1
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Sherris AR, Loftus CT, Szpiro AA, Dearborn LC, Hazlehurst MF, Carroll KN, Moore PE, Adgent MA, Barrett ES, Bush NR, Day DB, Kannan K, LeWinn KZ, Nguyen RHN, Ni Y, Riederer AM, Robinson M, Sathyanarayana S, Zhao Q, Karr CJ. Prenatal polycyclic aromatic hydrocarbon exposure and asthma at age 8-9 years in a multi-site longitudinal study. Environ Health 2024; 23:26. [PMID: 38454435 PMCID: PMC10921622 DOI: 10.1186/s12940-024-01066-2] [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: 06/30/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND AIM Studies suggest prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) may influence wheezing or asthma in preschool-aged children. However, the impact of prenatal PAH exposure on asthma and wheeze in middle childhood remain unclear. We investigated these associations in socio-demographically diverse participants from the ECHO PATHWAYS multi-cohort consortium. METHODS We included 1,081 birth parent-child dyads across five U.S. cities. Maternal urinary mono-hydroxylated PAH metabolite concentrations (OH-PAH) were measured during mid-pregnancy. Asthma at age 8-9 years and wheezing trajectory across childhood were characterized by caregiver reported asthma diagnosis and asthma/wheeze symptoms. We used logistic and multinomial regression to estimate odds ratios of asthma and childhood wheezing trajectories associated with five individual OH-PAHs, adjusting for urine specific gravity, various maternal and child characteristics, study site, prenatal and postnatal smoke exposure, and birth year and season in single metabolite and mutually adjusted models. We used multiplicative interaction terms to evaluate effect modification by child sex and explored OH-PAH mixture effects through Weighted Quantile Sum regression. RESULTS The prevalence of asthma in the study population was 10%. We found limited evidence of adverse associations between pregnancy OH-PAH concentrations and asthma or wheezing trajectories. We observed adverse associations between 1/9-hydroxyphenanthrene and asthma and persistent wheeze among girls, and evidence of inverse associations with asthma for 1-hydroxynathpthalene, which was stronger among boys, though tests for effect modification by child sex were not statistically significant. CONCLUSIONS In a large, multi-site cohort, we did not find strong evidence of an association between prenatal exposure to PAHs and child asthma at age 8-9 years, though some adverse associations were observed among girls.
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Affiliation(s)
- Allison R Sherris
- Department of Environmental and Occupational Health Sciences, University of Washington4225, Roosevelt Way NE, Suite 300, Seattle, WA, 98105, US.
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, University of Washington4225, Roosevelt Way NE, Suite 300, Seattle, WA, 98105, US
| | - Adam A Szpiro
- Department of Biostatistics, University of Washington, Seattle, WA, US
| | - Logan C Dearborn
- Department of Environmental and Occupational Health Sciences, University of Washington4225, Roosevelt Way NE, Suite 300, Seattle, WA, 98105, US
| | - Marnie F Hazlehurst
- Department of Environmental and Occupational Health Sciences, University of Washington4225, Roosevelt Way NE, Suite 300, Seattle, WA, 98105, US
| | | | - Paul E Moore
- Vanderbilt University Medical Center, Nashville, TN, US
| | | | - Emily S Barrett
- Rutgers University School of Public Health, Piscataway, NJ, US
| | | | - Drew B Day
- Seattle Children's Research Institute, Seattle, WA, US
| | | | | | | | - Yu Ni
- San Diego State University, San Diego, CA, US
| | - Anne M Riederer
- Department of Environmental and Occupational Health Sciences, University of Washington4225, Roosevelt Way NE, Suite 300, Seattle, WA, 98105, US
| | | | | | - Qi Zhao
- University of Tennessee Health Science Center, Memphis, TN, US
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, University of Washington4225, Roosevelt Way NE, Suite 300, Seattle, WA, 98105, US
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2
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Zhou JX, Guo Y, Teng YZ, Zhu LL, Lu J, Hao XM, Yan SQ, Tao FB, Huang K. Maternal anxiety during pregnancy and children's asthma in preschool age: The Ma'anshan birth cohort study. J Affect Disord 2023; 340:312-320. [PMID: 37549810 DOI: 10.1016/j.jad.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/17/2023] [Accepted: 08/04/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The fetal immune system and consequent elevated risk of asthma in childhood may be impacted by maternal anxiety during pregnancy. Limited studies have evaluated whether there was a sensitive period and cumulative effect of the relationship between prenatal anxiety and children's asthma. METHODS 3131 mother-child pairs made up the study's sample from the Ma'anshan Birth Cohort Study in China. Maternal anxiety status was repeated three times using the pregnancy-related anxiety questionnaire in the 1st, 2nd and 3rd trimesters of pregnancy. Diagnostic information on asthma was collected three times at 24, 36, and 48 months of age. RESULTS After adjusting for confounders, children born to mothers with anxiety in the 1st, 2nd and 3rd trimesters of pregnancy all had an elevated risk of total asthma from 12 to 48 months of age. After further adjusting prenatal anxiety in the other trimesters, no association was observed between prenatal anxiety in any trimester and preschoolers' asthma. Children of mothers with persistently high anxiety score trajectory during pregnancy had an elevated risk of total asthma and high prevalence trajectory of asthma. Cumulative effects analysis showed that the more frequent the mother's anxiety, the higher the risk of her offspring developing a high prevalence trajectory of asthma from 12 to 48 months of age. The results of the subgroup analysis by age showed similar associations overall. CONCLUSIONS Maternal antenatal anxiety was associated with an elevated risk of preschool children's asthma, and a possible cumulative effect was observed. Maternal mental health conditions during pregnancy should receive constant attention throughout pregnancy, not just during one period.
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Affiliation(s)
- Ji-Xing Zhou
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Yufan Guo
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Yu-Zhu Teng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Lin-Lin Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Jingru Lu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Xue-Mei Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Shuang-Qin Yan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Maternal and Child Health Care Center of Ma'anshan, No 24 Jiashan Road, Ma'anshan 243011, Anhui, China
| | - Fang-Biao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, China; Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei 230032, China; NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei 230032, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China; Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Anhui Province, China.
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Sherris AR, Loftus CT, Szpiro AA, Dearborn L, Hazlehurst MF, Carroll KN, Moore PE, Adgent MA, Barrett ES, Bush NR, Day DB, Kannan K, LeWinn KZ, Nguyen RHN, Ni Y, Riederer AM, Robinson M, Sathyanarayana S, Zhao Q, Karr CJ. Prenatal polycyclic aromatic hydrocarbon exposure and asthma at age 8-9 years in a multi-site longitudinal study. RESEARCH SQUARE 2023:rs.3.rs-3129552. [PMID: 37503063 PMCID: PMC10371133 DOI: 10.21203/rs.3.rs-3129552/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background and aim Studies suggest prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) may influence wheezing or asthma in preschool-aged children. However, the impact of prenatal PAH exposure on asthma and wheeze in middle childhood remain unclear. We investigated these associations in diverse participants from the ECHO PATHWAYS multi-cohort consortium. Methods We included 1,081 birth parent-child dyads across five U.S. cities. Maternal urinary mono-hydroxylated PAH metabolite concentrations (OH-PAH) were measured during mid-pregnancy. Asthma at age 8-9 years and wheezing trajectory across childhood were characterized by caregiver reported asthma diagnosis and asthma/wheeze symptoms. We used logistic and multinomial regression to estimate odds ratios of asthma and childhood wheezing trajectories associated with five individual OH-PAHs, adjusting for urine specific gravity, various maternal and child characteristics, study site, prenatal and postnatal smoke exposure, and birth year and season in single metabolite and mutually adjusted models. We used multiplicative interaction terms to evaluate effect modification by child sex and explored OH-PAH mixture effects through Weighted Quantile Sum regression. Results The prevalence of asthma in the study population was 10%. We found limited evidence of adverse associations between pregnancy OH-PAH concentrations and asthma or wheezing trajectories. We observed adverse associations between 1/9-hydroxyphenanthrene and asthma and persistent wheeze among girls, and evidence of inverse associations with asthma for 1-hydroxynathpthalene, which was stronger among boys, though tests for effect modification by child sex were not statistically. Conclusions In a large, multi-site cohort, we did not find strong evidence of an association between prenatal exposure to PAHs and child asthma at age 8-9 years, though some adverse associations were observed among girls.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Qi Zhao
- University of Tennessee Health Science Center
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4
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Islam JY, Hoppin J, Mora AM, Soto-Martinez ME, Gamboa LC, Castañeda JEP, Reich B, Lindh C, van Wendel de Joode B. Respiratory and allergic outcomes among 5-year-old children exposed to pesticides. Thorax 2023; 78:41-49. [PMID: 35210357 PMCID: PMC9533533 DOI: 10.1136/thoraxjnl-2021-218068] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the effects of pesticides on children's respiratory and allergic outcomes. We evaluated associations of prenatal and current pesticide exposures with respiratory and allergic outcomes in children from the Infants' Environmental Health Study in Costa Rica. METHODS Among 5-year-old children (n=303), we measured prenatal and current specific gravity-corrected urinary metabolite concentrations of insecticides (chlorpyrifos, pyrethroids), fungicides (mancozeb, pyrimethanil, thiabendazole) and 2,4-D. We collected information from caregivers on respiratory (ever doctor-diagnosed asthma and lower respiratory tract infections (LRTI), wheeze and cough during last 12 months) and allergic (nasal allergies, itchy rash, ever eczema) outcomes. We fitted separate multivariable logistic regression models for high (≥75th percentile (P75)) vs low (<P75) metabolite concentrations with respiratory and allergic outcomes. We also ran models including metabolite concentrations as continuous exposure variables. RESULTS Children's respiratory outcomes were common (39% cough, 20% wheeze, 12% asthma, 5% LRTI). High current pyrethroid metabolite concentrations (∑pyrethroids) were associated with wheeze (OR=2.37, 95% CI 1.28 to 4.34), itchy rash (OR=2.74, 95% CI 1.33 to 5.60), doctor-diagnosed asthma and LRTI. High current ethylene thiourea (ETU) (specific metabolite of mancozeb) was somewhat associated with LRTI (OR=2.09, 95% CI 0.68 to 6.02). We obtained similar results when modelling ∑pyrethroids and ETU as continuous variables. We saw inconsistent or null associations for other pesticide exposures and health outcomes. CONCLUSIONS Current pyrethroid exposure may affect children's respiratory and allergic health at 5 years of age. Current mancozeb exposure might contribute to LRTI. These findings are important as pyrethroids are broadly used in home environments and agriculture and mancozeb in agriculture.
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Affiliation(s)
- Jessica Y Islam
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA,Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Jane Hoppin
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA,Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Ana M Mora
- Infants' Environmental Health (ISA) Program, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica,Center for Environmental Research and Children's Health (CERCH), University of California, Berkeley, California, USA
| | | | - Leonel Córdoba Gamboa
- Infants' Environmental Health (ISA) Program, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Jorge Ernesto Peñaloza Castañeda
- Infants' Environmental Health (ISA) Program, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
| | - Brian Reich
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA,Department of Biostatistics, North Carolina State University, Raleigh, North Carolina, USA
| | - Christian Lindh
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Berna van Wendel de Joode
- Infants' Environmental Health (ISA) Program, Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
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5
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Murphy VE. Asthma in pregnancy - Management, maternal co-morbidities, and long-term health. Best Pract Res Clin Obstet Gynaecol 2022; 85:45-56. [PMID: 35871149 DOI: 10.1016/j.bpobgyn.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 12/14/2022]
Abstract
Asthma is the most prevalent chronic disease in pregnancy, and as symptoms can change with pregnancy, and exacerbations of asthma are common, regular review of asthma symptoms, the provision of self-management education, and appropriate medication use are the hallmarks of management. Co-morbidities are also prevalent among pregnant women with asthma, with obesity, gestational diabetes, hypertension, rhinitis, depression, and anxiety, more common among women with asthma than women without asthma. Less is known about reflux, obstructive sleep apnoea and vocal cord dysfunction, along with nutritional deficiencies to iron and vitamin D. Maternal asthma impacts the offspring's long-term health, particularly in increasing the risk of early life wheeze and asthma in childhood. While breastfeeding may modify the risk of infant wheeze, less is known about the mechanisms involved. More research is needed to further understand the relationship between asthma in pregnancy and the risk of poor neurodevelopmental outcomes, such as autism.
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Affiliation(s)
- Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, and Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, NSW, Australia.
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6
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Shapiro DJ, Wu AC. Intermittent Tiotropium for Episodic Wheezing. Pediatrics 2022; 150:188735. [PMID: 35942819 DOI: 10.1542/peds.2022-057926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Daniel J Shapiro
- Divisions of Emergency Medicine.,Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ann Chen Wu
- General Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
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7
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Wheezing trajectories from childhood to adulthood in a population-based cohort. Allergol Int 2022; 71:200-206. [PMID: 34600810 DOI: 10.1016/j.alit.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Wheezing may lead to asthma and reduced pulmonary function in later life. The study aims to identify wheezing trajectories and investigate their relation with pulmonary function and asthma-related outcomes at 22 years of age. METHODS Individuals from a population-based cohort in Brazil (1993 Pelotas Birth Cohort) with post-bronchodilator pulmonary function data at 22 years (3350) were included in the study. From parentally reported (4 and 11 years) and self-reported (15, 18 and 22 years) history of wheezing in the last 12 months, we used a group-based trajectory modelling approach to derive wheezing trajectories. RESULTS Four trajectories were identified: never/infrequent, transient-early, late-onset and persistent wheeze. After adjustments, wheezing trajectories remained associated with lower post-bronchodilator values of pulmonary function. Individuals in the persistent wheeze trajectory had a markedly poorer pulmonary function and also showed greater odds of asthma-related outcomes compared to other trajectories groups. Those following this trajectory had on average -109 ml (95% CI: -188; -35), -1.80 percentage points (95% CI: -2.73; -0.87) and -316 ml/s (95% CI: -482; -150) lower FEV1, FEV1/FVC ratio and FEF25-75% respectively; higher odds of self-reported medical diagnosis of allergy (OR 6.18; 95% CI: 3.59; 10.61) and asthma (OR 12.88; 95% CI: 8.91; 18.61) and asthma medication use (OR 9.42; 95% CI: 5.27; 16.87) compared to the never/infrequent group. CONCLUSIONS Wheezing trajectories, especially the persistent wheeze trajectory, were related to lower pulmonary function values and increased risk of asthma and allergy diagnosis in early adulthood.
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8
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Ezmigna D, Brown M, Daines C, Morgan W. Bronchoalveolar lavage profiles in uncontrolled wheezy children compared by asthma predictive index. Pediatr Pulmonol 2022; 57:293-299. [PMID: 34609079 DOI: 10.1002/ppul.25716] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The asthma predictive index (API) predicts later asthma in preschoolers with frequent wheeze. We hypothesized that airway cytology differs between API positive (API+)/negative (API-) children with uncontrolled/recurrent wheezing with dominance of eosinophils in API+ and neutrophils in API- groups respectively. The main objective of this study is to compare bronchoalveolar lavage (BAL) cell profiles in API+/API- children with recurrent wheezing unresponsive to inhaled corticosteroids (ICS). DESIGN Retrospective analysis of BAL in 43 children, 3-36 months (median: 14 months) receiving ICS (31 API+, 12 API-). BAL cell differential counts, bacterial/viral cultures, and lipid-laden macrophage percentages were analyzed. Cell counts presented as median (range). RESULTS Neutrophil percentages were increased in both groups (API- 16% [1%-76%]; API+ 42% [1%-95%]; p = NS). Cell percentages were similar for lymphocytes (API- 12% [1%-30%]; API+ 7% [1%-37%]), and macrophages (API- 67.5% [12%-97%]; API+ 41% [2%-94%]). Eosinophil percentages were low in both groups (API- 1% [1%-2%]; API+ 1% [1%-11%]). There was no difference in cellular distributions using absolute cell counts comparing API groups. Bacterial cultures were positive in 18 (60%) API+ and 5 (41%) API- patients (p = 0.10). CONCLUSION Cell profiles do not differ between API groups in children ≤36 months with recurrent wheezing unresponsive to ICS. Neutrophil percentages and total granulocyte count correlate with positive bacterial cultures independent of API status. Persistent bacterial bronchitis likely plays an important role in the persistence of symptoms unresponsive to ICS therapy regardless of API status with a trend to more positive cultures in API positive children.
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Affiliation(s)
- Dima Ezmigna
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Mark Brown
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Cori Daines
- Department of Pediatrics, The University of Arizona, Tucson, Arizona, USA
| | - Wayne Morgan
- Department of Pediatrics, The University of Arizona, Tucson, Arizona, USA
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9
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Dai R, Miliku K, Gaddipati S, Choi J, Ambalavanan A, Tran MM, Reyna M, Sbihi H, Lou W, Parvulescu P, Lefebvre DL, Becker AB, Azad MB, Mandhane PJ, Turvey SE, Duan Q, Moraes TJ, Sears MR, Subbarao P. Wheeze trajectories: Determinants and outcomes in the CHILD Cohort Study. J Allergy Clin Immunol 2021; 149:2153-2165. [PMID: 34974064 DOI: 10.1016/j.jaci.2021.10.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Wheezing in early life is associated with asthma in adulthood; however, the determinants of wheezing trajectories and their associations with asthma and lung function in childhood remain poorly understood. OBJECTIVE In the CHILD Cohort Study, we aimed to identify wheezing trajectories and examine the associations between these trajectories, risk factors, and clinical outcomes at age 5 years. METHODS Wheeze data were collected at 8 time points from 3 months to 5 years of age. We used group-based trajectory models to derive wheeze trajectories among 3154 children. Associations with risk factors and clinical outcomes were analyzed by weighted regression models. RESULTS We identified 4 trajectories: a never/infrequent trajectory, transient wheeze, intermediate-onset (preschool) wheeze, and persistent wheeze. Higher body mass index was a common risk factor for all wheeze trajectories compared with that in the never/infrequent group. The unique predictors for specific wheeze trajectories included male sex, lower respiratory tract infections, and day care attendance for transient wheeze; paternal history of asthma, atopic sensitization, and child genetic risk score of asthma for intermediate wheeze; and maternal asthma for persistent wheeze. Blood eosinophil counts were higher in children with the intermediate wheeze trajectory than in those children with the other trajectories at the ages of 1 and 5 years. All wheeze trajectories were associated with decreased lung function and increased risk of asthma at age 5 years. CONCLUSIONS We identified 4 distinct trajectories in children from 3 months to 5 years of age, reflecting different phenotypes of early childhood wheeze. These trajectories were characterized by different biologic and physiologic traits and risk factors.
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Affiliation(s)
- Ruixue Dai
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Kozeta Miliku
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | | | - Jihoon Choi
- Department of Biomedical and Molecular Sciences, School of Computing, Queen's University, Kingston, Canada
| | - Amirthagowri Ambalavanan
- Department of Biomedical and Molecular Sciences, School of Computing, Queen's University, Kingston, Canada
| | - Maxwell M Tran
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Myrtha Reyna
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Hind Sbihi
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Paula Parvulescu
- Public Health Department, Liverpool City Council, Liverpool, United Kingdom
| | | | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Qingling Duan
- Department of Biomedical and Molecular Sciences, School of Computing, Queen's University, Kingston, Canada
| | - Theo J Moraes
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada; Department of Medicine, McMaster University, Hamilton, Canada.
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Machine Learning for Predicting the Risk for Childhood Asthma Using Prenatal, Perinatal, Postnatal and Environmental Factors. Healthcare (Basel) 2021; 9:healthcare9111464. [PMID: 34828510 PMCID: PMC8623896 DOI: 10.3390/healthcare9111464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/16/2022] Open
Abstract
The prevalence rate for childhood asthma and its associated risk factors vary significantly across countries and regions. In the case of Morocco, the scarcity of available medical data makes scientific research on diseases such as asthma very challenging. In this paper, we build machine learning models to predict the occurrence of childhood asthma using data from a prospective study of 202 children with and without asthma. The association between different factors and asthma diagnosis is first assessed using a Chi-squared test. Then, predictive models such as logistic regression analysis, decision trees, random forest and support vector machine are used to explore the relationship between childhood asthma and the various risk factors. First, data were pre-processed using a Chi-squared feature selection, 19 out of the 36 factors were found to be significantly associated (p-value < 0.05) with childhood asthma; these include: history of atopic diseases in the family, presence of mites, cold air, strong odors and mold in the child's environment, mode of birth, breastfeeding and early life habits and exposures. For asthma prediction, random forest yielded the best predictive performance (accuracy = 84.9%), followed by logistic regression (accuracy = 82.57%), support vector machine (accuracy = 82.5%) and decision trees (accuracy = 75.19%). The decision tree model has the advantage of being easily interpreted. This study identified important maternal and prenatal risk factors for childhood asthma, the majority of which are avoidable. Appropriate steps are needed to raise awareness about the prenatal risk factors.
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11
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Creese H, Lai E, Mason K, Schlüter DK, Saglani S, Taylor-Robinson D, Saxena S. Disadvantage in early-life and persistent asthma in adolescents: a UK cohort study. Thorax 2021; 77:854-864. [PMID: 34650003 PMCID: PMC9411911 DOI: 10.1136/thoraxjnl-2021-217312] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/20/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine how early-life risk factors explain socioeconomic inequalities in persistent asthma in adolescence. METHODS We did a causal mediation analysis using data from 7487 children and young people in the UK Millennium Cohort Study. Persistent asthma was defined as having a diagnosis reported at any two or more time points at 7, 11 or 14 years. The main exposure was maternal education, a measure of early-life socioeconomic circumstances (SECs), used to calculate the relative index of inequality. We assessed how blocks of perinatal (maternal health behaviours, infant characteristics and duration of breastfeeding, measured at 9 months) and environmental risk factors (family housing conditions; potential exposure to infections through childcare type and sibling number, and neighbourhood characteristics, measured at 3 years) mediated the total effect of childhood SECs on persistent asthma risk, calculating the proportion mediated and natural indirect effect (NIE) via blocks of mediators. RESULTS At age 14 the overall prevalence of persistent asthma was 15%. Children of mothers with lower educational qualifications were more likely to have persistent asthma, with a clear social gradient (degree plus: 12.8% vs no qualifications: 20.3%). The NIE gives the effect of SECs acting only via the mediators and shows a 31% increased odds of persistent asthma when SECs are fixed at the highest level, and mediators at the level which would naturally occur at the lowest SECs versus highest SECs (NIE OR 1.31, 95% CI 1.04 to 1.65). Overall, 58.9% (95% CI 52.9 to 63.7) of the total effect (OR 1.70, 95% CI 1.20 to 2.40) of SECs on risk of persistent asthma in adolescence was mediated by perinatal and environmental characteristics. CONCLUSIONS Perinatal characteristics and the home environment in early life are more important in explaining socioeconomic inequalities in persistent asthma in British adolescents than more distal environmental exposures outside the home.
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Affiliation(s)
- Hanna Creese
- School of Public Health, Imperial College London, London, UK
| | - Eric Lai
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK.,Institute of Health Equity, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Kate Mason
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Daniela K Schlüter
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
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12
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Kahlon GK, Pooni PA, Bhat D, Dhooria GS, Bhargava S, Arora K, Gill KS. Role of montelukast in multitrigger wheezers attending chest clinic in Punjab, India. Pediatr Pulmonol 2021; 56:2530-2536. [PMID: 34102024 DOI: 10.1002/ppul.25522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Wheeze is seen in 40% of preschool children, one-third of these may develop recurrent wheeze. Montelukast is an oral, once a day, easy to give therapy but there is no definite evidence to support its use in a recent meta-analysis. Present study was done to evaluate role of daily montelukast and various factors affecting the outcome after therapy in multitrigger wheeze (MTW). METHODS A prospective study conducted in Pediatric chest clinic over 18 months at DMCH, Ludhiana. Children from 6 months to 5 years, diagnosed cases of MTW were started on montelukast. Diagnosis based on symptoms of recurrent wheeze triggered by various allergens/precipitants was made by pediatrician in charge of chest clinic. Children were followed up at 1 and 3 months. They were labeled as controlled, partially controlled, or uncontrolled as per global initiative for asthma guidelines. Data were used to compare the outcome related to various factors. RESULTS Total 139 out of 150 children came for regular follow-up. At the end of 3 months, 94 (67.7%) were controlled, 8 (5.7%) partially controlled, and 37 (26.6%) children remained uncontrolled on montelukast. Factors associated with poor control were onset of symptoms at younger age (<6 months of age), family history of allergies, prior multiple visits or hospitalizations due to MTW, use of MDI in the past. No significant side effects were reported by parents. CONCLUSION Symptomatically two-third of children became better after starting montelukast. There were few factors which resulted in poorer control in subset of patients.
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Affiliation(s)
| | - Puneet A Pooni
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Deepak Bhat
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | | | | | - Kamal Arora
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Karambir S Gill
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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13
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Furuhata M, Otsuka Y, Kaneita Y, Nakagome S, Jike M, Itani O, Ohida T. Factors Associated with the Development of Childhood Asthma in Japan: A Nationwide Longitudinal Study. Matern Child Health J 2021; 24:911-922. [PMID: 32342275 DOI: 10.1007/s10995-020-02944-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Many environmental factors are related to the development of asthma. However, the key factors of childhood asthma onset have not been sufficiently elucidated. Further, low-weight births have increased in Japan. The aim of this study was to examine the risk factors for the incidence of childhood asthma and to evaluate whether these risk factors differ according to birth weight in Japan. METHODS We used the National Longitudinal Survey from 2001 to 2010. Multiple logistic regression analyses were conducted to determine the effects of gender, birth weight, single vs. multiple births, birth order, nutrition, keeping pets in the home, place of residence, annual household income, and parent ages, smoking behaviors, and educational backgrounds on asthma-related hospital visits. RESULTS Overall, 45,060 children were analyzed. The rate of cumulative hospital visits until age 10 was 18.9%. Birth weight < 2500 g (adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI] 1.03-1.26), being a boy (AOR = 1.27, 95% CI 1.21-1.33), having older siblings (AOR = 1.07, 95% CI 1.02-1.14), parental smoking behavior, mother`s age, and low household income (AOR = 1.17, 95% CI 1.10-1.24) were associated with asthma-related hospital visits. DISCUSSION Parental smoking behavior is a key risk factor for the development of asthma. Among low birth weight infants, being a boy, having older siblings, and father`s smoking behavior were predictive factors for the development of asthma. However, low birth weight was not associated with the development of asthma after 6 years of age.
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Affiliation(s)
- Masakazu Furuhata
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sachi Nakagome
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Maki Jike
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Ohida
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
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14
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Distinguishing Wheezing Phenotypes from Infancy to Adolescence. A Pooled Analysis of Five Birth Cohorts. Ann Am Thorac Soc 2020; 16:868-876. [PMID: 30888842 PMCID: PMC6600832 DOI: 10.1513/annalsats.201811-837oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Rationale: Pooling data from multiple cohorts and extending the time frame across childhood should minimize study-specific effects, enabling better characterization of childhood wheezing. Objectives: To analyze wheezing patterns from early childhood to adolescence using combined data from five birth cohorts. Methods: We used latent class analysis to derive wheeze phenotypes among 7,719 participants from five birth cohorts with complete report of wheeze at five time periods. We tested the associations of derived phenotypes with late asthma outcomes and lung function, and investigated the uncertainty in phenotype assignment. Results: We identified five phenotypes: never/infrequent wheeze (52.1%), early onset preschool remitting (23.9%), early onset midchildhood remitting (9%), persistent (7.9%), and late-onset wheeze (7.1%). Compared with the never/infrequent wheeze, all phenotypes had higher odds of asthma and lower forced expiratory volume in 1 second and forced expiratory volume in 1 second/forced vital capacity in adolescence. The association with asthma was strongest for persistent wheeze (adjusted odds ratio, 56.54; 95% confidence interval, 43.75–73.06). We observed considerable within-class heterogeneity at the individual level, with 913 (12%) children having low membership probability (<0.60) of any phenotype. Class membership certainty was highest in persistent and never/infrequent, and lowest in late-onset wheeze (with 51% of participants having membership probabilities <0.80). Individual wheezing patterns were particularly heterogeneous in late-onset wheeze, whereas many children assigned to early onset preschool remitting class reported wheezing at later time points. Conclusions: All wheeze phenotypes had significantly diminished lung function in school-age children, suggesting that the notion that early life episodic wheeze has a benign prognosis may not be true for a proportion of transient wheezers. We observed considerable within-phenotype heterogeneity in individual wheezing patterns.
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15
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Lundholm C, Gunnerbeck A, D'Onofrio BM, Larsson H, Pershagen G, Almqvist C. Smoking and snuff use in pregnancy and the risk of asthma and wheeze in pre-schoolchildren-A population-based register study. Clin Exp Allergy 2020; 50:597-608. [PMID: 32149429 DOI: 10.1111/cea.13593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/27/2020] [Accepted: 02/10/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Associations between tobacco smoking during pregnancy and offspring asthma have been observed, but the role of nicotine and familial factors remains unclear. OBJECTIVE To estimate the association between tobacco use in pregnancy, both smoking and Swedish oral moist snuff, and asthma/wheeze in the offspring, how it varies by the child's age and explore the influence of measured and unmeasured familial confounding. METHODS Register-based cohort study with sibling comparisons. The cohort included 788 508 children, born in Sweden 2005-2012 with information on maternal tobacco use in pregnancy, followed until December 2015. Asthma was based on a validated algorithm using asthma diagnoses from hospital visits and prescribed asthma drugs from nation-wide registers, both as incident asthma/wheeze in age 0-8 years and current asthma at ages 2, 3, 4, 5 and 6 years. RESULTS For smoking during pregnancy (SDP), we saw a pattern with higher hazard ratios for asthma/wheeze around ages 5 and 18 months. Snuff did not show the same pattern. For current asthma, we saw the strongest association at age 2 years (adjOR = 1.22, 95% CI: 1.17-1.28), for snuff it was weaker (adjOR = 1.06, 95% CI: 0.96-1.18). When using sibling controls, the estimates for SDP were clearly attenuated, albeit with wide confidence intervals. CONCLUSION AND CLINICAL RELEVANCE We saw an association between SDP and asthma at early age. The association with snuff was clearly weaker. The associations with SDP were attenuated when adjusting for measured and unmeasured familial factors shared by siblings. Based on those results, nicotine seems to have a limited role in the association between SDP and asthma; rather environmental tobacco smoke and other familial factors seem to explain observed associations.
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Affiliation(s)
- Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Gunnerbeck
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Pediatric Endocrinology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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16
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Parks J, McCandless L, Dharma C, Brook J, Turvey SE, Mandhane P, Becker AB, Kozyrskyj AL, Azad MB, Moraes TJ, Lefebvre DL, Sears MR, Subbarao P, Scott J, Takaro TK. Association of use of cleaning products with respiratory health in a Canadian birth cohort. CMAJ 2020; 192:E154-E161. [PMID: 32071106 PMCID: PMC7030878 DOI: 10.1503/cmaj.190819] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Comprehensive longitudinal studies are important for understanding the complex risk factors, pathways, exposures and interactions that lead to the development and persistence of asthma. We aimed to examine associations between use of household cleaning products in early life and childhood respiratory and allergic disease using data from the Canadian Healthy Infant Longitudinal Development (CHILD) Cohort Study. METHODS We summed responses from parental questionnaires that indicated the frequency of use of 26 household cleaning products in the homes of 2022 children from this birth cohort when they were 3-4 months of age to create a cumulative Frequency of Use Score (FUS). We used multivariable logistic regression models to assess whether frequent compared with less frequent use was associated with recurrent wheeze, atopy or asthma diagnosis, as defined by the questionnaire and clinical assessments at age 3 years. Data were collected between 2008 and 2015. RESULTS Children in homes with a higher frequency of use of cleaning products in infancy, as determined by an interquartile range increase, had higher odds of recurrent wheeze (adjusted odds ratio [OR] 1.35, 95% confidence interval [CI] 1.11-1.64), recurrent wheeze with atopy (adjusted OR 1.49, 95% CI 1.02-2.16) and asthma diagnosis (adjusted OR 1.37, 95% CI 1.09-1.70), but no increase in the odds of atopy at age 3 years (adjusted OR 1.14, 95% CI 0.96-1.35). Compared with the lowest tertile of FUS exposure, infants in the highest tertile had higher odds of acquiring asthma. Stratification of the results showed that females had higher ORs than males for all outcomes, although the p values for this sex difference did not reach statistical significance. INTERPRETATION Frequent use of household cleaning products in early life was associated with an increased risk for childhood wheeze and asthma but not atopy at age 3 years. Our findings add to the understanding of how early life exposures to cleaning products may be associated with the development of allergic airway disease and help to identify household behaviours as a potential area for intervention.
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Affiliation(s)
- Jaclyn Parks
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Lawrence McCandless
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Christoffer Dharma
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Jeffrey Brook
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Stuart E Turvey
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Piush Mandhane
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Allan B Becker
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Anita L Kozyrskyj
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Meghan B Azad
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Theo J Moraes
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Diana L Lefebvre
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Malcolm R Sears
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Padmaja Subbarao
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - James Scott
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont
| | - Tim K Takaro
- Faculty of Health Sciences (Parks, McCandless, Takaro), Simon Fraser University, Vancouver, BC; Department of Medicine (Dharma, Lefebvre, Sears), McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Brook, Scott), University of Toronto, Toronto, Ont.; Department of Pediatrics (Turvey), University of British Columbia, Vancouver, BC; Department of Pediatrics (Mandhane, Kozyrskyj), University of Alberta, Edmonton, Alta.; Department of Pediatrics & Child Health (Becker, Azad), University of Manitoba, Winnipeg, Man.; Department of Pediatrics (Moraes, Subbarao), University of Toronto and Hospital for Sick Children, Toronto, Ont.
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17
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Mikeš O, Vrbová M, Klánová J, Čupr P, Švancara J, Pikhart H. Early-life exposure to household chemicals and wheezing in children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 663:418-425. [PMID: 30716632 DOI: 10.1016/j.scitotenv.2019.01.254] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 06/09/2023]
Abstract
The prevalence of the asthmatic symptoms among children increases globally over the time. Reduced exposure to pathogens in early childhood and increased exposure to anthropogenic irritants result in increased risk of wheezing in children, and all of this may be related to the usage of household chemicals. Objective of this analysis thus was to study the potential effects of overall exposure to home chemicals in the early life on the phenotypes of wheezing from birth until five years of age. 3411 mother-infant pairs from the Czech part of the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ) participated in the study. The exposure was estimated by the composite household chemical score from 18 chemical-based products. Social, medical and environmental factors were taken into account as covariates in multivariable multinomial logistic regression using phenotypes of wheezing as a study outcome. We were able to determine the association between several wheezing childhood phenotypes and the frequent usage of household chemicals in the fully adjusted model. Statistically significant odds ratios (OR) for increasing exposures per 1 SD of exposure score were obtained for the intermediate onset transient (OR 1.27, 95% CI 1.10-1.47), intermediated onset persistent (OR 1.23, 95% CI 1.03-1.46), and early onset persistent phenotypes (OR 1.36, 95% CI 1.04-1.77) in comparison to never wheezing children. Moreover, the persistent phenotypes were significantly associated with school age asthma. Our study has shown the negative role of the increased household chemicals usage on the respiratory outcomes in children up to five years of age. Overall evaluation of the household chemical exposure may be useful tool for any large epidemiological studies.
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Affiliation(s)
- Ondřej Mikeš
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Markéta Vrbová
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic; Department of Internal Gastroenterology, University Hospital Brno, Masaryk University, Faculty of Medicine, Jihlavska 20, 625 00 Brno, Czech Republic; Depertment of Clinical Immunology and Allergy, St. Anne's University Hospital, Masaryk University, Pekarska 53, Brno, Czech Republic
| | - Jana Klánová
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Pavel Čupr
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic
| | - Jan Švancara
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic; Institute of Biostatistics and Analyses, Faculty of Medicine and Faculty of Science, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic
| | - Hynek Pikhart
- Research Centre for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Kamenice 753/5, 625 00 Brno, Czech Republic; Department of Epidemiology & Public Health, University College London,1 - 19 Torrington Place, London WC1E 6BT, United Kingdom.
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18
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El-Heneidy A, Abdel-Rahman ME, Mihala G, Ross LJ, Comans TA. Milk Other Than Breast Milk and the Development of Asthma in Children 3 Years of Age. A Birth Cohort Study (2006⁻2011). Nutrients 2018; 10:E1798. [PMID: 30463252 PMCID: PMC6267177 DOI: 10.3390/nu10111798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/27/2018] [Accepted: 11/15/2018] [Indexed: 01/04/2023] Open
Abstract
Prevalence of asthma in Australian children is amongst the highest in the world. Although breastfeeding positively influences infant immunity, early introduction of Milk Other than Breast Milk (MOTBM) may also play an important role in the development of Asthma. The aim of this study was to investigate the association between the introduction of MOTBM in the first six months after birth and the development of reported persistent asthma in 3-year olds. A sample of 1121 children was extracted from the Environments for Healthy Living longitudinal birth cohort study. Introduction of MOTBM during the first six months after birth increased almost two-fold the risk of development of persistent asthma after adjusting for other covariates (Adjusted Relative Risk (ARR): 1.71, 95% CI: 1.03⁻2.83, p = 0.038). This study indicates that the introduction of MOTBM in the first six months of life is a risk factor for asthma incidence among 3-year old children. This result is important in explaining the benefits of breastfeeding as part of public health interventions to encourage mothers to increase breastfeeding initiation and duration, and avoid the introduction of MOTBM in the first six months after childbirth.
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Affiliation(s)
- Asmaa El-Heneidy
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
| | - Manar E Abdel-Rahman
- Department of Public Health, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| | - Gabor Mihala
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
| | - Lynda J Ross
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia.
| | - Tracy A Comans
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
- Centre for Health Services Research, University of Queensland, Brisbane QLD 4072, Australia.
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Quigley MA, Carson C, Kelly Y. Breastfeeding and Childhood Wheeze: Age-Specific Analyses and Longitudinal Wheezing Phenotypes as Complementary Approaches to the Analysis of Cohort Data. Am J Epidemiol 2018; 187:1651-1661. [PMID: 29617923 PMCID: PMC6070068 DOI: 10.1093/aje/kwy057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/09/2018] [Indexed: 11/12/2022] Open
Abstract
Systematic reviews suggest that breastfeeding is associated with a lower risk of asthma, although marked heterogeneity exists. Using UK Millennium Cohort Study data (n = 10,126 children, born 2000-2002), we examined the association between breastfeeding duration and wheezing in the previous year, first for each age group separately (ages 9 months, 3 years, 5 years, 7 years, and 11 years) and then in terms of a longitudinal wheezing phenotype: "early transient" (wheezing any time up to age 5 years but not thereafter), "late onset" (any time from age 7 years but not beforehand), and "persistent" (any time up to age 5 years and any time from age 7 years). The association between breastfeeding and wheeze varied by age (2-sided P for interaction = 0.0003). For example, breastfeeding for 6-9 months was associated with lower odds of wheezing at ages 9 months, 3 years, and 5 years but less so at ages 7 years and 11 years (adjusted odds ratios = 0.73, 0.78, 0.79, 0.84, 1.06, respectively). There was a strong dose-response relationship for breastfeeding per month and early transient wheeze (adjusted odds ratio for linear trend = 0.961, 95% confidence interval: 0.942, 0.980) but no clear trend for late-onset or persistent wheeze. Our results identified heterogeneity in the association between breastfeeding and wheezing according to age at wheezing and wheezing phenotype.
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Affiliation(s)
- Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Claire Carson
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Yvonne Kelly
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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20
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Thomsen AML, Ehrenstein V, Riis AH, Toft G, Mikkelsen EM, Olsen J. The potential impact of paternal age on risk of asthma in childhood: a study within the Danish National Birth Cohort. Respir Med 2018; 137:30-34. [PMID: 29605209 DOI: 10.1016/j.rmed.2018.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Advanced paternal age has been associated with offspring morbidity and mortality, possibly due to de novo mutations and epigenetic changes in male germ cells. Epigenetic changes in the cord blood cells have been linked to asthma symptoms in offspring, but the role of paternal age has been less studied. METHODS From the Danish National Birth Cohort, 48,785 children who completed the 7-year follow-up were included. Parental reports of physician-diagnosed asthma had been obtained by a posted or web-based questionnaire. Paternal age at delivery was obtained through linkage with maternal civil registration number in the Danish Civil Registration System and classified into four groups: ≤24, 25-34 (reference), 35-39, and >40 years. We calculated the prevalence proportion of asthma and prevalence ratios (PRs) with 95% confidence intervals (CIs) using log-binomial regression, adjusting for paternal smoking, paternal asthma, and paternal socioeconomic status. RESULTS At the 7-year follow-up, 5875 children (12%) had physician-diagnosed asthma. The prevalence of asthma in 7-year old children was higher with paternal age of ≤24 (adjusted PR 1.40; 95% CI: 1.26; 1.55) and lower with the paternal age of ≥35 years (adjusted PR 0.84; 95% CI: 0.78; 0.89) compared to the reference group. CONCLUSIONS Paternal age of ≥35 years was associated with a lower prevalence of asthma in childhood, and paternal age of ≤24 years with higher prevalence compared with paternal age of 25-34 years. The potential causes of higher asthma prevalence among offspring of young fathers warrant further investigation.
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Affiliation(s)
- Anne Marie L Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Anders Hammerich Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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21
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Ogawa K, Morisaki N, Kobayashi M, Jwa SC, Tani Y, Sago H, Horikawa R, Fujiwara T. Maternal vegetable intake in early pregnancy and wheeze in offspring at the age of 2 years. Eur J Clin Nutr 2018; 72:761-771. [PMID: 29434319 DOI: 10.1038/s41430-018-0102-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 09/24/2017] [Accepted: 11/29/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND/OBJECTIVES Vegetable intake during childhood may reduce the risk of subsequent asthma. We verified the effect of maternal intake during pregnancy on asthma risk in offspring, which has rarely been studied. SUBJECTS/METHODS In a hospital-based birth cohort study conducted in Tokyo, we administered a food frequency questionnaire at two periods during the respondents' pregnancy: early and mid to late periods. In addition, a questionnaire including the International Study of Asthma and Allergies in Childhood questionnaire was conducted when the offspring were 2 years old. Multivariate Poisson regression adjusting for maternal baseline demographics was used to elucidate the association between maternal vegetable intake and the incidence of wheeze in the offspring. RESULTS Among 310 singletons, 82 (26.5%) experienced wheeze at 2 years of age. Women with the highest intake of cruciferous, and folate-rich vegetables during early pregnancy reported a significantly lower prevalence of wheeze in their child at 2 years of age in comparison with those who reported the lowest intake (adjusted risk ratio: 0.48 and 0.47, 95% confidence interval: 0.26-0.89, and 0.25-0.87, respectively). In trend analysis, a higher maternal intake of cruciferous, folate-rich vegetables, and total vegetables during early pregnancy was less likely to be associated with wheeze in the offspring at 2 years old (p for trend: 0.038, <0.001, and 0.028, respectively). Maternal vegetable intake during mid to late pregnancy was not associated with wheeze in the offspring. CONCLUSIONS Maternal vegetable intake during early pregnancy may have a protective effect against asthma in offspring at 2 years of age.
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Affiliation(s)
- Kohei Ogawa
- Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Tokyo, 157-8535, Japan. .,Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Tokyo, 157-8535, Japan. .,Collaborative Departments of Advanced Pediatric Medicine, Graduate School of Medicine, Tohoku University, 2-1 Seiryotyo, aoba-ku, Sendaishi, 980-8575, Japan.
| | - Naho Morisaki
- Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Tokyo, 157-8535, Japan
| | - Minatsu Kobayashi
- Department of Food Science, Otsuma Women's University, 12 Sanbancho, Tokyo, 102-8537, Japan
| | - Seung Chik Jwa
- Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Tokyo, 157-8535, Japan
| | - Yukako Tani
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, 113-8510, Japan.,Research Fellow of Japan Society for the Promotion of Science, 5-3-1, Kojimachi, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Tokyo, 157-8535, Japan.,Collaborative Departments of Advanced Pediatric Medicine, Graduate School of Medicine, Tohoku University, 2-1 Seiryotyo, aoba-ku, Sendaishi, 980-8575, Japan
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, 2-10-1 Okura, Tokyo, 157-8535, Japan
| | - Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Tokyo, 157-8535, Japan.,Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45 Yushima, Tokyo, 113-8510, Japan
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22
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Madsen C, Haberg SE, Magnus MC, Aamodt G, Stigum H, London SJ, Nystad W, Nafstad P. Pregnancy exposure to air pollution and early childhood respiratory health in the Norwegian Mother and Child Cohort Study (MoBa). BMJ Open 2017; 7:e015796. [PMID: 29282255 PMCID: PMC5770814 DOI: 10.1136/bmjopen-2016-015796] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES It is unclear whether maternal air pollution exposure during pregnancy induces changes in the developing respiratory system of a child and whether it has consequences for respiratory health in early childhood. We investigated associations between exposure to moderate levels of air pollution during pregnancy and early childhood lower respiratory tract infections (LRTI) and wheezing. METHODS This study used a subgroup of 17 533 participants in the Norwegian Mother and Child Cohort Study. Air pollution levels at residential addresses were estimated using land use regression models, and back-extrapolated to the period of each pregnancy. Information on LRTI and wheezing and lifestyle factors was collected from questionnaires completed by mothers during pregnancy and when the child was 6 and 18 months of age. RESULTS Moderate mean levels of NO2 (13.6 µg/m3, range 0.01-60.4) exposure at residential address during pregnancy were not statistically associated with LRTI and wheezing. No association was found per 10 µg/m3 change in NO2 exposure and LRTI before the age of 6 months (adjusted risk ratio (RR) 0.99; 95% CI 0.84 to 1.17), or between 6 and 18 months of age (adjusted RR 1.05; 95% CI 0.94 to 1.16). Similarly, we found no association per 10 µg/m3 change in NO2 exposure and wheezing between 6 and 18 months of age (adjusted RR 1.02; 95% CI 0.97 to 1.07). CONCLUSIONS There were no statistically significant associations for moderate levels of pregnancy NO2 exposure and respiratory health outcomes during early childhood in overall analyses.
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Affiliation(s)
- Christian Madsen
- Department of Health & Inequality, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Eldevik Haberg
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Maria C Magnus
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Geir Aamodt
- Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, As, Norway
| | - Hein Stigum
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Medical Faculty, University of Oslo, Oslo, Norway
| | - Stephanie J London
- Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Wenche Nystad
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Nafstad
- Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, Medical Faculty, University of Oslo, Oslo, Norway
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23
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Lee E, Lee SH, Kwon JW, Kim YH, Yoon J, Cho HJ, Yang SI, Jung YH, Kim HY, Seo JH, Kim HB, Lee SY, Kwon HJ, Hong SJ. Persistent asthma phenotype related with late-onset, high atopy, and low socioeconomic status in school-aged Korean children. BMC Pulm Med 2017; 17:45. [PMID: 28231776 PMCID: PMC5324247 DOI: 10.1186/s12890-017-0387-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/16/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Treatment guidelines for asthma have been established based on asthma severity; there are limitations in the identification of underlying pathophysiology and prediction of prognosis in heterogeneous phenotypes of asthma. Although the complex interactions between environmental and genetic factors affect the development and progression of asthma, studies on asthma phenotypes considering environmental factors are limited. This study aimed to identify asthma phenotypes using latent class analysis including environmental factors in school-age children. METHODS We included 235 children (6-8 years) with parent-reported, physician-diagnosed asthma from the Children's HEalth and Environmental Research (CHEER) study, which is a 4-year prospective follow-up study with 2-year intervals. At every survey, pulmonary function tests, methacholine challenge tests and blood tests with questionnaire were conducted. RESULTS Four asthma phenotypes were identified. Cluster 1 (22% of children) was characterized by high prevalence of atopy and mild symptoms; subjects in cluster 2 (17%) consisted of less atopy and normal lung function, but intermittent troublesome; cluster 3 (29%) experienced late-onset atopic troublesome asthma with decreased lung function in combination with low socioeconomic status; and cluster 4 was associated with early-onset and less-atopic infrequent asthma. CONCLUSIONS Late-onset, high atopy, and low socioeconomic status are associated with troublesome persistent asthma phenotype in school-age children. Environmental factors might be implicated in the clinical heterogeneity of asthma. Asthma phenotypes considering diverse factors might be more helpful in the identification of asthma pathogenesis and its prevention.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, South Korea
| | - Si Hyeon Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Ho Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Jisun Yoon
- Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hyun-Ju Cho
- Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Young-Ho Jung
- Department of Pediatrics, CHA University School of Medicine, Seongnam, South Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, South Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - So Yeon Lee
- Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43 gil, Songpa-gu, Seoul, 05505, South Korea.
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Deliu M, Belgrave D, Sperrin M, Buchan I, Custovic A. Asthma phenotypes in childhood. Expert Rev Clin Immunol 2016; 13:705-713. [PMID: 27817211 DOI: 10.1080/1744666x.2017.1257940] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Asthma is no longer thought of as a single disease, but rather a collection of varying symptoms expressing different disease patterns. One of the ongoing challenges is understanding the underlying pathophysiological mechanisms that may be responsible for the varying responses to treatment. Areas Covered: This review provides an overview of our current understanding of the asthma phenotype concept in childhood and describes key findings from both conventional and data-driven methods. Expert Commentary: With the vast amounts of data generated from cohorts, there is hope that we can elucidate distinct pathophysiological mechanisms, or endotypes. In return, this would lead to better patient stratification and disease management, thereby providing true personalised medicine.
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Affiliation(s)
- Matea Deliu
- a Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health , University of Manchester , Manchester , UK
| | - Danielle Belgrave
- b Department of Paediatrics , Imperial College of Science, Technology & Medicine , London , UK
| | - Matthew Sperrin
- a Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health , University of Manchester , Manchester , UK
| | - Iain Buchan
- a Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health , University of Manchester , Manchester , UK
| | - Adnan Custovic
- b Department of Paediatrics , Imperial College of Science, Technology & Medicine , London , UK
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25
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Matok I, Elizur A, Perlman A, Ganor S, Levine H, Kozer E. Association of Acetaminophen and Ibuprofen Use With Wheezing in Children With Acute Febrile Illness. Ann Pharmacother 2016; 51:239-244. [PMID: 27794128 DOI: 10.1177/1060028016678006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many infants and children receive acetaminophen and/or ibuprofen during febrile illness. Previously, some studies have linked acetaminophen and ibuprofen use to wheezing and exacerbation of asthma symptoms in infants and children. OBJECTIVE To assess whether acetaminophen or ibuprofen use are associated with wheezing in children presenting to the emergency department (ED) with febrile illness. METHODS This was a cross-sectional study of children who presented with fever to the pediatric ED between 2009 and 2013. The data were collected from questionnaires and from the children's medical files. Patients with wheezing in the ED were compared with nonwheezing patients. Associations between medication use and wheezing were assessed using univariate and multivariate analyses. The multivariate analysis adjusted for potential confounding variables (ie, age, atopic dermatitis, allergies, smoking, antibiotics use, etc) via propensity scores. RESULTS During the study period, 534 children admitted to the ED met our inclusion criteria, of whom 347 (65%) were included in the study. The use of acetaminophen was similar in children diagnosed with wheezing compared with those without wheezing (n = 39, 81.3%, vs n = 229, 82.7%, respectively). Ibuprofen use was significantly lower in children diagnosed with wheezing (n = 22, 52.4%, vs n = 168, 69.4%, respectively). In multivariate analysis, acetaminophen was not associated with a higher rate of wheezing during acute febrile illness (adjusted odds ratio [OR] = 0.76, 95% CI = 0.24- 2.39), whereas ibuprofen was associated with a lower risk of wheezing (adjusted OR = 0.36, 95% CI = 0.13-0.96). CONCLUSIONS Our study suggests that acetaminophen and ibuprofen are not associated with increased risk for wheezing during acute febrile illness.
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Affiliation(s)
- Ilan Matok
- 1 The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arnon Elizur
- 2 Assaf-Harofeh Medical Center, Zerifin, Israel.,3 Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | | | - Shani Ganor
- 3 Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Hagai Levine
- 4 Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Eran Kozer
- 2 Assaf-Harofeh Medical Center, Zerifin, Israel.,3 Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
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26
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Pellegrini-Belinchón J, Lorente-Toledano F, Galindo-Villardón P, González-Carvajal I, Martín-Martín J, Mallol J, García-Marcos L. Factors associated to recurrent wheezing in infants under one year of age in the province of Salamanca, Spain: Is intervention possible? A predictive model. Allergol Immunopathol (Madr) 2016; 44:393-9. [PMID: 26810119 DOI: 10.1016/j.aller.2015.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/02/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Wheezing is a very common problem in infants in the first months of life. The objective of this study is to identify risk factors that may be acted upon in order to modify the evolution of recurrent wheezing in the first months of life, and to develop a model based on certain factors associated to recurrent wheezing in nursing infants capable of predicting the probability of developing recurrent wheezing in the first year of life. METHODS The sample was drawn from a cross-sectional, multicentre, descriptive epidemiological study based on the general population. A total of 1164 children were studied, corresponding to a questionnaire response rate of 71%. The questionnaire of the Estudio Internacional de Sibilancias en Lactantes (EISL) was used. Multiple logistic regression analysis was used to estimate the probability of developing recurrent wheezing and to quantify the contribution of each individual variable in the presence of the rest. RESULTS Infants presenting eczema and attending nursery school, with a mother who has asthma, smoked during the third trimester of pregnancy, and did not consume a Mediterranean diet during pregnancy were found to have a probability of 79.7% of developing recurrent wheezing in the first year of life. In contrast, infants with none of these factors were seen to have a probability of only 4.1% of developing recurrent wheezing in the first year of life. These results in turn varied according to modifications in the risk or protective factors. CONCLUSIONS The mathematical model estimated the probability of developing recurrent wheezing in infants under one year of age in the province of Salamanca (Spain), according to the risk or protective factors associated to recurrent wheezing to which the infants are or have been exposed.
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27
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Abid Z, Oh SS, Hu D, Sen S, Huntsman S, Eng C, Farber HJ, Rodriguez-Cintron W, Rodriguez-Santana JR, Serebrisky D, Avila PC, Thyne SM, Kim KYA, Borrell LN, Williams LK, Seibold MA, Burchard EG, Kumar R. Maternal age and asthma in Latino populations. Clin Exp Allergy 2016; 46:1398-1406. [PMID: 27238356 DOI: 10.1111/cea.12765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/02/2016] [Accepted: 05/16/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Younger maternal age at birth is associated with increased risk of asthma in offspring in European descent populations, but has not been studied in Latino populations. OBJECTIVES We sought to examine the relationship between maternal age at birth and prevalence of asthma in a nationwide study of Latino children. METHODS We included 3473 Latino children aged 8-21 years (1696 subjects with physician-diagnosed asthma and 1777 healthy controls) from five US centres and Puerto Rico recruited from July 2008 through November 2011. We used multiple logistic regression models to examine the effect of maternal age at birth on asthma in offspring overall and in analyses stratified by ethnic subgroup (Mexican American, Puerto Rican and other Latino). Secondary analyses evaluated the effects of siblings, acculturation and income on this relationship. RESULTS Maternal age < 20 years was significantly associated with decreased odds of asthma in offspring, independent of other risk factors (OR = 0.73, 95% CI: 0.57-0.93). In subgroup analyses, the protective effect of younger maternal age was observed only in Mexican Americans (OR = 0.53, 95% CI: 0.36, 0.79). In Puerto Ricans, older maternal age was associated with decreased odds of asthma (OR = 0.65, 95% CI: 0.44-0.97). In further stratified models, the protective effect of younger maternal age in Mexican Americans was seen only in children without older siblings (OR = 0.44, 95% CI: 0.23-0.81). CONCLUSION AND CLINICAL RELEVANCE In contrast to European descent populations, younger maternal age was associated with decreased odds of asthma in offspring in Mexican American women. Asthma is common in urban minority populations but the factors underlying the varying prevalence among different Latino ethnicities in the United States is not well understood. Maternal age represents one factor that may help to explain this variability.
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Affiliation(s)
- Z Abid
- Division of Allergy-Immunology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - S S Oh
- Department of Medicine, University of California, San Francisco, CA, USA
| | - D Hu
- Department of Medicine, University of California, San Francisco, CA, USA
| | - S Sen
- Department of Biostatistics, University of California, San Francisco, CA, USA
| | - S Huntsman
- Department of Medicine, University of California, San Francisco, CA, USA
| | - C Eng
- Department of Medicine, University of California, San Francisco, CA, USA
| | - H J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | | | - D Serebrisky
- Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY, USA
| | - P C Avila
- Division of Allergy-Immunology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - S M Thyne
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - K-Y A Kim
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - L N Borrell
- Department of Health Sciences, Lehman College, CUNY, New York, NY, USA
| | - L K Williams
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - M A Seibold
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA
| | - E G Burchard
- Department of Medicine, University of California, San Francisco, CA, USA
| | - R Kumar
- Division of Allergy-Immunology, Department of Pediatrics, Northwestern University, Chicago, IL, USA. .,The Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Gorlanova O, Thalmann S, Proietti E, Stern G, Latzin P, Kühni C, Röösli M, Frey U. Effects of Breastfeeding on Respiratory Symptoms in Infancy. J Pediatr 2016; 174:111-117.e5. [PMID: 27063808 DOI: 10.1016/j.jpeds.2016.03.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/17/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the impact of potential risk factors on the development of respiratory symptoms and their specific modification by breastfeeding in infants in the first year of life. STUDY DESIGN We prospectively studied 436 healthy term infants from the Bern-Basel Infant Lung Development cohort. The breastfeeding status, and incidence and severity of respiratory symptoms (score) were assessed weekly by telephone interview during the first year of life. Risk factors (eg, pre- and postnatal smoking exposure, mode of delivery, gestational age, maternal atopy, and number of older siblings) were obtained using standardized questionnaires. Weekly measurements of particulate matter <10 μg were provided by local monitoring stations. The associations were investigated using generalized additive mixed model with quasi Poisson distribution. RESULTS Breastfeeding reduced the incidence and severity of the respiratory symptom score mainly in the first 27 weeks of life (risk ratio 0.70; 95% CI 0.55-0.88). We found a protective effect of breastfeeding in girls but not in boys. During the first 27 weeks of life, breastfeeding attenuated the effects of maternal smoking during pregnancy, gestational age, and cesarean delivery on respiratory symptoms. There was no evidence for an interaction between breastfeeding and maternal atopy, number of older siblings, child care attendance, or particulate matter <10 μg. CONCLUSIONS This study shows the risk-specific effect of breastfeeding on respiratory symptoms in early life using the comprehensive time-series approach.
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Affiliation(s)
- Olga Gorlanova
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | - Simone Thalmann
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | - Elena Proietti
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland; Pediatric Respiratory Medicine, Inselspital and University of Bern, Bern, Switzerland
| | - Georgette Stern
- Pediatric Respiratory Medicine, Inselspital and University of Bern, Bern, Switzerland
| | - Philipp Latzin
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland; Pediatric Respiratory Medicine, Inselspital and University of Bern, Bern, Switzerland
| | - Claudia Kühni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Urs Frey
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland.
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Dratva J, Zemp E, Dharmage SC, Accordini S, Burdet L, Gislason T, Heinrich J, Janson C, Jarvis D, de Marco R, Norbäck D, Pons M, Real FG, Sunyer J, Villani S, Probst-Hensch N, Svanes C. Early Life Origins of Lung Ageing: Early Life Exposures and Lung Function Decline in Adulthood in Two European Cohorts Aged 28-73 Years. PLoS One 2016; 11:e0145127. [PMID: 26811913 PMCID: PMC4728209 DOI: 10.1371/journal.pone.0145127] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/27/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives Early life environment is essential for lung growth and maximally attained lung function. Whether early life exposures impact on lung function decline in adulthood, an indicator of lung ageing, has scarcely been studied. Methods Spirometry data from two time points (follow-up time 9–11 years) and information on early life exposures, health and life-style were available from 12862 persons aged 28–73 years participating in the European population-based cohorts SAPALDIA (n = 5705) and ECRHS (n = 7157). The associations of early life exposures with lung function (FEV1) decline were analysed using mixed-effects linear regression. Results Early life exposures were significantly associated with FEV1 decline, with estimates almost as large as personal smoking. FEV1 declined more rapidly among subjects born during the winter season (adjusted difference in FEV1/year of follow-up [95%CI] -2.04ml [-3.29;-0.80]), of older mothers, (-1.82 ml [-3.14;-0.49]) of smoking mothers (-1.82ml [-3.30;-0.34] or with younger siblings (-2.61ml [-3.85;-1.38]). Less rapid FEV1-decline was found in subjects who had attended daycare (3.98ml [2.78;5.18]), and indicated in subjects with pets in childhood (0.97ml [-0.16;2.09]). High maternal age and maternal smoking appeared to potentiate effects of personal smoking. The effects were independent of asthma at any age. Conclusion Early life factors predicted lung function decline decades later, suggesting that some mechanisms related lung ageing may be established early in life. Early life programming of susceptibility to adult insults could be a possible pathway that should be explored further.
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Affiliation(s)
- Julia Dratva
- Swiss Tropical and Public Health Institute, Dept. Epidemiology and Public Health, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Dept. Epidemiology and Public Health, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Luc Burdet
- Hôpital Intercantonal de la Broye, Payerne, Switzerland
| | - Thorarinn Gislason
- Dept. of Respiratory Medicine and Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | - Joachim Heinrich
- Helmholtz Center Munich, National Research Centre for Environmental Health, Munich, Germany
- Ludwig Maximilians University Munich, University Hospital Munich, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine and German Center for Lung Research (DZL), Munich, Germany
| | - Christer Janson
- Department of Medical Sciences: Respiratory Medicine & Allergology, Uppsala University, Uppsala, Sweden
| | - Deborah Jarvis
- Department of Public Health Sciences, Imperial College London, London, United Kingdom
| | - Roberto de Marco
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Dan Norbäck
- Department of Medical Sciences: Occupational & Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Marco Pons
- Division of Pulmonary Medicine, Regional Hospital of Lugano, Lugano, Switzerland
| | - Francisco Gómez Real
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Simona Villani
- University of Pavia, Faculty of Medicine, Dept. of Public Health, Neurosciences, Experimental and Legal Medicine, Pavia, Italy
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Dept. Epidemiology and Public Health, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Cecilie Svanes
- Bergen Respiratory Research Group, Centre for International Health, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
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30
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Bush A, Nagakumar P. Preschool Wheezing Phenotypes. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10310308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Wheezing in preschool children is very common, with a wide differential diagnosis. It is essential to be sure of the exact sound that parents are describing; the term ‘wheeze‘ is often applied to non-specific sounds. Structural airway disease such as vascular ring should be considered. Thereafter we propose that umbrella terms for preschool wheeze should be abandoned in favour of ‘Hargreave phenotyping’, in which the presence and extent of the components of infection, inflammation, variable airflow obstruction, and fixed airflow obstruction are determined as far as is possible, rather than using a general umbrella term such as ‘asthma’. The justification for this approach is that it leads to a logical approach to treatment in the disparate airway diseases presenting in the preschool years, and should hopefully prevent over-treatment with inhaled corticosteroids. If, despite this approach, doubt remains as to the nature of the airway disease, then a therapeutic trial of treatment is permissible, but it should be for a short defined period only. In any event, such children should be reviewed regularly to see if treatments need to be changed.
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Affiliation(s)
- Andrew Bush
- Department of Paediatrics, Imperial College London, London, UK; Department of Paediatric Respirology, National Heart and Lung Institute, Imperial College London, London, UK; Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Prasad Nagakumar
- Department of Paediatric Respirology, National Heart and Lung Institute, Imperial College London, London, UK; Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
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31
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Pacheco-Gonzalez RM, Mallol J, Solé D, Brand PLP, Perez-Fernandez V, Sanchez-Solis M, Garcia-Marcos L. Factors associated with the time to the first wheezing episode in infants: a cross-sectional study from the International Study of Wheezing in Infants (EISL). NPJ Prim Care Respir Med 2016; 26:15077. [PMID: 26796896 PMCID: PMC4721498 DOI: 10.1038/npjpcrm.2015.77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/01/2015] [Accepted: 10/06/2015] [Indexed: 12/17/2022] Open
Abstract
Male gender, asthmatic heredity, perinatal tobacco smoke exposure and respiratory infections have been associated with wheeze in the first years of life, among other risk factors. However, information about what factors modify the time to the first episode of wheeze in infants is lacking. The present study analyses which factors are associated with shorter time to the first episode of wheeze in infants. Parents of 11- to 24-month-old children were surveyed when attending their health-care centres for a control visit. They answered a questionnaire including the age in months when a first wheeze episode (if any) had occurred (outcome variable). The study was performed in 14 centres in Latin America (LA) and in 8 centres in Europe (EU) (at least 1,000 infants per centre). Factors known to be associated with wheezing in the cohort were included in a survival analysis (Cox proportional hazards model). Summary hazard ratios adjusted for all risk factors (aHR) were calculated using the meta-analysis approach with random effects. A total of 15,067 infants had experienced wheezing at least once, out of 35,049 surveyed. Male gender in LA (aHR 1.05, 95% confidence interval (CI) 1.00-1.10, P=0.047), parental asthma in LA and EU (aHR 1.05, 95% CI 1.00-1.11, P=0.037), infant eczema in EU (aHR 1.25, 95% CI 1.12-1.39, P<0.001) and having a cold during the first 3 months in LA and EU (aHR 1.97, 95% CI 1.90-2.04, P<0.001), in LA (aHR 1.98, 95% CI 1.90-2.06, P<0.001) and in EU (aHR 1.91, 95% CI 1.75-2.09, P<0.001) were associated with a shorter period of time to the first episode. Breast feeding for at least 3 months was associated with a longer period, only in LA (aHR 0.91, 95% CI 0.86-0.96, P<0.001). Cold symptoms during the first 3 months is the most consistent factor shortening the time to the first episode of wheezing; breast feeding for ⩾3 months delays it only in LA, whereas eczema shortens it only in EU. Avoiding a common cold in the first months of life could be a good strategy to delay the first wheeze episode; however, cohort studies will help to elucidate this association.
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Affiliation(s)
- Rosa M Pacheco-Gonzalez
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain
| | - Javier Mallol
- Department of Pediatric Respiratory Medicine, Hospital El Pino, University of Santiago de Chile (USACH), Chile, USA
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Paul L P Brand
- Princess Amalia Children's Clinic, Isala Klinieken, Zwolle, The Netherlands.,UMCG Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Manuel Sanchez-Solis
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain
| | - Luis Garcia-Marcos
- Pediatric Respiratory and Allergy Unit, 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Murcia, Spain.,IMIB Bioresearch Institute, Murcia, Spain
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Pereira AM, Morais-Almeida M, Santos N, Nunes C, Bousquet J, Fonseca JA. Severity of rhinitis and wheezing is strongly associated in preschoolers: A population-based study. Pediatr Allergy Immunol 2015; 26:618-27. [PMID: 26110374 DOI: 10.1111/pai.12430] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND In preschool children, no study assessed the relation between wheezing and rhinitis severity. Our aims were to estimate the prevalence of current wheezing (CW) in preschoolers and to study the association between CW and current rhinitis (CR), considering its severity/persistency. METHODS This is a cross-sectional, nationwide, population-based study including a representative sample of 5003 Portuguese children aged 3-5 years. Data were collected by a face-to-face interview with caregivers using an adapted ISAAC questionnaire. CW was defined as presence of ≥1 wheezing episode in the previous 12 months. Rhinitis severity/persistency was classified according to Allergic Rhinitis and its Impact on Asthma. RESULTS Current wheezing prevalence was 24.5% [95% CI 23.3-25.7]; 9.4% of the participants had ≥4 wheezing episodes in the previous year. Children with CR had an odds ratio (OR) of 4.0 [95% CI 3.4-4.5] for CW; it was highest for children with moderate-severe persistent rhinitis (11.5 [95% CI 8.1-16.3]), even after adjusting for possible confounders. Wheezers with CR reported more wheezing treatment use (p = 0.024) than those without CR. There was a trend for a higher number of wheezing episodes with more persistent and severe nasal disease - 48.4% of children with moderate-severe persistent rhinitis had >4 wheezing episodes vs. 28.9% in moderate-severe intermittent, 20.0% in mild persistent, 10.8% in mild intermittent, and 3.6% in those without CR; p < 0.001. CONCLUSIONS Current wheezing was present in almost 25% of preschool children and was strongly associated with rhinitis, especially moderate-severe persistent disease. Preschoolers with both CW and rhinitis seem to have a more severe phenotype, emphasizing the need for concurrent evaluation of nasal and bronchial symptoms even in small children.
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Affiliation(s)
- Ana Margarida Pereira
- Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.,Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,Allergy Unit, CUF-Porto Hospital & Institute, Porto, Portugal
| | - Mário Morais-Almeida
- Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.,Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal
| | - Natacha Santos
- Immunoallergy Department, CUF-Descobertas Hospital, Lisbon, Portugal.,Allergy and Clinical Immunology Department, Centro Hospitalar S. João E.P.E., Porto, Portugal
| | - Carlos Nunes
- Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal.,Algarve Immunoallergy Center, Portimão, Portugal
| | - Jean Bousquet
- Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France
| | - João Almeida Fonseca
- Health Information and Decision Sciences Department, Faculty of Medicine of the University of Porto, Porto, Portugal.,Allergy Unit, CUF-Porto Hospital & Institute, Porto, Portugal.,Portuguese Society of Allergy and Clinical Immunology, Sociedade Portuguesa de Alergologia e Imunologia Clínica (SPAIC), Lisbon, Portugal.,CINTESIS - Center for Research in Health Technologies and Information Systems, Porto, Portugal
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33
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Bercedo-Sanz A, Lastra-Martínez L, Pellegrini-Belinchón J, Vicente-Galindo E, Lorente-Toledano F, García-Marcos L. Wheezing and risk factors in the first year of life in Cantabria, Spain. The EISL study. Allergol Immunopathol (Madr) 2015; 43:543-52. [PMID: 25796305 DOI: 10.1016/j.aller.2014.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/26/2014] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine the prevalence of wheezing during the first year of life in Cantabria, Spain and its associated risk factors. METHODOLOGY A cross-sectional, multicentre, descriptive epidemiological study was carried out in a representative sample of 958 infants in the first year of life, born in Cantabria. A previously validated and standardised written questionnaire was completed by the parents of infants seen between 12 and 15 months of age in the Primary Care Centres. RESULTS The prevalence of wheezing was 32.7%. A relationship was found with male gender (OR 1.38, 95%CI [1.05-1.81]), the presence of a sibling (OR 2.43 [1.38-3.98]), attending nursery school (OR 2.40 [1.71-3.35]), exclusive breastfeeding for <3 months (OR 1.47 [1.12-1.93]), a first cold at ≤3 months (OR 2.07 [1.56-2.74]), asthma in siblings (OR 2.17 [1.25-3.77]), parental allergic rhinitis (OR 1.62 [1.10-2.37]) and paracetamol use >1 a week (OR 2.49 [1.31-4.73]), and maternal smoking during pregnancy (OR 2.18 [1.51-3.15]). The prevalence of recurrent wheezing (≥3 episodes) was 14.3%. Significant associations were observed with the male gender (OR 1.79 [1.23-2.60]), attending nursery school (OR 2.92 [1.96-4.35]), first cold at ≤3 months (OR 2.11 [1.46-3.04]), eczema (OR 1.92 [1.21-3.04]), maternal asthma (OR 1.77 [1.00-3.14]), exclusive breastfeeding for <3 months (OR 1.53 [1.06-2.22]), and maternal smoking during pregnancy (OR 1.53 [1.05-2.22]). CONCLUSIONS One third of the infants experienced wheezing during the first year of life; those who were less exclusively breastfed, attended nursery school, presented eczema, family asthma or allergic rhinitis, and maternal smoking during pregnancy.
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Clinical Endpoints for Respiratory Syncytial Virus Prophylaxis Trials in Infants and Children in High-income and Middle-income Countries. Pediatr Infect Dis J 2015; 34:1086-92. [PMID: 26121204 DOI: 10.1097/inf.0000000000000813] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Respiratory syncytial virus (RSV) continues to cause significant clinical and economic burden around the world. Historically, RSV-associated hospitalization was used as a primary endpoint for RSV prophylaxis trials in infants. However, because of the changing epidemiology and healthcare system landscape, this endpoint has become a critical bottleneck on the pathway to licensure for new therapeutics. A panel of 7 RSV experts was convened (Chicago, IL, May 22, 2014) to evaluate the challenges of defining RSV prevention endpoints for clinical trials and to develop endpoints that are clinically meaningful while minimizing subjectivity and bias to achieve sufficient consistency of response for regulatory approval. Particular consideration was given to the ability to collect data systematically and consistently in countries with different healthcare practices and systems, while capturing the greatest proportion of disease impact. The group consensus was that a clinically meaningful primary endpoint could include medically attended RSV illness in settings beyond RSV-associated hospitalizations alone, in particular, a composite reduction in hospitalization, emergency room or urgent care center visits because of an RSV respiratory infection. Relevant secondary endpoints included reductions in RSV lower respiratory tract infection, RSV-related intensive care unit rates, subsequent recurrent wheezing or asthma and direct and indirect costs.
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Silvestri M, Franchi S, Pistorio A, Petecchia L, Rusconi F. Smoke exposure, wheezing, and asthma development: a systematic review and meta-analysis in unselected birth cohorts. Pediatr Pulmonol 2015; 50:353-62. [PMID: 24648197 DOI: 10.1002/ppul.23037] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 02/23/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The understanding of the role of smoking exposure in the induction of wheezing and asthma in children is important for prevention. METHODS A systematic review of literature and a meta-analysis were conducted to identify studies on unselected prospective birth cohorts. The effect of exposure to maternal/parental smoking on the induction of current wheezing or asthma was evaluated in children aged 6 months, <6 years, and ≥6 years. Pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated. RESULTS We identified 43 papers. Exposure to maternal prenatal smoking was associated with an increased risk of wheezing in <6-year-olds (OR 1.36; 95% CI: 1.19-1.55) and of wheezing or asthma in ≥6-year-olds (OR: 1.22, 95% CI: 1.03-1.44). A positive association (OR: 1.24, 95% CI: 1.11-1.38) was also found in the only three studies that evaluated exposure to maternal prenatal smoking alone. Postnatal exposures to maternal/parental smoking were associated with wheezing in <6-year-olds (OR: 1.21; 95% CI: 1.13-1.31 and OR: 1.30; 95% CI: 1.13-1.51), although it was often impossible to separate the role of postnatal from that of prenatal exposure; data in schoolchildren are limited and this precluded a meta-analysis. No clear association was found between exclusive postnatal exposure and wheezing or asthma. CONCLUSIONS We confirmed an important role of prenatal exposure to maternal smoking on the induction of wheezing and asthma in offspring, particularly in the first years of life. More studies with a consistent number of subjects only exposed to smoke postnatally are needed to better investigate the harmful effects on the induction of wheezing or asthma, particularly in schoolchildren.
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Affiliation(s)
- Michela Silvestri
- Pediatric Pulmonology and Allergy Unit, Istituto Giannina Gaslini, Genoa, Italy
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Miller LL, Henderson J, Northstone K, Pembrey M, Golding J. Do grandmaternal smoking patterns influence the etiology of childhood asthma? Chest 2014; 145:1213-1218. [PMID: 24158349 PMCID: PMC4042509 DOI: 10.1378/chest.13-1371] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Animal data suggest that tobacco smoke exposure of a mother when she is in utero influences DNA methylation patterns in her offspring and that there is an effect on the respiratory system, particularly airway responsiveness. The only study, to our knowledge, in humans suggests that there is a similar effect on asthma. The present study tests whether an association with respiratory problems can be confirmed in a large population study and aims to determine whether in utero exposure of the father has similar effects on his offspring. Methods: Information from the Avon Longitudinal Study of Parents and Children was used to compare the offspring of women and of men who had themselves been exposed to cigarette smoke in utero; separate analyses were performed for children of women smokers and nonsmokers. The outcome measures were trajectories of history of early wheezing, doctor-diagnosed asthma by age 7 years, and results of lung function and methacholine challenge tests at 8 years. A variety of social and environmental factors were taken into account; offspring sexes were examined separately. Results: There was no association with any outcome in relation to maternal prenatal exposure. There was some evidence of an increase in asthma risk with paternal prenatal exposure when the study mother was a nonsmoker (adjusted OR, 1.17; 95% CI, 0.97-1.41). This was particularly strong for girls (adjusted OR, 1.39; 95% CI, 1.04-1.86). Conclusions: We did not find that maternal prenatal exposure to her mother’s smoking had any effect on her children’s respiratory outcomes. There was suggestive evidence of paternal prenatal exposure being associated with asthma and persistent wheezing in the granddaughters.
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Affiliation(s)
- Laura L Miller
- School of Social and Community Medicine, University of Bristol, Bristol, England
| | - John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Kate Northstone
- School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Marcus Pembrey
- School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Jean Golding
- School of Social and Community Medicine, University of Bristol, Bristol, England.
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Caudri D, Savenije OEM, Smit HA, Postma DS, Koppelman GH, Wijga AH, Kerkhof M, Gehring U, Hoekstra MO, Brunekreef B, de Jongste JC. Perinatal risk factors for wheezing phenotypes in the first 8 years of life. Clin Exp Allergy 2014; 43:1395-405. [PMID: 24261948 DOI: 10.1111/cea.12173] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 05/24/2013] [Accepted: 06/21/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND A novel data-driven approach was used to identify wheezing phenotypes in pre-schoolchildren aged 0-8 years, in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort. Five phenotypes were identified: never/infrequent wheeze, transient early wheeze, intermediate onset wheeze, persistent wheeze and late onset wheeze. It is unknown which perinatal risk factors drive development of these phenotypes. OBJECTIVE The objective of the study was to assess associations of perinatal factors with wheezing phenotypes and to identify possible targets for prevention. METHODS In the PIAMA study (n = 3963), perinatal factors were collected at 3 months, and wheezing was assessed annually until the age of 8 years. Associations between perinatal risk factors and the five wheezing phenotypes were assessed using weighted multinomial logistic regression models. Odds ratios were adjusted for confounding variables and calculated with 'never/infrequent wheeze' as reference category. RESULTS Complete data were available for 2728 children. Risk factors for transient early wheeze (n = 455) were male gender, maternal and paternal allergy, low maternal age, high maternal body mass index, short pregnancy duration, smoking during pregnancy, presence of older siblings and day-care attendance. Risk factors for persistent wheeze (n = 83) were male gender, maternal and paternal allergy, and not receiving breastfeeding for at least 12 weeks. Intermediate onset wheeze (n = 98) was associated with a lower birth weight and late onset wheeze (n = 45) with maternal allergy. CONCLUSION AND CLINICAL RELEVANCE We identified different risk factors for specific childhood wheezing phenotypes. Some of these are modifiable, such as maternal age and body mass index, smoking, day-care attendance and breastfeeding, and may be important targets for prevention programmes.
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Affiliation(s)
- D Caudri
- Department of Pediatrics/Respiratory Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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Belgrave DCM, Custovic A, Simpson A. Characterizing wheeze phenotypes to identify endotypes of childhood asthma, and the implications for future management. Expert Rev Clin Immunol 2014; 9:921-36. [PMID: 24128156 DOI: 10.1586/1744666x.2013.836450] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It is now a commonly held view that asthma is not a single disease, but rather a set of heterogeneous diseases sharing common symptoms. One of the major challenges in treating asthma is understanding these different asthma phenotypes and their underlying biological mechanisms. This review gives an epidemiological perspective of our current understanding of the different phenotypes that develop from birth to childhood that come under the umbrella term 'asthma'. The review focuses mainly on publications from longitudinal birth cohort studies where the natural history of asthma symptoms is observed over time in the whole population. Identifying distinct pathophysiological mechanisms for these different phenotypes will potentially elucidate different asthma endotypes, ultimately leading to more effective treatment and management strategies.
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Affiliation(s)
- Danielle C M Belgrave
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
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Abstract
A clinical diagnosis of asthma is often considered when a child presents with recurrent cough, wheeze and breathlessness. However, there are many other causes of wheeze in a young child. These range from recurrent viral infections to chronic suppurative lung disease, gastro-oesophageal reflux disease and rare structural abnormalities. Arriving at a diagnosis includes taking into consideration the symptomatology, triggers, atopic features, family history, absence of red flags and therapeutic trial, where indicated.
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Affiliation(s)
- Mark Chung Wai Ng
- SingHealth Family Medicine Residency Programme, 3 Second Hospital Avenue, Singapore 168937.
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40
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Abstract
Wheezing is a common condition in pediatric practice, it can be defined as a musical sound, high-pitched and continuous, emitting from the chest during breath exhalation. Although almost 50% of children experiences wheeze in the first 6 years of life, only 40% of them will report continued wheezing symptoms after childhood. The classification of wheeze in preschool children is more difficult compared to school aged children. It is based on the onset and duration of symptoms and divided children in three categories: transient early wheezing, non-atopic wheezing and atopic wheezing/asthma. History and physical examination, skin prick test, exhaled nitric oxide, lung function test are the parameter to evaluate children with wheezing. The aim of management of wheezing is to finalize the control of symptoms, reduce exacerbations and improve the quality of life. All guidelines underline the complexity in making a diagnosis of asthma under five years and the need to identify phenotypes that may help paediatricians in the therapeutic choices.
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A simple asthma prediction tool for preschool children with wheeze or cough. J Allergy Clin Immunol 2013; 133:111-8.e1-13. [PMID: 23891353 DOI: 10.1016/j.jaci.2013.06.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 05/24/2013] [Accepted: 06/03/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Many preschool children have wheeze or cough, but only some have asthma later. Existing prediction tools are difficult to apply in clinical practice or exhibit methodological weaknesses. OBJECTIVE We sought to develop a simple and robust tool for predicting asthma at school age in preschool children with wheeze or cough. METHODS From a population-based cohort in Leicestershire, United Kingdom, we included 1- to 3-year-old subjects seeing a doctor for wheeze or cough and assessed the prevalence of asthma 5 years later. We considered only noninvasive predictors that are easy to assess in primary care: demographic and perinatal data, eczema, upper and lower respiratory tract symptoms, and family history of atopy. We developed a model using logistic regression, avoided overfitting with the least absolute shrinkage and selection operator penalty, and then simplified it to a practical tool. We performed internal validation and assessed its predictive performance using the scaled Brier score and the area under the receiver operating characteristic curve. RESULTS Of 1226 symptomatic children with follow-up information, 345 (28%) had asthma 5 years later. The tool consists of 10 predictors yielding a total score between 0 and 15: sex, age, wheeze without colds, wheeze frequency, activity disturbance, shortness of breath, exercise-related and aeroallergen-related wheeze/cough, eczema, and parental history of asthma/bronchitis. The scaled Brier scores for the internally validated model and tool were 0.20 and 0.16, and the areas under the receiver operating characteristic curves were 0.76 and 0.74, respectively. CONCLUSION This tool represents a simple, low-cost, and noninvasive method to predict the risk of later asthma in symptomatic preschool children, which is ready to be tested in other populations.
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Population-based study on association between birth weight and risk of asthma: a propensity score approach. Ann Allergy Asthma Immunol 2012; 110:18-23. [PMID: 23244653 DOI: 10.1016/j.anai.2012.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/21/2012] [Accepted: 10/14/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous studies that assessed the role of birth weight in the risk of asthma have been limited because of selection bias and covariate imbalance. OBJECTIVE To assess the association between birth weight and risk of asthma by applying a propensity score approach. METHODS The study was designed as a retrospective cohort study based on a birth cohort of children born between January 1, 1976, and December 31, 1979, in Rochester, Minnesota. The propensity scores for birth weight were formulated using 16 covariates. We matched the propensity scores for children having low birth weight (<2,500 g) within a caliper of 0.2 SD of logit function of propensity scores. We calculated the cumulative incidence of asthma between low and normal birth weight groups using the Kaplan-Meier curve. RESULTS There were 3933 eligible children born between January 1, 1976, and December 31, 1979. Before matching, 13 of the 193 children (6.7%) born weighing 2,500 g developed asthma, whereas 201 of the 3,740 children (5.4%) born weighing 2,500 g and above developed asthma (P=.42). There were significant covariate imbalances between comparison groups. However, after propensity score matching, covariate imbalance was significantly reduced, and children born weighing less than 2,500 g had a similar risk to matched children born with normal birth weight (8.3% vs 7.3%, P=.75). CONCLUSION Birth weight is not associated with risk of asthma during the first 6 years of life. The propensity score may be a useful method for observational studies concerning asthma epidemiology.
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Spanier AJ, Kahn RS, Kunselman AR, Hornung R, Xu Y, Calafat AM, Lanphear BP. Prenatal exposure to bisphenol A and child wheeze from birth to 3 years of age. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:916-20. [PMID: 22334053 PMCID: PMC3385426 DOI: 10.1289/ehp.1104175] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 02/14/2012] [Indexed: 05/25/2023]
Abstract
BACKGROUND Bisphenol A (BPA), an endocrine-disrupting chemical that is routinely detected in > 90% of Americans, promotes experimental asthma in mice. The association of prenatal BPA exposure and wheeze has not been evaluated in humans. OBJECTIVE We examined the relationship between prenatal BPA exposure and wheeze in early childhood. METHODS We measured BPA concentrations in serial maternal urine samples from a prospective birth cohort of 398 mother-infant pairs and assessed parent-reported child wheeze every 6 months for 3 years. We used generalized estimating equations with a logit link to evaluate the association of prenatal urinary BPA concentration with the dichotomous outcome wheeze (wheeze over the previous 6 months). RESULTS Data were available for 365 children; BPA was detected in 99% of maternal urine samples during pregnancy. In multivariable analysis, a one-unit increase in log-transformed creatinine-standardized mean prenatal urinary BPA concentration was not significantly associated with child wheeze from birth to 3 years of age, but there was an interaction of BPA concentration with time (p = 0.003). Mean prenatal BPA above versus below the median was positively associated with wheeze at 6 months of age [adjusted odds ratio (AOR) = 2.3; 95% confidence interval (CI): 1.3, 4.1] but not at 3 years (AOR = 0.6; 95% CI: 0.3, 1.1). In secondary analyses evaluating associations of each prenatal BPA concentration separately, urinary BPA concentrations measured at 16 weeks gestation were associated with wheeze (AOR = 1.2; 95% CI: 1.0, 1.5), but BPA concentrations at 26 weeks of gestation or at birth were not. CONCLUSIONS Mean prenatal BPA was associated with increased odds of wheeze in early life, and the effect diminished over time. Evaluating exposure at each prenatal time point demonstrated an association between wheeze from 6 months to 3 years and log-transformed BPA concentration at 16 weeks gestation only.
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Affiliation(s)
- Adam J Spanier
- Department of Pediatrics, Penn State University Hershey Medical Center, Hershey, Pennsylvania 17033-0850, USA.
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44
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Abstract
PURPOSE OF REVIEW There is currently limited ability to identify which infants and young children with recurrent wheezing will ultimately develop persistent asthma. In addition, it is not clear how risk factors influence the development of asthma in later childhood and adulthood. This review will discuss efforts to categorize these children with recurrent wheezing and develop asthma-predictive tools. RECENT FINDINGS Transient and persistent wheezing phenotypes have been identified with atopy, reduced lung function, and viral and bacterial respiratory infection as major risk factors for persistence of asthma. Children with severe asthma tend to have greater magnitude of atopy and lower lung function than those with mild-moderate asthma. These phenotypes and risk factors have been described in previous studies and are supported by the recent literature. SUMMARY Heterogeneity of wheezing phenotypes may account for different responses to treatment and varied outcomes. Overlap in phenotypes and instability over time also add additional challenges to defining discrete groups of children with specific outcomes. Further studies are needed to determine combinations of variables that may improve phenotype designation with the goal of improving asthma prevention and treatment as well as predicting outcomes and understanding the pathogenesis of asthma.
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Herr M, Just J, Nikasinovic L, Foucault C, Le Marec AM, Giordanella JP, Momas JI. Influence of host and environmental factors on wheezing severity in infants: findings from the PARIS birth cohort. Clin Exp Allergy 2012; 42:275-83. [PMID: 22288513 DOI: 10.1111/j.1365-2222.2011.03933.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Determinants of wheezing severity are poorly documented in infants. OBJECTIVES To study the determinants of wheezing severity in infants aged 18 months followed-up in the PARIS (« Pollution and Asthma Risk : an Infant Study ») birth cohort. METHODS Data on wheezing disorders, medical visits and medications, as well as biological markers of atopy, were collected during a medical examination at age 18 months. Severe wheeze was defined as wheeze that required inhaled corticosteroid and/or hospital-based care. Environmental exposures were assessed prospectively with regular questionnaires. Risk factors for wheeze in the first 18 months of life were assessed by multivariate regression models. RESULTS Participation in the medical examination concerned 48.2% of the original cohort. Prevalence of wheeze was 560/1879 (35.7%) and was influenced by male gender, parental history of asthma, siblings, daycare attendance, heavy parental smoking at home, and carpet covered floor in the child's bedroom. Being overweight increased the risk of wheeze by 62% (OR = 1.62, 95%CI 1.13-2.32). In addition, trends towards an increased risk of wheeze were found in infants exposed to daily use of cleaning sprays and to renovation activities. Conversely, the presence of a cat reduced the risk of wheeze (OR = 0.65, 95%CI 0.47-0.89), without any evidence of healthy-pet keeping effect. Severe wheeze concerned 286 of the wheezers (42.7%). The prevalence of severe wheeze was related to atopy, and risk of severe wheeze was in particular increased in infants having eosinophilia (OR = 1.76, 95%CI 1.21-2.55) or being sensitized to ≥ 2 allergens (OR = 1.88, 95%CI 1.13-3.14). CONCLUSIONS AND CLINICAL RELEVANCE Whilst risk factors for wheeze before 18 months of age are factors related to infections, indoor air pollution, and being overweight, the severity of wheeze is mainly due to the atopic status of the child. We suggest that atopy should be further considered in the assessment of wheezing severity in infants.
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Affiliation(s)
- M Herr
- Univ Paris Descartes, Sorbonne Paris Cité, Laboratoire Santé Publique et Environnement, Paris, France
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46
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Pellegrini-Belinchón J, Miguel-Miguel G, De Dios-Martín B, Vicente-Galindo E, Lorente-Toledano F, García-Marcos L. Study of wheezing and its risk factors in the first year of life in the Province of Salamanca, Spain. The EISL Study. Allergol Immunopathol (Madr) 2012; 40:164-71. [PMID: 21802825 DOI: 10.1016/j.aller.2011.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 03/29/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the prevalence of wheezing and its associated risk factors in infants in the first year of life in the province of Salamanca, Spain. METHODS A multicentre, cross-sectional, descriptive epidemiological study was designed to evaluate a representative sample of 750 infants in the first year of life, born in the province of Salamanca between 1 June 2008 and 30 September 2009. The study was based on a previously validated and standardised written questionnaire administered among the parents of those children seen for control at 12 months of age in any of the Primary Care centres in the province of Salamanca. RESULTS The recorded wheezing rate was 32.3%. Feeding and sleep were seen to be affected in 46.3% and 80.9% of the wheezing children, respectively, and parent activity was also altered in 39.3% of the cases. A relationship was found between wheezing and nursery attendance (OR: 1.66, 95% confidence interval [1.19-2.31]); weight at birth >3500 g (OR: 1.45 [1.02-2.06]); the presence of eczema at this age (OR: 2.72 [1.75-4.24]); exclusive breastfeeding for <3 months (OR: 1.33 [0.98-1.81]); and maternal smoking during the last three months of pregnancy (OR: 1.60 [0.96-2.68]). The prevalence of recurrent wheezing (defined as three or more episodes) was 11.9%. Significant differences were observed with respect to nursery attendance (OR: 1.71 [1.08-2.72]), the presence of eczema at this age (OR: 2.55 [1.48-4.42]), a history of maternal asthma (OR: 2.19 [1.08-4.44]) and exclusive breastfeeding for <3 months (OR: 1.53 [0.98-2.38]). CONCLUSIONS In the province of Salamanca, one third of the infants studied suffered wheezing in the first year of life. Infants exclusively breastfed for less than three months; attending a nursery; having suffered eczema; or with an asthmatic mother showed significantly more wheezing than the rest. Wheezing proved recurrent in 11.9% of the cases.
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Cheraghi M, Dadgarinejad A, Salvi S. A Cross-Sectional Study to Find Prevalence and Risk Factors for Childhood Asthma in Pune City, India. ACTA ACUST UNITED AC 2012. [DOI: 10.5402/2012/361456] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We aimed to determine current prevalence of asthma and risk factors associated with it in Pune, India. Methods. This was a cross-sectional school-population-based study in which parents of school children aged 6-7 and 13-14 were administered an ISAAC questionnaire and an additional set of questions that detected the presence of potential risk factors known to be associated with asthma during 2008-2009 academic years. Results. Prevalence of current asthma was 6.7% (7% amongst 6-7-year olds and 6.3% amongst 13-14 year olds. Asthma was more common amongst boys (8.1%) than girls (4.9%) and more frequent in students studying in private schools (7.3%) than in those studying in public schools (5.8%). Risk factors such as family history of atopy, caesarian delivery, use of biomass fuel for cooking, absence of separate kitchen, absence of exclusive breastfeeding during the first 6 months of life, preterm birth, snoring, dampness at home, male sex, and parental smoking were significantly associated with asthma. Conclusion. There was a high prevalence of childhood asthma in Pune, India, which was associated with genetic and environmental risk factors.
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Affiliation(s)
- Maria Cheraghi
- Department of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook DG, Britton JR, McKeever TM. Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics 2012; 129:735-44. [PMID: 22430451 DOI: 10.1542/peds.2011-2196] [Citation(s) in RCA: 457] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Exposure to passive smoke is a common and avoidable risk factor for wheeze and asthma in children. Substantial growth in the prospective cohort study evidence base provides an opportunity to generate new and more detailed estimates of the magnitude of the effect. A systematic review and meta-analysis was conducted to provide estimates of the prospective effect of smoking by parents or household members on the risk of wheeze and asthma at different stages of childhood. METHODS We systematically searched Medline, Embase, and conference abstracts to identify cohort studies of the incidence of asthma or wheeze in relation to exposure to prenatal or postnatal maternal, paternal, or household smoking in subjects aged up to 18 years old. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated by using random effects model. RESULTS We identified 79 prospective studies. Exposure to pre- or postnatal passive smoke exposure was associated with a 30% to 70% increased risk of incident wheezing (strongest effect from postnatal maternal smoking on wheeze in children aged ≤2 years, OR = 1.70, 95% CI = 1.24-2.35, 4 studies) and a 21% to 85% increase in incident asthma (strongest effect from prenatal maternal smoking on asthma in children aged ≤2 years, OR = 1.85, 95% CI = 1.35-2.53, 5 studies). CONCLUSIONS Building upon previous findings, exposure to passive smoking increases the incidence of wheeze and asthma in children and young people by at least 20%. Preventing parental smoking is crucially important to the prevention of asthma.
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Affiliation(s)
- Hannah Burke
- Division of Epidemiology and Public Health, University of Nottingham, City Hospital, UK Centre for Tobacco Control Studies, Nottingham, UK
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Hsu NY, Wang JY, Wu PC, Su HJ. Paternal heredity and housing characteristics affect childhood asthma and allergy morbidity. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2012; 67:155-62. [PMID: 22845728 DOI: 10.1080/19338244.2011.598890] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A birth cohort was initiated when each pregnant woman was asked for her own and her husband's history of asthma and allergic diseases at the time of recruitment. They were further inquired to verify their housing conditions, and current health status of children 3 to 5 years old at the time of interview. Paternal history was the most significant risk factor associated with reporting childhood morbidities at age of 3 to 5 years. Housing characteristics became meaningful variables only if the fathers were asthmatic or atopic. A 9-fold increase of risk was found if children with paternal history and also exposed to incense burning and water damage at home. This is the first epidemiological evidence of East Asia suggesting paternal heredity, with concurrent indoor hazardous exposures, as a predominant risk on developing childhood asthma and allergy.
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Affiliation(s)
- Nai-Yun Hsu
- Department of Environmental and Occupational Health, National Cheng Kung University, Tainan, Taiwan
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50
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Wang QP, Wu KM, Li ZQ, Xue F, Chen W, Ji H, Wang BL. Association between maternal allergic rhinitis and asthma on the prevalence of atopic disease in offspring. Int Arch Allergy Immunol 2011; 157:379-86. [PMID: 22123070 DOI: 10.1159/000328789] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 04/20/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Asthma is a common co-morbidity of allergic rhinitis (AR). The prevalence of these two allergic diseases has increased in China and has been shown to cluster in families independently. This study evaluated the association between maternal AR (presenting with or without asthma) and the allergic conditions in offspring. METHODS Women (n = 592) diagnosed with AR were recruited for this study; 379 patients presented with AR and 213 presented with both AR and asthma. Total serum IgE levels and nasal eosinophil counts were analyzed and correlated with disease presentation. RESULTS The prevalence of allergic conditions in offspring of mothers diagnosed with AR and asthma was significantly higher than the prevalence observed in children born to mothers presenting with AR only. Maternal total serum IgE and eosinophil counts were predictive of atopy in offspring. Children born to mothers presenting with persistent moderate-to-severe AR had the highest risk of developing atopic conditions (OR 6.26, 95% CI 3.26-12.02). Maternal age of 25-30 years at delivery was also associated with a higher risk for the allergic disease in offspring compared to maternal age of 36-40 (OR 2.13, 95% CI 1.31-3.47). CONCLUSIONS The severity of maternal AR, asthma co-morbidity, elevated serum IgE levels and nasal eosinophilia were all associated with an increased risk of offspring developing allergic conditions. Children born to older mothers were protected against developing atopic disease.
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Affiliation(s)
- Qiu-Ping Wang
- Department of Otolaryngology-Head and Neck Surgery, Jinling Hospital, Nanjing, PR China
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