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Barbieri MA, Ferraro AA, Simões VMF, Goldani MZ, Cardoso VC, Moura da Silva AA, Bettiol H. Cohort Profile: The 1978-79 Ribeirao Preto (Brazil) birth cohort study. Int J Epidemiol 2021; 51:27-28g. [PMID: 34564724 DOI: 10.1093/ije/dyab190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Marco Antônio Barbieri
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - Marcelo Zubaran Goldani
- Department of Pediatrics, Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Viviane Cunha Cardoso
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Heloisa Bettiol
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Simoneti CS, Nocera TSB, Vianna EO. Exposição prolongada a animais de laboratório está associada ao aumento de casos de asma. REVISTA BRASILEIRA DE SAÚDE OCUPACIONAL 2020. [DOI: 10.1590/2317-6369000036718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: descrever o resultado do acompanhamento de trabalhadores sensibilizados a animais de laboratório que prolongaram sua exposição. Métodos: após um período de aproximadamente 7 anos, entramos em contato com todos os indivíduos com sensibilização alérgica ocupacional detectada em estudo anterior. Um questionário foi aplicado para situação ocupacional atual, relação entre alergia e a decisão de deixar o trabalho ou exposição e para asma, sibilância, rinite, sintomas cutâneos e dispneia noturna. Resultados: dos 74 indivíduos com sensibilização ocupacional, 45 responderam ao questionário na segunda avaliação e 37 ainda estavam expostos. Ao comparar os dados da primeira avaliação com os da avaliação atual, observou-se um aumento na frequência de asma. Na primeira avaliação, entre todos os sensibilizados (n = 74), 27,0% responderam sim a ambas as questões “Você tem ou já teve asma?” e “A asma foi diagnosticada por um médico?”. Na segunda avaliação, 7 anos depois, dos 37 sujeitos que ainda estavam expostos, 51,3% responderam sim a essas questões (OR: 2,80; IC95%: 1,23-6,38; p = 0,013). Não houve mudança na frequência de respostas positivas às outras perguntas. Conclusão: os dados demonstram aumento da frequência de asma entre trabalhadores com sensibilização ocupacional que prolongam a exposição a animais de laboratório.
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Sá-Sousa A, Pereira AM, Almeida R, Araújo L, Couto M, Jacinto T, Freitas A, Bousquet J, Fonseca JA. Adult Asthma Scores-Development and Validation of Multivariable Scores to Identify Asthma in Surveys. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:183-190.e6. [PMID: 30031106 DOI: 10.1016/j.jaip.2018.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/11/2018] [Accepted: 06/30/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND One of the questions in epidemiology is the identification of adult asthma in studies. OBJECTIVE To develop and validate multivariable scores for adult asthma identification in epidemiological studies and to explore cutoffs to rule in/rule out asthma, compared with asthma diagnosed by a physician after clinical examination and diagnostic tests, blinded to the self-administered questions. METHODS We analyzed data (n = 711 adults) from a nationwide population-based study. The predictors were self-administered questions identified in a literature review (the Adult Asthma Epidemiological Score [A2 score]) and from the Global Allergy and Asthma Network of Excellence (GA2LEN) questionnaire (the GA2LEN Asthma Epidemiological Score [GA2LEN score]). Scores were developed using exploratory factor analysis. Internal consistency, discriminative power, and diagnostic accuracy were assessed. RESULTS The A2 score comprises 8 questions (including "Did a physician confirm you had asthma?") and the GA2LEN score comprises 6 questions (including "Have you ever had asthma?"). Both had high Cronbach α (0.89 and 0.85, respectively, for the A2 score and the GA2LEN score) and good area under the receiver-operating characteristic curve (90.4% and 89.0%). The scoring is the sum of positive answers. Asthma is present (rule in) for scores of 4 or more (specificity, 99.2%; PPV, 93.3% and 91.7%; accuracy, 89.4% and 87.4%, respectively, for the A2 score and the GA2LEN score). Asthma is excluded (rule out) for A2 scores of 0 to 1 and a GA2LEN score of 0 (sensitivity, 93.1%; NPV, 98.2% and 98.0%; accuracy 89.4% and 82.8%, respectively, for the A2 score and the GA2LEN score). CONCLUSIONS These practical scores can be used to rule in/rule out asthma in epidemiological studies and clinical screening/triage settings. They may help physicians in primary care or other specialties to screen patients with asthma using a simple score with a high level of discrimination and to identify the best candidates to be referred for a diagnostic workup. Moreover, their use may contribute to reducing the inconsistencies of operational definitions of asthma across studies and surveys.
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Affiliation(s)
- Ana Sá-Sousa
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Ana Margarida Pereira
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Luís Araújo
- MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal; Immunology Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Mariana Couto
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal
| | - Tiago Jacinto
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Department of Cardiovascular and Respiratory Sciences, Escola Superior de Saúde, Politécnico do Porto, Porto, Portugal
| | - Alberto Freitas
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Jean Bousquet
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - João A Fonseca
- CINTESIS-Center for Health Technology and Services Research, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; MEDCIDS-Department of Community Medicine, Information, and Health Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Allergy Unit, Instituto & Hospital CUF Porto, Porto, Portugal.
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de Menezes MB, Ferraz E, Brannan JD, Martinez EZ, Vianna EO. The efficacy and safety of mannitol challenge in a workplace setting for assessing asthma prevalence. J Asthma 2018; 55:1278-1285. [PMID: 29300533 DOI: 10.1080/02770903.2017.1418887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE There is no standard definition of asthma for epidemiological purposes; most surveys use symptoms and bronchial hyperresponsiveness. Few studies tested mannitol challenge test (MCT) in occupational settings. We sought to determine efficacy and safety of MCT in detecting subjects with asthma symptoms in the workplace. METHODS In this cross-sectional study we recruited 908 workers in 2 universities; they underwent a respiratory questionnaire, spirometry, skin prick tests, and MCT. RESULTS Eight hundred and eleven subjects completed the study; 11.1% had a positive MCT; 8.14% had asthma. MCT had low sensitivity (35.4-61.9%) but high specificity (90.2-94.9%) to detect symptomatic individuals. The most prevalent symptom was wheezing in the last 12 months. Twenty-four of those with a positive MCT (26.7%) had no positive replies to the questions on asthma symptoms. Among subjects with a positive MCT, 71.9% achieved 95% of baseline FEV1 after 15 minutes of salbutamol recovery treatment. Nine subjects (1.1%) had adverse events that prevented the test from being completed. CONCLUSIONS MCT has high specificity but low sensitivity to detect symptomatic subjects in the workplace. It may detect subjects with hyperresponsiveness but no symptoms, who could be at risk of developing airway diseases. The test is safe and well tolerated.
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Affiliation(s)
- Marcelo B de Menezes
- a Department of Medicine , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Erica Ferraz
- b Department of Physiotherapy , Regional University Center of Espírito Santo do Pinhal , Espírito Santo do Pinhal , São Paulo , Brazil
| | - John D Brannan
- c Department of Respiratory & Sleep Medicine , John Hunter Hospital , New Lambton , NSW , Australia
| | - Edson Z Martinez
- d Department of Social Medicine , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
| | - Elcio O Vianna
- a Department of Medicine , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil
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Simoneti CS, Ferraz E, de Menezes MB, Bagatin E, Arruda LK, Vianna EO. Allergic sensitization to laboratory animals is more associated with asthma, rhinitis, and skin symptoms than sensitization to common allergens. Clin Exp Allergy 2017; 47:1436-1444. [PMID: 28787776 DOI: 10.1111/cea.12994] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/21/2017] [Accepted: 07/06/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Workers exposed to laboratory animals have a high risk of developing laboratory animal allergy (LAA). Atopy seems to be the main risk factor for LAA. We hypothesized that occupational sensitization is a better predictor for the development of asthma, rhinitis, and bronchial hyperresponsiveness (BHR) than common sensitization. OBJECTIVE To investigate the association between occupational sensitization to laboratory animals and clinical outcomes. METHODS This was a cross-sectional study performed at two universities on students and employees dealing with small rodents. The subjects were allocated in groups: non-sensitized, common sensitization, or occupational sensitization, according to the results of the skin prick test (SPT). All subjects answered a questionnaire about animal exposures, symptoms, allergic diseases, and underwent spirometry and bronchial challenge test with mannitol. Multivariate analysis was performed using Poisson regression to estimate the prevalence ratio (PR). RESULTS Data from 453 volunteers were analysed. Non-sensitized group comprised 237 subjects; common sensitization group, 142 subjects; and occupational sensitization group, 74 subjects. Occupational sensitization was associated with greater risk for all outcomes studied. When the common sensitization group was reference, skin symptoms had PR of 1.36, 95% confidence interval (CI): 1.01-1.85; wheezing had PR of 1.75, CI 95%: 1.21-2.53; rhinitis had PR of 1.25, 95%: 1.11-1.40; nocturnal dyspnoea had PR of 2.40, 95% CI: 1.31-4.40; bronchial hyperresponsiveness (BHR) had PR of 2.47, 95% CI: 1.50-4.09; and confirmed asthma had PR of 2.65, 95% CI: 1.45-4.85. In addition, the overlap of asthma, rhinitis, and skin symptoms in a same subject was significantly more prevalent in the occupational sensitization group, 16.2% versus 4.9% in the common sensitization group. CONCLUSION AND CLINICAL RELEVANCE Occupational sensitization is associated with allergic symptoms and respiratory diseases. SPT with occupational allergens along with other parameters may contribute to detection of risk for allergic and respiratory diseases associated with exposure to laboratory animals.
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Affiliation(s)
- C S Simoneti
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - E Ferraz
- Regional University Center of Espírito Santo do Pinhal, Espírito Santo do Pinhal, Brazil
| | - M B de Menezes
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - E Bagatin
- Faculty of Medical Sciences, Department of Preventive and Social Medicine, State University of Campinas, Campinas, Brazil
| | - L K Arruda
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - E O Vianna
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
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Meneghini AC, Paulino ACB, Pereira LP, Vianna EO. Accuracy of spirometry for detection of asthma: a cross-sectional study. SAO PAULO MED J 2017; 135:428-433. [PMID: 29211208 PMCID: PMC10027253 DOI: 10.1590/1516-3180.2017.0041250517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/25/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Asthma is a chronic inflammatory disease with airway hyperresponsiveness. Spirometry is the most commonly used test among asthmatic patients. Another functional test used for diagnosing asthma is the bronchial challenge test. The aim of this study was to analyze the accuracy of spirometry for detecting asthma in the general population. DESIGN AND SETTING Cross-sectional study with data analysis to evaluate the accuracy of spirometry through calculating sensitivity, specificity and predictive values and through the kappa agreement test. METHODS Subjects who constituted a birth cohort were enrolled at the age of 23 to 25 years. Spirometric abnormality was defined as reduced forced expiratory volume in one second, i.e. lower than 80% of the predicted value. Measurement of bronchial responsiveness was performed by means of the bronchial challenge test with methacholine. The gold-standard diagnosis of asthma was defined as the presence of bronchial hyperresponsiveness in association with respiratory symptoms. RESULTS Asthma was detected in 200 subjects (10.4%) out of the sample of 1922 individuals. Spirometric abnormality was detected in 208 subjects (10.9%) of the sample. The specificity of spirometric abnormality for detecting asthma was 90%, sensitivity was 23%, positive predictive value was 22%, and negative predictive value was 91%. The kappa test revealed weak agreement of 0.13 (95% confidence interval, CI: 0.07-0.19) between spirometry and the diagnosis of asthma. CONCLUSION Spirometry, as a single test, has limitations for detecting asthma in the general population.
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Affiliation(s)
- Andréa Cristina Meneghini
- MSc. Doctoral Student, Department of Social Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.
| | - Ana Carolina Botto Paulino
- MSc. Nurse, Department of Social Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.
| | - Luciano Penha Pereira
- MD, MSc. Preceptor of Internship, Pneumology Service, Hospital Santa Casa de Ribeirão Preto, Ribeirão Preto (SP), Brazil.
| | - Elcio Oliveira Vianna
- MD, PhD. Associate Professor, Department of Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo (USP), Ribeirão Preto (SP), Brazil.
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Ferraz E, Arruda LKDP, Bagatin E, Martinez EZ, Cetlin AA, Simoneti CS, Freitas AS, Martinez JAB, Borges MC, Vianna EO. Laboratory animals and respiratory allergies: the prevalence of allergies among laboratory animal workers and the need for prophylaxis. Clinics (Sao Paulo) 2013; 68:750-9. [PMID: 23778494 PMCID: PMC3674264 DOI: 10.6061/clinics/2013(06)05] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/09/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Subjects exposed to laboratory animals are at a heightened risk of developing respiratory and allergic diseases. These diseases can be prevented by simple measures such as the use of personal protective equipment. We report here the primary findings of the Laboratory Animals and Respiratory Allergies Study regarding the prevalence of allergic diseases among laboratory animal workers, the routine use of preventive measures in laboratories and animal facilities, and the need for prevention programs. METHODS Animal handlers and non-animal handlers from 2 Brazilian universities (University of São Paulo and State University of Campinas) answered specific questionnaires to assess work conditions and symptoms. These subjects also underwent spirometry, a bronchial challenge test with mannitol, and skin prick tests for 11 common allergens and 5 occupational allergens (rat, mouse, guinea pig, hamster, and rabbit). RESULTS Four hundred fifty-five animal handlers (32±10 years old [mean±SD], 209 men) and 387 non-animal handlers (33±11 years old, 121 men) were evaluated. Sensitization to occupational allergens was higher among animal handlers (16%) than non-animal handlers (3%, p<0.01). Accessibility to personal protective equipment was measured at 85% (median, considering 73 workplaces of the animal handler group). Nineteen percent of the animal handlers indicated that they wear a respirator at all times while handling animals or working in the animal room, and only 25% of the animal handlers had received an orientation about animal-induced allergies, asthma, or rhinitis. CONCLUSION In conclusion, our data indicate that preventive programs are necessary. We suggest providing individual advice to workers associated with institutional programs to promote a safer work environment.
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Affiliation(s)
- Erica Ferraz
- University of São Paulo, Department of Medicine, Medical School of Ribeirão Preto, Ribeirão Preto/SP, Brasil
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Cetlin AA, Gutierrez MR, Bettiol H, Barbieri MA, Vianna EO. Influence of asthma definition on the asthma-obesity relationship. BMC Public Health 2012; 12:844. [PMID: 23035704 PMCID: PMC3491029 DOI: 10.1186/1471-2458-12-844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 09/27/2012] [Indexed: 11/24/2022] Open
Abstract
Background Epidemiological studies suggest an association between obesity and asthma in adults and children. Asthma diagnosis criteria are different among studies. The aim of this study was to test the influence of asthma definition on the asthma-obesity relationship. Methods In a cross-sectional analysis of 1922 men and women, subjects completed a translated questionnaire from the European Community Respiratory Health Survey and underwent spirometry and a bronchial challenge test. Weight, height and waist circumference were measured. Multiple logistic regression analysis was carried out to assess the association of variables related to obesity and asthma. Asthma was defined either by the presence of symptoms with bronchial hyperresponsiveness (BHR) or by a self-report of a physician-made diagnosis. The following variables were separately tested for associations with asthma: socioeconomic characteristics, schooling, physical activity, smoking status, anthropometry and spirometry. Results No association was detected between asthma confirmed by BHR and obesity indicators, odds ratio (OR) = 1.08 (95% confidence interval: 0.69 - 1.68) for obesity assessed by body mass index ≥ 30 kg/m2; OR = 1.02 (0.74 - 1.40) for obesity assessed by abnormal waist-to-height ratio; and, OR = 0.96 (0.69 - 1.33) for abnormal waist circumference. On the contrary, a previous diagnosis of asthma was associated with obesity, OR = 1.48 (1.01 - 2.16) for body mass index ≥ 30 kg/m2; OR = 1.48 (1.13 - 1.93) for abnormal waist-to-height ratio; and, OR = 1.32 (1.00 – 1.75) for abnormal waist circumference. Female gender, schooling ≥ 12 years and smoking were associated with BHR-confirmed asthma. Physically inactive subjects were associated with a previous diagnosis of asthma. Conclusions Our findings indicate that the relationship between asthma and obesity in epidemiological studies depends on the definition adopted. Certain components of asthma, for instance, symptoms may be more prone to the obesity influence than other ones, like bronchial hyperresponsiveness.
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Affiliation(s)
- Andrea Antunes Cetlin
- Department of Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Borges MDC, Ferraz E, Vianna EO. Bronchial provocation tests in clinical practice. SAO PAULO MED J 2011; 129:243-9. [PMID: 21971900 PMCID: PMC10896023 DOI: 10.1590/s1516-31802011000400008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 02/26/2009] [Accepted: 02/24/2011] [Indexed: 11/22/2022] Open
Abstract
Bronchial hyperresponsiveness, which consists of an exaggerated response of the airways to bronchoconstrictor stimuli, is one of the main characteristics of asthma, presented in nearly all asthmatic patients. Bronchial hyperresponsiveness may also be present in other diseases, such as allergic rhinitis, chronic obstructive pulmonary disease, cystic fibrosis, heart failure and respiratory infection, and with some medications, such as β-blockers. Bronchial provocation tests (also known as bronchial challenges) are used to evaluate bronchial responsiveness. These tests have become increasingly used over the last 20 years, with the development and validation of accurate, safe and reproducible tests, and with the publication of well-detailed protocols. Several stimuli can be used in a bronchial challenge, and they are classified as direct and indirect stimuli. There are many indications for a bronchial challenge. In this review, we discuss the main differences between direct and indirect stimuli, and the use of bronchial challenges in clinical practice, especially for confirming diagnoses of asthma, exercise-induced bronchoconstriction and cough-variant asthma, and for use among elite-level athletes.
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Affiliation(s)
- Marcos de Carvalho Borges
- MD, PhD. Visiting Professor, Department of Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, São Paulo, and Adjunct Professor, Department of Medicine, Universidade de São Carlos (UFSCar), São Carlos, São Paulo, Brazil.
| | - Erica Ferraz
- PhD. Research Collaborator, Department of Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, São Paulo, Brazil.
| | - Elcio Oliveira Vianna
- MD, PhD. Associate Professor, Department of Medicine, Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, São Paulo, Brazil.
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Büchele G, Genuneit J, Weinmayr G, Björkstén B, Gehring U, von Mutius E, Priftanji A, Stein RT, Addo-Yobo EO, Priftis KN, Shah JR, Forastiere F, Svabe V, Crane J, Nystad W, García-Marcos L, Saraçlar Y, El-Sharif N, Strachan DP. International variations in bronchial responsiveness in children: findings from ISAAC phase two. Pediatr Pulmonol 2010; 45:796-806. [PMID: 20597079 DOI: 10.1002/ppul.21259] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
RATIONALE Bronchial responsiveness is an objectively measurable trait related to asthma. Its prevalence and association with asthma symptoms among children in many countries are unknown. OBJECTIVES To investigate international variations in bronchial responsiveness (BR) and their associations with asthma symptoms and atopic sensitization. METHODS Bronchial challenge tests were conducted in 6,826 schoolchildren (aged 8-12 years) in 16 countries using hypertonic (4.5%) saline. FEV(1) was measured at baseline and after inhalation for 0.5, 1, 2, 4, and 8 min. BR was analyzed both as a dichotomous (bronchial hyperreactivity, BHR, at least 15% decline in FEV(1)) and as a continuous variable (time-response slope, BR slope, individual decline in FEV(1) per log(min)). RESULTS Prevalence of wheeze last year ranged from 4.4% in Tirana (Albania) to 21.9% in Hawkes Bay (New Zealand) and of BHR from 2.1% in Tirana to 48% in Mumbai (India). The geometric mean BR slope varied between 3.4%/log(min) in Tirana and 12.8%/log(min) in Mumbai and Rome (Italy). At the individual level, BHR was positively associated with wheeze during the past 12 months both in affluent countries (OR = 3.6; 95% CI: 2.7-5.0) and non-affluent countries (OR = 3.0; 1.6-5.5). This association was more pronounced in atopic children. There was a correlation (rho = 0.64, P = 0.002) between center-specific mean BR slope and wheeze prevalence in atopic, but not in non-atopic children. CONCLUSIONS BR to saline in children varied considerably between countries. High rates of BR were not confined to affluent countries nor to centers with high prevalences of asthma symptoms. The association between wheeze and BHR at the individual level differed across centers and this heterogeneity can be largely explained by effect modification by atopy. Pediatr. Pulmonol. 2010; 45:796-806. (c) 2010 Wiley-Liss, Inc.
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Affiliation(s)
- Gisela Büchele
- Institute of Epidemiology, University of Ulm, Ulm, Germany.
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