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RISK EFFECTS OF NEAR-ROADWAY POLLUTANTS AND ASTHMA STATUS ON BRONCHITIC SYMPTOMS IN CHILDREN. Environ Epidemiol 2018; 2. [PMID: 30519674 PMCID: PMC6277033 DOI: 10.1097/ee9.0000000000000012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Background: Bronchitic symptoms in children pose a significant clinical and public health burden. Exposures to criteria air pollutants affect bronchitic symptoms, especially in children with asthma. Less is known about near-roadway exposures. Methods: Bronchitic symptoms (bronchitis, chronic cough, or phlegm) in the past 12 months were assessed annually with 8 to 9 years of follow-up on 6757 children from the southern California Children’s Health Study. Residential exposure to freeway and non-freeway near-roadway air pollution was estimated using a line-source dispersion model. Mixed-effects logistic regression models were used to relate near-roadway air pollutant exposures to bronchitic symptoms among children with and without asthma. Results: Among children with asthma, a 2 SD increase in non-freeway exposures (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.17, 1.78) and freeway exposures (OR: 1.31; 95% CI: 1.06, 1.60) were significantly associated with increased risk of bronchitic symptoms. Among children without asthma, only non-freeway exposures had a significant association (OR: 1.14; 95% CI: 1.00, 1.29). Associations were strongest among children living in communities with lower regional particulate matter. Conclusions: Near-roadway air pollution was associated with bronchitic symptoms, especially among children with asthma and those living in communities with lower regional particulate matter. Better characterization of traffic pollutants from non-freeway roads is needed since many children live in close proximity to this source.
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McConnell R, Barrington-Trimis JL, Wang K, Urman R, Hong H, Unger J, Samet J, Leventhal A, Berhane K. Electronic Cigarette Use and Respiratory Symptoms in Adolescents. Am J Respir Crit Care Med 2017; 195:1043-1049. [PMID: 27806211 DOI: 10.1164/rccm.201604-0804oc] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Rates of adolescent electronic (e-) cigarette use are increasing, but there has been little study of the chronic effects of use. Components of e-cigarette aerosol have known pulmonary toxicity. OBJECTIVES To investigate the associations of e-cigarette use with chronic bronchitis symptoms and wheeze in an adolescent population. METHODS Associations of self-reported use of e-cigarettes with chronic bronchitic symptoms (chronic cough, phlegm, or bronchitis) and of wheeze in the previous 12 months were examined in 2,086 Southern California Children's Health Study participants completing questionnaires in 11th and 12th grade in 2014. MEASUREMENTS AND MAIN RESULTS Ever e-cigarette use was reported by 502 (24.0%), of whom 201 (9.6%) used e-cigarettes during the last 30 days (current users). Risk of bronchitic symptoms was increased by almost twofold among past users (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.37-2.49), compared with never-users, and by 2.02-fold (95% CI, 1.42-2.88) among current users. Risk increased with frequency of current use (OR, 1.66; 95% CI, 1.02-2.68) for 1-2 days and 2.52 (95% CI, 1.56-4.08) for 3 or more days in past 30 days compared with never-users. Associations were attenuated by adjustment for lifetime number of cigarettes smoked and secondhand smoke exposure. However, risk of bronchitic symptoms among past e-cigarette users remained elevated after adjustment for relevant potential confounders and was also observed among never-cigarette users (OR, 1.70; 95% CI, 1.11-2.59). There were no statistically significant associations of e-cigarette use with wheeze after adjustment for cigarette use. CONCLUSIONS Adolescent e-cigarette users had increased rates of chronic bronchitic symptoms. Further investigation is needed to determine the long-term effects of e-cigarettes on respiratory health.
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Affiliation(s)
- Rob McConnell
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Jessica L Barrington-Trimis
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Kejia Wang
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Robert Urman
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Hanna Hong
- 2 Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer Unger
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Jonathan Samet
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Adam Leventhal
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Kiros Berhane
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
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Donnelly D, Critchlow A, Everard ML. Outcomes in children treated for persistent bacterial bronchitis. Thorax 2006; 62:80-4. [PMID: 17105776 PMCID: PMC2111283 DOI: 10.1136/thx.2006.058933] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Persistent bacterial bronchitis (PBB) seems to be under-recognised and often misdiagnosed as asthma. In the absence of published data relating to the management and outcomes in this patient group, a review of the outcomes of patients with PBB attending a paediatric respiratory clinic was undertaken. METHODS A retrospective chart review was undertaken of 81 patients in whom a diagnosis of PBB had been made. Diagnosis was based on the standard criterion of a persistent, wet cough for >1 month that resolves with appropriate antibiotic treatment. RESULTS The most common reason for referral was a persistent cough or difficult asthma. In most of the patients, symptoms started before the age of 2 years, and had been present for >1 year in 59% of patients. At referral, 59% of patients were receiving asthma treatment and 11% antibiotics. Haemophilus influenzae and Streptococcus pneumoniae were the most commonly isolated organisms. Over half of the patients were completely symptom free after two courses of antibiotics. Only 13% of patients required > or =6 courses of antibiotics. CONCLUSION PBB is often misdiagnosed as asthma, although the two conditions may coexist. In addition to eliminating a persistent cough, treatment may also prevent progression to bronchiectasis. Further research relating to both diagnosis and treatment is urgently required.
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Affiliation(s)
- Deirdre Donnelly
- Paediatric Respiratory Unit, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK
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Tesfaigzi Y, Meek P, Lareau S. Exacerbations of chronic obstructive pulmonary disease and chronic mucus hypersecretion. CLINICAL AND APPLIED IMMUNOLOGY REVIEWS 2006; 6:21-36. [PMID: 32288656 PMCID: PMC7110639 DOI: 10.1016/j.cair.2006.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2005] [Revised: 02/09/2006] [Accepted: 02/13/2006] [Indexed: 11/25/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) exacerbations are an important cause of the considerable morbidity and mortality found in COPD. COPD exacerbations increase with increasing severity of COPD, and some patients are prone to frequent exacerbations leading to hospital admission and readmission. These frequent exacerbations may have considerable impact on quality of life and activities of daily living. Factors that increase the risk for COPD exacerbations are associated with increased airway inflammation caused by common pollutants and bacterial and/or viral infections. These inflammatory responses cause mucus hypersecretion and, thereby, airway obstruction and associated exacerbations. While chronic mucus hypersecretion is a significant risk factor for frequent and severe exacerbations, patients with chronic mucus hypersecretion have a lower rate of relapse after initial treatment for acute exacerbation. The benefit of antibiotics for treatment of COPD exacerbations is small but significant. While the mechanisms of actions are not clear, mucolytic agents reduce the number of days of disability in subjects with exacerbations. Reducing mucous cell numbers in small airways could be a useful way to reduce chronic mucus hypersecretion. Our studies suggest that programmed cell death is crucial in the resolution of metaplastic mucous cells, and understanding these mechanisms may provide novel therapies to reduce the risk of COPD exacerbations.
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Key Words
- Airway epithelium
- Apoptosis
- CMH, chronic mucus hypersecretion
- COPD, chronic obstructive pulmonary disease
- FEV1, forced expiratory volume in 1 second
- GCM, goblet cell metaplasia
- Hospitalization
- IL, interleukin
- Inflammation
- LPS, lipopolysaccharide
- Mucous cell metaplasia
- NAC, N-acetylcysteine
- PCR, polymerase chain reaction
- RSV, respiratory syncytial virus
- Small airways
- URI, upper respiratory infection
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Affiliation(s)
- Yohannes Tesfaigzi
- Lovelace Respiratory Research Institute, 2425 Ridgecrest Drive, SE, Albuquerque, NM 87108, USA
| | - Paula Meek
- College of Nursing, University of New Mexico, Albuquerque, NM 87131, USA
| | - Suzanne Lareau
- Pulmonary Section, New Mexico Veterans Administration Medical Center, Albuquerque, NM 87108, USA
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Rusconi F, Panisi C, Dellepiane RM, Cardinale F, Chini L, Martire B, Bonelli N, Felisati G, Pietrogrande MC. Pulmonary and sinus diseases in primary humoral immunodeficiencies with chronic productive cough. Arch Dis Child 2003; 88:1101-5. [PMID: 14670780 PMCID: PMC1719410 DOI: 10.1136/adc.88.12.1101] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS To prospectively evaluate sinopulmonary disease in 24 patients with primary humoral immunodeficiency (11 with agammaglobulinaemia, nine with isolated IgA deficiency, and two with common variable immunodeficiency) and chronic productive cough, ascertain the usefulness of chest high resolution computed tomography (HRCT) in evaluating the progression of lung disease, and test a therapeutic approach to chronic sinusitis. METHODS Pulmonary abnormalities were evaluated using lung function tests and HRCT (Bhalla score); chronic sinusitis was diagnosed clinically and confirmed by flexible fibreoptic endoscopy. Sixteen patients entered the three year follow up. RESULTS Lung function testing revealed an obstruction in four patients; chest HRCT was abnormal in 16. There was a linear relation between the Bhalla score > or =4 and the number of months with cough/year over the previous two years (clinical score), and between the difference in clinical scores during follow up and in the previous two years and the difference in Bhalla score. The pulmonary lesions did not significantly progress over a three year period. Thirteen patients had chronic sinusitis; 6/10 patients followed up were successfully treated with antibiotics plus topical therapy and two with nasal polypoid disease with endoscopic sinus surgery. CONCLUSIONS In patients with primary humoral immunodeficiency and chronic productive cough, HRCT is very useful in delineating the extent of lung damage. The correlation between Bhalla score and clinical findings and the favourable outcome of the disease suggests that in most patients chest HRCT should not be repeated annually as previously suggested. Medical therapy seems to be effective in many cases of chronic sinusitis.
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Affiliation(s)
- F Rusconi
- Department of Paediatrics, University of Milan, ICP, Milan, Italy.
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Abstract
There is convincing evidence that several distinct wheezing syndromes exist in childhood. The purpose of this research was to assess the potential of using healthcare utilization profiles to identify wheezing syndromes in children which are distinct from asthma. Using population-based healthcare administrative data, a cohort of children, aged 5-15 years, with bronchitis diagnoses from time of birth to 1995, but no physician diagnoses of asthma, was followed over the period January 1996-March 1998. In this follow-up period, 13% had subsequent healthcare utilization for asthma, 23% had continued healthcare utilization for bronchitis, and 64% had no further healthcare utilization. The likelihood of bronchitis vs. asthma outcomes was determined for a variety of asthma risk factors. In a cohort of 11,043 children with initial healthcare contact for bronchitis but not asthma, two potentially distinct entities of bronchitis emerged from our data: 1) transient bronchitis, similar to transient wheezing of early childhood, which was associated with winter-only healthcare utilization and absence of allergy, and 2) recurrent bronchitis which differed from asthma on the basis of winter-only healthcare utilization, prematurity at birth, absence of allergy, and low socioeconomic status. Healthcare administrative records can be used to describe the natural history of wheezing in children and to identify markers which may discriminate asthma from other syndromes.
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Affiliation(s)
- Anita L Kozyrskyj
- Department of Community Health Sciences, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.
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Neuspiel DR, Rush D, Butler NR, Golding J, Bijur PE, Kurzon M. Parental smoking and post-infancy wheezing in children: a prospective cohort study. Am J Public Health 1989; 79:168-71. [PMID: 2783639 PMCID: PMC1349927 DOI: 10.2105/ajph.79.2.168] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The contribution of parental smoking to wheezing in children was studied in a subset of all British births between April 5 and 11, 1970 (N = 9,670). Children of smoking mothers had an 18.0 per cent cumulative incidence of post-infancy wheezing through 10 years of age, compared with 16.2 per cent among children of nonsmoking mothers (risk ratio 1.11, 95% CI: 1.02, 1.21). This difference was confined to wheezing attributed to wheezy bronchitis, of which children of smokers had 7.4 per cent, and those of nonsmokers had 5.2 per cent (risk ratio 1.44, 95% CI: 1.24, 1.68). The incidence of wheezy bronchitis increased as mothers smoked more cigarettes. After multiple logistic regression analysis was used to control for paternal smoking, social status, sex, family allergy, crowding, breast-feeding, gas cooking and heating, and bedroom dampness, the association of maternal smoking with childhood wheezy bronchitis persisted. Some of this effect was explained by maternal respiratory symptoms and maternal depression, but not by neonatal problems, the child's allergic symptoms, or paternal respiratory symptoms. There was a 14 per cent increase in childhood wheezy bronchitis when mothers smoked over four cigarettes per day, and a 49 per cent increase when mothers smoked over 14 cigarettes daily.
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Affiliation(s)
- D R Neuspiel
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
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Abstract
Data from the 1970 through 1984 National Hospital Discharge Surveys indicate that the rate of hospitalization for children under 15 years old with asthma has increased at least 145 per cent while the average length of stay for children with asthma decreased by 26 per cent from 5 days in 1970 to 3.6 days in 1984. Over an analogous period (1970 to 1980), data from the National Health Interview Survey indicate that the prevalence of childhood asthma has increased by approximately 28 per cent for children 6 to 16 years of age. Several potential explanations for the hospital trend are discussed, including changes in the disease classification and information system, criteria for admission, organizational factors, changes in therapy, and changes in morbidity.
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