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The Cotton Dust-Related Allergic Asthma: Prevalence and Associated Factors among Textile Workers in Nam Dinh Province, Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189813. [PMID: 34574732 PMCID: PMC8467793 DOI: 10.3390/ijerph18189813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 11/16/2022]
Abstract
Objective: To determine the prevalence of cotton dust-related allergic asthma and associated factors among textile workers in Nam Dinh province, Vietnam. Methods: A cross-sectional study was performed with 1082 workers in two textile garment companies using the asthma diagnostic criteria of the GINA (Global Initiative for Asthma) 2016 guidelines. Results: Among study participants, 11.9% had suspected asthma symptoms, 7.4% were diagnosed with asthma, and 4.3% (3.6% in men and 4.5% in women) were diagnosed with cotton dust-related allergic asthma. Overweight, seniority more than 10 years, history of asthma, allergic rhinitis, family history of allergy, and exposure to cotton dust from more than one hour per day in the working environment were found to be important predictors of cotton dust-related allergic asthma among textile workers. Conclusions: Textile workers in two companies in Nam Dinh, Vietnam had a high prevalence of dust-related allergic asthma compared to estimates from the general population. There is a need to design appropriate measures of prevention, screening, and care for dust-related asthma in the textile industry. Further evaluation with better exposure assessment is necessary.
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Ikbariyeh B, Al Habashneh R, Khassawneh B, Alrawashdeh M, Elsalim L, Al-Nusair J. Clinical and Biological Indicators of Periodontal Disease in Obese and non-Obese adults with and without Bronchial Asthma. J Asthma 2021; 59:1758-1766. [PMID: 34324826 DOI: 10.1080/02770903.2021.1962907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: The present study aims to assess clinical and inflammatory parameters as indicators for periodontal disease in obese and non-obese adults with and without bronchial asthma (BA).Methods: 168 patients visiting the outpatient pulmonary clinics were divided into four groups according to BA and obesity. Obesity was defined by body mass index (BMI) and BA was diagnosed by a pulmonary consultant and being on inhaled asthma medication for at least 12 months. Participants were examined for clinical periodontal parameters and samples of gingival crevicular fluid (GCF) were taken and analyzed for the levels of 5 different inflammatory cytokines.Results: Compared with controls, obese asthmatic group had significant higher mean clinical attachment loss (CAL) (2.64 vs. 1.00, p<.001). Also, the occurrence of periodontitis was significantly higher among obese patients compared to non-obese patients (p = 0.003). Multivariate logistic regression model showed that age was the strongest predictor of periodontitis (aOR =1.23). The levels of IL-1β and IL-8 were significantly higher in the non-obese asthmatic group compared to the control group (p < 0.05). The level of IL-6 was significantly lower in the control group compared to the other groups (p < 0.001). Obese patients had significantly higher concentration of hsCRP compared to non-obese patients (p < 0.001). There was no significant difference in the level of TNF- α between groups.Conclusions: BA and obesity combined did not seem to be associated with a significant increased risk of having periodontitis. BA and obesity are associated with increased levels of some local proinflammatory cytokines which adds to the local and systemic inflammatory burden.
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Affiliation(s)
- Bader Ikbariyeh
- Faculty of Dentistry, Preventive Dentistry, Jordan University of Science & Technology, Irbid, Jordan
| | - Rola Al Habashneh
- Faculty of Dentistry, Preventive Dentistry, Jordan University of Science & Technology, Irbid, Jordan
| | - Basheer Khassawneh
- Faculty of Medicine, Internal Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Mohammad Alrawashdeh
- Faculty of Nursing, Community and Mental Health Nursing, Jordan University of Science & Technology, Irbid, Jordan
| | - Lina Elsalim
- Faculty of Medicine, Department of Pharmacology, Jordan University of Science & Technology, Irbid, Jordan
| | - Jowan Al-Nusair
- Medical Student, College of Medicine, Jordan University of Science & Technology, Irbid, Jordan
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Wen X, Qian C, Zhang Y, Wu R, Lu L, Zhu C, Cheng X, Cui R, You H, Mei F, Gao J, Li F, Bu L, Qu S. Key pathway and gene alterations in the gastric mucosa associated with obesity and obesity-related diabetes. J Cell Biochem 2018; 120:6763-6771. [PMID: 30450618 DOI: 10.1002/jcb.27976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/02/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The stomach plays an important role in obesity and obesity-related diabetes; yet, little is known about key pathways in the gastric mucosa associated with obesity and diabetes. METHODS We performed gene microarray and real time-polymerase chain reaction (RT-PCR) on gut mucosa samples from control subjects (CON), patients with simple obesity (OB), and patients with obesity and comorbid diabetes (OD) (n = 3 per group). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were used to predict the functional significance of differentially expressed genes. RESULTS In total, 262 genes were upregulated and 265 genes were downregulated in the OB group whereas 1756 genes were upregulated and 1053 genes were downregulated in the OD group compared with the CON group. Of these, 23 were co-regulated in both comparisons. Seven differentially expressed genes were validated by RT-PCR (NRIP3, L1CAM, TPO, P2RY1, OR8A1, ADAMTS19, and ASIC3). A functional analysis revealed that genes differentially expressed between the OB or OD and CON groups played crucial roles in metabolic, T cell, and G-protein coupled receptor biological processes, and primarily participated in the PI3K-Akt and AGE-RAGE signaling pathways. CONCLUSIONS Obesity and obesity-related diabetes are associated with important gene expression and pathway alterations in the stomach.
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Affiliation(s)
- Xin Wen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Chunhua Qian
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Yi Zhang
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, National key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ruijin Wu
- Department of Gastroenterology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liesheng Lu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Cuiling Zhu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Xiaoyun Cheng
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Rai Cui
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Hui You
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Fangyun Mei
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Jingyang Gao
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Feng Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Le Bu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
| | - Shen Qu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,National Metabolic Management Center, Shanghai Tenth People's Hospital, Shanghai, China.,Thyroid Research Center of Shanghai, Shanghai Tenth People's Hospital, China
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Caspard H, Jabbour S, Hammar N, Fenici P, Sheehan JJ, Kosiborod M. Recent trends in the prevalence of type 2 diabetes and the association with abdominal obesity lead to growing health disparities in the USA: An analysis of the NHANES surveys from 1999 to 2014. Diabetes Obes Metab 2018; 20:667-671. [PMID: 29077244 PMCID: PMC5836923 DOI: 10.1111/dom.13143] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/04/2017] [Accepted: 10/21/2017] [Indexed: 12/29/2022]
Abstract
AIM To assess whether the secular trends in type 2 diabetes prevalence differ between abdominally obese and non-obese individuals. METHODS Data from the National Health and Nutrition Examination Surveys (NHANES) were used to estimate the prevalence of type 2 diabetes and abdominal obesity among individuals aged ≥20 years in the USA from 1999/2000 to 2013/2014, after standardization to the age, sex and ethnicity population distribution estimates on January 1, 2014, as published by the US Census Bureau. RESULTS The prevalence of abdominal obesity in the US population increased from 47.4% (95% confidence interval [CI] 42.6-52.2) in 1999/2000 to 57.2% (95% CI 55.9-58.5) in 2013/2014. A significant increase was observed in all age groups: 20 to 44, 45 to 64, and ≥65 years. The prevalence of type 2 diabetes has also increased from 8.8% (95% CI 7.2-10.4) in 1999/2000 to 11.7% (95% CI 10.9-12.6) in 2013/2014, with no substantial change in trend over the recent years. However, the increase in the prevalence of type 2 diabetes was limited to individuals with abdominal obesity, and more specifically to individuals aged ≥45 years with abdominal obesity, with no significant change in prevalence in the non-obese group and in individuals aged <45 years. CONCLUSION These findings highlight the critical importance of abdominal obesity-both as a likely key contributor to the continuing epidemic of type 2 diabetes in the USA and as a priority target for public health interventions.
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Affiliation(s)
| | - Serge Jabbour
- Division of Endocrinology, Diabetes and Metabolic DiseasesSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvania
| | - Niklas Hammar
- AstraZeneca R&DMölndalSweden
- Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Peter Fenici
- AstraZeneca Global Medicines DevelopmentCambridgeUK
| | | | - Mikhail Kosiborod
- Department of Cardiovascular Diseases, St Luke's Mid‐America Heart Institute and University of MissouriKansas CityMissouri
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Barros R, Delgado L. Visceral adipose tissue: A clue to the obesity-asthma endotype(s)? REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 22:253-4. [PMID: 27612387 DOI: 10.1016/j.rppnen.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- R Barros
- Faculty of Nutrition, University of Porto, Porto, Portugal
| | - L Delgado
- Immunology Lab, Basic & Clinical Immunology, Faculty of Medicine, University of Porto, Porto, Portugal.
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Yılmaz M, Bozkurt Yılmaz HE, Şen N, Altın C, Tekin A, Müderrisoğlu H. Investigation of the relationship between asthma and subclinical atherosclerosis by carotid/femoral intima media and epicardial fat thickness measurement. J Asthma 2017; 55:50-56. [PMID: 28453377 DOI: 10.1080/02770903.2017.1313272] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Since asthma and atherosclerosis may share similar pathophysiological mechanism, this study is planned to investigate whether epicardial fat thickness (EFT), carotid and femoral intima media thicknesses, which are markers of subclinical atherosclerosis, are increased in patients with asthma. METHODS The study was designed as a cross-sectional study. A total of 154 participants (83 patients with asthma and 71 healthy volunteers) were enrolled into the study. Epicardial fat, carotid, and femoral intima media thicknesses were measured and recorded in both groups. The statistical difference between the two groups was examined. RESULTS Both carotid and femoral intima media thicknesses were significantly higher in patients with asthma compared to control group (5.52 ± 0.4 mm vs. 5.36 ± 0.4 mm; p = 0.038 and 5.64 ± 0.4 mm vs. 5.46 ± 0.5 mm; p = 0.036, respectively). However, there was not a significant difference in EFT between the groups [5.9 mm (5.3-6.6; IQR = 1.3) vs. 5.6 mm (4.7-6.5; IQR = 1.8); p = 0.1]. On comparison of control group and asthma subgroups (mild, moderate, and severe), there was a statistically significant difference among these four groups in terms of carotid and femoral intima media thicknesses (p = 0.002 and p < 0.001, respectively). Subgroup analyses showed that this difference was mainly due to patients with severe asthma. CONCLUSIONS Carotid and femoral intima media thicknesses in asthmatic patients were found to be increased compared to the normal population. As a result, the risk of subclinical atherosclerosis in asthmatic patients may be high.
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Affiliation(s)
- Mustafa Yılmaz
- a Department of Cardiology , Baskent University Faculty of Medicine , Adana , Turkey
| | | | - Nazan Şen
- b Department of Pulmonary Medicine , Baskent University Faculty of Medicine , Adana , Turkey
| | - Cihan Altın
- c Department of Cardiology , Baskent University Faculty of Medicine , İzmir , Turkey
| | - Abdullah Tekin
- a Department of Cardiology , Baskent University Faculty of Medicine , Adana , Turkey
| | - Haldun Müderrisoğlu
- d Department of Cardiology , Baskent University Faculty of Medicine , Ankara , Turkey
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Asthma, a Comprehensive Clinical Review. Dela J Public Health 2017; 3:10-22. [PMID: 34466893 PMCID: PMC8352467 DOI: 10.32481/djph.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Quality of Life and Health Outcomes in Overweight and Non-Overweight Children With Asthma. J Pediatr Health Care 2017; 31:37-45. [PMID: 26874457 DOI: 10.1016/j.pedhc.2016.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/13/2016] [Accepted: 01/18/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND During the past two decades, the number of children and adolescents who are obese has more than doubled. Following this trend in childhood obesity, there has been an alarming increase in the number of children with asthma who are overweight. OBJECTIVE The aim of this study was to examine the differences in quality of life (QOL) and health outcomes of obese and overweight children with asthma compared with normal-weight children with asthma using a descriptive comparative survey design. METHODS This comparative study consisted of 90 overweight and normal-weight 9- to 14-year-olds with asthma. Health outcomes examined included asthma-related missed number of school days, emergency department (ED) visits, hospitalizations, number of days wheezing, and number of night awakenings. QOL was measured using the Pediatric Asthma Quality of Life Questionnaire. RESULTS The obese group reported the highest percentage of ED visits, hospitalizations, and number of days wheezing compared with the normal-weight group. A risk ratio analysis showed that the obese group had an overall 2.73 (95% confidence interval [CI] 2.15, 3.63) times higher likelihood of going to the ED and a 2.46 (95% CI 1.97, 3.19) times higher likelihood of hospitalization than the overweight and normal-weight groups. Asthma severity was a significant predictor of overall QOL (β = -23.737, p = .002). CONCLUSIONS The study results are consistent with other investigations that demonstrate that obese persons are at higher risk of experiencing severe asthma symptoms and support obesity as a potentially modifiable risk factor for asthma mitigation and prevention.
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9
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Barros R, Moreira P, Padrão P, Teixeira VH, Carvalho P, Delgado L, Moreira A. Obesity increases the prevalence and the incidence of asthma and worsens asthma severity. Clin Nutr 2016; 36:1068-1074. [PMID: 27448950 DOI: 10.1016/j.clnu.2016.06.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/20/2016] [Accepted: 06/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS We aimed to explore the association between obesity and asthma prevalence, incidence and severity. METHODS The study included 32,644 adults, 52.6% female, from a representative sample of the 4th Portuguese National Health Survey. The following asthma definitions were used: ever asthma (ever medical doctor asthma diagnosis), current asthma (asthma within the last 12 months), current persistent asthma (required asthma medication within the last 12 months), current severe asthma (attending an emergency department because of asthma within the last 12 months), and incident asthma (asthma diagnosis within the last 12 months). Body mass index was calculated based on self-reported weight and height and categorised according to WHO classification. Logistic regression models adjusted for confounders were performed. RESULTS Prevalence of ever asthma was 5.3%, current asthma 3.5%, current persistent asthma 3.0%, current severe asthma 1.4%, and incident asthma 0.2%. Prevalence of obesity was 16%, overweight 37.6%, normal weight 44.6% and underweight 0.2%. Being overweight, obesity class I and II, and obesity class III were associated with an OR (95% CI) with ever asthma 1.22 (1.21-1.24), 1.39 (1.36-1.41), 3.24 (3.08-3.40) respectively; current asthma 1.16 (1.14-1.18), 1.86 (1.82-1.90), 4.73 (4.49-4.98) respectively; current persistent asthma 1.08 (1.06-1.10), 2.06 (2.01-2.10), 5.24 (4.96-5.53), and current severe asthma 1.36 (1.32-1.40), 1.50 (1.45-1.55) and 3.70 (3.46-3.95), respectively. Considering the incidence of asthma, obesity more than quadrupled the odds (OR = 4.46, 95% CI 4.30, 4.62). CONCLUSION Obesity is associated in a dose dependent way with an increase of prevalent and incident asthma, and it seems to increase the odds of a more persistent and severe asthma phenotype independently of socio-demographic determinants, physical activity, and dietary patterns. Our results provide rational for future lifestyle intervention studies for weight reduction in the obesity-asthma phenotype.
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Affiliation(s)
- R Barros
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.
| | - P Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; Research Centre on Physical Activity and Health, University of Porto, Porto, Portugal; EPI Unit, Public Health Institute, University of Porto, Porto, Portugal
| | - P Padrão
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; EPI Unit, Public Health Institute, University of Porto, Porto, Portugal
| | - V H Teixeira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; EPI Unit, Public Health Institute, University of Porto, Porto, Portugal
| | - P Carvalho
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - L Delgado
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João, Porto, Portugal
| | - A Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal; Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João, Porto, Portugal
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Keough L, Beckman D, Sinclair T, Young S, Baichoo S, Cobb M. Weight patterns of youth entering an urban juvenile justice facility. JOURNAL OF CORRECTIONAL HEALTH CARE 2016; 21:45-52. [PMID: 25559629 DOI: 10.1177/1078345814557793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescents with a history of incarceration face a disproportionate number of health issues compared with their peers in virtually all areas, including perceived well-being; self-esteem; acute, chronic, and psychosocial disorders; and physical activity. Some studies have shown correlates of weight status and incarceration; however, the literature is conflicting. The current study sought to assess weight patterns of primarily minority urban youth (N = 548) entering a juvenile justice facility as well as associations between medications and weight status. Results indicate incarcerated adolescents have higher rates of overweight and obesity (40%) in comparison with nonincarcerated adolescents in the state (20 to 30%) or surrounding community (30 to 34%). Of interest, incarcerated adolescents taking asthma medications have significantly higher rates of overweight and obesity when compared with those not taking asthma medications. The clinical implications of these findings are discussed and implications for future research explored.
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Affiliation(s)
- Lori Keough
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA School of Nursing, University of Massachusetts Lowell College of Health and Sciences, Lowell, MA, USA
| | - Dawn Beckman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Tatum Sinclair
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Shannah Young
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Shelanda Baichoo
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Meghan Cobb
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Wurst KE, Kelly-Reif K, Bushnell GA, Pascoe S, Barnes N. Understanding asthma-chronic obstructive pulmonary disease overlap syndrome. Respir Med 2015; 110:1-11. [PMID: 26525374 DOI: 10.1016/j.rmed.2015.10.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/27/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
Abstract
Asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS) is a loosely-defined clinical entity referring to patients who exhibit characteristics of both asthma and chronic obstructive pulmonary disease (COPD). Clinical definitions and classifications for ACOS vary widely, which impacts our understanding of prevalence, diagnosis and treatment of the condition. This literature review was therefore conducted to characterize the prevalence of ACOS and the effect of different disease definitions on these estimates, as this has not previously been explored. From an analysis of English language literature published from 2000 to 2014, the estimated prevalence of ACOS ranges from 12.1% to 55.2% among patients with COPD and 13.3%-61.0% among patients with asthma alone. This variability is linked to differences in COPD and asthma diagnostic criteria, disease ascertainment methods (spirometry-based versus clinical or symptom-based diagnoses and claims data), and population characteristics including age, gender and smoking. Understanding the reasons for differences in prevalence estimates of ACOS across the literature may help guide decision making on the most appropriate criteria for defining ACOS and aid investigators in designing future ACOS clinical studies aimed at effective treatment.
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Affiliation(s)
| | - Kaitlin Kelly-Reif
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Greta A Bushnell
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | | | - Neil Barnes
- GSK, Brentford, Middlesex, UK; William Harvey Institute, Barts and The London School of Medicine and Dentistry
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12
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Mohanan S, Tapp H, McWilliams A, Dulin M. Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care. Exp Biol Med (Maywood) 2014; 239:1531-40. [PMID: 24719380 PMCID: PMC4230977 DOI: 10.1177/1535370214525302] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The effects of obesity on asthma diagnosis, control, and exacerbation severity are increasingly recognized; however, the underlying pathophysiology of this association is poorly understood. Mainstream clinical practice has yet to adopt aggressive management of obesity as a modifiable risk factor in asthma care, as is the case with a risk factor like tobacco or allergen exposure. This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. Our review suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly using patient-centered approaches such as shared decision making. There is a need for research to better understand the mechanisms of asthma in the obese patient and to develop new therapies specifically targeted to this unique patient population.
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Affiliation(s)
- Sveta Mohanan
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| | - Hazel Tapp
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| | - Andrew McWilliams
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
| | - Michael Dulin
- Department of Family Medicine, Carolinas HealthCare System, Charlotte, NC 28207, USA
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Abstract
BACKGROUND Obesity is more prevalent in asthmatics. Sleep duration is a novel risk factor for obesity in general populations. OBJECTIVE We tested the association of sleep duration and asthma characteristics with obesity. METHODS Adults at tertiary clinics were surveyed on asthma symptoms and habitual sleep duration. Medical records were used to assess asthma severity step (1-4), extract height and weight, current medications and diagnosed comorbid conditions. BMI ≥30 kg/m(2) defined obesity. Habitual sleep was categorized as <6 (very short), 6 to <7 h (short), 7-8 h (normal), >8 to ≤9 h (long) and >9 h (very long). Inhaled corticosteroid doses were categorized as low, moderate and high. RESULTS Among 611 participants (mean BMI 30 ± 8), 249 (41%) were obese. After adjustment for covariates, obesity was associated with short and very long sleep: as compared to normal sleepers, the odds of being obese were on an average 66% higher ([95% CI: 1.07-2.57], p = 0.02) among short and 124% higher ([1.08-1.65], p = 0.03) among very long sleepers, and the association with very short sleep approached significance (1.74 [0.96-3.14], p = 0.06). Obesity was also significantly related to highest asthma step (1.87 [1.09-3.21], p = 0.02) and psychopathology (1.64 [1.08-2.48], p = 0.02), and a trend was seen with high-dose inhaled corticosteroids (1.82 [0.93-3.56], p = 0.08). CONCLUSIONS Obesity in asthmatics is associated with shorter and very long sleep duration, worse asthma severity, psychopathology and high-dose inhaled corticosteroids. Although this cross-sectional study cannot prove causality, we speculate that further investigation of sleep may provide new opportunities to reduce the rising prevalence of obesity among asthmatics.
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Affiliation(s)
- Mihaela Teodorescu
- James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Center for Sleep Medicine and Sleep Research/Wisconsin Sleep, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David A. Polomis
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ronald E. Gangnon
- Departments of Biostatistics and Medical Informatics, and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Flavia B. Consens
- Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Ronald D. Chervin
- Department of Neurology and Sleep Disorders Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Mihai C. Teodorescu
- James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
- Center for Sleep Medicine and Sleep Research/Wisconsin Sleep, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Division of Geriatrics and Gerontology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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14
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Pleasants RA, Ohar JA, Croft JB, Liu Y, Kraft M, Mannino DM, Donohue JF, Herrick HL. Chronic obstructive pulmonary disease and asthma-patient characteristics and health impairment. COPD 2013; 11:256-66. [PMID: 24152212 DOI: 10.3109/15412555.2013.840571] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED Abstract Background: Persons with chronic obstructive pulmonary disease (COPD) and/or asthma have great risk for morbidity. There has been sparse state-specific surveillance data to estimate the impact of COPD or COPD with concomitant asthma (overlap syndrome) on health-related impairment. METHODS The North Carolina (NC) Behavioral Risk Factor Surveillance System (BRFSS) was used to assess relationships between COPD and asthma with health impairment indicators. Five categories [COPD, current asthma, former asthma, overlap syndrome, and neither] were defined for 24,073 respondents. Associations of these categories with health impairments (physical or mental disability, use of special equipment, mental or physical distress) and with co-morbidities (diabetes, coronary heart disease, stroke, arthritis, and high blood pressure) were assessed. RESULTS Fifteen percent of NC adults reported a COPD and/or asthma history. The overall age-adjusted prevalence of any self-reported COPD and current asthma were 5.6% and 7.6%, respectively; 2.4% reported both. In multivariable analyses, adults with overlap syndrome, current asthma only, and COPD only were twice as likely as those with neither disease to report health impairments (p < 0.05). Compared to those with neither disease, adults with overlap syndrome and COPD were more likely to have co-morbidities (p < 0.05). The prevalence of the five co-morbid conditions was highest in overlap syndrome; comparisons with the other groups were significant (p < 0.05) only for diabetes, stroke, and arthritis. CONCLUSIONS The BRFSS demonstrates different levels of health impairment among persons with COPD, asthma, overlap syndrome, and those with neither disease. Persons reporting overlap syndrome had the most impairment and highest prevalence of co-morbidities.
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Affiliation(s)
- Roy A Pleasants
- 1Campbell University College of Pharmacy and Health Sciences and Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine , Durham, NC , USA
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15
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Ioachimescu OC, Teodorescu M. Integrating the overlap of obstructive lung disease and obstructive sleep apnoea: OLDOSA syndrome. Respirology 2013; 18:421-31. [PMID: 23368952 DOI: 10.1111/resp.12062] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Revised: 11/17/2012] [Accepted: 01/16/2013] [Indexed: 12/30/2022]
Abstract
Obstructive lung diseases (OLD) such as asthma and chronic obstructive pulmonary disease (COPD) are very prevalent conditions. Disease phenotypes (e.g. chronic bronchitis, emphysema, etc.) often overlap, and significant confusion exists about their optimal nosologic characterization. Obstructive sleep apnoea (OSA) is also a common condition that features bidirectional interactions with OLD. OSA appears to be more commonly seen in patients with OLD, perhaps as a result of shared risk factors, for example obesity, smoking, increased airway resistance, local and systemic inflammation, anti-inflammatory therapy. Conversely, OSA is associated with worse clinical outcomes in patients with OLD, and continuous positive airway pressure therapy has potential beneficial effects on this vicious pathophysiological interaction. Possible shared mechanistic links include increased parasympathetic tone, hypoxaemia-related reflex bronchoconstriction/vasoconstriction, irritation of upper airway neural receptors, altered nocturnal neurohormonal secretion, pro-inflammatory mediators, within and inter-breath interactions between upper and lower airways, lung volume-airway dependence, etc. While the term overlap syndrome has been defined as the comorbid association of COPD and OSA, the interaction between asthma and OSA has not been integrated yet nosologically; in this review, the latter will be called alternative overlap syndrome. In an effort to bolster further investigations in this area, an integrated, lumping nomenclature for OSA in the setting of OLD is proposed here--OLDOSA (obstructive lung disease and obstructive sleep apnoea) syndrome.
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Affiliation(s)
- Octavian C Ioachimescu
- Atlanta Veterans Affairs Medical Center, Emory University School of Medicine, Atlanta, GA 30033, USA.
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16
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Moreira A, Bonini M, Garcia-Larsen V, Bonini S, Del Giacco SR, Agache I, Fonseca J, Papadopoulos NG, Carlsen KH, Delgado L, Haahtela T. Weight loss interventions in asthma: EAACI evidence-based clinical practice guideline (part I). Allergy 2013; 68:425-39. [PMID: 23452010 DOI: 10.1111/all.12106] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asthma and obesity are chronic multifactorial conditions that are associated with gene-environment interaction and immune function. Although the data are not fully consistent, it seems that obesity increases the risk of asthma and compromises asthma control. OBJECTIVE To investigate the impact that weight changes have on asthma. METHODS We carried out a systematic review of three large biomedical databases. Studies were scrutinized and critically appraised according to agreed exclusion and inclusion criteria. Quality assessment of eligible papers was conducted using the GRADE method. Meta-analyses of comparable studies were carried out. RESULTS Thirty studies met the eligibility criteria of the review. Interventions were limited to dietary manipulation in three studies, one of which also used anti-obesity drugs, and bariatric surgery in four. All the other studies reported observational data. Becoming obese increased the odds for incident asthma by 1.82 (95% CI 1.47, 2.25) in adults and 1.98 (95% CI 0.71, 5.52) in children. Weight loss was associated with significant improvement in mean scores for symptoms, rescue medication score, and asthma exacerbations in the only randomized controlled trial. Similarly, evidence gathered from observational studies, with follow-up ranging between 8 weeks to 1 year, and from changes 1 year after bariatric surgery showed improvements in all asthma control-related outcomes. Changes in lung function were reported in one randomized controlled and eight observational studies of asthmatic subjects, with conflicting results. Either improvement after weight loss, decline with weight gain, or no effects at all were reported. Changes in airway inflammation and responsiveness were reported only by observational studies. CONCLUSION Weight increases above the obesity threshold significantly increase the risk of asthma. The available studies show weak evidence of benefits from weight reduction on asthma outcomes.
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Affiliation(s)
- A. Moreira
- Faculty of Medicine; University of Porto and Hospital São João; Porto; Portugal
| | - M. Bonini
- Department of Internal Medicine Lung Function Unit; “Sapienza” University of Rome; Rome; Italy
| | - V. Garcia-Larsen
- National Heart and Lung Institute, Imperial College London; London; UK
| | - S. Bonini
- Department of Internal Medicine; Second University of Naples; Naples
| | - S. R. Del Giacco
- Department of Medical Sciences “M. Aresu”; University of Cagliari; Cagliari; Italy
| | - I. Agache
- Transylvania University; Brasov; Romania
| | - J. Fonseca
- Faculty of Medicine; University of Porto and Hospital São João; Porto; Portugal
| | - N. G. Papadopoulos
- Allergy Department; 2nd Pediatric Clinic; University of Athens; Athens; Greece
| | - K.-H. Carlsen
- Department of Medicine and Allergology; University of Oslo; Oslo; Norway
| | - L. Delgado
- Faculty of Medicine; University of Porto and Hospital São João; Porto; Portugal
| | - T. Haahtela
- Skin and Allergy Hospital; Helsinki University Central Hospital; Helsinki; Finland
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Velsor-Friedrich B, Militello LK, Kouba J, Harrison PR, Manion A, Doumit R. Pediatric obesity and asthma quality of life. Nurs Clin North Am 2013; 48:259-70. [PMID: 23659812 DOI: 10.1016/j.cnur.2013.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Widely researched as separate entities, our understanding of the comorbid effects of childhood obesity and asthma on quality of life is limited. This article discusses the effects of childhood obesity and asthma on self-reported quality of life in low-income African American teens with asthma. When controlling for the influence of symptom frequency, asthma classification, asthma self-efficacy, and asthma self-care levels, body mass index remains a most important factor in determining self-reported quality of life among teens with asthma. Although overweight and obesity did not change the effectiveness of the asthma intervention program, obesity did affect participants quality of life scores.
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Abstract
Asthma is one of the most common chronic illnesses in the world, affecting an estimated 300 million people. Globally, the prevalence of asthma has continued to spread as economic improvements in developing countries create a population trend toward urbanization and adoption of a western lifestyle. Research supports an association between obesity and asthma. Only by making weight management a priority in the treatment of asthma can the rising prevalence of both diseases be hindered and global health improved.
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Affiliation(s)
- Amy B Manion
- Northwestern Children's Practice, Chicago, IL, USA.
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19
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Carter RM, Symons Downs D, Bascom R, Dyer AM, Weisman CS. The moderating influence of asthma diagnosis on biobehavioral health characteristics of women of reproductive age. Matern Child Health J 2012; 16:448-55. [PMID: 21400202 DOI: 10.1007/s10995-011-0749-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Promoting healthy behaviors to improve pregnancy outcomes requires an understanding of the factors influencing health behaviors among at-risk populations. We hypothesized that women with an asthma diagnosis would have poorer biobehavioral health risk factors and pregnancy outcomes compared to women without an asthma diagnosis. The Central Pennsylvania Women's Health Study (CePAWHS) included a population-based survey examining health status indicators, risk factors and outcomes, and detailed pregnancy histories among 2,002 women (ages 18-45). 213 asthmatics were identified. Compared with Non-asthmatic women (NA), Asthmatic (A) women reported lower rates of excellent health status (45% A vs. 65% NA, P < 0.001), were more likely to be overweight or obese (68% A vs. 50% NA, P < 0.001), and were more likely to have smoked cigarettes during their first pregnancy (25% A vs. 17% NA, P < 0.01). Psychological measures (psychosocial hassles, low self-esteem, depression) were reported more often in asthmatics than non-asthmatics. Also, asthmatics reported a higher incidence of gestational diabetes (10% A vs. 6% of NA, P = 0.05), preterm births (25% A vs. 16% NA, P < 0.01), and had a higher proportion of low birth weight infants (20% A vs. 13% NA, P = 0.03) compared with non-asthmatics. As predicted, asthmatics had poorer biobehavioral risk factors and outcomes compared to non-asthmatics. These findings illustrate the need to target asthmatic women of reproductive age, particularly in this largely rural setting, with interventions to reduce biobehavioral risk factors as part of a strategy to improve pregnancy outcomes.
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Affiliation(s)
- RyaLynn M Carter
- Department of Obstetrics and Gynecology, The Pennsylvania State University College of Medicine, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
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21
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McHugh MK, Symanski E, Pompeii LA, Delclos GL. Prevalence of asthma among adult females and males in the United States: results from the National Health and Nutrition Examination Survey (NHANES), 2001-2004. J Asthma 2009; 46:759-66. [PMID: 19863277 DOI: 10.1080/02770900903067895] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prevalence of asthma has increased over the last three decades with females exhibiting a higher prevalence of asthma than males. The objective of this study was to obtain gender-specific estimates of the prevalence of current and ever asthma and describe the relationships between risk factors and asthma by gender in US men and women ages 20 to 85. METHODS Data for this study came from two cycles (2001-2002 and 2003-2004) of National Health and Nutrition Examination Survey (NHANES) and included 9,243 eligible adults: 4,589 females and 4,654 males. Multiple logistic regression was used to investigate gender-specific associations between race/ethnicity, body mass index (BMI), sociodemographic characteristics, and smoking habits for current asthma and ever asthma. RESULTS The prevalence of current asthma was 8.8% for women and 5.8% for men, while the prevalence of ever having been diagnosed with asthma was higher (13.7% and 10.4% for women and men, respectively). Current asthma was less prevalent in Mexican American women (1.9%) and men (0.9%) born in Mexico as compared to Mexican Americans born in the U.S. (8.7% and 5.2% for women and men, respectively) or for any other ethnic group. Approximately 20% of extremely obese women and men had ever been diagnosed with asthma; among this group, 15% reported they had current asthma. Results from multiple logistic regression models indicate that extreme obesity and living in poverty were strongly associated with current and ever asthma for both women and men, as was former smoking and ever asthma for men. CONCLUSION As compared to previous NHANES reports, our results indicate that the prevalence of asthma among U.S. adults continues to increase. Further, our findings of marked differences among subgroups of the population suggest asthma-related disparities for impoverished persons and greater prevalence of asthma among obese and extremely obese US adults.
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Affiliation(s)
- Michelle K McHugh
- Division of Environmental and Occupational Health Sciences, University of Texas School of Public Health, Houston, Texas 77030, USA
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22
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Clerisme-Beaty EM, Karam S, Rand C, Patino CM, Bilderback A, Riekert KA, Okelo SO, Diette GB. Does higher body mass index contribute to worse asthma control in an urban population? J Allergy Clin Immunol 2009; 124:207-12. [PMID: 19615731 PMCID: PMC2733240 DOI: 10.1016/j.jaci.2009.05.034] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 05/12/2009] [Accepted: 05/15/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Epidemiologic findings support a positive association between asthma and obesity. OBJECTIVE Determine whether obesity or increasing level of body mass index (BMI) are associated with worse asthma control in an ethnically diverse urban population. METHODS Cross-sectional assessment of asthma control was performed in patients with asthma recruited from primary care offices by using 4 different validated asthma control questionnaires: the Asthma Control and Communication Instrument (ACCI), the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ), and the Asthma Therapy Assessment Questionnaire (ATAQ). Multiple linear regression analysis was performed to evaluate the association between obesity and increasing BMI level and asthma control. RESULTS Of 292 subjects with a mean age of 47 years, the majority were women (82%) and African American (67%). There was a high prevalence of obesity with 63%, with only 15% normal weight. The mean score from all 4 questionnaires showed an average suboptimal asthma control (mean score/maximum possible score): ACCI (8.3/19), ACT (15.4/25), ACQ (2.1/6), and ATAQ (1.3/4). Regression analysis showed no association between obesity or increasing BMI level and asthma control using all 4 questionnaires. This finding persisted even after adjusting for FEV(1), smoking status, race, sex, selected comorbid illnesses, and long-term asthma controller use. CONCLUSION Using 4 validated asthma control questionnaires, we failed to find an association between obesity and asthma control in an urban population with asthma. Weight loss may not be an appropriate strategy to improve asthma control in this population.
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Affiliation(s)
| | - Sabine Karam
- Department of Medicine, Albert Einstein College of Medicine, New York, NY
| | - Cynthia Rand
- Department of Medicine, Johns Hopkins University, Baltimore MD
| | - Cecilia M Patino
- Department of Preventive Medicine, University of Southern California, Los Angeles CA
| | | | | | - Sande O. Okelo
- Department of Pediatrics, Johns Hopkins University, Baltimore MD
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Musaad SMA, Patterson T, Ericksen M, Lindsey M, Dietrich K, Succop P, Khurana Hershey GK. Comparison of anthropometric measures of obesity in childhood allergic asthma: central obesity is most relevant. J Allergy Clin Immunol 2009; 123:1321-7.e12. [PMID: 19439348 DOI: 10.1016/j.jaci.2009.03.023] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND Established indicators of central obesity include waist circumference, waist/height ratio, and the conicity index. Studies using such measures (as opposed to body mass index [BMI] percentiles) to characterize the association between obesity and asthma are lacking, despite the fact that these measures have been shown to be most relevant for many other chronic diseases. OBJECTIVES We sought to examine measures assessing the distribution of obesity in the context of childhood allergic rhinitis and asthma and to elucidate the association of obesity, including central obesity, with allergic asthma in children. METHODS Children with allergic rhinitis with (cases) or without (control subjects) asthma were recruited. BMI percentiles were derived by using national growth charts. Waist circumference, waist/height ratio, and conicity index values were obtained. RESULTS Central obesity was associated with asthma, asthma severity, lower lung function, and reduced atopy in asthmatic subjects. CONCLUSION Measures of central obesity are more associated with the presence of asthma and asthma severity in children with allergic rhinitis when compared with standard BMI measures.
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Affiliation(s)
- Salma M A Musaad
- Division of Asthma Research and Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Abstract
OBJECTIVE Having demonstrated that prior history of prolapse was a risk factor for pelvic floor repair procedures after hysterectomy, the objective of this study was to assess medical risk factors for pelvic floor repair after hysterectomy. METHODS Using the Rochester Epidemiology Project database of 8,220 Olmsted County, Minnesota, women who had hysterectomy for benign indications from 1965-2002, we conducted a nested case-control study in 144 pairs, comparing women who underwent pelvic floor repair after hysterectomy (case group) with women matched for known risk factors (ie, age, pelvic floor disorders at baseline, year and type of hysterectomy, and pelvic floor repair during hysterectomy) (control group). RESULTS The median duration between hysterectomy and pelvic floor repair was 13 years. Chronic pulmonary disease (odds ratio [OR] 14.3, 95% confidence interval [CI] 1.2-178), but not obstetric history, obesity, indication for hysterectomy, or chronic constipation, was associated with an increased risk of pelvic floor repair after hysterectomy. Between the hysterectomy and subsequent pelvic floor repair, overall pelvic organ prolapse severity changed by one grade or less in 54 case patients (38%, group A) but increased by two or more grades in 72 case patients (50%, group B). In group A, but not group B, uterine prolapse (OR 25, 95% CI 2.1-300) and chronic pulmonary disease (OR 22, 95% CI 1.5-328) at baseline remained risk factors for pelvic floor repair after hysterectomy. CONCLUSION In this matched case-control study, chronic pulmonary disease was the only risk factor for pelvic floor repair after hysterectomy for benign indications, underscoring the need to address pulmonary status before surgery.
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Affiliation(s)
- Daniel Waggoner
- Division of Allergy and Immunology, Creighton University School of Medicine, Omaha, Nebraska 68131, USA
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26
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Mannino DM. Doc, my asthma (depression) has gotten me down (wheezing). Chest 2009; 134:1116-1117. [PMID: 19059954 DOI: 10.1378/chest.08-2047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Westermann H, Choi TN, Briggs WM, Charlson ME, Mancuso CA. Obesity and exercise habits of asthmatic patients. Ann Allergy Asthma Immunol 2008; 101:488-94. [PMID: 19055202 PMCID: PMC2597623 DOI: 10.1016/s1081-1206(10)60287-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND National guidelines recommend 20 to 30 minutes of exercise 3 to 5 days a week. However, achieving these goals may be challenging for asthmatic patients whose symptoms are exacerbated by exercise. OBJECTIVE To describe relationships among exercise habits, weight, and asthma severity and control in adults with asthma. METHODS Self-reported exercise habits were obtained from 258 stable patients by using the Paffenbarger Physical Activity and Exercise Index. Disease status was measured by using the Asthma Control Questionnaire and the Severity of Asthma Scale. Exercise habits were evaluated in multivariate analyses with age, sex, education, body mass index, and asthma control and severity as independent variables. RESULTS The mean patient age was 42 years; 75% were women, 62% were college graduates, and 40% were obese. Only 44% of patients did any exercise. In bivariate analysis, patients with well-controlled asthma were more likely to exercise; however, in multivariate analysis, asthma control and severity were not associated, but male sex (P = .01), having more education (P = .04), and not being obese (P < .001) were associated. Asthma control and severity also were not associated with type, duration, or frequency of exercise, but not being obese was associated in multivariate analyses. Only 22% of all patients (49% of those who exercised) met national guidelines for weekly exercise. Not being obese was the only variable associated with meeting guidelines in multivariate analysis (P = .02). CONCLUSIONS Compared with the general population, a lower proportion of asthmatic patients did any routine exercise and met national exercise guidelines. Physicians need to manage asthma and obesity to help asthmatic patients meet exercise goals.
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Affiliation(s)
| | | | | | | | - Carol A. Mancuso
- Weill Cornell Medical College, New York, New York
- Hospital for Special Surgery, New York, New York
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Tonorezos ES, Karpati AM, Wang Y, Barr RG. Does the relationship between asthma and obesity differ by neighborhood? Respir Med 2008; 102:1797-804. [PMID: 18707858 DOI: 10.1016/j.rmed.2008.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 06/19/2008] [Accepted: 06/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prior studies suggest that obesity may cause asthma. Obesity and asthma are prevalent in low-income urban neighborhoods, but the impact of obesity on asthma in such neighborhoods has not been examined. METHODS The New York City Department of Health and Mental Hygiene surveyed 6119 adults age 18-54 years in 2002. Obesity was defined as body mass index > or = 30 kg/m(2) and current asthma as physician diagnosed asthma plus recent symptoms. We calculated prevalence (risk) differences (RD) and population attributable risk percents (PAR%). RESULTS Obese individuals had a 2.0% (95% CI: 0.5%, 3.6%; p=0.01) higher risk of current asthma than normal weight individuals overall. Obesity was more common in low-income neighborhoods compared with middle-to-upper-income neighborhoods (23% vs. 14%, p<0.001), as was current asthma (6% vs. 4%, respectively, p=0.02). The risk of current asthma associated with obesity was similar in low-income (RD: 1.3%, 95% CI: -1.5%, 4.0%; p=0.36) and middle-to-upper-income neighborhoods (RD: 2.0%, 95% CI: 0.1%, 3.9%; p=0.04). The PAR% for asthma due to obesity was not greater in low-income (7.3%) than in middle-to-upper-income neighborhoods (7.7%). CONCLUSIONS It is unlikely that the excess asthma prevalence in urban low-income neighborhoods is disproportionately attributable to obesity. Instead, alternative causes of excess asthma should be sought.
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Affiliation(s)
- Emily S Tonorezos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University, New York, NY, USA
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Jacobson JS, Mellins RB, Garfinkel R, Rundle AG, Perzanowski MS, Chew GL, Andrews HF, Goldstein IF. Asthma, body mass, gender, and Hispanic national origin among 517 preschool children in New York City. Allergy 2008; 63:87-94. [PMID: 18053018 DOI: 10.1111/j.1398-9995.2007.01529.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Striking differences in asthma prevalence have been reported among Hispanic adults and children living in different cities of the USA. Prevalence is highest among those of Puerto Rican and lowest among those of Mexican origin. We hypothesized that body size would mediate this association. METHODS Parents of children in New York City Head Start programs completed a questionnaire including demographic factors, health history, a detailed history of respiratory conditions, lifestyle, and home environment. Children's height and weight were measured in home visits. Logistic regression was used to model the association of asthma with body mass index percentile (<85th percentile, gender/age specific vs>or=85th percentile, gender/age specific), national origin, and other factors. RESULTS Of 517 children at mean age of 4.0 +/- 0.6 years, 34% met the study criteria for asthma, and 43% were above the 85th percentile. Asthma was strongly associated with non-Mexican national origin, male gender, allergy symptoms, and maternal asthma, and marginally with body size. The odds of asthma among boys of non-Mexican origin was 5.9 times that among boys of Mexican origin [95% confidence interval (CI): 2.9-12.2]; the comparable odds ratio (OR) among girls was 1.8 (95% CI: 0.9-3.6). Body mass was associated with asthma among girls [OR = 2.0 (95% CI: 1.1-3.7)], but not boys [OR = 1.4 (95% CI: 0.8-2.6)]. CONCLUSIONS The association of asthma with both body mass and national origin was gender-specific among the children in our study. Ours is one of the first studies to report on pediatric asthma in different Hispanic populations in the same city, by gender.
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Affiliation(s)
- J S Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
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Bender BG, Fuhlbrigge A, Walders N, Zhang L. Overweight, race, and psychological distress in children in the Childhood Asthma Management Program. Pediatrics 2007; 120:805-13. [PMID: 17908768 DOI: 10.1542/peds.2007-0500] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to determine whether overweight in youth with mild-to-moderate asthma occurs with increased frequency and is accompanied by impaired psychological functioning. PATIENTS AND METHODS The interrelationships among BMI and demographic and psychological characteristics were examined in 1005 children (aged 5-12 years) enrolled in the Childhood Asthma Management Program and seen for repeated visits over 4 1/2 years. RESULTS Baseline rates of overweight (BMI for age: > or = 95th percentile) were comparable, but rates of overweight risk (BMI for age: 85th to < 95th percentile) among children in the Childhood Asthma Management Program were elevated in comparison with the general population of children in the United States. Rates of overweight and overweight risk did not increase over the course of the longitudinal study. Overweight and overweight risk were more frequent among black and Hispanic than white children, although they were not higher relative to same-race groups in the general population. Overweight at baseline was associated with lower IQ, more social withdrawal, and greater internalized psychological distress. As the children became older, the overweight group demonstrated increased evidence of behavior problems and decreased physical activity. CONCLUSIONS This study identifies an increase in overweight risk but not overweight in children with mild-to-moderate asthma. Comorbidity between asthma and overweight may be underestimated, because children with severe asthma and those from impoverished backgrounds were not represented in this sample. For the 14% of children who were overweight, some associated psychological difficulties were present in childhood, and additional problems were seen during adolescence. These results suggest a need for programs that encourage greater vigilance and intervention for overweight children with asthma.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206, USA.
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Tsai HJ, Tsai AC, Nriagu J, Ghosh D, Gong M, Sandretto A. Associations of BMI, TV-watching time, and physical activity on respiratory symptoms and asthma in 5th grade schoolchildren in Taipei, Taiwan. J Asthma 2007; 44:397-401. [PMID: 17613637 DOI: 10.1080/02770900701364304] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The study evaluated the associations of body fatness, TV-watching time, and physical activity with the occurrences of asthma and respiratory symptoms in schoolchildren in Taipei, Taiwan. A questionnaire survey was conducted to elicit episodes of respiratory symptoms and data on lifestyle and anthropometric factors in 2290 5th-grade schoolchildren. Results show that overweight was positively associated with 5 of the 7 respiratory symptoms. The risk of having respiratory symptoms increased 47%-94% in overweight schoolchildren. Watching TV > or = 3 hrs/day was associated with more occurrences of respiratory symptoms (aOR = 1.42-1.90). Physical activity > or =3 times/week was associated with fewer occurrences of respiratory symptoms (aOR = 0.66-0.73). Overweight was positively associated with an increased risk of suspected asthma in boys (aOR = 1.56, 95% CI = 1.07-2.29), but not in girls. In summary, overweight and greater TV-watching time increase the risk of respiratory symptoms, while habitual physical activity decreases the risk of respiratory symptoms. Weight status, sedentary life, and frequency of physical exercise are the factors that can impact on the respiratory health of schoolchildren.
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Affiliation(s)
- Hsin-Jen Tsai
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
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Abstract
Obesity is an important public health problem. An increasing body of data supports the hypothesis that obesity is a risk factor for asthma. These data include numerous large cross-sectional and prospective studies performed in adults, adolescents, and children throughout the world. With few exceptions, these studies indicate an increased relative risk of asthma in the obese and overweight and demonstrate that obesity antedates asthma. Obesity appears to be a particularly important issue for severe asthma. Studies showing improvements in asthma in subjects who lose weight, as well as studies showing that obese mice have innate airway hyperresponsiveness (AHR) as well as increased responses to certain asthma triggers also suggest a causal relationship between obesity and asthma. The mechanistic basis for this relationship has not been established. It may be that obesity and asthma share some common etiology, such as a common genetic predisposition, common effects of in utero conditions, or that obesity and asthma are both the result of some other predisposing factor such as physical activity or diet. However, there are also plausible biological mechanisms whereby obesity could be expected to either cause or worsen asthma. These include co-morbidities such as gastroesophageal reflux, complications from sleep-disordered breathing (SDB), breathing at low lung volume, chronic systemic inflammation, and endocrine factors, including adipokines and reproductive hormones. Understanding the mechanistic basis for the relationship between obesity and asthma may lead to new therapeutic strategies for treatment of this susceptible population.
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Affiliation(s)
- Stephanie A Shore
- Physiology Program, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.
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