[Exacerbations of asthma--precipitating factors: drugs]

Discriminant analysis and logistic regression on genetic history and environmental factors in children with asthma

BACKGROUND

Asthma is known to be related to genetic and environmental factors, we aimed to identify the predictors discriminating between children with asthma and a control group in order to build typical profiles of these children.

METHODS

A multidimensional analysis covered children (58 with asthma and 217 as control group), under 17 years of age, involving environmental variables and medical history of these children and their families.

RESULTS

Chi-square tests highlighted significant links between variables as rhinitis and conjunctivitis (P<0.001). The results showed, in group of asthmatic children, significant high frequencies of allergies, mainly seasonal (P<0.001), rhinitis, family history more present in mothers (P=0.002) and in maternal aunts and uncles (P<0.02). Allergies were mostly present in mothers of asthmatic children (P=0.03). Children whose father, mother or both had asthma were significantly more numerous in asthmatic group (P=0.0007). A multiple correspondence analysis (MCA) identified two typical profiles of children, a first group of asthmatic children with positive modalities of family history, medical and environmental factors, a second, the control group (nA, non-asthmatic children), with essentially negative modalities of the variables. Logistic regression (LR) resulted in a final model which retained four significant predictors, rhinitis (P=0.01), atopic dermatitis (P=0.04), mother antecedents (P=0.03) and paternal uncle antecedents (P=0.008) with a globally appreciable predictive value (82%) of the Hosmer-Lemeshow Test.

CONCLUSIONS

These results allowed the drafting of a typical profile quantifying through a function of a few predictors, the variation of the probability for a child to develop an asthma.

Major depressive disorder is associated with subsequent adult-onset asthma: a population-based cohort study

AIM

To examine the incidence of asthma in adult patients with major depressive disorder (MDD).

METHODS

From the National Health Insurance database of Taiwan, we identified 30 169 adult patients who were newly diagnosed with MDD between 2000 and 2010. Individuals without depression were randomly selected four times and frequency matched for sex, age and year of diagnosis. Both cohorts were followed-up for the occurrence of asthma up to the end of 2011. Adjusted hazard ratios (aHRs) of asthma were estimated using the Cox proportional hazards method.

RESULTS

The overall incidence of asthma was 1.91-fold higher in the MDD cohort than in the non-depression cohort (7.55 v. 3.96 per 1000 person-years), with an aHR of 1.66 (95% confidence interval (CI) 1.55-1.78). In both cohorts, the incidence of asthma was higher in patients and controls who were female, aged, with comorbidities and users of aspirin or beta-adrenergic receptor blockers. No significant difference was observed in the occurrence of asthma between patients with MDD treated with selective serotonin reuptake inhibitors (SSRIs) and those treated with non-SSRIs (SSRIs to non-SSRIs aHR = 1.03, 95% CI 0.91-1.17).

CONCLUSION

Adult patients with MDD are at a higher risk of asthma than those without depression are.

Identifying asthma triggers

Asthma has many triggers including rhinosinusitis; allergy; irritants; medications (aspirin in aspirin-exacerbated respiratory disease); and obesity. Paradoxic vocal fold dysfunction mimics asthma and may be present along with asthma. This article reviews each of these triggers, outlining methods of recognizing the trigger and then its management. In many patients more than one trigger may be present. Full appreciation of the complexity of these relationships and targeted therapy to the trigger is needed to best care for the patient with asthma.