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McGinn EA, Bye E, Gonzalez T, Sosa A, Bilodeaux J, Seedorf G, Smith BJ, Abman SH, Mandell EW. Antenatal Endotoxin Induces Dysanapsis in Experimental Bronchopulmonary Dysplasia. Am J Respir Cell Mol Biol 2024; 70:283-294. [PMID: 38207120 DOI: 10.1165/rcmb.2023-0157oc] [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: 05/02/2023] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Abstract
Bronchopulmonary dysplasia (BPD), the chronic lung disease of prematurity, is characterized by impaired lung development with sustained functional abnormalities due to alterations of airways and the distal lung. Although clinical studies have shown striking associations between antenatal stress and BPD, little is known about the underlying pathogenetic mechanisms. Whether dysanapsis, the concept of discordant growth of the airways and parenchyma, contributes to late respiratory disease as a result of antenatal stress is unknown. We hypothesized that antenatal endotoxin (ETX) impairs juvenile lung function as a result of altered central airway and distal lung structure, suggesting the presence of dysanapsis in this preclinical BPD model. Fetal rats were exposed to intraamniotic ETX (10 μg) or saline solution (control) 2 days before term. We performed extensive structural and functional evaluation of the proximal airways and distal lung in 2-week-old rats. Distal lung structure was quantified by stereology. Conducting airway diameters were measured using micro-computed tomography. Lung function was assessed during invasive ventilation to quantify baseline mechanics, response to methacholine challenge, and spirometry. ETX-exposed pups exhibited distal lung simplification, decreased alveolar surface area, and decreased parenchyma-airway attachments. ETX-exposed pups exhibited decreased tracheal and second- and third-generation airway diameters. ETX increased respiratory system resistance and decreased lung compliance at baseline. Only Newtonian resistance, specific to large airways, exhibited increased methacholine reactivity in ETX-exposed pups compared with controls. ETX-exposed pups had a decreased ratio of FEV in 0.1 second to FVC and a normal FEV in 0.1 second, paralleling the clinical definition of dysanapsis. Antenatal ETX causes abnormalities of the central airways and distal lung growth, suggesting that dysanapsis contributes to abnormal lung function in juvenile rats.
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Affiliation(s)
- Elizabeth A McGinn
- Pediatric Heart Lung Center, Department of Pediatrics
- Department of Pediatric Critical Care Medicine
| | - Elisa Bye
- Pediatric Heart Lung Center, Department of Pediatrics
| | | | - Alexander Sosa
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jill Bilodeaux
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Bradford J Smith
- Pediatric Heart Lung Center, Department of Pediatrics
- Department of Pediatric Pulmonary and Sleep Medicine, and
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Steven H Abman
- Pediatric Heart Lung Center, Department of Pediatrics
- Department of Pediatric Pulmonary and Sleep Medicine, and
| | - Erica W Mandell
- Pediatric Heart Lung Center, Department of Pediatrics
- Department of Neonatology, University of Colorado School of Medicine, Aurora, Colorado; and
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2
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McGinn EA, Mandell EW, Smith BJ, Duke JW, Bush A, Abman SH. Dysanapsis as a Determinant of Lung Function in Development and Disease. Am J Respir Crit Care Med 2023; 208:956-963. [PMID: 37677135 PMCID: PMC10870865 DOI: 10.1164/rccm.202306-1120pp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/07/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
| | - Erica W. Mandell
- Pediatric Heart Lung Center, Department of Pediatrics
- Department of Neonatology
| | - Bradford J. Smith
- Pediatric Heart Lung Center, Department of Pediatrics
- Department of Pediatric Pulmonary and Sleep Medicine, and
- Department of Bioengineering, Anschutz School of Medicine, University of Colorado–Denver, Aurora, Colorado
| | - Joseph W. Duke
- Department of Biological Sciences, Northern Arizona University, Flagstaff, Arizona; and
| | - Andrew Bush
- Center for Pediatrics and Child Health, Imperial College of Medicine, London, United Kingdom
| | - Steven H. Abman
- Pediatric Heart Lung Center, Department of Pediatrics
- Department of Pediatric Pulmonary and Sleep Medicine, and
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3
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Collaro AJ, McElrea MS, Marchant JM, Chatfield MD, Sondergeld P, Perret JL, Vicendese D, Anuntaseree W, Dharmage SC, Chang AB. The effect of early childhood respiratory infections and pneumonia on lifelong lung function: a systematic review. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:429-440. [PMID: 37037210 DOI: 10.1016/s2352-4642(23)00030-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 04/12/2023]
Abstract
Early childhood respiratory infections, including pneumonia, are an important global public health issue, with more than 40 million annual cases resulting in approximately 650 000 deaths. A growing number of published studies have examined the effects of early childhood lower respiratory tract infections (LRTIs) or pneumonia on lung function, particularly as part of large early-life exposure studies. To our knowledge, there is no published systematic review of these data. We searched PubMed, Embase, and Web of Science for studies published between database inception and May 12, 2022. Case-control, cohort, and cross-sectional studies were included if they reported forced expiratory volume in 1 s (FEV1) or forced vital capacity (FVC) values of participants older than 5 years. Article titles and abstracts were screened in Rayyan before retrieval, assessment, and data extraction of the full text. Primary outcome measures were differences in mean FEV1 or FVC values between exposed groups (ie, children aged ≤5 years with LRTIs) and non-exposed groups. This study is registered with PROSPERO, CRD42021265295. Database searches yielded 3070 articles, and 14 studies were included in this systematic review, providing a total of 23 276 participants, including 9969 children and 13 307 adults. Eight of 14 articles reported significant reductions in FEV1 values, and six of 12 studies reported reductions in FVC values in children and adults with a history of early childhood LRTIs or pneumonia, compared with unexposed controls (p<0·05). Most studies reporting reductions in lung function described deficits consistent with a restrictive spirometry pattern. Only two of 14 studies reported data from low-income and middle-income countries or disadvantaged populations in middle-income and high-income countries, and there were scarce data available on the effect of LRTI severity and recurrence on lung function. LRTIs in early childhood could be associated with a restrictive spirometry pattern in later childhood and adulthood. Data are needed from low-income and middle-income nations, and from disadvantaged populations in middle-income and high-income countries in which early childhood respiratory infection burden is disproportionately high. Data are also needed on the effect of LRTI severity and recurrence on future lung function.
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Affiliation(s)
- Andrew J Collaro
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.
| | - Margaret S McElrea
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Julie M Marchant
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Peter Sondergeld
- Library, Queensland University of Technology, Brisbane, QLD, Australia
| | - Jennifer L Perret
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia
| | - Don Vicendese
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Engineering and Mathematical Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Wanaporn Anuntaseree
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Shyamali C Dharmage
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
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4
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Jin C, Zhang T, Li Y, Shi W. Early-Life Exposure to Malnutrition From the Chinese Famine on Risk of Asthma and Chronic Obstructive Pulmonary Disease in Adulthood. Front Nutr 2022; 9:848108. [PMID: 35711537 PMCID: PMC9194571 DOI: 10.3389/fnut.2022.848108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Intrauterine malnutrition has a long-term effect on respiratory and lung function. However, few studies have explored the association between early-life exposure to famine with asthma and chronic obstructive pulmonary disease (COPD) in adulthood. Therefore, we aimed to investigate the association of early-life exposure to the Chinese famine of 1959–1962 with asthma and COPD later in life. Methods This national population-based study included 6,771 participants from the baseline survey of the China Health and Retirement Longitudinal Study (CHARLS) who were born around the time of the Chinese famine. The famine exposure groups were determined according to the participants' birth year as non-exposed (1964–1967), fetal-exposed (1959–1962), preschool-exposed (1954–1957), and school-age exposed (1950–1953). Information about the demographic characteristics, self-reported doctor-diagnosed asthma and COPD, behavior and lifestyles, and indoor pollution were collected using validated questionnaires. In addition, peak expiratory flow (PEF) was measured to assess pulmonary function. Multivariable logistic regression and generalized linear mixed models were performed to explore the risk of adult asthma and COPD, PEF changes during various famine exposure periods compared with the non-exposed group. Stratified and sensitivity analyses were conducted to examine the modification and robustness of the association. Results The prevalence of doctor-diagnosed asthma and COPD was 2.8 and 8.1%, respectively. Compared with the non-exposed group, the risk was significantly higher in the fetal-exposed group for asthma [adjusted odds ratio, (aOR) = 1.87, 95% confidence interval (CI):1.14–3.07] and the school-age exposed group [1.30 (1.00–1.69)] for COPD after controlling for confounders. Furthermore, we observed that fetal exposure to famine was significantly associated with a decrement of PEF in adulthood [β = −11.38 (−22.75 to −0.02)] compared with the non-exposed group. Stratified analyses showed that the association of asthma was stronger in men, who resided in severely famine-affected areas, smoked, and used solid fuels for cooking. No clearly consistent association was observed for subsequent COPD. Conclusions Our results suggest that fetal exposure to the Chinese famine is significantly associated with the increased risk of asthma in adulthood. Future prospective studies are warranted to examine the association and mechanisms.
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Affiliation(s)
- Changbo Jin
- Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tiantian Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Yongzhen Li
- Department of Nutrition and Food Science, School of Public Health, Fudan University, Shanghai, China
| | - Wenming Shi
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.,Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
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Nguyen T, Jordan BK. Let's Talk about Dex: When do the Benefits of Dexamethasone for Prevention of Bronchopulmonary Dysplasia Outweigh the Risks? NEWBORN 2022; 1:91-96. [PMID: 35821876 PMCID: PMC9272690 DOI: 10.5005/jp-journals-11002-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bronchopulmonary dysplasia (BPD) is the most common complication of extreme prematurity and carries increased respiratory morbidity into childhood and adulthood. Systemic administration of dexamethasone during the preterm period has been shown to decrease the incidence of BPD in this population. However, enthusiasm about its use has been tempered by early evidence that suggested potential adverse neurodevelopmental outcomes. More recent studies suggest that the timing, dosing, and duration of therapy may have a significant impact on the safety and efficacy of dexamethasone administration and that side effects and harms may be minimized if its use is appropriately targeted. Focusing on studies published since the 2010s American Academy of Pediatrics (AAP) statement on dexamethasone, this review seeks to examine the evidence from recent clinical trials to present the current state of knowledge regarding the systemic dexamethasone administration to prevent BPD in extremely premature infants and how dose, duration, and timing might impact its safety and efficacy in this vulnerable population.
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Affiliation(s)
- Thuy Nguyen
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Brian K Jordan
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States of America
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Röhl A, Baek SH, Kachroo P, Morrow JD, Tantisira K, Silverman EK, Weiss ST, Sharma A, Glass K, DeMeo DL. Protein interaction networks provide insight into fetal origins of chronic obstructive pulmonary disease. Respir Res 2022; 23:69. [PMID: 35331221 PMCID: PMC8944072 DOI: 10.1186/s12931-022-01963-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 02/08/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of death in adults that may have origins in early lung development. It is a complex disease, influenced by multiple factors including genetic variants and environmental factors. Maternal smoking during pregnancy may influence the risk for diseases during adulthood, potentially through epigenetic modifications including methylation. METHODS In this work, we explore the fetal origins of COPD by utilizing lung DNA methylation marks associated with in utero smoke (IUS) exposure, and evaluate the network relationships between methylomic and transcriptomic signatures associated with adult lung tissue from former smokers with and without COPD. To identify potential pathobiological mechanisms that may link fetal lung, smoke exposure and adult lung disease, we study the interactions (physical and functional) of identified genes using protein-protein interaction networks. RESULTS We build IUS-exposure and COPD modules, which identify connected subnetworks linking fetal lung smoke exposure to adult COPD. Studying the relationships and connectivity among the different modules for fetal smoke exposure and adult COPD, we identify enriched pathways, including the AGE-RAGE and focal adhesion pathways. CONCLUSIONS The modules identified in our analysis add new and potentially important insights to understanding the early life molecular perturbations related to the pathogenesis of COPD. We identify AGE-RAGE and focal adhesion as two biologically plausible pathways that may reveal lung developmental contributions to COPD. We were not only able to identify meaningful modules but were also able to study interconnections between smoke exposure and lung disease, augmenting our knowledge about the fetal origins of COPD.
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Affiliation(s)
- Annika Röhl
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.
| | - Seung Han Baek
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Priyadarshini Kachroo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jarrett D Morrow
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kelan Tantisira
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Division of Pediatric Respiratory Medicine, University of California San Diego, San Diego, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Scott T Weiss
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Amitabh Sharma
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Center for Complex Network Research, Northeastern University, Boston, MA, USA
| | - Kimberly Glass
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Dawn L DeMeo
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
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7
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Zhang XY, Li W, Zhang JR, Li CY, Zhang J, Lv XJ. Roles of sirtuin family members in chronic obstructive pulmonary disease. Respir Res 2022; 23:66. [PMID: 35313881 PMCID: PMC8939123 DOI: 10.1186/s12931-022-01986-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/14/2022] [Indexed: 12/11/2022] Open
Abstract
The globally increasing annual incidence of chronic obstructive pulmonary disease (COPD), a common chronic disease, poses a serious risk to public health. Although the exact mechanism underlying the pathogenesis of COPD remains unclear, a large number of studies have shown that its pathophysiology and disease course are closely related to oxidative stress, inflammation, apoptosis, autophagy, and aging. The key players involved in COPD include the sirtuin family of NAD-dependent deacetylases that comprise seven members (SIRT1-7) in mammals. Sirtuins play an important role in metabolic diseases, cell cycle control, proliferation, apoptosis, and senescence. Owing to differences in subcellular localization, sirtuins exhibit anisotropy. In this narrative review, we discuss the roles and molecular pathways of each member of the sirtuin family involved in COPD to provide novel insights into the prevention and treatment of COPD and how sirtuins may serve as adjuvants for COPD treatment.
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Affiliation(s)
- Xi-Yue Zhang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Li
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jin-Rong Zhang
- Department of Pathogeny Biology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin, China
| | - Chun-Yan Li
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jie Zhang
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Xue-Jiao Lv
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China.
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Goulden N, Cousins M, Hart K, Jenkins A, Willetts G, Yendle L, Doull I, Williams EM, Hoare Z, Kotecha S. Inhaled Corticosteroids Alone and in Combination With Long-Acting β2 Receptor Agonists to Treat Reduced Lung Function in Preterm-Born Children: A Randomized Clinical Trial. JAMA Pediatr 2022; 176:133-141. [PMID: 34902004 PMCID: PMC8669602 DOI: 10.1001/jamapediatrics.2021.5111] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/03/2021] [Indexed: 12/05/2022]
Abstract
Importance Decreases in future lung function are a hallmark of preterm birth, but studies for management of decreased lung function are limited. Objective To determine whether 12 weeks of treatment with inhaled corticosteroids (ICS) alone or in combination with long-acting β2 agonists (LABA) improves spirometry and exercise capacity in school-aged preterm-born children who had percent predicted forced expiratory volume in 1 second (%FEV1) less than or equal to 85% compared with inhaled placebo treatment. Design, Setting, and Participants A double-blind, randomized, placebo-controlled trial was conducted to evaluate ICS and ICS/LABA against placebo. Preterm-born children (age, 7-12 years; gestation ≤34 weeks at birth) who did not have clinically significant congenital, cardiopulmonary, or neurodevelopmental abnormalities underwent spirometry, exercise testing, and measurement of fractional exhaled nitric oxide before and after treatment. A total of 144 preterm-born children at the Children's Hospital for Wales in Cardiff, UK, were identified and enrolled between July 1, 2017, and August 31, 2019. Interventions Each child was randomized to 1 of 3 cohorts: fluticasone propionate, 50 μg, with placebo; fluticasone propionate, 50 μg, with salmeterol, 25 μg; or placebo inhalers, all given as 2 puffs twice daily for 12 weeks. Children receiving preexisting ICS treatment underwent washout prior to randomization to ICS or ICS/LABA. Main Outcomes and Measures The primary outcome was between-group differences assessed by adjusted pretreatment and posttreatment differences of %FEV1 using analysis of covariance. Intention-to-treat analysis was conducted. Results Of 144 preterm-born children who were identified with %FEV1 less than or equal to 85%, 53 were randomized. Treatment allocation was 20 children receiving ICS (including 5 with prerandomization ICS), 19 children receiving ICS/LABA (including 4 with prerandomization ICS), and 14 children receiving placebo. The mean (SD) age of children was 10.8 (1.2) years, and 29 of the randomized children (55%) were female. The posttreatment %FEV1 was adjusted for sex, gestation, bronchopulmonary dysplasia, intrauterine growth restriction, pretreatment corticosteroid status, treatment group, and pretreatment values. Posttreatment adjusted means for %FEV1, using analysis of covariance, were 7.7% (95% CI, -0.27% to 15.72%; P = .16) higher in the ICS group and 14.1% (95% CI, 7.3% to 21.0%; P = .002) higher in the ICS/LABA group compared with the placebo group. Active treatment decreased the fractional exhaled nitric oxide and improved postexercise bronchodilator response but did not improve exercise capacity. One child developed cough when starting inhaler treatment; no other adverse events reported during the trial could be attributed to the inhaler treatment. Conclusions and Relevance The results of this randomized clinical trial suggest that combined ICS/LABA treatment is beneficial for prematurity-associated lung disease in children. Trial Registration EudraCT number: 2015-003712-20.
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Affiliation(s)
- Nia Goulden
- NWORTH, Bangor University, Bangor, United Kingdom
| | - Michael Cousins
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Kylie Hart
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | | | - Gill Willetts
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Louise Yendle
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Iolo Doull
- Department of Paediatrics, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - E. Mark Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Zoe Hoare
- NWORTH, Bangor University, Bangor, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, United Kingdom
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Yang W, Li F, Li C, Meng J, Wang Y. Focus on Early COPD: Definition and Early Lung Development. Int J Chron Obstruct Pulmon Dis 2021; 16:3217-3228. [PMID: 34858022 PMCID: PMC8629909 DOI: 10.2147/copd.s338359] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/03/2021] [Indexed: 12/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease with high incidence rate and mortality rates worldwide. It is the third leading cause of death in the world. Nevertheless, little progress has been made in treating and preventing the disease. Under these circumstances, the concept of “early COPD” was proposed. Although this concept is not new, most health-care workers do not fully understand early COPD and tend to confuse it with mild COPD. In this review, we mainly discuss the definition of early COPD and the developmental trajectory of lung function. Although patients with early COPD have no symptoms, their lung function is already lower than that of normal people. A relatively complete definition is needed to identify this group of people. Reduced lung function is the diagnostic criterion for COPD, but lung development is a long-term dynamic process. In addition to smoking and air pollution, we should pay more attention to prenatal and childhood risk factors, for example, parents smoking, birth weight, preterm birth, mode of delivery, childhood respiratory infections and childhood asthma. Health-care workers need to be fully aware of early COPD, to reduce the morbidity of COPD and take effective measures to prevent these risk factors.
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Affiliation(s)
- Weichang Yang
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Fengyuan Li
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Can Li
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Jiaqi Meng
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
| | - Ying Wang
- Department of Respiratory and Critical Care Medicine, Nanchang First Hospital, Nanchang University, Nanchang, 330000, Jiangxi, People's Republic of China
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10
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Olloquequi J. COVID-19 Susceptibility in chronic obstructive pulmonary disease. Eur J Clin Invest 2020; 50:e13382. [PMID: 32780415 PMCID: PMC7435530 DOI: 10.1111/eci.13382] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
In barely nine months, the pandemic known as COVID-19 has spread over 200 countries, affecting more than 22 million people and causing over than 786 000 deaths. Elderly people and patients with previous comorbidities such as hypertension and diabetes are at an increased risk to suffer a poor prognosis after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although the same could be expected from patients with chronic obstructive pulmonary disease (COPD), current epidemiological data are conflicting. This could lead to a reduction of precautionary measures in these patients, in the context of a particularly complex global health crisis. Most COPD patients have a long history of smoking or exposure to other harmful particles or gases, capable of impairing pulmonary defences even years after the absence of exposure. Moreover, COPD is characterized by an ongoing immune dysfunction, which affects both pulmonary and systemic cellular and molecular inflammatory mediators. Consequently, increased susceptibility to viral respiratory infections have been reported in COPD, often worsened by bacterial co-infections and leading to serious clinical outcomes. The present paper is an up-to-date review that discusses the available research regarding the implications of coronavirus infection in COPD. Although validation in large studies is still needed, COPD likely increases SARS-CoV-2 susceptibility and increases COVID-19 severity. Hence, specific mechanisms to monitor and assess COPD patients should be addressed in the current pandemic.
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Affiliation(s)
- Jordi Olloquequi
- Laboratory of Cellular and Molecular Pathology, Facultad de Ciencias de la Salud, Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Talca, Chile
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11
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Peralta GP, Abellan A, Montazeri P, Basterrechea M, Esplugues A, González-Palacios S, Roda C, Santa-Marina L, Sunyer J, Vrijheid M, Casas M, Garcia-Aymerich J. Early childhood growth is associated with lung function at 7 years: a prospective population-based study. Eur Respir J 2020; 56:13993003.00157-2020. [PMID: 32855223 DOI: 10.1183/13993003.00157-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 07/23/2020] [Indexed: 11/05/2022]
Abstract
Previous studies have related early postnatal growth with later lung function but their interpretation is limited by the methods used to assess a child's growth. We aimed to assess the association of early childhood growth, measured by body mass index (BMI) trajectories up to 4 years, with lung function at 7 years.We included 1257 children from the Spanish Infancia y Medio Ambiente population-based birth cohort. Early childhood growth was classified into five categories based on BMI trajectories up to 4 years previously identified using latent class growth analysis. These trajectories differed in birth size ("lower", "average", "higher") and in BMI gain velocity ("slower", "accelerated"). We related these trajectories to lung function (forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC and forced expiratory flow at 25%-75% of FVC (FEF25-75%)) at 7 years, using multivariable mixed regression.Compared to children with average birth size and slower BMI gain (reference), children with higher birth size and accelerated BMI gain had a higher FVC % pred (3.3%, 95% CI 1.0%-5.6%) and a lower FEV1/FVC % pred (-1.5%, 95% CI -2.9%--0.1%) at 7 years. Similar associations were observed for children with lower birth size and accelerated BMI gain. Children with lower birth size and slower BMI gain had lower FVC % pred at 7 years. No association was found for FEF25-75%Independently of birth size, children with accelerated BMI gain in early childhood had higher lung function at 7 years but showed airflow limitation. Children with lower birth size and slower BMI gain in early childhood had lower lung function at 7 years.
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Affiliation(s)
- Gabriela P Peralta
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Alicia Abellan
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Parisa Montazeri
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mikel Basterrechea
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Public Health Division of Gipuzkoa, Basque Government, San Sebastian, Spain
| | - Ana Esplugues
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I, Universitat de Valencia, Valencia, Spain.,Nursing Dept, Faculty of Nursing and Chiropody, Universitat de València, Valencia, Spain
| | - Sandra González-Palacios
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Dept of Public Health, History of Medicine and Gynecology, Miguel Hernández University and Institute for Health and Biomedical Research (ISABIAL Foundation), Alicante, Spain
| | - Célina Roda
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Université de Paris, CRESS, INSERM - HERA team (Health Environmental Risk Assessment), INRA, Paris, France
| | - Loreto Santa-Marina
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Public Health Division of Gipuzkoa, Basque Government, San Sebastian, Spain
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maribel Casas
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Shared last authorship
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Shared last authorship
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12
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Collaro AJ, Chang AB, Marchant JM, Rodwell LT, Masters IB, Chatfield MD, McElrea MS. Pediatric Patients of Outreach Specialist Queensland Clinics Have Lung Function Improvement Comparable to That of Tertiary Pediatric Patients. Chest 2020; 158:1566-1575. [PMID: 32387516 DOI: 10.1016/j.chest.2020.03.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/04/2020] [Accepted: 03/28/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Inequitable access to quality health care contributes to the known poorer outcomes of people living in regional/remote areas (compared with urban-based), especially for First Nations people. Integration of specialist outreach services within primary care is one strategy that can reduce the inequity when modeled to the needs and available resources of target communities. RESEARCH QUESTION To evaluate whether respiratory outreach clinics in regional and remote Queensland are as effective as tertiary respiratory services at improving the lung function of children. STUDY DESIGN AND METHODS From existing databases, we obtained spirometry data of children (aged 3-18 years) seen at Indigenous-focused outreach clinics in regional and remote Queensland and Brisbane-based pediatric tertiary hospitals over the same contemporary period (October 2010 to July 2019). We compared the change in spirometry z scores (Δz) at follow-up for both groups of children. RESULTS Lung function significantly improved in both groups: Tertiary hospital (n = 2,249; ΔzFEV1 = 0.22, 95% CI, 0.17 to 0.27; ΔzFVC = 0.23, 95% CI, 0.18 to 0.28); outreach (n = 252; ΔzFEV1 = 0.35, 95% CI, 0.22 to 0.48; ΔzFVC = 0.36, 95% CI, 0.23 to 0.50). No significant intergroup differences were found in ΔzFEV1 (0.13; 95%CI, -0.02 to 0.28; P = .10) or ΔzFVC (0.14; 95% CI, -0.02 to 0.29; P = .08) improvement from baseline. In both groups, the proportion of children with zFEV1 > 0 at follow-up (hospital = 31.7%; outreach = 46.8%) significantly increased (hospital P = .001; outreach P = .009) from baseline (hospital = 27.2%; outreach = 35.3%). Numbers of children with zFEV1 > 0 significantly increased for asthma and bronchiectasis outreach subgroups, and for children with asthma in the hospital-based group. INTERPRETATION Comparable significant lung function improvement of children was seen in Indigenous-focused outreach remote/regional clinics and paediatric tertiary hospitals. This suggests that effective clinical care is achievable within the outreach setting.
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Affiliation(s)
- Andrew J Collaro
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia.
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia; Child Health Division, Menzies School of Health Research, NT, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia
| | - Leanne T Rodwell
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia
| | - Ian B Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, NT, Australia; Faculty of Medicine, The University of Queensland, QLD, Australia
| | - Margaret S McElrea
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, QLD, Australia; Centre for Children's Health Research, Queensland University of Technology, QLD, Australia; Indigenous Respiratory Outreach Care, The Prince Charles Hospital, QLD, Australia
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13
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Zar HJ, Pellowski JA, Cohen S, Barnett W, Vanker A, Koen N, Stein DJ. Maternal health and birth outcomes in a South African birth cohort study. PLoS One 2019; 14:e0222399. [PMID: 31751344 PMCID: PMC6874071 DOI: 10.1371/journal.pone.0222399] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background Maternal physical and mental health during pregnancy are key determinants of birth outcomes. There are relatively few prospective data that integrate physical and mental maternal health measures with birth outcomes in low- and middle-income country settings. We aimed to investigate maternal health during pregnancy and the impact on birth outcomes in an African birth cohort study, the Drakenstein Child Health Study. Methods Pregnant women attending 2 public health clinics, Mbekweni (serving a predominantly black African population) and TC Newman (predominantly mixed ancestry) in a poor peri-urban area of South Africa were enrolled in their second trimester and followed through childbirth. All births occurred at a single public hospital. Maternal sociodemographic, physical and psychosocial characteristics were comprehensively assessed. Multivariable linear regression models were used to explore associations between maternal health and birth outcomes. Results Over 3 years, 1137 women (median age 25.8 years; 21% HIV-infected) gave birth to 1143 live babies. Most pregnancies were uncomplicated but gestational diabetes (1%), anaemia (22%) or pre-eclampsia (2%) occurred in a minority. Most households (87%) had a monthly income of less than USD 350; only 27% of moms were employed and food insecurity was common (37%). Most babies (80%) were born by vaginal delivery at full term; 17% were preterm, predominantly late preterm. Only 74 (7%) of babies required hospitalisation immediately after birth and only 2 babies were HIV-infected. Food insecurity, socioeconomic status, pregnancy-associated hypertension, pre-eclampsia, gestational diabetes and mixed ancestry were associated with lower infant gestational age while maternal BMI at enrolment was associated with higher infant gestational age. Primigravida or alcohol use during pregnancy were negatively associated with infant birth weight and head circumference. Maternal BMI at enrolment was positively associated with birth weight and gestational diabetes was positively associated with birth weight and head circumference for gestational age. Smoking during pregnancy was associated with lower infant birth weight. Conclusion Several modifiable risk factors including food insecurity, smoking, and alcohol consumption during pregnancy were identified as associated with negative birth outcomes, all of which are amenable to public health interventions. Interventions to address key exposures influencing birth outcomes are needed to improve maternal and child health in low-middle income country settings.
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Affiliation(s)
- Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Sophie Cohen
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Nastassja Koen
- Department of Psychiatry and Mental Health and SA-MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and SA-MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
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14
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Kantar A, Seminara M. Why chronic cough in children is different. Pulm Pharmacol Ther 2019; 56:51-55. [PMID: 30851475 DOI: 10.1016/j.pupt.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 12/11/2022]
Abstract
Recently, there have been robust changes in our knowledge of the neurophysiology of cough and novel clinical etiologies. Specifically, cough hypersensitivity in adults and protracted bacterial bronchitis (PBB) in children have been increasingly investigated, and differences between chronic cough in children and adults have been widely reported. In young children, postinfectious cough, bronchiectasis, airway malacia, PBB, and asthma appear to be the main causes of cough; however, by adolescence, the causes of cough are more likely to become those common in adults, namely, gastroesophageal reflux, asthma, and upper airway syndrome. These differences are attributed to changes in various characteristics of the respiratory tract, immune system, and nervous system between children and adults. New knowledge about the neural aspects of cough has revealed a complex network of pathways that initiate cough. The effect of inflammation on cough neural processing occurs at multiple peripheral and central sites within the nervous system. Evidence exists that direct or indirect neuroimmune interaction induces a complex response, which can be altered by mediators released by the sensory or parasympathetic neurons and vice versa. During childhood, the respiratory tract and the nervous system undergo a series of anatomical and physiological maturation processes that produce the cough neural circuits. Alterations provoked by various pathological processes, noxious agents, infection, and inflammation during the developmental period can lead to persistent or irreversible modifications, which may explain why many adult patients, in addition to expressing high cough sensitivity, remain refractive to disease-specific therapies.
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Affiliation(s)
- Ahmad Kantar
- Paediatric Asthma and Cough Centre, University and Research Hospitals, Gruppo Ospedaliero San Donato, Bergamo, Italy.
| | - Manuela Seminara
- Paediatric Asthma and Cough Centre, University and Research Hospitals, Gruppo Ospedaliero San Donato, Bergamo, Italy
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15
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Kotecha SJ, Watkins WJ, Lowe J, Granell R, Henderson AJ, Kotecha S. Comparison of the Associations of Early-Life Factors on Wheezing Phenotypes in Preterm-Born Children and Term-Born Children. Am J Epidemiol 2019; 188:527-536. [PMID: 30668648 PMCID: PMC6395162 DOI: 10.1093/aje/kwy268] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 12/20/2022] Open
Abstract
Although respiratory symptoms, including wheezing, are common in preterm-born subjects, the natural history of the wheezing phenotypes and the influence of early-life factors and characteristics on phenotypes are unclear. Participants from the Millennium Cohort Study who were born between 2000 and 2002 were studied at 9 months and at 3, 5, 7, and 11 years. We used data-driven methods to define wheezing phenotypes in preterm-born children and investigated whether the association of early-life factors and characteristics with wheezing phenotypes was similar between preterm- and term-born children. A total of 1,049/1,502 (70%) preterm-born children and 12,307/17,063 (72%) term-born children had recent wheeze data for 3 or 4 time points. Recent wheeze was more common at all time points in the preterm-born group than in term-born group. Four wheezing phenotypes were defined for both groups: no/infrequent, early, persistent, and late. Early-life factors and characteristics, especially antenatal maternal smoking, atopy, and male sex, were associated with increased rates for all phenotypes in both groups, and breastfeeding was protective in both groups, except late wheeze in the preterm group. Preterm-born children had similar phenotypes to term-born children. Although early-life factors and characteristics were similarly associated with the wheezing phenotypes in both groups, the preterm-born group had higher rates of early and persistent wheeze. However, a large proportion of preterm-born children had early wheeze that resolved with time.
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Affiliation(s)
- Sarah J Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - W John Watkins
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - John Lowe
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Raquel Granell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - A John Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sailesh Kotecha
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, United Kingdom
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16
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D’Elia C, Mallol J, Solé D. Prevalence of recurrent wheezing during the first year of life in Setúbal district, Portugal. Allergol Immunopathol (Madr) 2019; 47:122-127. [PMID: 30078621 DOI: 10.1016/j.aller.2018.04.006] [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: 03/20/2018] [Accepted: 04/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recurrent wheezing during the first year of life is a major cause of respiratory morbidity worldwide, yet there are no studies on its prevalence in Portugal. OBJECTIVE Determine the prevalence and severity of recurrent wheezing, treatments employed and other related aspects, in infants during their first year of life in Setúbal, Portugal. METHODS This is a cross-sectional study of a random sample of infants aged 12-15 months living in Setúbal district. It uses a validated questionnaire answered by parents/caregivers at local healthcare facilities where infants attend for growth/development monitoring and/or vaccine administration. RESULTS Among the 202 infants surveyed, 44.6% (95% CI 37.7-51.4) had at least one episode of wheezing; and 18.3% (95% CI 12.9-23.6) had recurrent wheezing. There was significant morbidity associated to recurrent wheezing in terms of severe episodes (17.3%-95% CI 12-22.5), visits to the emergency department (26.2%-95% CI 20.1-32.2) and hospital admissions (5.4%-95% CI 2.2-8.5); 10.4% (95% CI 6.1-14.6) used inhaled corticosteroids and 7.9% (95% CI 4.1-11.6) used a leukotriene receptor antagonist. CONCLUSIONS The prevalence of recurrent wheezing in infants during the first year of life is high and is associated with significant morbidity, presenting as a relevant public health problem. An important proportion of infants' progress with a more severe condition, resulting in high use of health resources (visits to emergency department and hospitalisations). The prevalence of recurrent wheezing in this district of Portugal stays between those related in other European and Latin American Centres, suggesting that maybe some of the well-known risk factors are shared with affluent countries.
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17
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Seeni I, Ha S, Nobles C, Liu D, Sherman S, Mendola P. Air pollution exposure during pregnancy: maternal asthma and neonatal respiratory outcomes. Ann Epidemiol 2018; 28:612-618.e4. [PMID: 30153910 PMCID: PMC6232679 DOI: 10.1016/j.annepidem.2018.06.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/01/2018] [Accepted: 06/05/2018] [Indexed: 01/24/2023]
Abstract
PURPOSE Maternal asthma increases adverse neonatal respiratory outcomes, and pollution may further increase risk. Air quality in relation to neonatal respiratory health has not been studied. METHODS Transient tachypnea of the newborn (TTN), asphyxia, and respiratory distress syndrome (RDS) were identified using medical records among 223,375 singletons from the Consortium on Safe Labor (2002-2008). Community Multiscale Air Quality models estimated pollutant exposures. Multipollutant Poisson regression models calculated adjusted relative risks of outcomes for interquartile range increases in average exposure. Maternal asthma and preterm delivery were evaluated as effect modifiers. RESULTS TTN risk increased after particulate matter (PM) less than or equal to 10-micron exposure during preconception and trimester one (9-10%), and whole-pregnancy exposure to PM less than or equal to 2.5 microns (PM2.5; 17%) and carbon monoxide (CO; 10%). Asphyxia risk increased after exposure to PM2.5 in trimester one (48%) and whole pregnancy (84%), CO in trimester two and whole pregnancy (28-32%), and consistently for ozone (34%-73%). RDS risk was associated with increased concentrations of nitrogen oxides (33%-42%) and ozone (9%-21%) during all pregnancy windows. Inverse associations were observed with several pollutants, particularly sulfur dioxide. No interaction with maternal asthma was observed. Restriction to term births yielded similar results. CONCLUSIONS Several pollutants appear to increase neonatal respiratory outcome risks.
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Affiliation(s)
- Indulaxmi Seeni
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Bethesda, MD
| | - Sandie Ha
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Bethesda, MD; University of California, Merced, Social Sciences and Management Building, Merced, CA
| | - Carrie Nobles
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Bethesda, MD
| | - Danping Liu
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Bethesda, MD; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Biostatistics Branch, Rockville, MD
| | | | - Pauline Mendola
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Intramural Population Health Research, Bethesda, MD.
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Scambler T, Holbrook J, Savic S, McDermott MF, Peckham D. Autoinflammatory disease in the lung. Immunology 2018; 154:563-573. [PMID: 29676014 PMCID: PMC6050210 DOI: 10.1111/imm.12937] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 01/11/2023] Open
Abstract
Ascertaining the dominant cell type driving an immunological disease is essential to understanding the causal pathology and, therefore, selecting or developing an effective treatment. Classifying immunological diseases in this way has led to successful treatment regimens for many monogenic diseases; however, when the dominant cell type is unclear and there is no obvious causal genetic mutation, then identifying the correct disease classification and appropriate therapy can be challenging. In this review we focus on pulmonary immunological diseases where an innate immune signature has been identified as a predominant aspect of the immunopathology. We describe the molecular pathology of 'autoinflammatory diseases of the lung' and propose that small molecule and biological therapies, including recombinant interleukin-1 receptor antagonist, that target key innate immune pathways, are likely be beneficial in the control of pulmonary and systemic inflammation in these conditions. In addition, the successful use of macrolide antibiotics to treat lung infections in these conditions further confirms that the innate immune system is the key conductor of inflammation in these pulmonary diseases, as there is a strong body of evidence that macrolides are able to modulate the NLRP3 inflammasome and interleukin-1β and interleukin-18 secretion, both of which are central players in the innate immune response. Throughout this review we highlight the published evidence of autoinflammatory disease in chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis and rheumatoid lung disease and suggest that the fundamental pathology of these diseases places them towards the autoinflammatory pole of the immunological disease continuum.
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Affiliation(s)
- Thomas Scambler
- Leeds Institute of Rheumatic and Musculoskeletal MedicineSt James's University HospitalLeedsUK
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
| | - Jonathan Holbrook
- Leeds Institute of Rheumatic and Musculoskeletal MedicineSt James's University HospitalLeedsUK
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
- Leeds Institute of Biomedical and Clinical SciencesSt James's University HospitalLeedsUK
| | - Sinisa Savic
- Leeds Institute of Rheumatic and Musculoskeletal MedicineSt James's University HospitalLeedsUK
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
- Department of Clinical Immunology and AllergySt James's University HospitalLeedsUK
| | - Michael F. McDermott
- Leeds Institute of Rheumatic and Musculoskeletal MedicineSt James's University HospitalLeedsUK
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
| | - Daniel Peckham
- Cystic Fibrosis Trust Strategic Research CentreSt James's University HospitalLeedsUK
- Leeds Institute of Biomedical and Clinical SciencesSt James's University HospitalLeedsUK
- Leeds Centre for Cystic FibrosisSt James's University HospitalLeedsUK
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19
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Savran O, Ulrik CS. Early life insults as determinants of chronic obstructive pulmonary disease in adult life. Int J Chron Obstruct Pulmon Dis 2018. [PMID: 29520136 PMCID: PMC5834168 DOI: 10.2147/copd.s153555] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Early life events may predispose to the development of chronic lung disease in adulthood. Aim To provide an update on current knowledge of early nongenetic origins of COPD. Materials and methods Systematic literature review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results A total of 16 studies, comprising 69,365 individuals, met the predefined criteria and were included in the present review. Studies have shown that in utero tobacco exposure, low birth weight, preterm birth, and respiratory diseases, primarily asthma and pneumonia, in early childhood are associated with lung function impairment later in childhood, and by that predispose to subsequent development of COPD, although the causal association between childhood respiratory diseases and COPD has been questioned in one study. Environmental tobacco exposure has also been shown to have negative impact on lung function in childhood possibly leading to COPD in adulthood, although it is at present not possible to clearly distinguish between the impact of active and the environmental tobacco exposure on subsequent development of COPD. Conclusion Tobacco exposure in utero and early life is a risk factor for subsequent development of COPD. Furthermore, low birth weight, lower respiratory tract infections and asthma, including wheezy bronchitis, in childhood also seem to be important determinants for later development of COPD. Early life insults may, therefore, be crucial to COPD development.
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Affiliation(s)
- Osman Savran
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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20
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Jung JH, Chu SY, Kim JY, Han TH, Park SH, Chung JY, Kim HB. Correlation of respiratory syncytial virus infection with climate parameters and air pollution levels in Korean children during 2005–2012. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.4.206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ji-Hyun Jung
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Shou-Yu Chu
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Je-Yeon Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Tae-Hee Han
- Department of Diagnostic Laboratory Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Sang-Hun Park
- Microbiology Division, Seoul Health Environment Research Center, Seoul, Korea
| | - Ju-Young Chung
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
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21
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Lambert L, Culley FJ. Innate Immunity to Respiratory Infection in Early Life. Front Immunol 2017; 8:1570. [PMID: 29184555 PMCID: PMC5694434 DOI: 10.3389/fimmu.2017.01570] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/01/2017] [Indexed: 01/09/2023] Open
Abstract
Early life is a period of particular susceptibility to respiratory infections and symptoms are frequently more severe in infants than in adults. The neonatal immune system is generally held to be deficient in most compartments; responses to innate stimuli are weak, antigen-presenting cells have poor immunostimulatory activity and adaptive lymphocyte responses are limited, leading to poor immune memory and ineffective vaccine responses. For mucosal surfaces such as the lung, which is continuously exposed to airborne antigen and to potential pathogenic invasion, the ability to discriminate between harmless and potentially dangerous antigens is essential, to prevent inflammation that could lead to loss of gaseous exchange and damage to the developing lung tissue. We have only recently begun to define the differences in respiratory immunity in early life and its environmental and developmental influences. The innate immune system may be of relatively greater importance than the adaptive immune system in the neonatal and infant period than later in life, as it does not require specific antigenic experience. A better understanding of what constitutes protective innate immunity in the respiratory tract in this age group and the factors that influence its development should allow us to predict why certain infants are vulnerable to severe respiratory infections, design treatments to accelerate the development of protective immunity, and design age specific adjuvants to better boost immunity to infection in the lung.
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Affiliation(s)
- Laura Lambert
- Faculty of Medicine, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Fiona J Culley
- Faculty of Medicine, Respiratory Infections Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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22
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Yuksel H, Turkeli A. Airway epithelial barrier dysfunction in the pathogenesis and prognosis of respiratory tract diseases in childhood and adulthood. Tissue Barriers 2017; 5:e1367458. [PMID: 28886270 DOI: 10.1080/21688370.2017.1367458] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The lungs are in direct contact with the environment through the tubular structure that constitutes the airway. Starting from the nasal orifice, the airway is exposed to foreign particles including infectious agents, allergens, and other substances that can damage the airways. Therefore, the airway must have a functional epithelial barrier both in the upper and lower airways to protect against these threats. As with the skin, it is likely that the pathogenesis of respiratory diseases is a consequence of epithelial barrier defects in these airways. The characteristics of this system, starting from the beginning of life and extending into maturing and aging, determine the prognosis of respiratory diseases. In this article, we discuss the pathogenesis, clinical phenotype, and prognosis of respiratory diseases from newborns to adulthood in the context of epithelial barrier function and dysfunction.
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Affiliation(s)
- Hasan Yuksel
- a Department of Pediatric Allergy and Pulmonology , Celal Bayar University Medical Faculty , Manisa , Turkey
| | - Ahmet Turkeli
- a Department of Pediatric Allergy and Pulmonology , Celal Bayar University Medical Faculty , Manisa , Turkey
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23
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Abstract
Recent years have witnessed critical contributions to our understanding of the determinants and long-term implications of lung function development. In this article, we review studies that have contributed to advances in understanding lung function development and its critical importance for lung health into adult life. In particular, we have focused on early life determinants that include genetic factors, perinatal events, environmental exposures, lifestyle, infancy lower respiratory tract infections, and persistent asthma phenotypes. Longitudinal studies have conclusively demonstrated that lung function deficits that are established by school age may track into adult life and increase the risk of adult lung obstructive diseases, such as chronic obstructive pulmonary disease. Furthermore, these contributions have provided initial evidence in support of a direct influence by early life events on an accelerated decline of lung function and an increased susceptibility to its environmental determinants well into adult life. As such, we argue that future health-care programs based on precision medicine approaches that integrate deep phenotyping with tailored medication and advice to patients should also foster optimal lung function growth to be fully effective.
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Affiliation(s)
- Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's Hospital, Södersjukhuset, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA.,ISGlobal Center for Research in Environmental Epidemiology, Barcelona, Spain
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24
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Kouzouna A, Gilchrist FJ, Ball V, Kyriacou T, Henderson J, Pandyan AD, Lenney W. A systematic review of early life factors which adversely affect subsequent lung function. Paediatr Respir Rev 2016; 20:67-75. [PMID: 27197758 DOI: 10.1016/j.prrv.2016.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 01/15/2023]
Abstract
It has been known for many years that multiple early life factors can adversely affect lung function and future respiratory health. This is the first systematic review to attempt to analyse all these factors simultaneously. We adhered to strict a priori criteria for inclusion and exclusion of studies. The initial search yielded 29,351 citations of which 208 articles were reviewed in full and 25 were included in the review. This included 6 birth cohorts and 19 longitudinal population studies. The 25 studies reported the effect of 74 childhood factors (on their own or in combinations with other factors) on subsequent lung function reported as percent predicted forced expiration in one second (FEV1). The childhood factors that were associated with a significant reduction in future FEV1 could be grouped as: early infection, bronchial hyper-reactivity (BHR) / airway lability, a diagnosis of asthma, wheeze, family history of atopy or asthma, respiratory symptoms and prematurity / low birth weight. A complete mathematical model will only be possible if the raw data from all previous studies is made available. This highlights the need for increased cooperation between researchers and the need for international consensus about the outcome measures for future longitudinal studies.
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Affiliation(s)
- A Kouzouna
- Institute of Science and Technology in Medicine, Keele University, Staffordshire, ST5 5BG, UK; School of Health Rehabilitation, Keele University, Staffordshire, ST5 5BG, UK
| | - F J Gilchrist
- Institute of Science and Technology in Medicine, Keele University, Staffordshire, ST5 5BG, UK; Royal Stoke University Hospital, Stoke on Trent, Newcastle Road, ST4 6QG
| | - V Ball
- School of Health Rehabilitation, Keele University, Staffordshire, ST5 5BG, UK
| | - T Kyriacou
- School of Computing, Keele University, Staffordshire, ST5 5BG, UK
| | - J Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2BN, UK
| | - A D Pandyan
- Institute of Science and Technology in Medicine, Keele University, Staffordshire, ST5 5BG, UK; School of Health Rehabilitation, Keele University, Staffordshire, ST5 5BG, UK
| | - W Lenney
- Institute of Science and Technology in Medicine, Keele University, Staffordshire, ST5 5BG, UK; Royal Stoke University Hospital, Stoke on Trent, Newcastle Road, ST4 6QG.
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25
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Jones RL, Noble PB, Elliot JG, James AL. Airway remodelling in COPD: It's not asthma! Respirology 2016; 21:1347-1356. [PMID: 27381663 DOI: 10.1111/resp.12841] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 04/03/2016] [Accepted: 04/30/2016] [Indexed: 11/29/2022]
Abstract
COPD is defined as airflow limitation that is not reversed by treatment. In asthma, airflow limitation is not only reversible, but also inducible. This is called 'airway hyperresponsiveness' (AHR) and is associated with thickening of the airway wall, predominantly the layer of airway smooth muscle, due to more cells, bigger cells and more extracellular matrix (ECM) in proportion to the increase in smooth muscle. AHR is also observed in COPD if the changes in airflow are expressed as a percent of the baseline lung function. However, the absolute change in baseline lung function that can be induced in COPD is actually less than that seen in normal subjects, suggesting that the airways in COPD are resistant not only to opening, but also to closing. This observation agrees with physiological measures showing increased airway wall stiffness in COPD. Like asthma, airway wall thickness is increased in COPD, including the layer of smooth muscle. Unlike asthma, however, fixed airflow obstruction appears to be characterized by a disproportionate increase in the ECM within the smooth muscle layer. In this review, we summarize the studies of airway matrix deposition in COPD and put forward the proposal that the airway remodelling in COPD is different from that in asthma and call for a systematic analysis of airway matrix deposition in COPD.
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Affiliation(s)
- Robyn L Jones
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. .,School of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, Western Australia, Australia.
| | - Peter B Noble
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, Western Australia, Australia.,Centre for Neonatal Research and Education, School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - John G Elliot
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
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26
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Perret JL, Walters H, Johns D, Gurrin L, Burgess J, Lowe A, Thompson B, Markos J, Morrison S, Thomas P, McDonald C, Wood-Baker R, Hopper J, Svanes C, Giles G, Abramson M, Matheson M, Dharmage S. Mother's smoking and complex lung function of offspring in middle age: A cohort study from childhood. Respirology 2016; 21:911-9. [PMID: 26969872 DOI: 10.1111/resp.12750] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 08/31/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Existing evidence that supports maternal smoking to be a potential risk factor for chronic obstructive pulmonary disease (COPD) for adult offspring has barely been mentioned in major guideline documents, suggesting a need for more robust and consistent data. We aimed to examine whether such early life exposure can predispose to COPD in middle age, possibly through its interaction with personal smoking. METHODS The fifth-decade follow-up of the Tasmanian Longitudinal Health Study cohort, which was first studied in 1968 (n = 8583), included a 2004 postal survey (n = 5729 responses) and subsequent laboratory attendance (n = 1389) for comprehensive lung function testing between 2006 and 2008. Multivariable linear and logistic regression models included sampling weights. RESULTS Post-bronchodilator airflow obstruction (less than fifth percentile) was detected for 9.3% (n = 123) of middle-aged offspring. Its association with heavy maternal smoking (>20 cigarettes/day) during childhood was 2.7-fold higher than for those without exposure (95% confidence interval [1.3, 5.7] P = 0.009). Maternal smoking per se approximately doubled the adverse effect of personal smoking on gas transfer factor (z-score -0.46 [-0.6 to -0.3] vs -0.25 [-0.4 to -0.1], P[interaction] = 0.048) and was paradoxically associated with reduced residual volumes for non-smokers. CONCLUSIONS Heavy maternal smoking during childhood appears to predispose to spirometrically defined COPD. The interplay between maternal and personal smoking on gas transfer factor suggests that early life exposure increases an individual's susceptibility to adult smoking exposure. These findings provide further evidence to suggest that maternal smoking might be a risk factor for COPD and reinforce the public health message advocating smoking abstinence.
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Affiliation(s)
- Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne.,Department of Respiratory and Sleep Medicine, Austin Hospital.,Institute for Breathing and Sleep (IBAS)
| | - Haydn Walters
- 'Breathe Well' Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania.,School of Medicine, University of Notre Dame
| | - David Johns
- 'Breathe Well' Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania
| | - Lyle Gurrin
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - John Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - Adrian Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - Bruce Thompson
- Institute for Breathing and Sleep (IBAS).,Allergy, Immunology and Respiratory Medicine, The Alfred Hospital.,Department of Medicine, Monash University
| | - James Markos
- Launceston General Hospital, Launceston, Tasmania
| | - Stephen Morrison
- Department of Medicine, University of Queensland, Brisbane, Queensland
| | - Paul Thomas
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Christine McDonald
- Department of Respiratory and Sleep Medicine, Austin Hospital.,Institute for Breathing and Sleep (IBAS)
| | - Richard Wood-Baker
- 'Breathe Well' Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania
| | - John Hopper
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne.,Department of Public Health, Seoul National University, Seoul, Korea
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Graham Giles
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne.,Cancer Epidemiology Centre, Cancer Council Victoria.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Abramson
- Allergy, Immunology and Respiratory Medicine, The Alfred Hospital.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
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27
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Margelidon-Cozzolino V, Chbini K, Freymond N, Devouassoux G, Belaaouaj A, Pacheco Y. [COPD: An early disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:49-60. [PMID: 26657351 PMCID: PMC7126852 DOI: 10.1016/j.pneumo.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/16/2015] [Indexed: 05/04/2023]
Abstract
This general review deals with the mechanisms which underlie the genetic factors in COPD. Many cellular and biochemical mechanisms occur in bronchial inflammation. We present the experimental models of COPD, insisting on the importance of oxydative stress, and on recent knowledge about the lung microbiome. Starting from this pathophysiology basis, we show how various genetic targets are able to interfere with the disease model. Thanks to these genetic targets, new markers in exhaled breath condensates and new drug targets are rising.
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Affiliation(s)
- V Margelidon-Cozzolino
- Service de pneumologie A, centre hospitalier de Lyon Sud, hospices civils de Lyon, faculté de médecine, université Claude-Bernard Lyon 1, 69310 Pierre-Bénite, France.
| | - K Chbini
- Service de cardiologie, CHU Mohammed VI, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc
| | - N Freymond
- Service de pneumologie A, centre hospitalier de Lyon Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - G Devouassoux
- Service de pneumologie, hôpital de la Croix Rousse, hospices civils de Lyon, faculté de médecine Lyon Sud, université Claude-Bernard Lyon 1, 69005 Lyon, France
| | - A Belaaouaj
- Inserm 1111, faculté de médecine Lyon Sud, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - Y Pacheco
- Service de pneumologie A, centre hospitalier de Lyon Sud, hospices civils de Lyon, faculté de médecine Lyon Sud, université Claude-Bernard Lyon 1, 69310 Pierre-Bénite, France
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28
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Abstract
A substantial proportion of the global burden of disease is directly or indirectly attributable to exposure to air pollution. Exposures occurring during the periods of organogenesis and rapid lung growth during fetal development and early post-natal life are especially damaging. In this State of the Art review, we discuss air toxicants impacting on children's respiratory health, routes of exposure with an emphasis on unique pathways relevant to young children, methods of exposure assessment and their limitations and the adverse health consequences of exposures. Finally, we point out gaps in knowledge and research needs in this area. A greater understanding of the adverse health consequences of exposure to air pollution in early life is required to encourage policy makers to reduce such exposures and improve human health.
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Affiliation(s)
- Fiona C Goldizen
- Queensland Children's Medical Research Institute, Brisbane, Queensland, Australia.,Children's Health and Environment Program, Children's Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, Brisbane, Queensland, Australia.,Children's Health and Environment Program, Children's Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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29
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Abstract
Despite the high prevalence of cough in children, the topic has been poorly researched. Although pediatricians recognize that chronic cough in children is different from that in adults, this difference seems less recognizable to other health professionals. During childhood, the respiratory tract and nervous system undergo a series of anatomical and physiological maturation processes that influence the cough reflex. Additionally, immunological responses undergo developmental and memorial processes that make infection and congenital abnormalities the overwhelming cause of cough in children. The lack of comprehensive clinical data regarding chronic cough in children has initially required pediatricians to adopt an adult approach to the problem. In the last 10 years, however, research has led to the reconsideration of the etiology of chronic cough in children. Currently, attention has focused on protracted bacterial bronchitis as a major cause of chronic cough in preschool-aged children and as a possible precursor of bronchiectasis. New research horizons are emerging for both the treatment and prevention of particular causes of chronic cough in children.
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Affiliation(s)
- Ahmad Kantar
- Pediatric Asthma and Cough Centre, Istituti Ospedalieri Bergamaschi, University and Research Hospitals, via Forlanini 15, Ponte San Pietro-Bergamo, 24036, Bergamo, Italy.
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30
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Hayden LP, Hobbs BD, Cohen RT, Wise RA, Checkley W, Crapo JD, Hersh CP. Childhood pneumonia increases risk for chronic obstructive pulmonary disease: the COPDGene study. Respir Res 2015; 16:115. [PMID: 26392057 PMCID: PMC4578796 DOI: 10.1186/s12931-015-0273-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/06/2015] [Indexed: 12/30/2022] Open
Abstract
Background Development of adult respiratory disease is influenced by events in childhood. The impact of childhood pneumonia on chronic obstructive pulmonary disease (COPD) is not well defined. We hypothesize that childhood pneumonia is a risk factor for reduced lung function and COPD in adult smokers. Methods COPD cases and control smokers between 45–80 years old from the United States COPDGene Study were included. Childhood pneumonia was defined by self-report of pneumonia at <16 years. Subjects with lung disease other than COPD or asthma were excluded. Smokers with and without childhood pneumonia were compared on measures of respiratory disease, lung function, and quantitative analysis of chest CT scans. Results Of 10,192 adult smokers, 854 (8.4 %) reported pneumonia in childhood. Childhood pneumonia was associated with COPD (OR 1.40; 95 % CI 1.17-1.66), chronic bronchitis, increased COPD exacerbations, and lower lung function: post-bronchodilator FEV1 (69.1 vs. 77.1 % predicted), FVC (82.7 vs. 87.4 % predicted), FEV1/FVC ratio (0.63 vs. 0.67; p < 0.001 for all comparisons). Childhood pneumonia was associated with increased airway wall thickness on CT, without significant difference in emphysema. Having both pneumonia and asthma in childhood further increased the risk of developing COPD (OR 1.85; 95 % CI 1.10-3.18). Conclusions Children with pneumonia are at increased risk for future smoking-related lung disease including COPD and decreased lung function. This association is supported by airway changes on chest CT scans. Childhood pneumonia may be an important factor in the early origins of COPD, and the combination of pneumonia and asthma in childhood may pose the greatest risk. Clinical trials registration ClinicalTrials.gov, NCT00608764 (Active since January 28, 2008). Electronic supplementary material The online version of this article (doi:10.1186/s12931-015-0273-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lystra P Hayden
- Division of Respiratory Diseases, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA. .,Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Ave., Boston, MA, 02115, USA.
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Ave., Boston, MA, 02115, USA. .,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
| | - Robyn T Cohen
- Department of Pediatrics, Boston University School of Medicine, 72 E Concord St., Boston, MA, 02118, USA.
| | - Robert A Wise
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD, 21205, USA.
| | - William Checkley
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 E. Monument St., Baltimore, MD, 21205, USA.
| | - James D Crapo
- Department of Medicine, National Jewish Health, 1400 Jackson St., Denver, CO, 80206, USA.
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, 181 Longwood Ave., Boston, MA, 02115, USA. .,Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
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31
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Abstract
INTRODUCTION Esophageal atresia and tracheoesophageal fistula (EA-TEF) survivors suffer respiratory morbidity of unclear pathogenesis. Defective lung morphogenesis has been described in the rat model. This study examined fetal lung growth and maturity in rats and patients with EA-TEF. METHODS Pregnant rats received either adriamycin or vehicle. Control and adriamycin-exposed lungs, with and without EA-TEF, were weighed and processed for RT-PCR, DNA quantification, immunofluorescence and immunoblot analysis of TTF1, VEGF, Sp-B, and α-sma. Twenty human lungs were also processed for immunofluorescence and Alcian-blue staining. RESULTS Lungs from fetuses with EA-TEF (E21) showed decreased total DNA; FGF7 and TTF1 mRNA expressions were upregulated at E15 and E18, respectively. Protein expression and immunofluorescent distribution of maturity markers were similar. Lungs from stillborns with EA-TEF showed decreased epithelial expression of Sp-B and VEGF whereas those from newborns tended to have less Sp-B and more VEGF and mucous glands. DISCUSSION The lungs of rats with EA-TEF were hypoplastic but achieved near-normal maturity. Stillborns with EA-TEF exhibited an apparently disturbed differentiation of the airway epithelium. Newborns with EA-TEF demonstrated subtle differences in the expression of differentiation markers, and increased number of mucous glands that could influence postnatal respiratory adaptation and explain some respiratory symptoms of EA-TEF survivors.
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Affiliation(s)
- Ana Catarina Fragoso
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; Department of Congenital Malformations, INGEMM and IdiPaz Research Laboratory, Madrid, Spain; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Leopoldo Martinez
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; Department of Congenital Malformations, INGEMM and IdiPaz Research Laboratory, Madrid, Spain
| | | | - Juan A Tovar
- Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; Department of Congenital Malformations, INGEMM and IdiPaz Research Laboratory, Madrid, Spain
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32
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Silva R, Oyarzún M, Olloquequi J. Pathogenic Mechanisms in Chronic Obstructive Pulmonary Disease Due to Biomass Smoke Exposure. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.arbr.2015.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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33
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Gibson PG, McDonald VM. Asthma-COPD overlap 2015: now we are six. Thorax 2015; 70:683-91. [PMID: 25948695 DOI: 10.1136/thoraxjnl-2014-206740] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/17/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The overlap between asthma and COPD is increasingly recognised. This review examines the new insights, treatment and remaining knowledge gaps for asthma-COPD overlap. METHOD A systematic literature review of cluster analyses of asthma and COPD was performed. Articles from 2009 to the present dealing with prevalence, morbidity and treatment of asthma-COPD overlap were identified and reviewed. RESULTS Asthma-COPD overlap was consistently recognised in studies using a variety of different study designs and sampling. The prevalence was approximately 20% in patients with obstructive airways diseases. Asthma-COPD overlap was associated with increased morbidity and possibly an increased mortality and comorbidity. There was evidence of a heterogeneous pattern of airway inflammation that included eosinophilic (in adult asthma), neutrophilic or mixed patterns (in severe asthma and COPD). Systemic inflammation was present in asthma-COPD overlap and resembled that of COPD. Within asthma-COPD overlap, there is evidence of different subgroups, and recognition using bronchodilator responsiveness has not been successful. Guidelines generally recommend a serial approach to assessment, with treatment recommendations dominated by an asthma paradigm. Research is needed into key clinical features that impact outcome, mechanisms and treatment approaches in asthma-COPD overlap. Identifying and treating disease components by multidimensional assessment shows promise. CONCLUSIONS Asthma-COPD overlap has drawn attention to the significant heterogeneity that exists within obstructive airway diseases. It should be replaced by novel approaches that identify and manage the components of this heterogeneity, such as multidimensional assessment and treatment. Future research is needed to test these novel and personalised approaches.
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Affiliation(s)
- Peter G Gibson
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle, Newcastle, New South Wales, Australia Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Vanessa M McDonald
- Priority Research Centre for Asthma and Respiratory Diseases, University of Newcastle, Newcastle, New South Wales, Australia Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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34
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Beamer PI, Lothrop N, Stern DA, Billheimer D, Wright AL, Martinez FD. Increased wheezing risk with diesel exposure among children of younger mothers. Eur Respir J 2015; 46:853-5. [PMID: 25882808 DOI: 10.1183/09031936.00227214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 03/03/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Paloma I Beamer
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA Environmental Health Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA Bio5 Institute, University of Arizona, Tucson, AZ, USA
| | - Nathan Lothrop
- Environmental Health Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Debra A Stern
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
| | - Dean Billheimer
- Bio5 Institute, University of Arizona, Tucson, AZ, USA Agricultural and Biosystems Engineering, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA
| | - Anne L Wright
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA
| | - Fernando D Martinez
- Arizona Respiratory Center, University of Arizona, Tucson, AZ, USA Bio5 Institute, University of Arizona, Tucson, AZ, USA
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35
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Melén E. Bridging genetics, epidemiology, and respiratory medicine. Am J Respir Crit Care Med 2015; 190:716-8. [PMID: 25271741 DOI: 10.1164/rccm.201408-1524ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Erik Melén
- 1 Institute of Environmental Medicine and the Centre for Allergy Research Karolinska Institutet Stockholm, Sweden and
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36
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Bonner R, Bountziouka V, Stocks J, Harding S, Wade A, Griffiths C, Sears D, Fothergill H, Slevin H, Lum S. Birth data accessibility via primary care health records to classify health status in a multi-ethnic population of children: an observational study. NPJ Prim Care Respir Med 2015; 25:14112. [PMID: 25612149 PMCID: PMC4353844 DOI: 10.1038/npjpcrm.2014.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/02/2014] [Accepted: 11/11/2014] [Indexed: 01/25/2023] Open
Abstract
Background: Access to reliable birth data (birthweight (BW) and gestational age (GA)) is essential for the identification of individuals who are at subsequent health risk. Aims: This study aimed to explore the feasibility of retrospectively collecting birth data for schoolchildren from parental questionnaires (PQ) and general practitioners (GPs) in primary care clinics, in inner city neighbourhoods with high density of ethnic minority and disadvantaged populations. Methods: Attempts were made to obtain birth data from parents and GPs for 2,171 London primary schoolchildren (34% White, 29% Black African origin, 25% South Asians, 12% Other) as part of a larger study of respiratory health. Results: Information on BW and/or GA were obtained from parents for 2,052 (95%) children. Almost all parents (2,045) gave consent to access their children’s health records held by GPs. On the basis of parental information, GPs of 1,785 children were successfully contacted, and GPs of 1,202 children responded. Birth data were retrieved for only 482 children (22% of 2,052). Missing birth data from GPs were associated with non-white ethnicity, non-UK born, English not the dominant language at home or socioeconomic disadvantage. Paired data were available in 376 children for BW and in 407 children for GA. No significant difference in BW or GA was observed between PQ and GP data, with <5% difference between sources regardless of normal or low birth weight, or term or preterm status. Conclusions: Parental recall of birth data for primary schoolchildren yields high quality and rapid return of data, and it should be considered as a viable alternative in which there is limited access to birth records. It provides the potential to include children with an increased risk of health problems within epidemiological studies.
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Affiliation(s)
- Rachel Bonner
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Vassiliki Bountziouka
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Janet Stocks
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
| | - Seeromanie Harding
- MRC/CSO, Social and Public Health Sciences Unit, University of Glasgow, 4 Lilybank Gardens, Glasgow, UK
| | - Angela Wade
- Clinical Epidemiology, Nutrition and Biostatistics Section, UCL, Institute of Child Health, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - David Sears
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Lung Function Unit, Royal Brompton Hospital, London, UK
| | - Helen Fothergill
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Torbay Hospital, South Devon NHS Trust, Torquay, Devon, UK
| | - Hannah Slevin
- 1] Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK [2] Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sooky Lum
- Respiratory, Critical Care & Anaesthesia Section (Portex Unit), UCL, Institute of Child Health, London, UK
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Silva R, Oyarzún M, Olloquequi J. Pathogenic mechanisms in chronic obstructive pulmonary disease due to biomass smoke exposure. Arch Bronconeumol 2015; 51:285-92. [PMID: 25614376 DOI: 10.1016/j.arbres.2014.10.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/12/2014] [Accepted: 10/14/2014] [Indexed: 12/31/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) mortality and morbidity have increased significantly worldwide in recent decades. Although cigarette smoke is still considered the main risk factor for the development of the disease, estimates suggest that between 25% and 33% of COPD patients are non-smokers. Among the factors that may increase the risk of developing COPD, biomass smoke has been proposed as one of the most important, affecting especially women and children in developing countries. Despite the epidemiological evidence linking exposure to biomass smoke with adverse health effects, the specific cellular and molecular mechanisms by which this pollutant can be harmful for the respiratory and cardiovascular systems remain unclear. In this article we review the main pathogenic mechanisms proposed to date that make biomass smoke one of the major risk factors for COPD.
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Affiliation(s)
- Rafael Silva
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Manuel Oyarzún
- Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Jordi Olloquequi
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.
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Abstract
Assessments of pulmonary function play an integral part in the clinical management of school age children as well as providing objective outcome measures in clinical and epidemiological research studies. Pulmonary function tests (PFTs) can also be undertaken in sleeping infants and in awake young children from 3 years of age. However, the clinical utility of such assessments, which are generally confined to specialist centres, has yet to be established. Whether requesting or undertaking paediatric PFTs, or simply reading about how these tests have been applied in research studies, it is essential to question whether results have been interpreted in a meaningful way. This review summarises some of the issues that need to be considered, including: why the tests are being performed; which tests are most likely to detect the suspected pathophysiology; how often such tests should be repeated; whether results are likely to be reliable (in terms of data quality, repeatability and the availability of suitable reference equations with which to distinguish the effects of disease from those of growth and development), and whether the selected tests are likely to be feasible in the individual child or study group under investigation.
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Perret JL, Walters EH, Abramson MJ, McDonald CF, Dharmage SC. The independent and combined effects of lifetime smoke exposures and asthma as they relate to COPD. Expert Rev Respir Med 2014; 8:503-14. [PMID: 24834459 DOI: 10.1586/17476348.2014.905913] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is part of a worldwide tobacco-related disease epidemic, and is associated with progressive airflow obstruction and varying degrees of emphysema and/or hyperinflation. Greater focus has been placed recently on the potential for early life factors to influence the development of COPD, based on the premise that delayed lung growth during childhood and adolescence might predispose to lung disease in later life. For most people, the adverse effects on lung function of adult and early childhood factors are additive, which provides no additional incentive for current smokers to quit. However, if there is a (synergistic) interaction between active smoking and asthma, smoking cessation is likely to have a greater lung function benefit for the smoker who is also asthmatic, especially if quitting occurs at an early age. This article critically evaluates the evidence for the independent associations of lifetime asthma, smoking and smoke exposures with airflow obstruction, plus their interaction when multiple factors are present.
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Affiliation(s)
- Jennifer L Perret
- Unit for Allergy and Lung Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne 3010, Victoria, Australia
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Abstract
Pediatricians play a key role in advancing child health research to best attain and improve the physical, mental, and social health and well-being of all infants, children, adolescents, and young adults. Child health presents unique issues that require investigators who specialize in pediatric research. In addition, the scope of the pediatric research enterprise is transdisciplinary and includes the full spectrum of basic science, translational, community-based, health services, and child health policy research. Although most pediatricians do not directly engage in research, knowledge of research methodologies and approaches promotes critical evaluation of scientific literature, the practice of evidence-based medicine, and advocacy for evidence-based child health policy. This statement includes specific recommendations to promote further research education and support at all levels of pediatric training, from premedical to continuing medical education, as well as recommendations to increase support and mentorship for research activities. Pediatric research is crucial to the American Academy of Pediatrics' goal of improving the health of all children. The American Academy of Pediatrics continues to promote and encourage efforts to facilitate the creation of new knowledge and ways to reduce barriers experienced by trainees, practitioners, and academic faculty pursuing research.
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Tai A, Tran H, Roberts M, Clarke N, Wilson J, Robertson CF. The association between childhood asthma and adult chronic obstructive pulmonary disease. Thorax 2014; 69:805-10. [DOI: 10.1136/thoraxjnl-2013-204815] [Citation(s) in RCA: 215] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Stocks J, Hislop A, Sonnappa S. Early lung development: lifelong effect on respiratory health and disease. THE LANCET RESPIRATORY MEDICINE 2013; 1:728-42. [PMID: 24429276 DOI: 10.1016/s2213-2600(13)70118-8] [Citation(s) in RCA: 236] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Interest in the contribution of changes in lung development during early life to subsequent respiratory morbidity is increasing. Most evidence of an association between adverse intrauterine factors and structural effects on the developing lung is from animal studies. Such evidence has been augmented by epidemiological studies showing associations between insults to the developing lung during prenatal and early postnatal life and adult respiratory morbidity or reduced lung function, and by physiological studies that have elucidated mechanisms underlying these associations. The true effect of early insults on subsequent respiratory morbidity can be understood only if the many prenatal and postnatal factors that can affect lung development are taken into account. Adverse factors affecting lung development during fetal life and early childhood reduce the attainment of maximum lung function and accelerate lung function decline in adulthood, initiating or worsening morbidity in susceptible individuals. In this Review, we focus on factors that adversely affect lung development in utero and during the first 5 years after birth, thereby predisposing individuals to reduced lung function and increased respiratory morbidity throughout life. We focus particularly on asthma and COPD.
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Affiliation(s)
- Janet Stocks
- University College London, Institute of Child Health, London, UK.
| | - Alison Hislop
- University College London, Institute of Child Health, London, UK
| | - Samatha Sonnappa
- University College London, Institute of Child Health, London, UK
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Abstract
PURPOSE OF REVIEW Unlike other major diseases, mortality for chronic obstructive pulmonary disease (COPD) continues to increase. In recent years, COPD has evolved to increasingly affect women, minorities, and individuals from low socioeconomic groups. In women and African-Americans, evidence exists supporting the earlier development of COPD after less lifetime smoking. This review highlights new information on racial and sex differences in COPD. RECENT FINDINGS Sex and related hormonal changes affect T-cell phenotypes, immunity, and smoking-related metabolism of toxic intermediate metabolites. Alterations in the bronchoalveolar lavage proteome of women, but not of men, have allowed the differentiation of healthy female smokers from smokers with COPD. Sex significantly influences levels of inflammatory cytokines and correlates with different clinical and physiological parameters in female COPD patients. African-Americans with COPD are younger, smoke less, are more likely to currently smoke, and have worse health-related quality of life (QOL). African-Americans are more likely to report hospitalized exacerbations that impact QOL. African-Americans with COPD and asthma are nearly four times more likely to experience exacerbations. SUMMARY There are sex-specific and race-related differences in the manifestation of COPD. These differences warrant further physiologic, biologic, and genetic investigations.
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Stocks J, Sonnappa S. Early life influences on the development of chronic obstructive pulmonary disease. Ther Adv Respir Dis 2013; 7:161-73. [PMID: 23439689 PMCID: PMC4107852 DOI: 10.1177/1753465813479428] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
There is increasing evidence that chronic obstructive pulmonary disease (COPD) is not simply a disease of old age that is largely restricted to heavy smokers, but may be associated with insults to the developing lung during foetal life and the first few years of postnatal life, when lung growth and development are rapid. A better understanding of the long-term effects of early life factors, such as intrauterine growth restriction, prenatal and postnatal exposure to tobacco smoke and other pollutants, preterm delivery and childhood respiratory illnesses, on the subsequent development of chronic respiratory disease is imperative if appropriate preventive and management strategies to reduce the burden of COPD are to be developed. The extent to which insults to the developing lung are associated with increased risk of COPD in later life depends on the underlying cause, timing and severity of such derangements. Suboptimal conditions in utero result in aberrations of lung development such that affected individuals are born with reduced lung function, which tends to remain diminished throughout life, thereby increasing the risk both of wheezing disorders during childhood and subsequent COPD in genetically susceptible individuals. If the current trend towards the ever-increasing incidence of COPD is to be reversed, it is essential to minimize risks to the developing lung by improvements in antenatal and neonatal care, and to reduce prenatal and postnatal exposures to environmental pollutants, including passive tobacco smoke. Furthermore, adult physicians need to recognize that lung disease is potentially associated with early life insults and provide better education regarding diet, exercise and avoidance of smoking to preserve precious reserves of lung function in susceptible adults. This review focuses on factors that adversely influence lung development in utero and during the first 5 years of life, thereby predisposing to subsequent COPD.
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Affiliation(s)
- Janet Stocks
- Portex Unit, University College London Institute of Child Health, 30, Guilford Street, London WC1N 1EH, UK.
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