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Marcot C, Migueres N, Ott M, Khayath N, De Blay F. [Allergenic and chemical pollutants of indoor environments and asthma: Characterization, assessment and eviction]. Rev Mal Respir 2023; 40:630-645. [PMID: 37391338 DOI: 10.1016/j.rmr.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 03/27/2023] [Indexed: 07/02/2023]
Abstract
The environment of an asthmatic patient can contain numerous sources of pollutants that degrade the quality of indoor air and have major repercussions on the occurrence and control of asthma. Assessment and improvement of the quality of indoor air should be assigned a major role in pneumology and allergology consultations. Characterization of an asthmatic's environment entails a search for biological pollutants with mite allergens, mildew, and allergens resulting from the proximity of pets. It is important to evaluate the chemical pollution represented by exposure to volatile organic compounds, which are increasingly present in our lodgings. Active or second-hand smoking must in all circumstances be sought out and quantified. Assessment of the environment is mediated by several methods, of which the application depends not only on the pollutant sought out, but also on enzyme-linked immunosorbent assay (ELISA), which has an essential role in quantification of biological pollutants. Attempts at expulsion of the different indoor environment pollutants is mediated by indoor environment advisors, whose efforts are aimed at obtaining reliable evaluation and control of indoor air. Implemented as a form of tertiary prevention, their methods are conducive to improved asthma control, in adults as well as children.
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Affiliation(s)
- C Marcot
- Pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France.
| | - N Migueres
- Pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; UMR 7357 laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie ICUBE, Strasbourg, France
| | - M Ott
- Pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - N Khayath
- Pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - F De Blay
- Pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Fédération translationnelle de médecine EA3070, université de Strasbourg, Strasbourg, France
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Le Moual N, Dumas O, Bonnet P, Eworo Nchama A, Le Bot B, Sévin E, Pin I, Siroux V, Mandin C. Exposure to Disinfectants and Cleaning Products and Respiratory Health of Workers and Children in Daycares: The CRESPI Cohort Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105903. [PMID: 37239629 DOI: 10.3390/ijerph20105903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
Although cleaning tasks are frequently performed in daycare, no study has focused on exposures in daycares in relation to respiratory health. The CRESPI cohort is an epidemiological study among workers (n~320) and children (n~540) attending daycares. The purpose is to examine the impact of daycare exposures to disinfectants and cleaning products (DCP) on the respiratory health of workers and children. A sample of 108 randomly selected daycares in the region of Paris has been visited to collect settled dust to analyze semi-volatile organic compounds and microbiota, as well as sample indoor air to analyze aldehydes and volatile organic compounds. Innovative tools (smartphone applications) are used to scan DCP barcodes in daycare and inform their use; a database then matches the barcodes with the products' compositions. At baseline, workers/parents completed a standardized questionnaire, collecting information on DCP used at home, respiratory health, and potential confounders. Follow-up regarding children's respiratory health (monthly report through a smartphone application and biannual questionnaires) is ongoing until the end of 2023. Associations between DCP exposures and the respiratory health of workers/children will be evaluated. By identifying specific environments or DCP substances associated with the adverse respiratory health of workers and children, this longitudinal study will contribute to the improvement of preventive measures.
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Affiliation(s)
- Nicole Le Moual
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Pierre Bonnet
- Scientific and Technical Center for Building (CSTB), Indoor Environment Quality Unit, 77420 Champs-sur-Marne, France
| | - Anastasie Eworo Nchama
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807 Villejuif, France
| | - Barbara Le Bot
- Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Inserm, École des Hautes Etudes en Santé Publique (EHESP), University of Rennes, 35000 Rennes, France
| | | | - Isabelle Pin
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Corinne Mandin
- Scientific and Technical Center for Building (CSTB), Indoor Environment Quality Unit, 77420 Champs-sur-Marne, France
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Delmas MC, Marguet C, Leynaert B. Time trends in the prevalence of asthma in French schoolchildren. Respir Med Res 2023; 83:101003. [PMID: 37037056 DOI: 10.1016/j.resmer.2023.101003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/10/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Affiliation(s)
| | | | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, France
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Petat H, Schuers M, Corbet S, Humbert X, Le Bas F, Marguet C, Pellerin L, Rabiaza A, Vabret A, Ar Gouilh M. The Design and Implementation of the ECOVIR Project: A Primary Health Care Surveillance System to Strengthen Co-Detection of Respiratory Viruses in Normandy. Methods Protoc 2022; 5:mps5060098. [PMID: 36548140 PMCID: PMC9787661 DOI: 10.3390/mps5060098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022] Open
Abstract
Acute respiratory infections (ARIs) need to be better understood and treated, as they are critical to public health, especially during crises such as the SARS-CoV2 pandemic. These are the most abundant infections in the general population and are seen primarily in primary care by general practitioners (GPs). Many different viruses are involved, according to epidemic variations. Viral co-detections account for a significant proportion of ARIs in hospital cohorts. The objective of the ECOVIR cohort was to study viral co-detections by setting up a biobank of respiratory tract samples from patients consulting their general practitioner for ARI symptoms. We report here on the course of the study: the design, the conduct, and the difficulties encountered. ECOVIR (Etude des CO-detections VIrales dans les prélèvements Respiratoires) was a prospective, multicenter cohort conducted in France during two epidemic seasons (2018-2019 and 2019-2020). We recruited GPs. Each GP investigator (GPI) saw patients weekly for examination, clinical data collection, and nasopharyngeal swabbing. Each sample was sent to the virology unit for biobanking and molecular analysis. Clinical and sociodemographic data were collected 7 days after inclusion. ECOVIR involved 36 GPIs. Patients with symptoms of an ARI were included (n = 685). The median number of inclusions was 16 patients per GPI over both seasons (IC25-75% [4.75; 27]). Patients aged 18 to 64 years were the most numerous (57%), followed by children (30%), and the elderly (13% over 65 years). This age distribution emphasizes the young adult and middle-aged population. Residents participated in the project and called patients on day 7 to obtain clinical and sociodemographic data. Our study triggered the creation of an original network, which plans to establish a functional link between research and primary health care. Primary care is unfortunately poorly represented in research protocols, particularly in respiratory infections, even though it is a cornerstone of our French health care system, as demonstrated every day in this period of crisis.
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Affiliation(s)
- Hortense Petat
- INSERM, UMR1311-DYNAMICURE—Institut de Biologie Clinique, CHU, F-7600 Rouen, France
- Laboratoire de Virologie, Centre Hospitalo-Universitaire, F-14033 Caen, France
- Centre Hospitalier Universitaire de Rouen, Département de Pédiatrie Médicale, EA2656 Université de Normandie, UNIRouen, F-7600 Rouen, France
- Correspondence:
| | - Matthieu Schuers
- Département de Médecine Générale, Normandie Université, UFR Santé Rouen, F-7600 Rouen, France
- INSERM, U1142, Laboratoire d’Informatique Médicale et d’Ingénierie des Connaissances en e-Santé, LIMICS, Sorbonne Université, F-75006 Paris, France
| | - Sandrine Corbet
- Laboratoire de Virologie, Centre Hospitalo-Universitaire, F-14033 Caen, France
- Centre Hospitalier Universitaire de Rouen, Département de Pédiatrie Médicale, EA2656 Université de Normandie, UNIRouen, F-7600 Rouen, France
| | - Xavier Humbert
- Département de Médecine Générale, Normandie University, UNICAEN, UFR Santé, F-14000 Caen, France
| | - François Le Bas
- Département de Médecine Générale, Normandie University, UNICAEN, UFR Santé, F-14000 Caen, France
| | - Christophe Marguet
- INSERM, UMR1311-DYNAMICURE—Institut de Biologie Clinique, CHU, F-7600 Rouen, France
- Centre Hospitalier Universitaire de Rouen, Département de Pédiatrie Médicale, EA2656 Université de Normandie, UNIRouen, F-7600 Rouen, France
| | - Lucille Pellerin
- Département de Médecine Générale, Normandie Université, UFR Santé Rouen, F-7600 Rouen, France
| | - Andry Rabiaza
- Département de Médecine Générale, Normandie University, UNICAEN, UFR Santé, F-14000 Caen, France
| | - Astrid Vabret
- INSERM, UMR1311-DYNAMICURE—Institut de Biologie Clinique, CHU, F-7600 Rouen, France
- Laboratoire de Virologie, Centre Hospitalo-Universitaire, F-14033 Caen, France
| | - Meriadeg Ar Gouilh
- INSERM, UMR1311-DYNAMICURE—Institut de Biologie Clinique, CHU, F-7600 Rouen, France
- Laboratoire de Virologie, Centre Hospitalo-Universitaire, F-14033 Caen, France
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[Asthma and suicidal behavior in adolescents: a literature review]. Rev Mal Respir 2022; 39:344-366. [PMID: 35459587 DOI: 10.1016/j.rmr.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Adolescence is a difficult time in life and asthma has major psychological consequences for adolescents. OBJECTIVES This systematic literature review focused on the association between asthma and suicidal behaviors (suicidal ideations [SI], suicide plans [SP] and suicide attempts [SA]) among adolescents in the general population. METHOD Research on Medline for the 1980-2021 period. Objectives This systematic literature review focused on the association between asthma and suicidal behaviors (suicidal ideations [SI], suicide plans [SP] and suicide attempts [SA]) among adolescents in the general population. RESULTS An overwhelming majority of the studies taken into consideration demonstrated a significant positive association between asthma and suicidal behaviors. Among the 10 studies assessing SI (with or without SP), 9 of them found a significant positive association between asthma and SI. Eight studies assessed SA; five cross-sectional studies and one prospective study demonstrated a significant positive association between asthma and SA. Only one case-control study did not find a significant positive association between asthma and SA after hospitalization for asthma. The two cross-sectional studies assessing suicidal risk taken as a whole (SI, SP and SA) demonstrated a significant positive association between asthma and at least one suicidal behavior. (OR=1.71; P<0.001). However, several studies did not include depression as an adjustment factor. CONCLUSION It is important that healthcare professionals assess suicide risk in adolescent suffering from asthma, the objective being to avoid SA or death from SA.
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Petat H, Schuers M, Rabiaza A, Marguet C, Pellerin L, Le Bas F, Humbert X, Corbet S, Deseille B, Gosse L, Lambert PA, Poupon T, Vervisch E, Morello R, Chaillot F, Ecovir M, Vabret A, Le Gouil M. [ECOVIR: Study of a primary care cohort in of patients with Acute Respiratory Infections in Normandy, an example of pluri-professional hospital-primary care coordination]. Rev Mal Respir 2022; 39:334-343. [PMID: 35289288 PMCID: PMC8916614 DOI: 10.1016/j.rmr.2022.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/09/2022] [Indexed: 12/14/2022]
Abstract
Acute Respiratory Infections (ARI) need be better understood and more effectively treated, especially insofar as they are of pivotal importance in public health, particularly during a crisis such as the SARS-CoV2 pandemic. The prospective, multicentric cohort study of viral codetections in respiratory samples study known as ECOVIR was conducted in Normandy, France during two winters (2018-2019, 2019-2020). The objective of the project was to create a biobank of respiratory tract samples from patients consulting their general practitioner (GP) for ARI symptoms. ECOVIR involved 36 GP investigators (GPI), from 8 health care centers throughout Normandy. Six hundred and eighty-five patients with ARI symptoms were included; naso-pharyngeal samples were taken by the GPIs and subsequently analyzed in virology laboratories for the purposes of viral codetection. The median of inclusions was 16 patients for each of the 31 actively participating GPIs over the two winters (CI25-75% [4.75; 27]). By D7, 92% of the patients contacted had responded to our call for participation, enabling us to obtain clinical, environmental and socio-demographic data. Through this study, we created an original functional network, thereby establishing a viable link between research and primary care, which is generally underrepresented in research protocols, even though it constitutes the cornerstone of the French health care system, especially during this prolonged period of sanitary crisis.
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Affiliation(s)
- H. Petat
- Groupe de recherche sur l’adaptation microbienne (GRAM 2.0), Normandie université, UNICAEN, UNIROUEN, EA2656, 14033 Caen, France,Laboratoire de virologie, centre hospitalo-universitaire, 14033 Caen, France,Département de pédiatrie médicale, centre hospitalier universitaire de Rouen, EA2656 université de Normandie, UNIRouen, 76000 Rouen, France,Auteur correspondant
| | - M. Schuers
- Normandie université, UFR Santé Rouen, département de médecine générale, 76000 Rouen, France,Inserm, U1142, laboratoire d’informatique médicale et d’ingénierie des connaissances en e-Santé, LIMICS, Sorbonne université, Paris, France
| | - A. Rabiaza
- Normandie université, UNICAEN, UFR Santé, département de médecine générale, 14000 Caen, France
| | - C. Marguet
- Groupe de recherche sur l’adaptation microbienne (GRAM 2.0), Normandie université, UNICAEN, UNIROUEN, EA2656, 14033 Caen, France,Département de pédiatrie médicale, centre hospitalier universitaire de Rouen, EA2656 université de Normandie, UNIRouen, 76000 Rouen, France
| | - L. Pellerin
- Normandie université, UFR Santé Rouen, département de médecine générale, 76000 Rouen, France
| | - F. Le Bas
- Normandie université, UNICAEN, UFR Santé, département de médecine générale, 14000 Caen, France
| | - X. Humbert
- Normandie université, UNICAEN, UFR Santé, département de médecine générale, 14000 Caen, France
| | - S. Corbet
- Laboratoire de virologie, centre hospitalo-universitaire, 14033 Caen, France,Département de pédiatrie médicale, centre hospitalier universitaire de Rouen, EA2656 université de Normandie, UNIRouen, 76000 Rouen, France
| | - B. Deseille
- Normandie université, UFR Santé Rouen, département de médecine générale, 76000 Rouen, France
| | - L. Gosse
- Normandie université, UFR Santé Rouen, département de médecine générale, 76000 Rouen, France
| | - P.-A. Lambert
- Normandie université, UFR Santé Rouen, département de médecine générale, 76000 Rouen, France
| | - T. Poupon
- Normandie université, UFR Santé Rouen, département de médecine générale, 76000 Rouen, France
| | - E. Vervisch
- Normandie université, UFR Santé Rouen, département de médecine générale, 76000 Rouen, France
| | - R. Morello
- CHU de Caen Normandie, Normandie université, UNICAEN, unité de biostatistique et recherche clinique, 14000 Caen, France
| | - F. Chaillot
- CHU de Caen Normandie, unité de recherche clinique, 14000 Caen, France
| | - M. Ecovir
- Normandie université, UFR Santé Rouen, département de médecine générale, 76000 Rouen, France
| | - A. Vabret
- Groupe de recherche sur l’adaptation microbienne (GRAM 2.0), Normandie université, UNICAEN, UNIROUEN, EA2656, 14033 Caen, France,Laboratoire de virologie, centre hospitalo-universitaire, 14033 Caen, France
| | - M. Le Gouil
- Groupe de recherche sur l’adaptation microbienne (GRAM 2.0), Normandie université, UNICAEN, UNIROUEN, EA2656, 14033 Caen, France,Laboratoire de virologie, centre hospitalo-universitaire, 14033 Caen, France
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7
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Delmas MC, Bénézet L, Ribet C, Iwatsubo Y, Zins M, Nadif R, Roche N, Leynaert B. Underdiagnosis of obstructive lung disease: findings from the French CONSTANCES cohort. BMC Pulm Med 2021; 21:319. [PMID: 34649556 PMCID: PMC8518215 DOI: 10.1186/s12890-021-01688-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background The burden of undiagnosed obstructive lung disease (OLD) (mainly asthma and chronic obstructive pulmonary disease) is not fully established, and targets for corrective action are yet to be identified. We assessed the underdiagnosis of OLD and its determinants in France. Methods CONSTANCES is a French population-based cohort of adults aged 18–69 years at inception. We analysed data collected at inclusion in 2013–2014. Undiagnosed OLD was defined as spirometry-confirmed airflow limitation (FEV1/FVC < lower limit of normal) without prior diagnosis of asthma, chronic obstructive pulmonary disease, or bronchiectasis. Multivariate analysis was performed with weighted robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of undiagnosed OLD. Results Spirometry results were available for 19,398 participants. The prevalence of airflow limitation was 4.6%. Overall, 64.4% of adults with airflow limitation did not report a previous diagnosis of OLD. Individuals with high cumulative tobacco consumption (≥ 10 pack-years) (aPR: 1.72 [1.28–2.32]), without respiratory symptoms (aPR: 1.51 [1.28–1.78]), and with preserved lung function (aPR: 1.21 [1.04–1.41] for a 10-point increase in FEV1% predicted) had a higher risk of being undiagnosed. Half of symptomatic individuals with airflow limitation (45% of those with moderate to severe airflow limitation) were undiagnosed with OLD. Conclusion Underdiagnosis of OLD is very common among French adults, even in patients with respiratory symptoms. Efforts should be made in France to raise awareness about OLD in the general population, improve the detection of respiratory symptoms, and increase the use of spirometry among primary care professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01688-z.
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Affiliation(s)
- Marie-Christine Delmas
- Santé Publique France, French National Public Health Agency, 12 Rue du Val d'Osne, 94415, Saint-Maurice Cedex, France.
| | - Laetitia Bénézet
- Santé Publique France, French National Public Health Agency, 12 Rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
| | - Céline Ribet
- Inserm UMS 011, Population-Based Epidemiological Cohorts, Villejuif, France
| | - Yuriko Iwatsubo
- Santé Publique France, French National Public Health Agency, 12 Rue du Val d'Osne, 94415, Saint-Maurice Cedex, France
| | - Marie Zins
- Inserm UMS 011, Population-Based Epidemiological Cohorts, Villejuif, France
| | - Rachel Nadif
- Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Université Paris-Saclay, UVSQ, Université Paris-Sud, Villejuif, France
| | - Nicolas Roche
- Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Université Paris-Saclay, UVSQ, Université Paris-Sud, Villejuif, France.,APHP Centre, Hôpital et Institut Cochin, Service de Pneumologie, Université de Paris, Paris, France
| | - Bénédicte Leynaert
- Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, Université Paris-Saclay, UVSQ, Université Paris-Sud, Villejuif, France
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Rhinovirus Infection and Familial Atopy Predict Persistent Asthma and Sensitisation 7 Years after a First Episode of Acute Bronchiolitis in Infancy. CHILDREN-BASEL 2021; 8:children8100850. [PMID: 34682115 PMCID: PMC8534717 DOI: 10.3390/children8100850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
Background: We set out to assess the risk factors for asthma outcome in a cohort of infants who experienced their first episode of acute bronchiolitis. Methods: A cohort of 222 infants who were included during a first episode of acute bronchiolitis was prospectively followed. Herein, we present the results of their assessments (symptom history, skin prick tests, specific IgE assay, respiratory function tests) at age seven. Results: Of the 68/222 (30.6%) children assessed at age seven, 15 (22.05%) presented with asthma and were mainly males (p = 0.033), 14 (20%) had respiratory allergies, 17 (25%) presented atopic dermatitis and none had a food allergy. Family history of atopy was associated with asthma and sensitisation to aeroallergens at age seven (p = 0.003, p = 0.007). Rhinovirus (hRV) infection and rhinovirus/respiratory syncytial virus (RSV) co-infection were significantly associated with asthma at age seven (p = 0.035, p = 0.04), but not with the initial severity of bronchiolitis. Eosinophil counts at ages three and seven were significantly higher in the asthmatics (p = 0.01, p = 0.046). Conclusion: Any infant, especially male, presenting a first episode of acute bronchiolitis due to hRV with a family history of atopy should be closely monitored via follow-up due to a higher risk for asthma at school age.
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Guerin S, Bertille N, Khraiche D, Bonnet D, Lebourgeois M, Goffinet F, Lelong N, Khoshnood B, Delacourt C. Respiratory morbidity in children with congenital heart disease. Arch Pediatr 2021; 28:525-529. [PMID: 34497013 DOI: 10.1016/j.arcped.2021.07.003] [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: 12/03/2020] [Revised: 04/06/2021] [Accepted: 07/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the respiratory outcome in children with congenital heart disease (CHD), considering recent management procedures and the CHD pathophysiology. DESIGN AND SETTING Clinical and functional respiratory outcome were evaluated in 8-year-old children with isolated CHD followed up from birth in the prospective population-based EPICARD cohort. PATIENTS Children were assigned to two groups, based on the pathophysiology of the CHD: CHDs with left-to-right shunt (n = 212) and CHDs with right outflow tract obstruction (n = 113). RESULTS Current wheezing episodes were observed in 15% of the children with isolated CHD and left-to-right shunt, and 11% of the children with isolated CHD and right outflow tract obstruction (not significant). Total lung capacity (TLC) was the only respiratory function parameter that significantly differed between the two groups. It was lower in children with left-to-right shunt (88.72 ± 0.65% predicted) than in those with right outflow tract obstruction (91.84 ± 0.96, p = 0.006). In multivariate analysis, CHD with left-to-right shunt (coeff. [95% CI]: -3.17 [-5.45; -0.89]) and surgery before the age of 2 months (-6.52 [-10.90; -2.15]) were identified as independent factors associated with significantly lower TLC values. CONCLUSION Lower TLC remains a long-term complication in CHD, particularly in cases with left-to-right shunt and in patients requiring early repair. These findings suggest that an increase in pulmonary blood flow may directly impair lung development.
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Affiliation(s)
- S Guerin
- Pediatric Pulmonology, Centre de référence des Maladies Respiratoires Rares - RESPIRARE, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France; Current address for Sophie GUERIN: Unité de pneumologie pédiatrique - Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - N Bertille
- INSERM UMR 1153, Obstetric, Perinatal and Pediatric Epidemiology Research Team (Epopé) Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), 75014 Paris, France
| | - D Khraiche
- Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France
| | - D Bonnet
- Pediatric Cardiology, Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France; Paris-Descartes University, University of Paris, Faculty of Medicine, 75006 Paris, France
| | - M Lebourgeois
- Pediatric Pulmonology, Centre de référence des Maladies Respiratoires Rares - RESPIRARE, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France
| | - F Goffinet
- INSERM UMR 1153, Obstetric, Perinatal and Pediatric Epidemiology Research Team (Epopé) Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), 75014 Paris, France; Paris-Descartes University, University of Paris, Faculty of Medicine, 75006 Paris, France
| | - N Lelong
- INSERM UMR 1153, Obstetric, Perinatal and Pediatric Epidemiology Research Team (Epopé) Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), 75014 Paris, France
| | - B Khoshnood
- INSERM UMR 1153, Obstetric, Perinatal and Pediatric Epidemiology Research Team (Epopé) Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), 75014 Paris, France
| | - C Delacourt
- Pediatric Pulmonology, Centre de référence des Maladies Respiratoires Rares - RESPIRARE, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, 75015 Paris, France; Paris-Descartes University, University of Paris, Faculty of Medicine, 75006 Paris, France
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The First 1000 Days: Impact of Prenatal Tobacco Smoke Exposure on Hospitalization Due to Preschool Wheezing. Healthcare (Basel) 2021; 9:healthcare9081089. [PMID: 34442226 PMCID: PMC8391353 DOI: 10.3390/healthcare9081089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/26/2022] Open
Abstract
Preschool wheezing and related hospitalization rates are increasing. Prenatal tobacco smoke exposure (PTSE) increases the risk of wheezing, yet >20% of French women smoke during pregnancy. In this observational retrospective monocentric study, we assessed the link between PTSE and hospital admissions. We included infants <2 years of age admitted for acute wheezing. A phone interview with mothers was completed by electronic records. The primary endpoint was the ratio of cumulative duration of the hospitalization stays (days)/age (months). 129 children were included (36.4% exposed to PTSE vs. 63.6% unexposed). There was a significant difference in the duration of hospitalization/age: 0.9 days/month (exposed) vs. 0.58 days/month (unexposed) (p = 0.008). Smoking one cigarette/day during pregnancy was associated with an increase in hospitalization duration of 0.055 days/month (r = 0.238, p = 0.006). In the multi-variable analysis, this positive association persisted (β = 0.04, p = 0.04; standardized β = 0.27, p = 0.03). There was a trend towards a dose-effect relationship between PTSE and other important parameters associated with hospital admissions. We have demonstrated a dose-effect relationship, without a threshold effect, between PTSE and duration of hospitalization for wheezing in non-premature infants during the first 2 years of life. Prevention campaigns for future mothers should be enforced.
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Tuppin P, Aguadé AS, Guillo S, Gastaldi C, Taillé C. Evaluation of drug deliveries and refunds for obstructive airway diseases in France between 2012 and 2017. Respir Med Res 2021; 80:100854. [PMID: 34385098 DOI: 10.1016/j.resmer.2021.100854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/15/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this survey was to investigate variations of drugs for obstructive airway diseases delivery rates and refunds at a national level which are rarely reported. METHODS The French national health data system (56 million, 87% of the population) was used to identify insurance beneficiaries with at least one drug delivery (Anatomical Therapeutic Classification R03) per year between 2012 and 2017. RESULTS At least one drug delivery in 2017 was identified for 7.5 million people (12.9%). High proportions of people with at least one, two or three drug deliveries were observed between the ages of 0 to 2 years (22%, 10%, 5.5%), then decreased between the ages of 18 and 40 years (9.3%, 3.8%, 2.3%) and increased again in people 75 years and older (17.8%, 11.9% 9.9%), with strong variations between years. In 2017, the proportions of people with at least one delivery, either alone or in combination with other drugs, were 68% for inhaled corticosteroids (ICS) (median 1; IQR 1-4), 59% for short-acting beta2-agonists (SABA) (1; 1-3), 42% for long-acting beta2-agonists (LABA) (2; 1-6), 11% for leukotriene receptor antagonists (3; 1-9), and 12% for inhaled anti-cholinergics (4; 1-10). Younger patients more often received SABAs (0-2 years: 84%) and leukotriene receptor antagonists (3-6 years: 14%) and people 75 years and older more often received LABAs (59%) and ICS, either alone or in combination with other drugs (28%).The mean annual refund reimbursed per person decreased from €136 in 2012 to €118 in 2017. CONCLUSION This study suggests a low level of use for drug classes associated with low delivery rates, suggesting inappropriate prescriptions and poor follow-up. These results highlight the difficulty of identifying these problems if delivery rates variations over several years are not taken into account.
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Affiliation(s)
| | | | - Sylvie Guillo
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), Unité de Recherche Clinique PSL-CFX, Paris, France
| | | | - Camille Taillé
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, Hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des Maladies Pulmonaires Rares; Inserm UMR 1152; Paris, France
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12
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Delmas MC, Bénézet L, Ribet C, Iwatsubo Y, Provost D, Varraso R, Zins M, Leynaert B, Nadif R, Roche N. [Prevalence of asthma among adults in France, data from the Constances cohort study]. Rev Mal Respir 2021; 38:797-806. [PMID: 34099358 DOI: 10.1016/j.rmr.2021.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/02/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The objectives of our study were to estimate the prevalence of asthma in adults in France and to study the effects of gender on the associations of asthma with the corpulence and socio-economic characteristics of individuals. METHODS We estimated the prevalence of current asthma (asthma attack in the past 12 months or current treatment for asthma) from data collected at inclusion in the Constances cohort study in 2013-2014. Analyses were performed separately in men and women, using robust Poisson regression for multivariate analysis. RESULTS Using data from 34,100 participants in the cohort (men: 47.7 %; mean age: 44.6 years), the prevalence of current asthma was estimated to be 5.8 % (5.1 % in men, 6.4 % in women). The risk of asthma was increased in women with high body mass index (BMI) or waist circumference. In men, only a high waist circumference was associated with an increased risk of asthma. An association with low socioeconomic status was observed only among women. CONCLUSION The associations of asthma with corpulence and socioeconomic status differed between men and women. Additional analyses should provide a better understanding of the mechanisms responsible for these differences.
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Affiliation(s)
- M-C Delmas
- Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex, France.
| | - L Bénézet
- Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex, France
| | - C Ribet
- UMS 011 Inserm-UVSQ, Unité « Cohortes épidémiologiques en population », Villejuif, France
| | - Y Iwatsubo
- Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex, France
| | - D Provost
- Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice cedex, France; Inserm U1219, EPICENE, ESSAT, Université Bordeaux, Bordeaux, France
| | - R Varraso
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire intégrative, CESP, Villejuif, France
| | - M Zins
- UMS 011 Inserm-UVSQ, Unité « Cohortes épidémiologiques en population », Villejuif, France
| | - B Leynaert
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire intégrative, CESP, Villejuif, France
| | - R Nadif
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire intégrative, CESP, Villejuif, France
| | - N Roche
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire intégrative, CESP, Villejuif, France; Pneumologie, Hôpital Cochin, APHP Centre-Université de Paris, Institut Cochin (UMR 1016), Paris, France
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13
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Alhammad AM, Alajmi G, Alenizi A, Alrashidi E, Alghannam G, Alaki E, Alsaadi MM, Mayet AY. Parental attitude and knowledge towards asthma care measures for their children in Saudi Arabia. Pediatr Pulmonol 2020; 55:2901-2907. [PMID: 32897645 DOI: 10.1002/ppul.25060] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Appropriate asthma management in children reduces emergency department visits, hospitalization, and improves the quality of life. We aim to assess the level of children asthma control and its association with parental knowledge. METHODS A prospective study conducted to measure childhood asthma control with a validated childhood asthma control test (C-ACT), and to assess asthma knowledge among the parents of children aged 4-11 years and their parents upon asthma clinic visits. C-ACT score ≤ 19 is considered as uncontrolled child asthma. RESULTS We have invited 238 parents to participate in the study; 177 (74.4%) completed the survey. The mean age of the parents and their children were 38.8 ± 7.6 and 7.8 ± 2.7 years, respectively; 28.2% of parents were smokers, and 46.3% of them were college graduated. Nearly 61.6% of the parents and children scored ≤ 19 on C-ACT; 54.2% and 37.9% of parents knew how inhaled salbutamol and corticosteroids work, respectively. A quarter of the parents received an asthma action plan. Multinomial logistic regression analysis showed that parents who did not know their children's medications name (OR, 6.1; 95% CI, 2.15-17.29), and when to use inhaled corticosteroid (OR, 2.1; 95% CI, 1.32-3.45) were independent factors predicting uncontrolled asthma in children with score ≤ 19. CONCLUSIONS The study indicated that there is an association between poor asthma control (scored ≤ 19 on C-ACT) and parental knowledge of asthma medications. The parents should be educated thoroughly on asthma care, including medications used to minimize asthma exacerbations in their children.
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Affiliation(s)
- Abdullah M Alhammad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ghada Alajmi
- Department of Pharmacy Services, King Khalid University Hospital-King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Alenizi
- Department of Pediatrics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Essa Alrashidi
- Department of Pediatrics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ghannam Alghannam
- Department of Pediatrics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Emadia Alaki
- Department of Pediatrics, King Saud Medical City, Riyadh, Saudi Arabia
| | - Muslim M Alsaadi
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Y Mayet
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Pamuk G, Le Bourgeois M, Abou Taam R, de Blic J, Delacourt C, Lezmi G. The economic burden of severe asthma in children: a comprehensive study. J Asthma 2020; 58:1467-1477. [PMID: 32820695 DOI: 10.1080/02770903.2020.1802747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The economic burden of severe asthma (SA) in children is poorly described. We aimed to determine the healthcare costs of SA in children for the French national health insurance (NHI). METHODS Children (6-18 years of age) with physician-confirmed diagnoses of SA or non-SA (NSA) were identified. Direct and indirect expenditures related to asthma and associated co-morbidities in the previous six months were determined, based on a physician-guided parental questionnaire and confirmed by medical records. The costs for the French NHI were assessed per child over a six month period. RESULTS Data from 74 children, including 48 with SA (22 requiring omalizumab) and 26 with NSA, were analyzed. The global cost of SA was €3,982 per child over a six-month period, including €3,821 direct costs and €161.9 indirect costs. The global cost was €6,716 (4,220) for those requiring omalizumab vs. €1,669 (3,108) for those who did not (p < 0.01). For children with SA, 65% of direct costs were attributed to medication. Among those on omalizumab, such treatment accounted for 93% of medication costs. The global cost was 10 times higher for children with SA than those with NSA (€3,982 (4,422) vs. €363.2 (352.6), p < 0.01), and 20 times higher for children with SA on omalizumab than those with NSA (p < 0.01). CONCLUSION The economic burden of SA in children for the French NHI is substantial and mainly driven by the most severe children requiring biologics.
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Affiliation(s)
- Gizem Pamuk
- Department of Pediatric Pulmonology and Allergy, AP-HP Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Muriel Le Bourgeois
- Department of Pediatric Pulmonology and Allergy, AP-HP Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Rola Abou Taam
- Department of Pediatric Pulmonology and Allergy, AP-HP Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Jacques de Blic
- Department of Pediatric Pulmonology and Allergy, AP-HP Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Faculty of Medicine, Université Paris Descartes, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology and Allergy, AP-HP Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Faculty of Medicine, Université Paris Descartes, Paris, France
| | - Guillaume Lezmi
- Department of Pediatric Pulmonology and Allergy, AP-HP Hôpital Universitaire Necker-Enfants Malades, Paris, France.,Faculty of Medicine, Université Paris Descartes, Paris, France
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Host S, Honoré C, Joly F, Saunal A, Le Tertre A, Medina S. Implementation of various hypothetical low emission zone scenarios in Greater Paris: Assessment of fine-scale reduction in exposure and expected health benefits. ENVIRONMENTAL RESEARCH 2020; 185:109405. [PMID: 32224341 DOI: 10.1016/j.envres.2020.109405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/25/2020] [Accepted: 03/16/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Literature assessing the effects of policies aimed at reducing traffic-related air pollution is scarce. The aims of this study were to evaluate the expected impacts, in terms of air quality and health effects, of various hypothetical low-emission zone (LEZ) scenarios in Greater Paris for a planned intervention in 2018/2019 which combine two different perimeters and two levels of vehicles ban, and to assess those impacts according to the socioeconomic status (SES) of the population. METHODS We evaluated the effects of four hypothetical LEZ scenarios on various stages of the full-chain model, more specifically, road traffic modelling (traffic flow, type of vehicles and related number of kilometers driven), emissions, fine scale PM2.5 and NO2 concentrations, related resident population exposure, and health effects. We computed the overall benefits of expected air pollution improvements in terms of preventable deaths and a decrease in new cases of the following three major chronic diseases: ischemic heart diseases in adults, asthma in children and low weight in full-term newborns. RESULTS The most stringent LEZ scenario would lower the maximum level of exposure from 55 μg/m3 to 42 μg/m3 in Paris. In one year, this scenario would help prevent: 340 deaths (-0.6%) representing 114,300 life years gained, 170 low-weight full-term births (-4.9%), 130 new cases of ischemic heart disease (IHD) (-1.8%) and 2930 new cases of asthma (-3.0%) among 9.4 million residents. Residents outside the LEZ would also benefit from this scenario. Results indicated that the intervention could contribute to increasing inequalities. The comparison of scenarios underlined the value of extending the LEZ to include a wider zone (including 80 more municipalities surrounding Paris). This would lead to a more equitable spread of the benefits over the population. CONCLUSION Traffic control policies such as LEZ are difficult to accept for some categories of commuters and economic stakeholders. As of June 2019, the concertation process for the proposed Paris LEZ is still ongoing. This work provides authorities with detailed analyses of the options for this measure as well as information on related implications. It will help decision makers prioritize which preventive measures to introduce.
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Affiliation(s)
- Sabine Host
- Regional Health Observatory Île-de-France, Paris, France.
| | | | | | - Adrien Saunal
- Regional Health Observatory Île-de-France, Paris, France
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Lejeune S, Deschildre A, Le Rouzic O, Engelmann I, Dessein R, Pichavant M, Gosset P. Childhood asthma heterogeneity at the era of precision medicine: Modulating the immune response or the microbiota for the management of asthma attack. Biochem Pharmacol 2020; 179:114046. [PMID: 32446884 PMCID: PMC7242211 DOI: 10.1016/j.bcp.2020.114046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
Exacerbations are a main characteristic of asthma. In childhood, the risk is increasing with severity. Exacerbations are a strong phenotypic marker, particularly of severe and therapy-resistant asthma. These early-life events may influence the evolution and be involved in lung function decline. In children, asthma attacks are facilitated by exposure to allergens and pollutants, but are mainly triggered by microbial agents. Multiple studies have assessed immune responses to viruses, and to a lesser extend bacteria, during asthma exacerbation. Research has identified impairment of innate immune responses in children, related to altered pathogen recognition, interferon release, or anti-viral response. Influence of this host-microbiota dialog on the adaptive immune response may be crucial, leading to the development of biased T helper (Th)2 inflammation. These dynamic interactions may impact the presentations of asthma attacks, and have long-term consequences. The aim of this review is to synthesize studies exploring immune mechanisms impairment against viruses and bacteria promoting asthma attacks in children. The potential influence of the nature of infectious agents and/or preexisting microbiota on the development of exacerbation is also addressed. We then discuss our understanding of how these diverse host-microbiota interactions in children may account for the heterogeneity of endotypes and clinical presentations. Finally, improving the knowledge of the pathophysiological processes induced by infections has led to offer new opportunities for the development of preventive or curative therapeutics for acute asthma. A better definition of asthma endotypes associated with precision medicine might lead to substantial progress in the management of severe childhood asthma.
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Affiliation(s)
- Stéphanie Lejeune
- CHU Lille, Univ. Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, F-59000 Lille, France; Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France
| | - Antoine Deschildre
- CHU Lille, Univ. Lille, Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, F-59000 Lille, France; Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France
| | - Olivier Le Rouzic
- Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France; CHU Lille, Univ. Lille, Department of Respiratory Diseases, F-59000 Lille Cedex, France
| | - Ilka Engelmann
- Univ. Lille, Virology Laboratory, EA3610, Institute of Microbiology, CHU Lille, F-59037 Lille Cedex, France
| | - Rodrigue Dessein
- Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France; Univ. Lille, Bacteriology Department, Institute of Microbiology, CHU Lille, F-59037 Lille Cedex, France
| | - Muriel Pichavant
- Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France
| | - Philippe Gosset
- Univ. Lille, INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, F-59019 Lille Cedex, France.
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Provost D, Delmas MC, Chastang JF, Raherison C, Chérié-Challine L, Iwatsubo Y. Asthme et itinéraire professionnel à partir des données de l’enquête SIP, 2006 et 2010. ARCH MAL PROF ENVIRO 2019. [DOI: 10.1016/j.admp.2019.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Leynaert B, Le Moual N, Neukirch C, Siroux V, Varraso R. [Environmental risk factors for asthma developement]. Presse Med 2019; 48:262-273. [PMID: 30910274 DOI: 10.1016/j.lpm.2019.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 12/20/2022] Open
Abstract
The prevalence of asthma has increased rapidly since the early 1970s, and only changes in exposure to environmental factors; which go together with changes in lifestyle, are likely to explain such a rapid increase. Exposure to allergens is a risk factor for allergic sensitization, and allergic sensitization is a risk factor for allergic asthma. However, apart from indoor mold exposure as a risk factor for childhood asthma, there is insufficient evidence to conclude that the associations between allergen exposure and asthma development are causal. A new challenge for research is to analyze the huge amount of data derived from the metagenomic characterization of the environmental and human microbiome, to understand the role of interactions between viruses, bacteria and allergens in the development of asthma. It is recognized that prenatal and postnatal exposure to air pollution and maternal smoking increase the risk of developing asthma in children. In adults, the data are scarce and the results remain controversial as regards these exposures and asthma incidence. Further research is needed to appraise the effect of exposure to phenols, phthalates and perfluorinated compounds, which are widespread in the environment and may be associated with asthma, especially in children. Frequent use of chemicals for home cleaning especially in the form of sprays - which is a common practice at the population level - is a risk factor for the development of adult asthma. The domestic use of cleaning products might also be a risk factor for asthma in children exposed at home. The chemicals involved in these relationships are still to be identified. Occupational asthma is a major phenotype of adult asthma. A significant part of these asthma cases might relate to occupational exposure to cleaning products. While there is evidence of associations between diet during pregnancy or during childhood and the risk of developing asthma in children, the data in adults are insufficient. Beyond genetic factors, body composition is influenced by dietary choices and physical activity. Further research is needed to clarify the complex interplay between these nutritional factors and asthma development. The new challenge for research is to decipher the role of all the environmental factors to which the individual is exposed since conception ("exposome") in the development of asthma, using a holistic approach.
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Affiliation(s)
- Bénédicte Leynaert
- UMR 1152 physiopathologie et épidémiologie des maladies respiratoires, équipe épidémiologie, Inserm, Paris, France; UMR 1152, université Paris Diderot, Paris, France.
| | - Nicole Le Moual
- Inserm U1168, VIMA (aging and chronic diseases, epidemiological and public health approaches), Villejuif, France; UVSQ, UMR-S 1168, université Versailles, Saint-Quentin-en-Yvelines, France
| | - Catherine Neukirch
- UMR 1152 physiopathologie et épidémiologie des maladies respiratoires, équipe épidémiologie, Inserm, Paris, France; UMR 1152, université Paris Diderot, Paris, France; Service de pneumologie A, hôpital Bichat, Assistance publique-Hôpitaux de Paris, Paris, France; DHU FIRE, Paris, France
| | - Valérie Siroux
- Équipe épidémiologie environnement appliquée à la reproduction et la santé respiratoire, Inserm, CNRS, centre de recherche Inserm U1209, institute for advanced biosciences (IAB), université Grenoble-Alpes, Grenoble, France
| | - Raphaëlle Varraso
- Inserm U1168, VIMA (aging and chronic diseases, epidemiological and public health approaches), Villejuif, France; UVSQ, UMR-S 1168, université Versailles, Saint-Quentin-en-Yvelines, France
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19
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Sasso F, Izard M, Beneteau T, Rakotozandry T, Ramadour M, Annesi-Maesano I, Robin D, Charpin D. 18-year evolution of asthma and allergic diseases in French urban schoolchildren in relation to indoor air pollutant levels. Respir Med 2019; 148:31-36. [PMID: 30827471 DOI: 10.1016/j.rmed.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND An initial epidemiological study carried out 18 years ago in Marseilles indicated that the air quality in schools was poor and that there was an association between the level of fine particulates and the occurrence of asthma in children. The aim of the present study was to evaluate the change in the prevalence of childhood asthma and allergic diseases and their link with the levels of air pollutants and other factors of potential risk. METHODS In 2016, using a questionnaire identical to the one used for the 1st survey in 1998-1999, we collected information regarding the symptoms, the diagnosis, and the potential confounding factors. We measured the main indoor and outdoor pollutants at the schools. RESULTS Overall, the prevalence of asthma and of allergic diseases exhibited an increasing trend in the time interval between the two studies, significant only for dry cough and pollen allergy. The level of air pollutants decreased significantly indoors. In spite of this, we found a correlation and a dose-effect relationship between the level of PM2.5 and the prevalence of asthma. A family history of asthma and allergies, the insalubrity of the place of residence, and a non-Mediterranean diet were also associated with the risk of these diseases. CONCLUSION In the time interval between the two studies, which were 18 years apart, despite a reduction in the level of air pollutants in classrooms, asthma was still related to PM2.5. Other potentially causative or contributing environmental factors were also related to asthma and allergies.
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Affiliation(s)
- Fabien Sasso
- Pulmonology Unit, La Timone Hospital, Marseille and Aix-Marseille University, France
| | | | - Thomas Beneteau
- EPAR, IPLESP, UMR S, 1136, INSERM & UPMC Paris 6, Sorbonne University, Medical School Saint-Antoine, France
| | - Thierry Rakotozandry
- Pulmonology Unit, La Timone Hospital, Marseille and Aix-Marseille University, France
| | | | - Isabella Annesi-Maesano
- EPAR, IPLESP, UMR S, 1136, INSERM & UPMC Paris 6, Sorbonne University, Medical School Saint-Antoine, France
| | | | - Denis Charpin
- Pulmonology Unit, La Timone Hospital, Marseille and Aix-Marseille University, France.
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Okubo Y, Michihata N, Yoshida K, Morisaki N, Matsui H, Fushimi K, Yasunaga H. Impact of pediatric obesity on acute asthma exacerbation in Japan. Pediatr Allergy Immunol 2017; 28:763-767. [PMID: 29044803 DOI: 10.1111/pai.12801] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Asthma and obesity are common health problems in children. This study investigated the impact of obesity on children hospitalized with acute asthma exacerbation. METHODS We obtained the hospital discharge records of inpatients aged 3-8 years with a diagnosis of asthma using a national inpatient database in Japan. The patients were classified into underweight, normal weight, overweight, and obese groups using weight for height and body mass index for age provided by the World Health Organization. We compared 30-day re-admission, need for intensive care, mean total hospitalization costs, and length of hospital stay between the 4 groups using multivariable regression models. RESULTS Overall, 38 679 patients were identified, including 3177 underweight, 28 904 normal weight, 3334 overweight, and 3264 obese patients. The obese group showed significantly higher 30-day re-admission (adjusted odds ratio, 1.26; 95% confidence interval, 1.03-1.54) and longer length of stay (adjusted difference, 0.12 days; 95% confidence interval, 0.10-0.20 days) than the normal weight group. The threshold was a 91st percentile of weight for length or body mass index for the relationship with 30-day re-admission. No significant difference was observed between the 4 groups regarding the need for intensive care and total hospitalization costs. CONCLUSION These findings demonstrated that obesity was a risk factor for repeated admissions caused by asthma in children, indicating the importance for the prevention of pediatric obesity.
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Affiliation(s)
- Yusuke Okubo
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Epidemiology, UCLA Fielding School of Public Health, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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