Division of Paediatric Allergology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Munich, Germany; German Centre for Lung Research (DZL).
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Grosshansdorf, Germany; Airway Research Centre North (ARCN), Lubeck, Germany; ARCN, Kiel, Germany; ARCN, Grosshansdorf, Germany; German Centre for Lung Research (DZL)
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany; Department of Medicine, Christian-Albrechts-University, Kiel, Germany; Airway Research Centre North (ARCN), Lubeck, Germany; ARCN, Kiel, Germany; ARCN, Grosshansdorf, Germany; German Centre for Lung Research (DZL)
| | - Erika von Mutius
- Division of Paediatric Allergology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Munich, Germany; German Centre for Lung Research (DZL)
| |
Collapse
|
41
|
Deshpande D, Morgan W. Wheezing disorders in children: Are girls and boys different? J Allergy Clin Immunol 2016; 138:1569-1570. [PMID: 27637384 DOI: 10.1016/j.jaci.2016.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/19/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | - Wayne Morgan
- Department of Pediatrics, University of Arizona, Tucson, Ariz; Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
| |
Collapse
|
42
|
Federico MJ, Hoch HE, Anderson WC, Spahn JD, Szefler SJ. Asthma Management for Children: Risk Identification and Prevention. Adv Pediatr 2016; 63:103-26. [PMID: 27426897 DOI: 10.1016/j.yapd.2016.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Monica J Federico
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Heather E Hoch
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - William C Anderson
- Pediatric Allergy & Immunology, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Joseph D Spahn
- Pediatric Allergy & Immunology, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Stanley J Szefler
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA.
| |
Collapse
|
43
|
Waidyatillake NT, Simpson JA, Allen KJ, Lodge CJ, Dharmage SC, Abramson MJ, De Livera AM, Matheson MC, Erbas B, Hill DJ, Lowe AJ. The effect of breastfeeding on lung function at 12 and 18 years: a prospective cohort study. Eur Respir J 2016; 48:125-32. [PMID: 27076592 DOI: 10.1183/13993003.01598-2015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 02/29/2016] [Indexed: 12/25/2022]
Abstract
The objective was to assess associations between duration of total and exclusive breastfeeding and lung function up to adolescence.A birth cohort (Melbourne Atopy Cohort Study) of 620 infants with a family history of allergic disease was recruited. Mothers were encouraged to breastfeed exclusively for 6 months. Lung function was assessed at 12 and 18 years of age. Associations between breastfeeding and lung function were investigated using multivariable linear regression and path analysis was used to assess the potential mediating factors.Duration of breastfeeding (total and exclusive) was not associated with most assessed lung function outcomes. However, there was a trend for increased pre-bronchodilator mid-expiratory flow (MEF) at both 12 (adjusted mean difference (95% CI) per week of breastfeeding of 10 (-1-20) mL·s(-1)) and 18 years (11 (-1-22) mL·s(-1)) (p-values of 0.07 and 0.08, respectively). There was a strong indirect effect of height on these observed associations.Duration of breastfeeding does not appear to greatly influence lung function outcomes in children with a family history of allergic diseases. Longer duration of exclusive breastfeeding may be associated with an increase in MEF, partly due to greater attained height of the child.
Collapse
Affiliation(s)
- Nilakshi T Waidyatillake
- Allergy and Lung Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Carlton, Australia
| | - Julie A Simpson
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Carlton, Australia
| | | | - Caroline J Lodge
- Allergy and Lung Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Carlton, Australia Murdoch Childrens Research Institute, Melbourne, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Carlton, Australia Murdoch Childrens Research Institute, Melbourne, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alysha M De Livera
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Carlton, Australia
| | - Melanie C Matheson
- Allergy and Lung Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Carlton, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - David J Hill
- Murdoch Childrens Research Institute, Melbourne, Australia
| | - Adrian J Lowe
- Allergy and Lung Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, the University of Melbourne, Carlton, Australia Murdoch Childrens Research Institute, Melbourne, Australia
| |
Collapse
|
44
|
The recurrently wheezing preschool child-benign or asthma in the making? Ann Allergy Asthma Immunol 2016; 115:463-70. [PMID: 26653278 DOI: 10.1016/j.anai.2015.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 09/21/2015] [Accepted: 09/26/2015] [Indexed: 12/28/2022]
|
45
|
Asthma in Urban Children: Epidemiology, Environmental Risk Factors, and the Public Health Domain. Curr Allergy Asthma Rep 2016; 16:33. [DOI: 10.1007/s11882-016-0609-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
46
|
Vardavas CI, Hohmann C, Patelarou E, Martinez D, Henderson AJ, Granell R, Sunyer J, Torrent M, Fantini MP, Gori D, Annesi-Maesano I, Slama R, Duijts L, de Jongste JC, Aurrekoetxea JJ, Basterrechea M, Morales E, Ballester F, Murcia M, Thijs C, Mommers M, Kuehni CE, Gaillard EA, Tischer C, Heinrich J, Pizzi C, Zugna D, Gehring U, Wijga A, Chatzi L, Vassilaki M, Bergström A, Eller E, Lau S, Keil T, Nieuwenhuijsen M, Kogevinas M. The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children. Eur Respir J 2016; 48:115-24. [PMID: 26965294 DOI: 10.1183/13993003.01016-2015] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/27/2016] [Indexed: 11/05/2022]
Abstract
Maternal smoking during pregnancy increases childhood asthma risk, but health effects in children of nonsmoking mothers passively exposed to tobacco smoke during pregnancy are unclear. We examined the association of maternal passive smoking during pregnancy and wheeze in children aged ≤2 years.Individual data of 27 993 mother-child pairs from 15 European birth cohorts were combined in pooled analyses taking into consideration potential confounders.Children with maternal exposure to passive smoking during pregnancy and no other smoking exposure were more likely to develop wheeze up to the age of 2 years (OR 1.11, 95% CI 1.03-1.20) compared with unexposed children. Risk of wheeze was further increased by children's postnatal passive smoke exposure in addition to their mothers' passive exposure during pregnancy (OR 1.29, 95% CI 1.19-1.40) and highest in children with both sources of passive exposure and mothers who smoked actively during pregnancy (OR 1.73, 95% CI 1.59-1.88). Risk of wheeze associated with tobacco smoke exposure was higher in children with an allergic versus nonallergic family history.Maternal passive smoking exposure during pregnancy is an independent risk factor for wheeze in children up to the age of 2 years. Pregnant females should avoid active and passive exposure to tobacco smoke for the benefit of their children's health.
Collapse
Affiliation(s)
- C I Vardavas
- Dept of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece Center for Global Tobacco Control, Dept of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - C Hohmann
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany University of Otago, Dunedin, New Zealand
| | - E Patelarou
- Dept of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - D Martinez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Dept of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - A J Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - R Granell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - J Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Dept of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| | - M Torrent
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain IB-Salut, Area de Salut de Menorca, Spain
| | - M P Fantini
- Dept of Biomedical and Neuromotor Sciences, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - D Gori
- Dept of Biomedical and Neuromotor Sciences, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - I Annesi-Maesano
- Inserm, Epidemiology of Allergic and Respiratory diseases (EPAR) Dept, U1136, Medical School Saint-Antoine, Univ6, Sorbonne Universités Paris, Paris, France UPMC, EPAR UMR-S 707, Medical School Saint-Antoine, Univ6, Sorbonne Universités Paris, Paris, France
| | - R Slama
- Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Inserm and Univ Grenoble Alpes Joint Research Centre (IAB, U823), Grenoble, France
| | - L Duijts
- The Generation R Study Group, Dept of Paediatrics, Division of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Dept of Paediatrics, Division of Neonatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Dept of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J C de Jongste
- The Generation R Study Group, Dept of Paediatrics, Division of Respiratory Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J J Aurrekoetxea
- Faculty of Medicine, University of the Basque Country (UPV/EHU), San Sebastian, Spain BIODONOSTIA Health Research Institute, San Sebastian, Spain Subdirección de Salud Pública de Gipuzkoa; Departamento de Sanidad del Gobierno Vasco, San Sebastian, Spain
| | - M Basterrechea
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain BIODONOSTIA Health Research Institute, San Sebastian, Spain Subdirección de Salud Pública de Gipuzkoa; Departamento de Sanidad del Gobierno Vasco, San Sebastian, Spain
| | - E Morales
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Virgen de la Arrixaca Universtiy Hospital, IMIB-Arrixaca Research Institute, Murcia, Spain
| | - F Ballester
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain FISABIO-Universitat de València-Universitat Jaume I Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | - M Murcia
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain FISABIO-Universitat de València-Universitat Jaume I Joint Research Unit of Epidemiology and Environmental Health, Valencia, Spain
| | - C Thijs
- Dept of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - M Mommers
- Dept of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - C E Kuehni
- Paediatric Respiratory Epidemiology, Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - E A Gaillard
- Institute for Lung Health, Dept of Infection Immunity and Inflammation, NIHR Leicester Respiratory Biomedical Research Unit, University of Leicester, Leicester, UK
| | - C Tischer
- Institute of Epidemiology I, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany
| | - J Heinrich
- Institute of Epidemiology I, German Research Centre for Environmental Health, Helmholtz Zentrum München, Neuherberg, Germany Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig Maximilians University Munich, München, Germany
| | - C Pizzi
- Cancer Epidemiology Unit, Dept of Medical Sciences, University of Turin, CPO Piedmont, Turin, Italy
| | - D Zugna
- Cancer Epidemiology Unit, Dept of Medical Sciences, University of Turin, CPO Piedmont, Turin, Italy
| | - U Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - A Wijga
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - L Chatzi
- Dept of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - M Vassilaki
- Dept of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - A Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Eller
- Dept of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - S Lau
- Dept for Pediatric Pneumology and Immunology, Charité University Medical Centre, Berlin, Germany
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - M Nieuwenhuijsen
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Dept of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - M Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain Dept of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain Hospital del Mar Research Institute (IMIM), Barcelona, Spain
| |
Collapse
|
47
|
Gibbs K, Collaco JM, McGrath-Morrow SA. Impact of Tobacco Smoke and Nicotine Exposure on Lung Development. Chest 2016; 149:552-561. [PMID: 26502117 DOI: 10.1378/chest.15-1858] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 09/29/2015] [Accepted: 10/04/2015] [Indexed: 12/17/2022] Open
Abstract
Tobacco smoke and nicotine exposure during prenatal and postnatal life can impair lung development, alter the immune response to viral infections, and increase the prevalence of wheezing during childhood. The following review examines recent discoveries in the fields of lung development and tobacco and nicotine exposure, emphasizing studies published within the last 5 years. In utero tobacco and nicotine exposure remains common, occurring in approximately 10% of pregnancies within the United States. Exposed neonates are at increased risk for diminished lung function, altered central and peripheral respiratory chemoreception, and increased asthma symptoms throughout childhood. Recently, genomic and epigenetic risk factors, such as alterations in DNA methylation, have been identified that may influence the risk for long-term disease. This review examines the impact of prenatal tobacco and nicotine exposure on lung development with a particular focus on nicotinic acetylcholine receptors. In addition, this review examines the role of prenatal and postnatal tobacco smoke and nicotine exposure and its association with augmenting infection risk, skewing the immune response toward a T-helper type 2 bias and increasing risk for developing an allergic phenotype and asthmalike symptoms during childhood. Finally, this review outlines the respiratory morbidities associated with childhood secondhand smoke and nicotine exposure and examines genetic and epigenetic modifiers that may influence respiratory health in infants and children exposed to in utero or postnatal tobacco smoke.
Collapse
Affiliation(s)
- Kevin Gibbs
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Sharon A McGrath-Morrow
- Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD.
| |
Collapse
|
48
|
Peters RL, Allen KJ, Dharmage SC, Lodge CJ, Koplin JJ, Ponsonby AL, Wake M, Lowe AJ, Tang MLK, Matheson MC, Gurrin LC. Differential factors associated with challenge-proven food allergy phenotypes in a population cohort of infants: a latent class analysis. Clin Exp Allergy 2016; 45:953-963. [PMID: 25523199 DOI: 10.1111/cea.12478] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/22/2014] [Accepted: 11/21/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Food allergy, eczema and wheeze are early manifestations of allergic disease and commonly co-occur in infancy although their interrelationship is not well understood. Data from population studies are essential to determine whether there are differential drivers of multi-allergy phenotypes. We aimed to define phenotypes and risk factors of allergic disease using latent class analysis (LCA). METHODS The HealthNuts study is a prospective, population-based cohort of 5276 12-month-old infants in Melbourne, Australia. LCA was performed using the following baseline data collected at age 12 months: food sensitization (skin prick test ≥ 2 mm) and allergy (oral food challenge) to egg, peanut and sesame; early (< 4 months) and late-onset eczema; and wheeze in the first year of life. Risk factors were modelled using multinomial logistic regression. RESULTS Five distinct phenotypes were identified: no allergic disease (70%), non-food-sensitized eczema (16%), single egg allergy (9%), multiple food allergies (predominantly peanut) (3%) and multiple food allergies (predominantly egg) (2%). Compared to the baseline group of no allergic disease, shared risk factors for all allergic phenotypes were parents born overseas (particularly Asia), delayed introduction of egg, male gender (except for single egg allergy) and family history of allergic disease, whilst exposure to pet dogs was protective for all phenotypes. Other factors including filaggrin mutations, vitamin D and the presence of older siblings differed by phenotype. CONCLUSIONS AND CLINICAL RELEVANCE Multiple outcomes in infancy can be used to determine five distinct allergy phenotypes at the population level, which have both shared and separate risk factors suggesting differential mechanisms of disease.
Collapse
Affiliation(s)
- R L Peters
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - K J Allen
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Vic., Australia.,School of Inflammation and Repair, The University of Manchester, Manchester, UK
| | - S C Dharmage
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - C J Lodge
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - J J Koplin
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - A-L Ponsonby
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - M Wake
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia
| | - A J Lowe
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - M L K Tang
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Department of Paediatrics, University of Melbourne, Parkville, Vic., Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Vic., Australia
| | - M C Matheson
- Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | - L C Gurrin
- Murdoch Childrens Research Institute, Parkville, Vic., Australia.,Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, Vic., Australia
| | | |
Collapse
|
49
|
Caffarelli C, Garrubba M, Greco C, Mastrorilli C, Povesi Dascola C. Asthma and Food Allergy in Children: Is There a Connection or Interaction? Front Pediatr 2016; 4:34. [PMID: 27092299 PMCID: PMC4821099 DOI: 10.3389/fped.2016.00034] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/23/2016] [Indexed: 01/19/2023] Open
Abstract
This review explores the relationship between food allergy and asthma. They can share the same risk factors, such as parental allergy, atopic eczema, and allergen sensitization, and they often coincide in the same child. Coexistence may negatively influence the severity of both conditions. However, it remains to be determined whether food allergy may directly affect asthma control. An early food sensitization in the first year of life can predict the onset of asthma. Furthermore, asthmatic symptoms could rarely be caused by ingestion or inhalation of the offending food. Asthma caused by food allergy is severe and may be associated with anaphylactic symptoms. Therefore, an accurate identification of the offending foods is necessary in order to avoid exposure. Patients should be instructed to treat asthmatic symptoms quickly and to use self-injectable epinephrine.
Collapse
Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Clinica and Experimental Medicine, Azienda Ospedaliero-Universitaria di Parma, University of Parma , Parma , Italy
| | - Marilena Garrubba
- Clinica Pediatrica, Department of Clinica and Experimental Medicine, Azienda Ospedaliero-Universitaria di Parma, University of Parma , Parma , Italy
| | - Chiara Greco
- Clinica Pediatrica, Department of Clinica and Experimental Medicine, Azienda Ospedaliero-Universitaria di Parma, University of Parma , Parma , Italy
| | - Carla Mastrorilli
- Clinica Pediatrica, Department of Clinica and Experimental Medicine, Azienda Ospedaliero-Universitaria di Parma, University of Parma , Parma , Italy
| | - Carlotta Povesi Dascola
- Clinica Pediatrica, Department of Clinica and Experimental Medicine, Azienda Ospedaliero-Universitaria di Parma, University of Parma , Parma , Italy
| |
Collapse
|
50
|
Garden FL, Simpson JM, Mellis CM, Marks GB. Change in the manifestations of asthma and asthma-related traits in childhood: a latent transition analysis. Eur Respir J 2015; 47:499-509. [PMID: 26493805 DOI: 10.1183/13993003.00284-2015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/17/2015] [Indexed: 11/05/2022]
Abstract
It is known that asthma is a heterogeneous entity whose manifestations vary with age. Our objective was to examine changes in the manifestation of asthma and asthma-related traits in childhood by defining empirically derived childhood asthma phenotypes and examining their transitions over time.To define the phenotypes we used data on respiratory symptoms, healthcare utilisation, medications, spirometry, airway hyperresponsiveness (AHR), exhaled nitric oxide concentration and atopy from a birth cohort recruited on the basis of having a first-degree relative with asthma. Data were acquired at ages 1.5-11.5 years and analysed using latent transition analysis.In a study population of 370 participants, we classified subjects into four phenotypes: 1) nonatopic, few symptoms (prevalence range from 1.5 to 5 years: 52-60%), 2) atopic, few symptoms (3-21%), 3) nonatopic, asthma and rhinitis symptoms (13-35%), and 4) atopic, asthma and rhinitis symptoms (2-14%) in early childhood; and 1) nonatopic, no respiratory disease (prevalence range from 8 to 11.5 years: 41-46%), 2) atopic, no respiratory disease (23-33%), 3) nonatopic, asthma symptoms, no AHR or airway inflammation (8-12%) and 4) atopic asthma (19%) in mid-childhood. Transitioning between phenotypes was common in early childhood, but less common in later childhood.This analysis represents the first attempt to incorporate longitudinal patterns of several manifestations of asthma into a single model to simultaneously define phenotypes and examine their transitions over time. It provides quantitative support for the view that asthma is a heterogeneous entity, and that some children with wheeze and other respiratory symptoms in early life progress to asthma in mid-childhood, while others become asymptomatic.
Collapse
Affiliation(s)
- Frances L Garden
- Sydney School of Public Health, University of Sydney, Sydney, Australia South Western Sydney Clinical School, University of New South Wales, Sydney, Australia Woolcock Institute of Medical Research, Sydney, Australia Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Judy M Simpson
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Craig M Mellis
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia Woolcock Institute of Medical Research, Sydney, Australia
| | | |
Collapse
|