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Wadhwa V, Wurzel D, Dharmage SC, Abramson MJ, Lodge C, Russell M. Do early-life allergic sensitization and respiratory infection interact to increase asthma risk? J Asthma 2024; 61:1212-1221. [PMID: 38551488 DOI: 10.1080/02770903.2024.2333473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The 'two-hit' hypothesis theorizes that early life allergic sensitization and respiratory infection interact to increase asthma risk. METHODS We sought to determine in a high allergy risk birth cohort whether interactions between early life allergic sensitization and respiratory infection were associated with increased risk for asthma at ages 6-7 years and 18 years. Allergic sensitization was assessed at 6, 12, and 24 months by skin prick testing to 3 food and 3 aeroallergens. Respiratory infection was defined as reported "cough, rattle, or wheeze" and assessed 4-weekly for 15 months, at 18 months, and age 2 years. Regression analysis was undertaken with parent-reported asthma at age 6-7 years and doctor diagnosed asthma at 18 years as distinct outcomes. Interactions between allergic sensitization and respiratory infection were explored with adjustment made for potential confounders. RESULTS Odds of asthma were higher in sensitized compared to nonsensitized children at age 6-7 years (OR = 14.46; 95% CI 3.99-52.4), There was no evidence for interactions between allergic sensitization and early life respiratory infection, with a greater frequency of respiratory infection up to 2 years of age associated with increased odds for asthma at age 6-7 years in both sensitized (OR = 1.13; 95% CI 1.02-1.25, n = 199) and nonsensitized children (OR = 1.31; 1.11-1.53, n = 211) (p interaction = 0.089). At age 18 years, these associations were weaker. CONCLUSIONS Our findings do not support 'two-hit' interactions between early life allergic sensitization and respiratory infection on asthma risk. Both early life respiratory infections and allergic sensitization were risk factors and children with either should be monitored closely for development of asthma.
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Affiliation(s)
- Vikas Wadhwa
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Danielle Wurzel
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Russell
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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2
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Calcaterra V, Farolfi A, D'Auria E, De Silvestri A, Baldassarre P, Ferrara F, Tiranini L, Ghezzi M, Garancini N, Bernardo L, Nappi RE, Zuccotti G. Perimenstrual Asthma and Premenstrual Disorders in Adolescents with Asthma. J Pediatr Adolesc Gynecol 2024; 37:132-136. [PMID: 37977436 DOI: 10.1016/j.jpag.2023.11.001] [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: 07/07/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Asthma is a common chronic disease in pediatric patients, and perimenstrual asthma (PMA), refers to the worsening of asthma symptoms during the perimenstrual period, mainly reported in adult women. However, there is limited information regarding the exacerbation of symptoms in the presence of premenstrual disorders (PMDs) in adolescents. The aim of this pilot observational study was to investigate the frequency and potential association of PMA and PMDs in a clinical sample of adolescents with asthma. PATIENTS AND METHODS The study included 50 adolescents (aged 12-18 years, mean 16.08 ± 2.35) with asthma and at least 2 years of gynecological age. The participants completed the Asthma Control Test (ACT) to assess asthma control (considered pathological if ACT score < 20) and the modified Premenstrual Symptoms Screening Tool for Adolescents (PSST-A) to evaluate PMDs. RESULTS A total of 75.5% of adolescents reported PMA. The prevalence of premenstrual symptoms did not significantly differ between the PMA and no-PMA group. Among the study sample, 38.7% experienced symptoms indicative of moderate/severe premenstrual syndrome, and 8.1% exhibited symptoms of premenstrual dysphoric disorder. Compared with the no-PMA group, patients with PMA showed a significant impairment in daily and home activities (P = .03 and P = .02, respectively) and exhibited a difference in the frequency of asthma symptoms (P < .001) and medication use (P ≤ .01). CONCLUSION Perimenstrual worsening of asthma symptoms may be common in adolescents with a severe form of asthma. Prospective data collection through menstrual diaries is necessary to further explore the association between PMA and PMDs. Identifying early risk factors for PMA could facilitate the development of preventive strategies and early interventions for adolescents with asthma.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Department of Pediatrics, Buzzi Children's Hospital, Milano, Italy
| | - Andrea Farolfi
- Department of Pediatrics, Buzzi Children's Hospital, Milano, Italy
| | - Enza D'Auria
- Department of Pediatrics, Buzzi Children's Hospital, Milano, Italy.
| | - Annalisa De Silvestri
- Scientific Direction, Clinical Epidemiology and Biometric Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Francesca Ferrara
- Department of Childhood and Adolescent Medicine and Gender Medicine, The Fatebenefratelli-Melloni Hospital, Milan, Italy
| | - Lara Tiranini
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, School of Medicine, University of Pavia, Italy
| | - Michele Ghezzi
- Department of Pediatrics, Buzzi Children's Hospital, Milano, Italy
| | - Nicolò Garancini
- Department of Pediatrics, Buzzi Children's Hospital, Milano, Italy
| | - Luca Bernardo
- Department of Childhood and Adolescent Medicine and Gender Medicine, The Fatebenefratelli-Melloni Hospital, Milan, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, School of Medicine, University of Pavia, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Buzzi Children's Hospital, Milano, Italy; Department of Biomedical and Clinical Science, University of Milano, Milano, Italy
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3
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Tan DJ, Lodge CJ, Walters EH, Lowe AJ, Bui DS, Bowatte G, Pham J, Erbas B, Hui J, Hamilton GS, Thomas PS, Hew M, Washko G, Wood-Baker R, Abramson MJ, Perret JL, Dharmage SC. Longitudinal Asthma Phenotypes from Childhood to Middle-Age: A Population-based Cohort Study. Am J Respir Crit Care Med 2023; 208:132-141. [PMID: 37209134 DOI: 10.1164/rccm.202208-1569oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/17/2023] [Indexed: 05/22/2023] Open
Abstract
Rationale: Asthma is a heterogeneous condition, and longitudinal phenotyping may provide new insights into the origins and outcomes of the disease. Objectives: We aimed to characterize the longitudinal phenotypes of asthma between the first and sixth decades of life in a population-based cohort study. Methods: Respiratory questionnaires were collected at seven time points in the TAHS (Tasmanian Longitudinal Health Study) when participants were aged 7, 13, 18, 32, 43, 50, and 53 years. Current-asthma and ever-asthma status was determined at each time point, and group-based trajectory modeling was used to characterize distinct longitudinal phenotypes. Linear and logistic regression models were fitted to investigate associations of the longitudinal phenotypes with childhood factors and adult outcomes. Measurements and Main Results: Of 8,583 original participants, 1,506 had reported ever asthma. Five longitudinal asthma phenotypes were identified: early-onset adolescent-remitting (40%), early-onset adult-remitting (11%), early-onset persistent (9%), late-onset remitting (13%), and late-onset persistent (27%). All phenotypes were associated with chronic obstructive pulmonary disease at age 53 years, except for late-onset remitting asthma (odds ratios: early-onset adolescent-remitting, 2.00 [95% confidence interval (CI), 1.13-3.56]; early-onset adult-remitting, 3.61 [95% CI, 1.30-10.02]; early-onset persistent, 8.73 [95% CI, 4.10-18.55]; and late-onset persistent, 6.69 [95% CI, 3.81-11.73]). Late-onset persistent asthma was associated with the greatest comorbidity at age 53 years, with increased risk of mental health disorders and cardiovascular risk factors. Conclusions: Five longitudinal asthma phenotypes were identified between the first and sixth decades of life, including two novel remitting phenotypes. We found differential effects of these phenotypes on risk of chronic obstructive pulmonary disease and nonrespiratory comorbidities in middle age.
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Affiliation(s)
- Daniel J Tan
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jonathan Pham
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jennie Hui
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences and
| | - Paul S Thomas
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Hew
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - George Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and
| | | | - Michael J Abramson
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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4
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Al-Shuweli S, Landt E, Ellervik C, Poulsen HE, Ramar M, Dahl M, Fedulov AV. Risk of asthma in offspring of asthmatic fathers versus mothers: A population-based study of 21,000 individuals in Denmark. Respir Med 2023; 207:107116. [PMID: 36642344 DOI: 10.1016/j.rmed.2023.107116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
Parental asthma or allergy have been linked to higher risk of asthma in a child; this occurs to a variable extent in different study populations. Moreover, it is debated whether maternal more so than paternal asthma history is a stronger predisposing factor: while in some countries/populations the maternal effect was clearly seen over paternal, in others the parental effects were equivalent, and in a few studies paternal effect dominated. Here we aimed to determine parental asthma and allergy effect in the Danish GEneral SUburban population Study (GESUS). This cross-sectional study has involved 21,362 adults aged 20+ years in the suburbs of Copenhagen. We used a combination of questionnaire approach, history of prescribed asthma medications and pulmonary function testing to determine odds ratios for maternal and paternal (and combined) asthma and allergy linked to asthma in the test subjects. We found that the input of maternal vs. paternal asthma effect was approximately equal (age and sex-adjusted OR 2.46, 95% CI: 2.15-2.81 for asthmatic mothers vs. 2.97, 2.58-3.42 for asthmatic fathers), except for the "ever asthma" age and sex-adjusted odds ratios where paternal allergy seems to have conferred a marginally greater effect (age and sex-adj. OR 1.96 for maternal allergy vs. 2.44 for paternal allergy, p = 0.03). Stratifying for gestational tobacco smoking did not affect the maternal results. We conclude that in the GESUS study parental asthma or allergy were strongly linked to higher asthma risk in offspring, without a prominent maternal or paternal effect.
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Affiliation(s)
- Suzan Al-Shuweli
- Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark
| | - Eskild Landt
- Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark
| | - Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Data Support, Region Zealand, Sorø, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Henrik Enghusen Poulsen
- Department of Endocrinology I, University Hospital Copenhagen Bispebjerg Frederiksberg Hospital, and Department of Cardiology, Copenhagen University Hospital Copenhagen at Hillerød, Denmark
| | - Mohankumar Ramar
- Department of Surgery, Warren Alpert Medical School, Brown University, RI, USA
| | - Morten Dahl
- Department of Clinical Biochemistry, Zealand University Hospital, Køge, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Alexey V Fedulov
- Department of Surgery, Warren Alpert Medical School, Brown University, RI, USA.
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Goldberg S, Picard E, Joseph L, Kedem R, Sommer A, Tzur D, Cohen S. Factors associated with resolution of childhood asthma by the age of 17: Large cohort analysis. Pediatr Pulmonol 2022; 57:878-884. [PMID: 35029064 PMCID: PMC9306541 DOI: 10.1002/ppul.25828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/09/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many children with asthma will become asymptomatic during adolescence. In this study, we evaluated factors associated with recovery from asthma by the age of 17. METHODS The medical records of 17-year-old conscripts to the Israeli army with asthma were compared with the records of conscripts with rigorously diagnosed resolved asthma. We assessed the association between the following parameters and asthma resolution: body mass index (BMI), recurrent rhinitis, birth season, socioeconomic level, and cognition. RESULTS Sixty-eight thousand and ninety conscripts with active asthma were compared to 14,695 with resolved asthma. In univariate analysis, rhinitis, overweight, underweight, higher socioeconomic level, and lower cognitive score were associated with active asthma (p < 0.001 for both sexes), but not the season of birth. In multivariate analysis, only overweight, underweight, rhinitis, and lower cognitive score (p < 0.001 for both sexes) remained significantly associated with persistence of asthma. CONCLUSIONS Although association does not prove causation, our finding is another reason to encourage adolescents with asthma to maintain a normal body weight. Prospective interventional studies are needed in order to decide whether changing weight to ensure BMI is within the ideal range and controlling rhinitis increases the odds of resolution of asthma in adolescence.
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Affiliation(s)
- Shmuel Goldberg
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elie Picard
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Leon Joseph
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ron Kedem
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Adir Sommer
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Dorit Tzur
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Shlomo Cohen
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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6
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Koefoed HJL, Vonk JM, Koppelman GH. Predicting the course of asthma from childhood until early adulthood. Curr Opin Allergy Clin Immunol 2022; 22:115-122. [PMID: 35197433 PMCID: PMC8915994 DOI: 10.1097/aci.0000000000000810] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To communicate recent insights about the natural history of childhood asthma, with a focus on prediction of persistence and remission of childhood asthma, up to early adulthood. RECENT FINDINGS Lung function around the age of 8-9 years is the strongest predictor: obstructive lung function predicts asthma persistence up to early adulthood, whereas normal lung function predicts remission. The ability to predict asthma remission improves when lung function is combined with blood eosinophil levels and degree of bronchial hyperresponsiveness. Interventions, such as inhaled corticosteroids and immunotherapy do not appear to alter the course of asthma. Epigenetic studies have revealed potential novel biomarkers of asthma remission, such as micro-RNA patterns in blood. Specifically, lower serum levels of mi-R221-5p, which is associated with lower IL-6 release and eosinophilic inflammation, predict remission. Higher levels of blood DNA-methylation of a CpG site in Peroxisomal Biogenesis Factor 11 Beta were associated with asthma remission. SUMMARY Lung function, allergic comorbidity and polysensitization in childhood predict the course of asthma. Recent epigenetic studies have provided a better understanding of underlying pathological processes in asthma remission, which may be used to improve prediction or develop novel treatments aimed at altering the course of asthma.
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Affiliation(s)
- Hans Jacob L. Koefoed
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital
- Groningen Research Institute for Asthma and COPD (GRIAC)
| | - Judith M. Vonk
- Groningen Research Institute for Asthma and COPD (GRIAC)
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital
- Groningen Research Institute for Asthma and COPD (GRIAC)
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7
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Robinson PD, Jayasuriya G, Haggie S, Uluer AZ, Gaffin JM, Fleming L. Issues affecting young people with asthma through the transition period to adult care. Paediatr Respir Rev 2022; 41:30-39. [PMID: 34686436 DOI: 10.1016/j.prrv.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/14/2021] [Indexed: 11/15/2022]
Abstract
Asthma is among the most common medical conditions affecting children and young people, with adolescence a recognised period of increased risk, overrepresented in analyses examining recent increasing asthma mortality rates. Asthma may change significantly during this period and management also occurs in the context of patients seeking increased autonomy and self-governance whilst navigating increasing academic and social demands. A number of disease factors can destabilise asthma during adolescence including: increased rates of anaphylaxis, anxiety, depression, obesity, and, in females, an emerging resistance to corticosteroids and the pro-inflammatory effects of oestrogen. Patient factors such as smoking, vaping, poor symptom recognition, treatment non-adherence and variable engagement with health services contribute to difficult to treat asthma. Significant deficiencies in the current approach to transition have been identified by a recent EAACI task force, and subsequent asthma-specific recommendations, published in 2020 provide an important framework moving forward. As with other chronic conditions, effective transition programmes plan ahead, engage with adolescents and their families to identify the patients' management priorities and the current challenges they are experiencing with treatment. Transition needs may vary significantly across asthma patients and for more complex asthma may include dedicated transition clinics involving multidisciplinary care requiring input including, amongst others, allergy and immunology, psychological medicine, respiratory physicians and scientists and nurse specialists. Across different global regions, barriers to treatment may vary but need to be elicited and an individualised approach taken to optimising asthma care which is sustainable within the local adult healthcare system.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia.
| | - Geshani Jayasuriya
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, Sydney Medical School, University of Sydney, Australia; Dept of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Stuart Haggie
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia; Department of Paediatrics, Shoalhaven District Memorial Hospital, Nowra, Australia
| | - Ahmet Z Uluer
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Louise Fleming
- National Heart and Lung Institute, Imperial College, London UK; Respiratory Paediatrics, Royal Brompton Hospital, London, UK
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8
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Tang MF, Leung ASY, Ngai NA, Chan OM, Wong GWK, Leung TF. Prospective study of disease persistence and lung function trajectories of childhood asthma. Pediatr Allergy Immunol 2022; 33:e13726. [PMID: 35212048 DOI: 10.1111/pai.13726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A proportion of asthmatic children outgrow their disease by adulthood, but there are limited data on predictors for asthma persistence. This prospective study characterized the trajectory of spirometric indices and identified predictors for the persistence of childhood asthma. METHODS Chinese asthmatic children aged 6-15 years from pediatric allergy clinic underwent annual visits for ≥5 years and until their adulthood. Pre-bronchodilator spirometry and anti-asthma medications were recorded at baseline and then at least annually. Asthma resolution was defined when patients were free from asthma symptoms and use of anti-asthma drugs for ≥2 years. Logistic regression was used to identify predictors for asthma persistence. Generalized estimating equation was used to analyze longitudinal changes in lung function parameters in relation to asthma persistence. RESULTS 181 asthmatic children aged [mean (SD)] 10.0 (2.7) years were followed for [mean (SD)] 12.5 (2.8) years. One third of them outgrew asthma during follow-up. Female was 3.36 times more likely to have persistent asthma. Inhaled corticosteroid (ICS) treatment ever and frequent asthma exacerbation (AE) predicted asthma persistence with respective odds ratios of 3.19 (95% confidence interval [CI] 1.44-7.09) and 3.05 (95% CI 1.39-6.68). Persistent asthma was inversely associated with baseline forced expiratory volume in 1-second (FEV1 %) with an odds ratio of 0.96 (95% CI 0.93-1.00). Throughout follow-up, patients with persistent asthma had generally lower forced expiratory indices than those with asthma resolution. Children with persistent asthma experienced poorer lung function growth. CONCLUSIONS Female, ICS ever, and frequent AE predicted persistent asthma. Patients with persistent asthma had lower forced expiratory indices and poorer lung function growth into adulthood.
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Affiliation(s)
- Man Fung Tang
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Agnes Sze Yin Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Noelle Anne Ngai
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Oi Man Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Gary Wing Kin Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.,Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Shatin, Hong Kong
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9
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Quirce S, Heffler E, Nenasheva N, Demoly P, Menzies-Gow A, Moreira-Jorge A, Nissen F, Hanania NA. Revisiting Late-Onset Asthma: Clinical Characteristics and Association with Allergy. J Asthma Allergy 2020; 13:743-752. [PMID: 33408487 PMCID: PMC7781019 DOI: 10.2147/jaa.s282205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
The Global Initiative for Asthma (GINA) 2020 defines late-onset asthma (LOA) as one of the clinical phenotypes of asthma wherein patients, particularly women, present with asthma for the first time in adult life, tend to be non-allergic and often require higher doses of inhaled corticosteroids (ICS) or are relatively refractory to corticosteroid treatment. In this review, we examine the published literature improve the understanding of the following aspects of LOA: 1) the age cut-off for its diagnosis; 2) its distinct clinical phenotypes, characteristics and risk factors; and 3) its association with allergic comorbidities and conditions. Overall, our review reveals that clinicians and researchers have used multiple age cut-offs to define LOA, with cut-off ages ranging from >12 years to ≥65 years. LOA has also been classified into several distinct phenotypes, some of which drastically differ in their clinical characteristics, course and prognosis. Although LOA has traditionally been considered non-allergic in nature, our review indicates that it is commonly associated with allergic features and comorbidities. Our findings suggest that there is an urgent need for the development of more clear clinical practice guidelines that can provide more clarity on the definition and other aspects of LOA. In addition, the association of LOA and allergy needs to be re-examined to frame a more optimal treatment strategy for patients with LOA.
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Affiliation(s)
- Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ and Universidad Autónoma de Madrid, Madrid, Spain
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - Natalia Nenasheva
- Department of Allergology and Immunology of Russian Medical Academy for Continuous Medical Education, Moscow, Russian Federation
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | | | | | - Francis Nissen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
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10
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Honkamäki J, Piirilä P, Hisinger-Mölkänen H, Tuomisto LE, Andersén H, Huhtala H, Sovijärvi A, Lindqvist A, Backman H, Lundbäck B, Rönmark E, Lehtimäki L, Pallasaho P, Ilmarinen P, Kankaanranta H. Asthma Remission by Age at Diagnosis and Gender in a Population-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1950-1959.e4. [PMID: 33338683 DOI: 10.1016/j.jaip.2020.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Child-onset asthma is known to remit with high probability, but remission in adult-onset asthma is seemingly less frequent. Reports of the association between remission and asthma age of onset up to late adulthood are scarce. OBJECTIVE To evaluate the association between asthma remission, age at diagnosis and gender, and assess risk factors of nonremission. METHODS In 2016, a random sample of 16,000 subjects aged 20 to 69 years from Helsinki and Western Finland were sent a FinEsS questionnaire. Physician-diagnosed asthma was categorized by age at diagnosis to early- (0-11 years), intermediate- (12-39 years), and late-diagnosed (40-69 years) asthma. Asthma remission was defined by not having had asthma symptoms and not having used asthma medication in the past 12 months. RESULTS Totally, 8199 (51.5%) responded, and 879 reported physician-diagnosed asthma. Remission was most common in early-diagnosed (30.2%), followed by intermediate-diagnosed (17.9%), and least common in late-diagnosed asthma (5.0%) (P < .001), and the median times from diagnosis were 27, 18.5, and 10 years, respectively. In males, the corresponding remission rates were 36.7%, 20.0%, and 3.4%, and in females, 20.4%, 16.6%, and 5.9% (gender difference P < .001). In multivariable binary logistic regression analysis, significant risk factors of asthma nonremission were intermediate (odds ratio [OR] = 2.15, 95% confidence interval: 1.37-3.36) and late diagnosis (OR = 11.06, 4.82-25.37) compared with early diagnosis, chronic obstructive pulmonary disease (COPD) (OR = 5.56, 1.26-24.49), allergic rhinitis (OR = 2.28, 1.50-3.46), and family history of asthma (OR = 1.86, 1.22-2.85). Results were similar after excluding COPD. CONCLUSION Remission was rare in adults diagnosed with asthma after age 40 years in both genders. Late-diagnosed asthma was the most significant independent risk factor for nonremission.
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Affiliation(s)
- Jasmin Honkamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | | | - Leena E Tuomisto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Heidi Andersén
- Thoracic Oncology Unit, Tema Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anssi Sovijärvi
- Unit of Clinical Physiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Ari Lindqvist
- Research Unit of Pulmonary Diseases, Helsinki University Hospital, University of Helsinki and Clinical Research Institute HUCH Ltd, Helsinki, Finland
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, Umeå University, Umeå, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Allergy Centre, Tampere University Hospital, Tampere, Finland
| | | | - Pinja Ilmarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
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11
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de Jong CCM, Pedersen ES, Goutaki M, Trachsel D, Barben J, Kuehni CE. Do clinical investigations predict long-term wheeze? A follow-up of pediatric respiratory outpatients. Pediatr Pulmonol 2019; 54:1156-1161. [PMID: 31026385 DOI: 10.1002/ppul.24347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/26/2019] [Accepted: 04/12/2019] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The contribution of clinical investigations to prediction of long-term outcomes of children investigated for asthma is unclear. AIM We performed a broad range of clinical tests and investigated whether they helped to predict long-term wheeze among children referred for evaluation of possible asthma. METHODS We studied children aged 6 to 16 years referred to two Swiss pulmonary outpatient clinics with a history of wheeze, dyspnea, or cough in 2007. The initial assessment included spirometry, fractional exhaled nitric oxide, skin prick tests, and bronchial provocation tests by exercise, methacholine, and mannitol. Respiratory symptoms were assessed with questionnaires at baseline and at follow-up 7 years later. Associations between baseline factors and wheeze at follow-up were investigated by logistic regression. RESULTS At baseline, 111 children were examined in 2007. After 7 years, 85 (77%) completed the follow-up questionnaire, among whom 61 (72%) had wheeze at baseline, while at follow-up 39 (46%) reported wheeze. Adjusting for age and sex, the following characteristics predicted wheeze at adolescence: wheeze triggered by pets (odds ratio, 4.2; 95% CI, 1.2-14.8), pollen (2.8, 1.1-7.0), and exercise (3.1, 1.2-8.0). Of the clinical tests, only a positive exercise test (3.2, 1.1-9.7) predicted wheeze at adolescence. CONCLUSION Reported exercise-induced wheeze and wheeze triggered by pets or pollen were important predictors of wheeze persistence into adolescence. None of the clinical tests predicted wheeze more strongly than reported symptoms. Clinical tests might be important for asthma diagnosis but medical history is more helpful in predicting prognosis in children referred for asthma.
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Affiliation(s)
- Carmen C M de Jong
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Eva Sl Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Daniel Trachsel
- Paediatric Respiratory Medicine, Children's University Hospital of Basel, Basel, Switzerland
| | - Juerg Barben
- Paediatric Respiratory Medicine, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Children's University Hospital of Bern, University of Bern, Bern, Switzerland
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12
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Withers ALI, Green R. Transition for Adolescents and Young Adults With Asthma. Front Pediatr 2019; 7:301. [PMID: 31396495 PMCID: PMC6664046 DOI: 10.3389/fped.2019.00301] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Asthma is a complex, heterogenous medical condition which is very common in children and adults. The transition process from pediatric to adult health care services can be a challenge for young people with chronic medical conditions. The significant changes in physical and mental health during this time, as well as the many unique developmental and psychosocial challenges that occur during adolescence can complicate and impede transition if not adequately addressed and managed. The transition period can also be a challenging time for health professionals to assess readiness for transition and manage some of the complications which are particularly common during this time, including poor adherence to therapy, smoking, drug use, and emerging mental health conditions. The natural history, presentation, symptoms, and management of asthma is often significantly different when comparing pediatric and adult practice. In addition, management in infants, toddlers, school aged children, and adolescents differs significantly, offering an additional challenge to pediatric physicians managing asthmatic children and young people. Despite these challenges, if the transition process for young people with asthma is planned and performed in a formalized manner, many of these issues can be addressed, allowing the transition to occur smoothly despite changes that may occur in medical and psychosocial domains.
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Affiliation(s)
| | - Ruth Green
- Glenfield Hospital, Leicester, United Kingdom
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13
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Genetic Architectures of Childhood- and Adult-Onset Asthma Are Partly Distinct. Am J Hum Genet 2019; 104:665-684. [PMID: 30929738 DOI: 10.1016/j.ajhg.2019.02.022] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/20/2019] [Indexed: 12/13/2022] Open
Abstract
The extent to which genetic risk factors are shared between childhood-onset (COA) and adult-onset (AOA) asthma has not been estimated. On the basis of data from the UK Biobank study (n = 447,628), we found that the variance in disease liability explained by common variants is higher for COA (onset at ages between 0 and 19 years; h2g = 25.6%) than for AOA (onset at ages between 20 and 60 years; h2g = 10.6%). The genetic correlation (rg) between COA and AOA was 0.67. Variation in age of onset among COA-affected individuals had a low heritability (h2g = 5%), which we confirmed in independent studies and also among AOA-affected individuals. To identify subtype-specific genetic associations, we performed a genome-wide association study (GWAS) in the UK Biobank for COA (13,962 affected individuals) and a separate GWAS for AOA (26,582 affected individuals) by using a common set of 300,671 controls for both studies. We identified 123 independent associations for COA and 56 for AOA (37 overlapped); of these, 98 and 34, respectively, were reproducible in an independent study (n = 262,767). Collectively, 28 associations were not previously reported. For 96 COA-associated variants, including five variants that represent COA-specific risk factors, the risk allele was more common in COA- than in AOA-affected individuals. Conversely, we identified three variants that are stronger risk factors for AOA. Variants associated with obesity and smoking had a stronger contribution to the risk of AOA than to the risk of COA. Lastly, we identified 109 likely target genes of the associated variants, primarily on the basis of correlated expression quantitative trait loci (up to n = 31,684). GWAS informed by age of onset can identify subtype-specific risk variants, which can help us understand differences in pathophysiology between COA and AOA and so can be informative for drug development.
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14
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Matheson MC, Abramson MJ, Allen K, Benke G, Burgess JA, Dowty JG, Erbas B, Feather IH, Frith PA, Giles GG, Gurrin LC, Hamilton GS, Hopper JL, James AL, Jenkins MA, Johns DP, Lodge CJ, Lowe AJ, Markos J, Morrison SC, Perret JL, Southey MC, Thomas PS, Thompson BR, Wood-Baker R, Haydn Walters E, Dharmage SC. Cohort Profile: The Tasmanian Longitudinal Health STUDY (TAHS). Int J Epidemiol 2018; 46:407-408i. [PMID: 27272183 DOI: 10.1093/ije/dyw028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Melanie C Matheson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Katrina Allen
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Geza Benke
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John A Burgess
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - James G Dowty
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Iain H Feather
- Gold Coast Hospital, Southport, Queensland, Australia.,Bond University, Varsity Lakes, Queensland, Australia
| | - Peter A Frith
- Flinders University School of Medicine, Repatriation General Hospital, Adelaide, South Australia, Australia
| | - Graham G Giles
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Lyle C Gurrin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Garun S Hamilton
- Department of Lung and Sleep Medicine, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Mark A Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David P Johns
- School of Medicine, University of Tasmania, Tasmania 7005, Australia
| | - Caroline J Lodge
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - James Markos
- Launceston General Hospital, Tasmania 7250, Australia
| | - Stephen C Morrison
- Department of Medicine, University of Queensland, Queensland 4072, Australia
| | - Jennifer L Perret
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, Austin Hospital, Victoria 3084, Australia.,Institute for Breathing and Sleep, Victoria, Australia
| | | | - Paul S Thomas
- Inflammation and Infection Research, Faculty of Medicine, University of New South Wales, New South Wales, Australia
| | - Bruce R Thompson
- Allergy Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Australia
| | | | - Eugene Haydn Walters
- School of Medicine, University of Tasmania, Tasmania 7005, Australia.,School of Medicine, University of Notre Dame, Victoria 3030, Australia
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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15
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Hallit S, Leynaert B, Delmas MC, Rocchi S, De Blic J, Marguet C, Scherer E, Dufourg MN, Bois C, Reboux G, Millon L, Charles MA, Raherison C. Wheezing phenotypes and risk factors in early life: The ELFE cohort. PLoS One 2018; 13:e0196711. [PMID: 29702689 PMCID: PMC5922557 DOI: 10.1371/journal.pone.0196711] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/18/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Different phenotypes of wheezing have been described to date but not in early life. We aim to describe wheezing phenotypes between the ages of two months and one year, and assess risk factors associated with these wheezing phenotypes in a large birth cohort. Methods We studied 18,041 infants from the ELFE (French Longitudinal Study of Children) birth cohort. Parents reported wheezing and respiratory symptoms at two and 12 months, and answered a complete questionnaire (exposure during pregnancy, parental allergy). Results Children with no symptoms (controls) accounted for 77.2%, 2.1% had had wheezing at two months but no wheezing at one year (intermittent), 2.4% had persistent wheezing, while 18.3% had incident wheezing at one year. Comparing persistent wheezing to controls showed that having one sibling (ORa = 2.19) or 2 siblings (ORa = 2.23) compared to none, nocturnal cough (OR = 5.2), respiratory distress (OR = 4.1) and excess bronchial secretions (OR = 3.47) at two months, reflux in the child at 2 months (OR = 1.55), maternal history of asthma (OR = 1.46) and maternal smoking during pregnancy (OR = 1.57) were significantly associated with persistent wheezing. These same factors, along with cutaneous rash in the child at 2 months (OR = 1.13) and paternal history of asthma (OR = 1.32) were significantly associated with increased odds of incident wheezing. Having one sibling (ORa = 1.9) compared to none, nocturnal cough at 2 months (OR = 1.76) and excess bronchial secretions at 2 months (OR = 1.65) were significantly associated with persistent compared to intermittent wheezing. Conclusion Respiratory symptoms (cough, respiratory distress, and excessive bronchial secretion) were significantly associated with a high risk of persistent wheezing at one year. Smoking exposure during pregnancy was also a risk factor for persistent and incident wheezing.
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Affiliation(s)
- Souheil Hallit
- U1219 INSERM, ISPED, Bordeaux University, Bordeaux, France
- * E-mail:
| | | | | | - Steffi Rocchi
- Parasitology Mycology Department, University Hospital, Besançon, France
- Chrono-environnement UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
| | - Jacques De Blic
- Pediatric Allergy and Pulmonology, CHU Necker Enfants Malades, Paris, France
| | | | - Emeline Scherer
- Parasitology Mycology Department, University Hospital, Besançon, France
- Chrono-environnement UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
| | | | | | - Gabriel Reboux
- Parasitology Mycology Department, University Hospital, Besançon, France
- Chrono-environnement UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
| | - Laurence Millon
- Parasitology Mycology Department, University Hospital, Besançon, France
- Chrono-environnement UMR CNRS 6249, Bourgogne Franche-Comté University, Besançon, France
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16
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Perret JL, Bowatte G, Lodge CJ, Knibbs LD, Gurrin LC, Kandane-Rathnayake R, Johns DP, Lowe AJ, Burgess JA, Thompson BR, Thomas PS, Wood-Baker R, Morrison S, Giles GG, Marks G, Markos J, Tang MLK, Abramson MJ, Walters EH, Matheson MC, Dharmage SC. The Dose-Response Association between Nitrogen Dioxide Exposure and Serum Interleukin-6 Concentrations. Int J Mol Sci 2017; 18:ijms18051015. [PMID: 28481326 PMCID: PMC5454928 DOI: 10.3390/ijms18051015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/26/2017] [Accepted: 04/28/2017] [Indexed: 12/04/2022] Open
Abstract
Systemic inflammation is an integral part of chronic obstructive pulmonary disease (COPD), and air pollution is associated with cardiorespiratory mortality, yet the interrelationships are not fully defined. We examined associations between nitrogen dioxide (NO2) exposure (as a marker of traffic-related air pollution) and pro-inflammatory cytokines, and investigated effect modification and mediation by post-bronchodilator airflow obstruction (post-BD-AO) and cardiovascular risk. Data from middle-aged participants in the Tasmanian Longitudinal Health Study (TAHS, n = 1389) were analyzed by multivariable logistic regression, using serum interleukin (IL)-6, IL-8 and tumor necrosis factor-α (TNF-α) as the outcome. Mean annual NO2 exposure was estimated at residential addresses using a validated satellite-based land-use regression model. Post-BD-AO was defined by post-BD forced expiratory ratio (FEV1/FVC) < lower limit of normal, and cardiovascular risk by a history of either cerebrovascular or ischaemic heart disease. We found a positive association with increasing serum IL-6 concentration (geometric mean 1.20 (95% CI: 1.1 to 1.3, p = 0.001) per quartile increase in NO2). This was predominantly a direct relationship, with little evidence for either effect modification or mediation via post-BD-AO, or for the small subgroup who reported cardiovascular events. However, there was some evidence consistent with serum IL-6 being on the causal pathway between NO2 and cardiovascular risk. These findings raise the possibility that the interplay between air pollution and systemic inflammation may differ between post-BD airflow obstruction and cardiovascular diseases.
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Affiliation(s)
- Jennifer L Perret
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
- Institute for Breathing and Sleep (IBAS), Heidelberg, Melbourne, Victoria 3084, Australia.
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Luke D Knibbs
- School of Public Health, the University of Queensland, Herston, Queensland 4006, Australia.
| | - Lyle C Gurrin
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Rangi Kandane-Rathnayake
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria 3004, Australia.
| | - David P Johns
- School of Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia.
- "Breathe Well" Center of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania 7005, Australia.
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - John A Burgess
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Bruce R Thompson
- Allergy, Immunology and Respiratory Medicine, the Alfred Hospital, Melbourne, Victoria 3004, Australia.
| | - Paul S Thomas
- Prince of Wales' Hospital Clinical School and School of Medicine Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Richard Wood-Baker
- School of Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia.
| | - Stephen Morrison
- Department of Medicine, University of Queensland, Brisbane, Queensland 4072, Australia.
| | - Graham G Giles
- Cancer Epidemiological Center, Cancer Council Victoria, Melbourne, Victoria 3053, Australia.
| | - Guy Marks
- South West Sydney Clinical School, the University of NSW, Liverpool, NSW 2170, Australia.
| | - James Markos
- Department of Respiratory Medicine, Launceston General Hospital, Launceston, Tasmania 7250, Australia.
| | - Mimi L K Tang
- Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria 3052, Australia.
- Allergy and Immune Disorders, Murdoch Children's Research Institute, Parkville, Victoria 3052, Australia.
- Department of Paediatrics, the University of Melbourne, Victoria 3010, Australia.
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.
| | - E Haydn Walters
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
- School of Medicine, University of Tasmania, Hobart, Tasmania 7001, Australia.
- "Breathe Well" Center of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania 7005, Australia.
| | - Melanie C Matheson
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, Victoria 3010, Australia.
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17
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Reliably estimating prevalences of atopic children: an epidemiological study in an extensive and representative primary care database. NPJ Prim Care Respir Med 2017; 27:23. [PMID: 28408759 PMCID: PMC5435092 DOI: 10.1038/s41533-017-0025-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 12/02/2022] Open
Abstract
Electronic health records stored in primary care databases might be a valuable source to study the epidemiology of atopic disorders and their impact on health-care systems and costs. However, the prevalence of atopic disorders in such databases varies considerably and needs to be addressed. For this study, all children aged 0–18 years listed in a representative primary care database in the period 2002–2014, with sufficient data quality, were selected. The effects of four different strategies on the prevalences of atopic disorders were examined: (1) the first strategy examined the diagnosis as recorded in the electronic health records, whereas the (2) second used additional requirements (i.e., the patient had at least two relevant consultations and at least two relevant prescriptions). Strategies (3) and (4) assumed the atopic disorders to be chronic based on strategy 1 and 2, respectively. When interested in cases with a higher probability of a clinically relevant disorder, strategy 2 yields a realistic estimation of the prevalence of atopic disorders derived from primary care data. Using this strategy, of the 478,076 included children, 28,946 (6.1%) had eczema, 29,182 (6.1%) had asthma, and 28,064 (5.9%) had allergic rhinitis; only 1251 (0.3%) children had all three atopic disorders. Prevalence rates are highly dependent on the clinical atopic definitions used. The strategy using cases with a higher probability of clinically relevant cases, yields realistic prevalences to establish the impact of atopic disorders on health-care systems. However, studies are needed to solve the problem of identifying atopic disorders that are missed or misclassified. The prevalence of atopic disorders in children can be more reliably calculated by incorporating clinical information with diagnosis data. Researchers in the Netherlands, led by David Pols from the Erasmus University Medical Center Rotterdam, examined the electronic health records of more than 660,000 children, aged 0 to 18, from a Dutch primary care database to determine the number of cases of atopic eczema, asthma, and allergic rhinitis. They looked for diagnosed children who also had at least two relevant clinical consultations and at least two relevant prescriptions. This strategy helps correct for the problem of overestimation, because it doesnot assume that a child, once diagnosed, will have an atopic disorder for life. However, other methods are still needed to identify cases that are missed or misclassified in the health database.
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18
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Environmental Determinants of Bronchial Asthma among Saudi School Children in Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 14:ijerph14010022. [PMID: 28036050 PMCID: PMC5295273 DOI: 10.3390/ijerph14010022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023]
Abstract
The aim here was to study the possible environmental and dietary determinants of asthma among school-aged children in Southwestern Saudi Arabia. In a cross-sectional study on a representative sample in Najran in Southwestern Saudi Arabia using an Arabic version of the modified ISAAC Phase III, parent-administered questionnaire data were collected. Skin prick tests (SPTs) were performed. The study included 1700 school children, out of them 468 (27.5%) were diagnosed with, cases of bronchial asthma and 20.8% (353) reported a 12-month nocturnal cough (as a proxy of severe asthma). In multivariable analysis, the study identified the following risk factors for having asthma or severe asthma: having dogs in the house, being male, being exposed to dense truck traffic on the street, using wood as a cooking fuel, conducting vigorous exercise, consuming eggs, consuming vegetables, having an allergic sensitization to dog hair, and being exposed to Cladosporium, pigweed, and Bermuda grass. On the other hand, the following food stuffs were found to be protective: seafood, fruit, and dairy products. Comprehensive school educational programs for both children and their parents should be adopted to prevent the use of wood in cooking and heating, to ensure that house pets are properly cared for, and to encourage proper dietary habits. Physicians should be informed of the patterns of allergens in order to improve asthma diagnosis and management.
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Strengths, Pitfalls, and Lessons from Longitudinal Childhood Asthma Cohorts of Children Followed Up into Adult Life. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2694060. [PMID: 27872847 PMCID: PMC5107825 DOI: 10.1155/2016/2694060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/26/2016] [Accepted: 09/21/2016] [Indexed: 12/03/2022]
Abstract
Asthma is a common problem worldwide and longitudinal studies of children followed up into adult life enable the assessment of clinical outcomes, examine the pattern of lung function outcomes, and importantly provide insight into aetiology and prognosis for patients with asthma. The aim of this review is to examine the major childhood asthma cohort studies which have continued into adult life, describing the strengths and weaknesses and the lessons that can be learnt regarding pathophysiology and potential future directions for research.
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Matheson MC, D Olhaberriague ALP, Burgess JA, Giles GG, Hopper JL, Johns DP, Abramson MJ, Walters EH, Dharmage SC. Preterm birth and low birth weight continue to increase the risk of asthma from age 7 to 43. J Asthma 2016; 54:616-623. [PMID: 27791430 DOI: 10.1080/02770903.2016.1249284] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Perinatal events can influence the development of asthma in childhood but current evidence is contradictory concerning the effects on life-time asthma risk. OBJECTIVE To assess the relationship between birth characteristics and asthma from childhood to adulthood. METHODOLOGY All available birth records for the Tasmanian Longitudinal Health Study (TAHS) cohort, born in 1961 were obtained from the Tasmanian State Archives and Tasmanian hospitals. Low birth weight (LBW) was defined as less than 2500 grams. Preterm birth was defined as delivery before 37 weeks' gestation. Small for gestational age (SGA) was defined as a birth weight below the 10th percentile for a given gestational age. Multivariate logistic and cox regression were used to examine associations between birth characteristics and lifetime risk of current and incident asthma, adjusting for confounders. RESULTS The prevalence of LBW was 5.2%, SGA was 13.8% and preterm was 3.3%. LBW (OR = 1.65, 95%CI 1.12,2.44) and preterm birth (OR = 1.81, 95%CI 0.99, 3.31) were both associated with an increased risk of current asthma between the ages of 7 to 43 years. There was no association between SGA and current asthma risk. However, SGA was associated with incident asthma (HR = 1.32, 95%CI 1.00, 1.74), and there was an interaction with sex (p value = 0.08), with males having a greater risk of incident asthma (HR = 1.70, 95%CI 1.16-2.49) than females (HR = 1.04, 95%CI 0.70-1.54). CONCLUSIONS Preterm birth and LBW were associated with an increased risk of current asthma into middle-age. These findings are the first to demonstrate the continuing impact of these characteristics on asthma risk into middle-age.
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Affiliation(s)
- Melanie C Matheson
- a Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics , The University of Melbourne , Australia
| | | | - John A Burgess
- a Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics , The University of Melbourne , Australia
| | | | - John L Hopper
- a Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics , The University of Melbourne , Australia
| | - David P Johns
- c Menzies Research Institute, University of Tasmania , Australia
| | - Michael J Abramson
- d Department of Epidemiology & Preventive Medicine , Monash University , Melbourne , Australia
| | - E Haydn Walters
- c Menzies Research Institute, University of Tasmania , Australia
| | - Shyamali C Dharmage
- a Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics , The University of Melbourne , Australia
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21
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Fuchs O, Bahmer T, Rabe KF, von Mutius E. Asthma transition from childhood into adulthood. THE LANCET RESPIRATORY MEDICINE 2016; 5:224-234. [PMID: 27666650 DOI: 10.1016/s2213-2600(16)30187-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 12/11/2022]
Abstract
Asthma is the most prevalent chronic respiratory disease both in children and adults and resembles a complex syndrome rather than a single disease. Different methods have been developed to better characterise distinct asthma phenotypes in childhood and adulthood. In studies of adults, most phenotyping relies on biomaterials from the lower airways; however, this information is missing in paediatric studies because of restricted accessibility. Few patients show symptoms throughout childhood, adolescence, and adulthood. Risk factors for this might be genetics, family history of asthma and atopy, infections early in life, allergic diseases, and lung function deficits. In turn, a large proportion of children with asthma lose their symptoms during school age and adolescence. This improved prognosis, which might also reflect a better treatment response, is associated with being male and with milder and less allergic disease. Importantly, whether clinical remission of symptoms equals the disappearance of underlying pathology is unknown. In fact, airway hyper-responsiveness and airway inflammation might remain despite the absence of overt symptoms. Additionally, a new-onset of asthma symptoms is apparent in adulthood, especially in women and in the case of impaired lung function. However, many patients do not remember childhood symptoms, which might reflect relapse rather than true initiation. Both relapse and adult-onset of asthma symptoms have been associated with allergic disease and sensitisation in addition to airway hyper-responsiveness. Thus, asthma symptoms beginning in adults might have originated in childhood. Equivocally, persistence into, relapse, and new-onset of symptoms in adulthood have all been related to active smoking. However, underlying mechanisms for the associations remain unclear, and future asthma research should therefore integrate standardised molecular approaches in identical ways in both paediatric and adult populations and in longitudinal studies.
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Affiliation(s)
- Oliver Fuchs
- Division of Paediatric Allergology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Munich, Germany; German Centre for Lung Research (DZL).
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Grosshansdorf, Germany; Airway Research Centre North (ARCN), Lubeck, Germany; ARCN, Kiel, Germany; ARCN, Grosshansdorf, Germany; German Centre for Lung Research (DZL)
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany; Department of Medicine, Christian-Albrechts-University, Kiel, Germany; Airway Research Centre North (ARCN), Lubeck, Germany; ARCN, Kiel, Germany; ARCN, Grosshansdorf, Germany; German Centre for Lung Research (DZL)
| | - Erika von Mutius
- Division of Paediatric Allergology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Munich, Germany; German Centre for Lung Research (DZL)
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22
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Dharmage SC, Perret JL, Burgess JA, Lodge CJ, Johns DP, Thomas PS, Giles GG, Hopper JL, Abramson MJ, Walters EH, Matheson MC. Current asthma contributes as much as smoking to chronic bronchitis in middle age: a prospective population-based study. Int J Chron Obstruct Pulmon Dis 2016; 11:1911-20. [PMID: 27574415 PMCID: PMC4993278 DOI: 10.2147/copd.s103908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Personal smoking is widely regarded to be the primary cause of chronic bronchitis (CB) in adults, but with limited knowledge of contributions by other factors, including current asthma. We aimed to estimate the independent and relative contributions to adult CB from other potential influences spanning childhood to middle age. METHODS The population-based Tasmanian Longitudinal Health Study cohort, people born in 1961, completed respiratory questionnaires and spirometry in 1968 (n=8,583). Thirty-seven years later, in 2004, two-thirds responded to a detailed postal survey (n=5,729), from which the presence of CB was established in middle age. A subsample (n=1,389) underwent postbronchodilator spirometry between 2006 and 2008 for the assessment of chronic airflow limitation, from which nonobstructive and obstructive CB were defined. Multivariable and multinomial logistic regression models were used to estimate relevant associations. RESULTS The prevalence of CB in middle age was 6.1% (95% confidence interval [CI]: 5.5, 6.8). Current asthma and/or wheezy breathing in middle age was independently associated with adult CB (odds ratio [OR]: 6.2 [95% CI: 4.6, 8.4]), and this estimate was significantly higher than for current smokers of at least 20 pack-years (OR: 3.0 [95% CI: 2.1, 4.3]). Current asthma and smoking in middle age were similarly associated with obstructive CB, in contrast to the association between allergy and nonobstructive CB. Childhood predictors included allergic history (OR: 1.3 [95% CI: 1.1, 1.7]), current asthma (OR: 1.8 [95% CI: 1.3, 2.7]), "episodic" childhood asthma (OR: 2.3 [95% CI: 1.4, 3.9]), and parental bronchitis symptoms (OR: 2.5 [95% CI: 1.6, 4.1]). CONCLUSION The strong independent association between current asthma and CB in middle age suggests that this condition may be even more influential than personal smoking in a general population. The independent associations of childhood allergy and asthma, though not childhood bronchitis, as clinical predictors of adult CB raise the possibility of some of this burden having originated in childhood.
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Affiliation(s)
- Shyamali C Dharmage
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, The University of Melbourne
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, The University of Melbourne
- Institute for Breathing and Sleep (IBAS), Melbourne, VIC
| | - John A Burgess
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, The University of Melbourne
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, The University of Melbourne
| | - David P Johns
- “Breathe Well” Center of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, TAS
| | - Paul S Thomas
- Inflammation and Infection Research, Faculty of Medicine, University of New South Wales, Sydney, NSW
| | - Graham G Giles
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, The University of Melbourne
- Cancer Epidemiology Center, Cancer Council Victoria, Melbourne, VIC, Australia
| | - John L Hopper
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, The University of Melbourne
- Department of Public Health, Seoul National University, Seoul, South Korea
| | - Michael J Abramson
- Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC
| | - E Haydn Walters
- “Breathe Well” Center of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, TAS
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Melanie C Matheson
- Allergy and Lung Health Unit, Center for Epidemiology and Biostatistics, The University of Melbourne
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Chetty A, Cao GJ, Sharda A, Tsay T, Nielsen HC. IgE mediates broncho-vascular remodeling after neonatal sensitization in mice. Front Biosci (Elite Ed) 2016; 8:370-7. [PMID: 27100345 DOI: 10.2741/e773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The temporal origins of childhood asthma are incompletely understood. We hypothesize that allergen sensitization which begins in early infancy causes IgE-mediated airway and vascular remodeling, and airway hyper-responsiveness. Mice were sensitized with ovalbumin (OVA) without or with anti-IgE antibody from postnatal day (P) 10 through P42. We studied airway resistance in response to Methacholine (MCh) challenge, bronchoalveolar lavage fluid (BAL) inflammatory cell content, immunohistochemistry for inflammation, alpha-smooth muscle actin (alpha-SMA) and platelet/endothelial cell adhesion molecule (PECAM) proteins, and Western blotting for vascular endothelial growth factor (VEGF) protein. Compared to controls, mice treated with OVA had increased airway resistance (baseline: 192% of control; MCH 12 mg/mL 170% of control; P less than 0.0.5). OVA treatment also increased lung alpha-SMA, VEGF and PECAM compared to controls. Inflammatory cells in the BAL and perivascular and peribronchiolar inflammatory cell infiltrates increased over controls with OVA exposure. These changes were counteracted by anti-IgE treatment. We conclude that mice sensitized in early infancy develop an IgE-mediated hyper-reactive airway disease with airway and vascular remodeling. Preventive approaches in early infancy of at-risk individuals may reduce childhood asthma.
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Affiliation(s)
- Anne Chetty
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA
| | - Gong-Jie Cao
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA
| | - Azeem Sharda
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA
| | - Theresia Tsay
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA
| | - Heber C Nielsen
- Department of Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA,
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24
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Perret JL, Walters H, Johns D, Gurrin L, Burgess J, Lowe A, Thompson B, Markos J, Morrison S, Thomas P, McDonald C, Wood-Baker R, Hopper J, Svanes C, Giles G, Abramson M, Matheson M, Dharmage S. Mother's smoking and complex lung function of offspring in middle age: A cohort study from childhood. Respirology 2016; 21:911-9. [PMID: 26969872 DOI: 10.1111/resp.12750] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 08/31/2015] [Accepted: 12/14/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Existing evidence that supports maternal smoking to be a potential risk factor for chronic obstructive pulmonary disease (COPD) for adult offspring has barely been mentioned in major guideline documents, suggesting a need for more robust and consistent data. We aimed to examine whether such early life exposure can predispose to COPD in middle age, possibly through its interaction with personal smoking. METHODS The fifth-decade follow-up of the Tasmanian Longitudinal Health Study cohort, which was first studied in 1968 (n = 8583), included a 2004 postal survey (n = 5729 responses) and subsequent laboratory attendance (n = 1389) for comprehensive lung function testing between 2006 and 2008. Multivariable linear and logistic regression models included sampling weights. RESULTS Post-bronchodilator airflow obstruction (less than fifth percentile) was detected for 9.3% (n = 123) of middle-aged offspring. Its association with heavy maternal smoking (>20 cigarettes/day) during childhood was 2.7-fold higher than for those without exposure (95% confidence interval [1.3, 5.7] P = 0.009). Maternal smoking per se approximately doubled the adverse effect of personal smoking on gas transfer factor (z-score -0.46 [-0.6 to -0.3] vs -0.25 [-0.4 to -0.1], P[interaction] = 0.048) and was paradoxically associated with reduced residual volumes for non-smokers. CONCLUSIONS Heavy maternal smoking during childhood appears to predispose to spirometrically defined COPD. The interplay between maternal and personal smoking on gas transfer factor suggests that early life exposure increases an individual's susceptibility to adult smoking exposure. These findings provide further evidence to suggest that maternal smoking might be a risk factor for COPD and reinforce the public health message advocating smoking abstinence.
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Affiliation(s)
- Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne.,Department of Respiratory and Sleep Medicine, Austin Hospital.,Institute for Breathing and Sleep (IBAS)
| | - Haydn Walters
- 'Breathe Well' Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania.,School of Medicine, University of Notre Dame
| | - David Johns
- 'Breathe Well' Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania
| | - Lyle Gurrin
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - John Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - Adrian Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - Bruce Thompson
- Institute for Breathing and Sleep (IBAS).,Allergy, Immunology and Respiratory Medicine, The Alfred Hospital.,Department of Medicine, Monash University
| | - James Markos
- Launceston General Hospital, Launceston, Tasmania
| | - Stephen Morrison
- Department of Medicine, University of Queensland, Brisbane, Queensland
| | - Paul Thomas
- Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Christine McDonald
- Department of Respiratory and Sleep Medicine, Austin Hospital.,Institute for Breathing and Sleep (IBAS)
| | - Richard Wood-Baker
- 'Breathe Well' Centre of Research Excellence for Chronic Respiratory Disease and Lung Ageing, School of Medicine, University of Tasmania, Hobart, Tasmania
| | - John Hopper
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne.,Department of Public Health, Seoul National University, Seoul, Korea
| | - Cecilie Svanes
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Graham Giles
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne.,Cancer Epidemiology Centre, Cancer Council Victoria.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Abramson
- Allergy, Immunology and Respiratory Medicine, The Alfred Hospital.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
| | - Shyamali Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, The University of Melbourne
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25
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Childhood asthma and chronic obstructive pulmonary disease: outcomes until the age of 50. Curr Opin Allergy Clin Immunol 2016; 15:169-74. [PMID: 25961391 DOI: 10.1097/aci.0000000000000146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW There has been recent interest in understanding the origins of chronic obstructive pulmonary disease. Epidemiological studies suggest that chronic obstructive pulmonary disease clearly has other causes apart from tobacco smoke. RECENT FINDINGS Cross-sectional studies of adult cohorts with chronic obstructive pulmonary disease highlight that childhood asthma is a risk factor. A recent longitudinal childhood cohort study of children from childhood to the age of 50 years describes that children with severe asthma are at increased risk of chronic obstructive pulmonary disease and that the deficit in lung function can be tracked back to early years. SUMMARY Children with severe asthma are at increased risk of developing chronic obstructive pulmonary disease.
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26
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Sears MR. Predicting asthma outcomes. J Allergy Clin Immunol 2016; 136:829-36; quiz 837. [PMID: 26449797 DOI: 10.1016/j.jaci.2015.04.048] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 12/31/2022]
Abstract
This review addresses predictors of remission or persistence of wheezing and asthma from early childhood through adulthood. Early childhood wheezing is common, but predicting who will remit or have persistent childhood asthma remains difficult. By adding parental history of asthma and selected infant biomarkers to the history of recurrent wheezing, the Asthma Predictive Index and its subsequent modifications provide better predictions of persistence than simply the observation of recurrent wheeze. Sensitization, especially to multiple allergens, increases the likelihood of development of classic childhood asthma. Remission is more likely in male subjects and those with milder disease (less frequent and less severe symptoms), less atopic sensitization, a lesser degree of airway hyperresponsiveness, and no concomitant allergic disease. Conversely, persistence is linked strongly to allergic sensitization, greater frequency and severity of symptoms, abnormal lung function, and a greater degree of airway hyperresponsiveness. A genetic risk score might predict persistence more accurately than family history. Remission of established adult asthma is substantially less common than remission during childhood and adolescence. Loss of lung function can begin early in life and tracks through childhood and adolescence. Despite therapy which controls symptoms and exacerbations, the outcomes of asthma appear largely resistant to pharmacologic therapy.
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Affiliation(s)
- Malcolm R Sears
- Department of Medicine, Faculty of Health Sciences, de Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
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27
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Duijts L, Granell R, Sterne JAC, Henderson AJ. Childhood wheezing phenotypes influence asthma, lung function and exhaled nitric oxide fraction in adolescence. Eur Respir J 2015; 47:510-9. [PMID: 26647439 DOI: 10.1183/13993003.00718-2015] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 08/31/2015] [Indexed: 11/05/2022]
Abstract
The objective of this study was to examine the associations of childhood wheezing phenotypes with asthma, lung function and exhaled nitric oxide fraction (FeNO) in adolescence.In a population-based, prospective cohort study of 6841 children, we used latent class analysis to identify wheezing phenotypes during the first 7 years of life. Physician-diagnosed asthma, spirometry and FeNO were assessed at 14-15 years.Compared with never/infrequent wheeze, intermediate-onset and persistent wheeze were consistently strongest associated with higher risk of asthma (risk ratio (95% CI) 10.9 (8.97-13.16) and 9.13 (7.74-10.77), respectively), lower forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (mean difference in standard deviation units (SDU) (95% CI) -0.34 (-0.54- -0.14) and -0.50 (-0.62- -0.38), respectively), lower forced expiratory flow at 25-75% of FVC (FEF25-75%) (mean difference in SDU (95% CI) -0.30 (-0.49- -0.10) and -0.42 (-0.54- -0.30), respectively) and increased FEV1 bronchodilator reversibility (mean difference in SDU (95% CI) 0.12 (0.02-0.22) and 0.13 (0.06-0.19), respectively). Prolonged early and persistent wheeze were associated with a decline in FEV1/FVC ratio and FEF25-75% between 8-9 and 14-15 years. Intermediate-onset, late-onset and persistent wheeze were associated with higher FeNO ratios (ratio of geometric means (95% CI) 1.90 (1.59-2.29), 1.57 (1.39-1.77) and 1.37 (1.22-1.53), respectively, compared with never/infrequent wheeze).Early-onset wheezing phenotypes persisting after 18 months of age show the strongest associations with asthma, lower lung function, even worsening from mid-childhood, and higher FeNO levels in adolescence.
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Affiliation(s)
- Liesbeth Duijts
- School of Social and Community Medicine, University of Bristol, Bristol, UK Dept of Pediatrics, Divisions of Respiratory Medicine and Neonatology, Erasmus University Medical Center, Rotterdam, The Netherlands Dept of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Raquel Granell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - A John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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28
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Matheson MC, Burgess JA, Lau MYZ, Lowe AJ, Gurrin LC, Hopper JL, Giles GG, Johns DP, Walters EH, Abramson MJ, Gómez Real F, Dharmage SC. Hormonal contraception increases risk of asthma among obese but decreases it among nonobese subjects: a prospective, population-based cohort study. ERJ Open Res 2015; 1:00026-2015. [PMID: 27730150 PMCID: PMC5005115 DOI: 10.1183/23120541.00026-2015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022] Open
Abstract
Epidemiological data on asthma suggest a sex difference that varies with age. Hormonal effects have been suggested as a possible explanation for these differences but there is a scarcity of evidence on these relationships. Our objective was to examine the relationship between reproductive factors and asthma risk among females and to examine whether body mass index (BMI) modifies this relationship. Female participants in the 2004 fifth decade follow-up postal survey of the Tasmanian Longitudinal Health Study formed the study population. Reproductive history and data on hormonal contraceptive (HC) use were collected on 2764 females. Multiple logistic regression was used to assess the association between the reproductive factors and current asthma. The mean age of participants was 43 years and the prevalence of middle-aged current asthma was 12.8%. Females with very early menarche (≤10 years) had higher odds of middle-aged current asthma (OR 1.91, 95% CI 1.14–3.2). Pregnancy history (number of births and age at first pregnancy) were not associated with current asthma risk at 44 years. Ever having used HCs, years of use and age started using HCs were not individually associated with current asthma risk. However, body mass index significantly modified the relationship between HC use and asthma. We found increasing years of pill use was associated with a significantly increased risk of current asthma in overweight/obese women but a reduced risk in normal weight women (interaction p=0.015). Hormonal effects from use of HCs and early menarche may contribute to the sex differential in asthma risk. Our findings suggest that in obese women with a history of long-term HC use may be at an increased risk of chronic respiratory disease, and regular monitoring for asthma and asthma symptoms may be recommended. Overweight or obese women are at increased risk of asthma if they use hormonal contraceptives for extended periodshttp://ow.ly/SwY8p
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Affiliation(s)
- Melanie C Matheson
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - John A Burgess
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Melisa Y Z Lau
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Adrian J Lowe
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Lyle C Gurrin
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, Australia
| | - David P Johns
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - E Haydn Walters
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Francisco Gómez Real
- The Department of Gynecology and Obstetrics, Haukeland University Hospital, Bergen, Norway; The Bergen Respiratory Research Group, Institute of Medicine, University of Bergen, Bergen, Norway
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
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Tan DJ, Walters EH, Perret JL, Lodge CJ, Lowe AJ, Matheson MC, Dharmage SC. Age-of-asthma onset as a determinant of different asthma phenotypes in adults: a systematic review and meta-analysis of the literature. Expert Rev Respir Med 2015; 9:109-23. [PMID: 25584929 DOI: 10.1586/17476348.2015.1000311] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Age-of-asthma onset is often used to distinguish different adult asthma phenotypes; however, similarities and differences between early- and late-onset adult asthma have not been summarized to date. Of the 2921 records found, we identified 12 studies comparing early- and late-onset current asthma in adults. Age 12 was most commonly used to delineate the two age-of-onset phenotypes. Adults with early-onset current asthma were more likely to be atopic and had a higher frequency of asthma attacks, whereas adults with late-onset disease were more likely to be female, smokers and had greater levels of spirometrically defined fixed airflow obstruction. The prevalence of severe asthma was similar in both groups, and, in general, there were few phenotypic differences between severe asthmatics regardless of age of onset. Findings for several key characteristics, including lung function, were inconsistent between studies. Overall, there appears to be distinctive phenotypic differences with age of asthma onset. Although early-onset adult asthma is likely more attributable to atopy and potentially genetic factors, late-onset adult asthma appears to be more related to environmental risk factors, and so may be better targeted by preventive strategies. More detailed research is required to better characterize these phenotypes and to clarify potential clinical implications.
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Affiliation(s)
- Daniel J Tan
- Allergy and Lung Health Unit, Centre of Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic 3052, Australia
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30
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Natural progression of childhood asthma symptoms and strong influence of sex and puberty. Ann Am Thorac Soc 2015; 11:939-44. [PMID: 24896645 DOI: 10.1513/annalsats.201402-084oc] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Asthma prevalence, onset, remission and relapse, and healthcare use have been intensively studied. However, asthma symptom progression through childhood and adolescence has not been well studied, in part due to the challenges in obtaining consistent and robust long-term follow-up data on a large series of subjects with asthma. OBJECTIVES To use the asthma diary symptom data of the Childhood Asthma Management Program placebo group (5 yr, 418 subjects, and total 564,518 records) to establish sex-specific high-resolution time courses of the natural progression of asthma symptoms through childhood and adolescence. METHODS We used the asthma diary symptom code as a measure of daily disease severity. Annual records of Tanner stage were used to determine the influence of puberty on severity. A data alignment technique was used to derive 13-year time courses of mean symptoms and mean Tanner stage. MEASUREMENTS AND MAIN RESULTS Data analyses showed three age- and sex-related phases of asthma symptom progression: Phase 1 (ages 5 and 6 yr)-greater severity in boys; Phase 2 (ages 7 to 9 yr)-no sex difference in severity; and Phase 3 (age 10-17 yr)-greater severity in girls. The continuous decline of symptoms in both sexes stops abruptly at the onset of puberty. CONCLUSIONS The severity of asthma symptoms varies through childhood and adolescence, and patterns differ by sex. Puberty has a strong influence on symptom progression in both sexes. Progression of symptoms is a distinct aspect of asthma epidemiology.
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Rolfsjord LB, Skjerven HO, Bakkeheim E, Carlsen K, Hunderi JOG, Kvenshagen BK, Mowinckel P, Lødrup Carlsen KC. Children hospitalised with bronchiolitis in the first year of life have a lower quality of life nine months later. Acta Paediatr 2015; 104:53-8. [PMID: 25169812 DOI: 10.1111/apa.12792] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/20/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
AIM Acute bronchiolitis increases the risk of asthma, and reduced quality of life (QoL) is reported in children with asthma and allergy. However, the impact of asthma risk factors on QoL is unclear. This study investigated whether bronchiolitis and common asthma risk factors in infancy had an influence on later QoL. METHODS The parents of 209 infants recruited during hospitalisation for bronchiolitis at a mean age of 4 months, and 206 controls responded to the generic Infant Toddler Quality of Life Questionnaire 9 months later. We used robust regression analyses to assess the association between four asthma risk factors, atopic eczema, parental asthma, parental allergic rhinoconjunctivitis and second-hand smoke and QoL in the two groups. RESULTS QoL was lower among children with previous bronchiolitis in the overall health and general health domains and lower in six of 13 domains in children with atopic eczema. Compared with no risk factors, children with previous bronchiolitis and three risk factors had lower scores in four domains, and control children with three risk factors had lower scores in three domains. CONCLUSION Having acute bronchiolitis, atopic eczema and three asthma risk factors were negatively associated with later QoL in early childhood.
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Affiliation(s)
- Leif Bjarte Rolfsjord
- Department of Paediatrics Innlandet Hospital Trust Elverum Norway
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Håvard Ove Skjerven
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Egil Bakkeheim
- Department of Paediatrics Oslo University Hospital Oslo Norway
| | - Kai‐Håkon Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Jon Olav Gjengstø Hunderi
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | | | | | - Karin C. Lødrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
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Hutchison AA, Leclerc F, Nève V, Pillow JJ, Robinson PD. The Respiratory System. PEDIATRIC AND NEONATAL MECHANICAL VENTILATION 2015. [PMCID: PMC7193717 DOI: 10.1007/978-3-642-01219-8_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This chapter addresses upper airway physiology for the pediatric intensivist, focusing on functions that affect ventilation, with an emphasis on laryngeal physiology and control in breathing. Effective control of breathing ensures that the airway is protected, maintains volume homeostasis, and provides ventilation. Upper airway structures are effectors for all of these functions that affect the entire airway. Nasal functions include air conditioning and protective reflexes that can be exaggerated and involve circulatory changes. Oral cavity and pharyngeal patency enable airflow and feeding, but during sleep pharyngeal closure can result in apnea. Coordination of breathing with sucking and nutritive swallowing alters during development, while nonnutritive swallowing at all ages limits aspiration. Laryngeal functions in breathing include protection of the subglottic airway, active maintenance of its absolute volume, and control of tidal flow patterns. These are vital functions for normal lung growth in fetal life and during rapid adaptations to breathing challenges from birth through adulthood. Active central control of breathing focuses on the coordination of laryngeal and diaphragmatic activities, which adapts according to the integration of central and peripheral inputs. For the intensivist, knowledge of upper airway physiology can be applied to improve respiratory support. In a second part the mechanical properties of the respiratory system as a critical component of the chain of events that result in translation of the output of the respiratory rhythm generator to ventilation are described. A comprehensive understanding of respiratory mechanics is essential to the delivery of optimized and individualized mechanical ventilation. The basic elements of respiratory mechanics will be described and developmental changes in the airways, lungs, and chest wall that impact on measurement of respiratory mechanics with advancing postnatal age are reviewed. This will be follwowed by two sections, the first on respiratory mechanics in various neonatal pathologies and the second in pediatric pathologies. The latter can be classified in three categories. First, restrictive diseases may be of pulmonary origin, such as chronic interstitial lung diseases or acute lung injury/acute respiratory distress syndrome, which are usually associated with reduced lung compliance. Restrictive diseases may also be due to chest wall abnormalities such as obesity or scoliosis (idiopathic or secondary to neuromuscular diseases), which are associated with a reduction in chest wall compliance. Second, obstructive diseases are represented by asthma and wheezing disorders, cystic fibrosis, long term sequelae of neonatal lung disease and bronchiolitis obliterans following hematopoietic stem cell transplantation. Obstructive diseases are defined by a reduced FEV1/VC ratio. Third, neuromuscular diseases, mainly represented by DMD and SMA, are associated with a decrease in vital capacity linked to respiratory muscle weakness that is better detected by PImax, PEmax and SNIP measurements.
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Chitano P, Wang L, Degan S, Worthington CL, Pozzato V, Hussaini SH, Turner WC, Dorscheid DR, Murphy TM. Ovalbumin sensitization of guinea pig at birth prevents the ontogenetic decrease in airway smooth muscle responsiveness. Physiol Rep 2014; 2:2/12/e12241. [PMID: 25501429 PMCID: PMC4332219 DOI: 10.14814/phy2.12241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Airway smooth muscle (ASM) displays a hyperresponsive phenotype at young age and becomes less responsive in adulthood. We hypothesized that allergic sensitization, which causes ASM hyperresponsiveness and typically occurs early in life, prevents the ontogenetic loss of the ASM hyperresponsive phenotype. We therefore studied whether neonatal allergic sensitization, not followed by later allergen challenges, alters the ontogenesis of ASM properties. We neonatally sensitized guinea pigs to ovalbumin and studied them at 1 week, 3 weeks, and 3 months (adult). A Schultz‐Dale response in isolated tracheal rings confirmed sensitization. The occurrence of inflammation was evaluated in the blood and in the submucosa of large airways. We assessed ASM function in tracheal strips as ability to produce force and shortening. ASM content of vimentin was also studied. A Schultz‐Dale response was observed in all 3‐week or older sensitized animals. A mild inflammatory process was characterized by eosinophilia in the blood and in the airway submucosa. Early life sensitization had no effect on ASM force generation, but prevented the ontogenetic decline of shortening velocity and the increase in resistance to shortening. Vimentin increased with age in control but not in sensitized animals. Allergic sensitization at birth without subsequent allergen exposures is sufficient to prevent normal ASM ontogenesis, inducing persistence to adulthood of an ASM hyperresponsive phenotype. Airway smooth muscle (ASM) displays a hyperresponsive phenotype at young age and becomes less responsive in adulthood. In this study, we found that allergic sensitization at birth without subsequent allergen exposures is sufficient to prevent normal ASM ontogenesis, inducing persistence to adulthood of an ASM hyperresponsive phenotype.
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Affiliation(s)
- Pasquale Chitano
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina James Hogg Research Centre, Institute for Heart and Lung Innovation and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lu Wang
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina James Hogg Research Centre, Institute for Heart and Lung Innovation and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Simone Degan
- Duke Center for Molecular and Biomolecular Imaging, Duke University Medical Center, Durham, North Carolina Duke Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Charles L Worthington
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Valeria Pozzato
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Syed H Hussaini
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Wesley C Turner
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Delbert R Dorscheid
- James Hogg Research Centre, Institute for Heart and Lung Innovation and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas M Murphy
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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Alonso J, de Jonge P, Lim CCW, Aguilar-Gaxiola S, Bruffaerts R, Caldas-de-Almeida JM, Liu Z, O'Neill S, Stein DJ, Viana MC, Al-Hamzawi AO, Angermeyer MC, Borges G, Ciutan M, de Girolamo G, Fiestas F, Haro JM, Hu C, Kessler RC, Lépine JP, Levinson D, Nakamura Y, Posada-Villa J, Wojtyniak BJ, Scott KM. Association between mental disorders and subsequent adult onset asthma. J Psychiatr Res 2014; 59:179-88. [PMID: 25263276 PMCID: PMC5120389 DOI: 10.1016/j.jpsychires.2014.09.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 07/18/2014] [Accepted: 09/05/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments. METHODS During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment. RESULTS 1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR = 1.8; 95%CI 1.3-2.5), panic (OR = 1.4; 95%CI 1.0-2.0), generalized anxiety (OR = 1.3; 95%CI 1.1-1.7), specific phobia (OR = 1.3; 95%CI 1.1-1.6); post-traumatic stress (OR = 1.5; 95%CI 1.1-1.9); binge eating (OR = 1.8; 95%CI 1.2-2.9) and alcohol abuse (OR = 1.5; 95%CI 1.1-2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21). CONCLUSIONS A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Pompeu Fabra University (UPF), Barcelona, Spain.
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Carmen C W Lim
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
| | - Sergio Aguilar-Gaxiola
- University of California, Davis, Center for Reducing Health Disparities, School of Medicine, Sacramento, CA, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC - KUL), Leuven, Belgium
| | - Jose Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, PR China
| | - Siobhan O'Neill
- Bamford Centre for Mental Health and Well-Being, University of Ulster, Derry, Northern Ireland, UK
| | - Dan J Stein
- University of Cape Town, Department of Psychiatry & Mental Health, Groote Schuur Hospital, Cape Town, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo (UFES), Vitória, Brazil
| | | | | | - Guilherme Borges
- Division of Epidemiological and Psychosocial Research, National Institute of Psychiatry (Mexico) and Metropolitan Autonomous University, Mexico City, Mexico
| | - Marius Ciutan
- National School of Public Health and Professional Development, Bucharest, Romania
| | | | - Fabian Fiestas
- Evidence Generation for Public Health Research Unit, National Institute of Health, Lima, Peru
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; CIBER de Salud Mental (CIBERSAM), Spain; University of Barcelona, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health and Shenzhen Kangning Hospital, Guangdong Province, PR China
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Jean Pierre Lépine
- Hôpital Saint-Louis Lariboisière Fernand Widal, INSERM U 705, CNRS UMR 8206, Paris, France
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi-ken, Japan
| | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, CALLE 28 No. 5B-02, Bogota, DC, Colombia
| | - Bogdan J Wojtyniak
- Department-Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Kate M Scott
- Department of Psychological Medicine, Otago University, Dunedin, New Zealand
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Wu TJ, Wu CF, Lee YL, Hsiue TR, Guo YL. Asthma incidence, remission, relapse and persistence: a population-based study in southern Taiwan. Respir Res 2014; 15:135. [PMID: 25387792 PMCID: PMC4232728 DOI: 10.1186/s12931-014-0135-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In western countries, late-onset asthmatics are more severe than early-onset asthmatics in clinic-based studies. However, whether asthma occurrence rates were higher in late ages than in younger ages was inconclusive. This information is essentially lacking in Asian population. METHODS The participants were schoolchildren's parents recruited from 94 elementary and middle schools in 2004. A cross-sectional self-administered questionnaire was sent through the children to their parents to survey their respiratory health. We investigated typical asthma symptoms occurring at different ages and subsequent remission or relapse after the first asthma event. Person-years of the participants from birth to the time of survey were used as the denominator. RESULTS Among the 25,377 participants consisting of 949,807 total person-years, 860 reported ever having asthma. Highest incidences occurred at ages 0-12 and 36-40 years. The incidence of asthma was higher in males before puberty, and higher in females after puberty, with overall incidences 1.00 and 0.77 per 1000 person-years for females and males, respectively. Participants with late-onset asthma (onset age >12 years) comprised a large portion of adult current asthmatics. More than 52% of persistence or relapse was observed in early-onset asthma (onset age ≤12 years). The younger birth cohort had a more prominent later peak of asthma incidence than the older one. CONCLUSIONS In Asian population, asthma occurrence showed a U-shape age distribution with a prominent second peak in the thirties. A high proportion of early-onset asthma relapsed and most of late-onset asthma persisted or relapsed in adulthood.
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Affiliation(s)
- Tsung-Ju Wu
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan. .,Division of Chest Medicine, Department of Internal Medicine, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan.
| | - Chang-Fu Wu
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.
| | - Yungling Leo Lee
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
| | - Tzuen-Ren Hsiue
- Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.
| | - Yue Leon Guo
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan. .,Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan.
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Yavuz ST, Civelek E, Comert S, Sahiner UM, Buyuktiryaki B, Tuncer A, Kalyoncu AF, Sekerel BE. Development of rhinitis may be an indicator for the persistence of childhood asthma. Int J Pediatr Otorhinolaryngol 2014; 78:843-9. [PMID: 24655470 DOI: 10.1016/j.ijporl.2014.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 02/19/2014] [Accepted: 02/20/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Results of previous studies have established several factors related with the natural course of childhood asthma. The aim of this study is to investigate the prognosis of childhood asthma and to determine possible risk factors for disease persistence. METHODS An outpatient cohort with a median (interquartile range) follow-up duration of 19.4 (17.7-21.8) years was re-evaluated. Current clinical remission (CR) was defined as no asthma symptoms and no use of controller medication within the past year. RESULTS Out of 115 patients, 78 could be surveyed with questionnaire and 46 patients with a median age of 25.3 (23.9-27.0) years were further investigated with clinical work-up. Nineteen (24.4%) patients were in CR in both visits (adolescence and young adulthood). A further 7 patients (9.0%) who were not in CR at adolescence were in CR at the young adulthood visit. However, 21 patients (26.9%) who were in CR at adolescence were not in CR at the young adulthood visit. Thirty-one patients (39.7%) with persistent symptoms at adolescence were not in CR at young adulthood, either. In multivariate logistic models, the presence of obstructive pattern (forced expiratory volume in 1s (FEV1)/forced vital capacity (FVC) <80% vs. ≥80%) in pulmonary function tests during the adolescence period (odds ratio; [95% confidence interval] (6.71 [1.65-27.29]; p=0.008) and later-onset rhinitis (10.27 [1.18-89.13]; p=0.035) predicted the absence of CR at young adulthood. CONCLUSION A substantial number of patients who were in CR during adolescence have re-emerging disease. The presence of obstructive pattern in adolescence and later-onset rhinitis were associated with the absence of CR in young adults with asthma. Awareness of risk factors along with early interventions may provide better results in childhood asthma.
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Affiliation(s)
- Suleyman Tolga Yavuz
- Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, 06100 Ankara, Turkey.
| | - Ersoy Civelek
- Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, 06100 Ankara, Turkey.
| | - Sule Comert
- Hacettepe University, Faculty of Medicine, Department of Adult Allergy, 06100 Ankara, Turkey.
| | - Umit Murat Sahiner
- Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, 06100 Ankara, Turkey.
| | - Betul Buyuktiryaki
- Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, 06100 Ankara, Turkey.
| | - Ayfer Tuncer
- Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, 06100 Ankara, Turkey.
| | - Ali Fuat Kalyoncu
- Hacettepe University, Faculty of Medicine, Department of Adult Allergy, 06100 Ankara, Turkey.
| | - Bulent Enis Sekerel
- Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, 06100 Ankara, Turkey.
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Outcomes of childhood asthma to the age of 50 years. J Allergy Clin Immunol 2014; 133:1572-8.e3. [PMID: 24495434 DOI: 10.1016/j.jaci.2013.12.1033] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 12/05/2013] [Accepted: 12/09/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND In 1964, The Melbourne Asthma Study was established to describe the spectrum and natural history of childhood asthma. OBJECTIVE To describe the clinical and lung function outcome of childhood asthma to the age of 50 years. METHOD Subjects were invited to complete an interviewer-administered questionnaire, skin prick testing, and measurement of lung function from the age of 7 years to the age of 50 years at 7-year intervals. RESULTS Of 458 survivors (from the original 484 subjects at recruitment), 346 subjects (76%) participated, of whom, 197 completed lung function measurement. Asthma remission at the age of 50 years was 64% in those with wheezy bronchitis, 47% for those with persistent asthma, and 15% for those with severe asthma in childhood. Multivariable analysis identified severe asthma in childhood (odds ratio [OR] 11.9 [95% CI, 3.4-41.8]), female sex (OR 2.0 [95% CI, 1.1-3.6]), and childhood hay fever (OR 2.0 [95% CI, 1.0-4.0]) as risk factors for "current asthma" at age 50 years. There was no evidence of a difference in the rate of decline in FEV1 (mL/y, 95% CI) between the severe asthma group (15 mL/y [95% CI, 9-22 mL/y]) and all the other recruitment groups: control (16 mL/y [95% CI, 12-20 mL/y]), mild wheezy bronchitis (14 mL/y [95% CI, 8-19 mL/y]), wheezy bronchitis (16 mL/y [95% CI, 11-20 mL/y]), and persistent asthma (19 mL/y [95% CI, 13-24 mL/y]). CONCLUSION The clinical and lung function outcome in adult life is strongly determined by asthma severity in childhood. The reduced lung function seen in adults is established in childhood and does not appear to decline more rapidly in adult years despite continuing symptoms.
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Belsky DW, Sears MR. The potential to predict the course of childhood asthma. Expert Rev Respir Med 2014; 8:137-41. [PMID: 24450326 DOI: 10.1586/17476348.2014.879826] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Many children experience pre-school or early childhood wheezing. In a significant proportion symptoms disappear as the child grows, but others have persistent and troublesome asthma which can be life-long. Tools to predict course of disease in young children are a priority for families and clinicians. This review summarizes evidence from several longitudinal population-based birth-cohort studies that have identified risk factors for persistence and remission of childhood asthma. These factors include clinical characteristics, environmental and other exposures, familial factors, biomarkers of allergic inflammation, measurements of lung function and airway responsiveness, and genetic variants. This review also introduces the concept of polygenic risk and genetic risk scores, and describes results from a recent study that suggests promise for the use of genetic information in predicting the course of childhood asthma. We conclude with a discussion of implications and future directions.
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Affiliation(s)
- Daniel W Belsky
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27708, USA
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Aydogan M, Ozen A, Akkoc T, Eifan AO, Aktas E, Deniz G, Gocmen I, Bahceciler NN, Barlan I. Risk factors for persistence of asthma in children: 10-year follow-up. J Asthma 2013; 50:938-44. [PMID: 23919566 DOI: 10.3109/02770903.2013.831872] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Risk factors related to the outcome of childhood asthma are not yet well established. We aimed to investigate the long-term outcome for children with asthma to determine the risk factors in predicting persistence of disease. METHODS Sixty-two children with asthma were evaluated retrospectively at the end of a 10-year follow-up. Patients were asked to complete a questionnaire requesting clinical information, and underwent physical examination, skin prick testing, a pulmonary function test and bronchial provocation testing. Immunologic parameters evaluated were allergen-specific IgE and IgG4 levels, and allergen-induced generation of CD4(+)CD25(+) cells. RESULTS Mean age at final assessment was 15.9 ± 3.6 years, and duration of follow-up was 10.30 ± 1.27 years. Fifty percent of patients outgrew their asthma during the 10-year follow-up period. All the non-atopic patients outgrew their disease during the study period, whereas 67% of atopic patients did not. We identified two risk factors independently related to the persistence of symptoms: presence of bronchial hyper-responsiveness and presence of rhinitis. Atopic children who were in remission demonstrated significantly higher allergen-induced CD4(+)CD25(+) T cells compared to healthy controls. CONCLUSIONS Atopy, presence of rhinitis, positive and presence of bronchial hyper-reactivity are important risk factors for the persistence of asthma in children. Allergen-induced CD4(+)CD25(+) T cells were higher in the atopic children who outgrew their disease, implicating an immunological mechanism of asthma remission in children.
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Affiliation(s)
- Metin Aydogan
- Department of Pediatric Allergy/Immunology, Faculty of Medicine, Marmara University , Istanbul , Turkey and
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Hancox RJ, Subbarao P, Sears MR. Relevance of birth cohorts to assessment of asthma persistence. Curr Allergy Asthma Rep 2013; 12:175-84. [PMID: 22415313 DOI: 10.1007/s11882-012-0255-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The definition of persistent asthma in longitudinal studies reflects symptoms reported at every assessment with no substantive asymptomatic periods. Early-childhood wheezing may be transient, especially if it is of viral etiology. Longitudinal studies provide greater opportunity to confirm the diagnosis by variability of symptoms, objective measurements, and therapeutic responses. Several clinical phenotypes of childhood asthma have been identified, with general consistency between cohorts. Persistent wheezing is often associated with loss of lung function, which is evident from early-childhood and related to persistent inflammation and airway hyperresponsiveness. Female sex, atopy, airway responsiveness, and personal smoking, but not exposure to environmental tobacco smoke, are risk factors for persistence of childhood asthma into adulthood. The effect of breastfeeding remains controversial, but gene-environment interactions may partly explain outcomes. Understanding the natural history and underlying causes of asthma may lead to development of strategies for primary prevention.
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Affiliation(s)
- Robert J Hancox
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
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Burgess JA, Abramson MJ, Gurrin LC, Byrnes GB, Matheson MC, May CL, Giles GG, Johns DP, Hopper JL, Walters EH, Dharmage SC. Childhood infections and the risk of asthma: a longitudinal study over 37 years. Chest 2013; 142:647-654. [PMID: 22459783 DOI: 10.1378/chest.11-1432] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Few studies have examined common childhood infections and adult asthma. We examined associations between childhood infectious diseases, childhood pneumonia, and current, persisting, and incident asthma to middle age. METHODS We analyzed data from the Tasmanian Longitudinal Health Study (TAHS). A history of pneumonia was ascertained from their parents when the TAHS participants were 7 years old. Measles, rubella, mumps, chickenpox, diphtheria, and pertussis were identified from school medical records. Associations with current, persisting, or incident asthma were examined using regression techniques. RESULTS Greater infectious diseases load was negatively associated with persisting asthma at all ages. Individually, pertussis (adjusted OR [aOR], 0.53; 95% CI, 0.28-1.00) was negatively associated with asthma persisting to age 13 years, chickenpox (aOR, 0.58; 95% CI, 0.38-0.88) was negatively associated with asthma persisting to age 32 years, and rubella was negatively associated with asthma persisting to ages 32 (aOR, 0.61; 95% CI, 0.31-0.96) and 44 years (aOR 0.53; 95% CI, 0.35-0.82). Pertussis was associated with preadolescent incident asthma (adjusted hazard ratio [aHR], 1.80; 95% CI, 1.10-2.96), whereas measles was associated with adolescent incident asthma (aHR, 1.66; 1.06-2.56). Childhood pneumonia was associated with current asthma at ages 7 (aOR, 3.12; 95% CI, 2.61-3.75) and 13 years (aOR, 1.32; 95% CI, 1.00-1.75), an association stronger in those without than those with eczema (aOR, 3.46; 95% CI, 2.83-4.24 vs aOR, 2.08; 95% CI, 1.38-3.12). CONCLUSIONS Overall, childhood infectious diseases protected against asthma persisting in later life, but pertussis and measles were associated with new-onset asthma after childhood. Measles and pertussis immunization might lead to a reduction in incident asthma in later life.
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Affiliation(s)
- John A Burgess
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Carlton, VIC, Australia.
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred, Melbourne, VIC, Australia
| | - Lyle C Gurrin
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Carlton, VIC, Australia
| | - Graham B Byrnes
- Biostatistics Group, International Agency for Research on Cancer, Lyon, France
| | - Melanie C Matheson
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Carlton, VIC, Australia
| | - Cathryn L May
- Victorian Cervical Cytology Registry, East Melbourne, VIC, Australia
| | - Graham G Giles
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Carlton, VIC, Australia; Cancer Epidemiology Centre, The Cancer Council Victoria, Carlton, VIC, Australia
| | - David P Johns
- Respiratory Research Group, Menzies Research Institute, The University of Tasmania, Hobart, TAS, Australia
| | - John L Hopper
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Carlton, VIC, Australia
| | - E Haydn Walters
- Respiratory Research Group, Menzies Research Institute, The University of Tasmania, Hobart, TAS, Australia
| | - Shyamali C Dharmage
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, The University of Melbourne, Carlton, VIC, Australia
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Koh YY. Long-term asthma remission during adolescence. ALLERGY ASTHMA & RESPIRATORY DISEASE 2013. [DOI: 10.4168/aard.2013.1.1.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Young Yull Koh
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Perret JL, Dharmage SC, Matheson MC, Johns DP, Gurrin LC, Burgess JA, Marrone J, Markos J, Morrison S, Feather I, Thomas PS, McDonald CF, Giles GG, Hopper JL, Wood-Baker R, Abramson MJ, Walters EH. The interplay between the effects of lifetime asthma, smoking, and atopy on fixed airflow obstruction in middle age. Am J Respir Crit Care Med 2012; 187:42-8. [PMID: 23155143 DOI: 10.1164/rccm.201205-0788oc] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The contribution by asthma to the development of fixed airflow obstruction (AO) and the nature of its effect combined with active smoking and atopy remain unclear. OBJECTIVES To investigate the prevalence and relative influence of lifetime asthma, active smoking, and atopy on fixed AO in middle age. METHODS The population-based Tasmanian Longitudinal Health Study cohort born in 1961 (n = 8,583) and studied with prebronchodilator spirometry in 1968 was retraced (n = 7,312) and resurveyed (n = 5,729 responses) from 2002 to 2005. A sample enriched for asthma and chronic bronchitis underwent a further questionnaire, pre- and post-bronchodilator spirometry (n = 1,389), skin prick testing, lung volumes, and diffusing capacity measurements. Prevalence estimates were reweighted for sampling fractions. Multiple linear and logistic regression were used to assess the relevant associations. MEASUREMENTS AND MAIN RESULTS Main effects and interactions between lifetime asthma, active smoking, and atopy as they relate to fixed AO were measured. The prevalence of fixed AO was 6.0% (95% confidence interval [CI], 4.5-7.5%). Its association with early-onset current clinical asthma was equivalent to a 33 pack-year history of smoking (odds ratio, 3.7; 95% CI, 1.5-9.3; P = 0.005), compared with a 24 pack-year history for late-onset current clinical asthma (odds ratio, 2.6; 95% CI, 1.03-6.5; P = 0.042). An interaction (multiplicative effect) was present between asthma and active smoking as it relates to the ratio of post-bronchodilator FEV(1)/FVC, but only among those with atopic sensitization. CONCLUSIONS Active smoking and current clinical asthma both contribute substantially to fixed AO in middle age, especially among those with atopy. The interaction between these factors provides another compelling reason for atopic individuals with current asthma who smoke to quit.
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Affiliation(s)
- Jennifer L Perret
- Centre for Molecular, Environmental, Genetic, and Analytical Epidemiology, University of Melbourne, Victoria, Australia.
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Riiser A, Hovland V, Carlsen KH, Mowinckel P, Lødrup Carlsen KC. Does bronchial hyperresponsiveness in childhood predict active asthma in adolescence? Am J Respir Crit Care Med 2012; 186:493-500. [PMID: 22798318 DOI: 10.1164/rccm.201112-2235oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Bronchial hyperresponsiveness (BHR) is an important, but not specific, asthma characteristic. OBJECTIVES We aimed to assess the predictive value of BHR tested by methacholine and exercise challenge at age 10 years for active asthma 6 years later. METHODS From a Norwegian birth cohort, 530 children underwent methacholine challenge and exercise-induced bronchoconstriction (EIB) test (n = 478) at 10 years and structured interview and clinical examination at age 16 years. The methacholine dose causing 20% reduction in FEV(1) (PD(20)) and the reduction in FEV(1) (%) after a standardized treadmill test were used for BHR assessment. Active asthma was defined with at least two criteria positive: doctor's diagnosis of asthma, symptoms of asthma, and/or treatment for asthma in the last year. MEASUREMENTS AND MAIN RESULTS PD(20) and EIB at 10 years of age increased the risk of asthma (β = 0.94 [95% confidence interval (CI), 0.92-0.96] per μmol methacholine and β = 1.10 [95% CI, 1.06-1.15] per %, respectively). Separately the tests explained 10 and 7%, respectively, and together 14% of the variation in active asthma 6 years later. The predicted probability for active asthma at the age of 16 years increased with decreasing PD(20) and increasing EIB. The area under the curve (receiver operating characteristic curves) was larger for PD(20) (0.69; 95% CI, 0.62-0.75) than for EIB (0.60; 95% CI, 0.53-0.67). CONCLUSIONS BHR at 10 years was a significant but modest predictor of active asthma 6 years later, with methacholine challenge being superior to exercise test.
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Affiliation(s)
- Amund Riiser
- Department of Paediatrics, Oslo University Hospital, NO-0407 Oslo, Norway.
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Different implications of paternal and maternal atopy for perinatal IgE production and asthma development. Clin Dev Immunol 2012; 2012:132142. [PMID: 22272211 PMCID: PMC3261469 DOI: 10.1155/2012/132142] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/03/2011] [Indexed: 12/16/2022]
Abstract
Asthma is a hereditary disease associated with IgE-mediated reaction. Whether maternal atopy and paternal atopy have different impacts on perinatal IgE production and asthma development remains unclear. This paper reviews and summarizes the effects of maternal and paternal atopy on the developmental aspects of IgE production and asthma. Maternal atopy affects both pre- and postnatal IgE production, whereas paternal atopy mainly affects the latter. Maternally transmitted genes GSTP1 and FceRI-beta are associated with lung function and allergic sensitization, respectively. In IgE production and asthma development, the maternal influence on gene-environment interaction is greater than paternal influence. Maternal, paternal, and/or postnatal environmental modulation of allergic responses have been linked to epigenetic mechanisms, which may be good targets for early prevention of asthma.
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Subbarao P, Becker A, Brook JR, Daley D, Mandhane PJ, Miller GE, Turvey SE, Sears MR. Epidemiology of asthma: risk factors for development. Expert Rev Clin Immunol 2010; 5:77-95. [PMID: 20476901 DOI: 10.1586/1744666x.5.1.77] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This comprehensive review of the recent literature was undertaken to determine the current state of knowledge of the risk factors involved in the development of asthma in order to focus investigations in a proposed new longitudinal birth cohort study. The origins of asthma appear to lie in the prenatal and early postnatal period, and renewed investigations in this period with long-term close follow-up and objective phenotypic characterization will help to unravel the role of the multiple putative environmental factors in the development of asthma. It is only after understanding these effects that one can hope to design rational prevention studies for asthma.
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Affiliation(s)
- Padmaja Subbarao
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Koshy G, Delpisheh A, Brabin BJ. Trends in prevalence of childhood and parental asthma in Merseyside, 1991-2006. J Public Health (Oxf) 2010; 32:488-95. [PMID: 20410066 DOI: 10.1093/pubmed/fdq027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To determine changes in prevalence of parental and childhood asthma in Merseyside between 1991 and 2006. METHODS Four standardized cross-sectional respiratory surveys using a parent-completed questionnaire were completed in 1991 (n = 1171), 1993 (n = 2368) 1998 (n = 1964) and in 2006 (n = 1074) among primary school children attending the same schools in lower socio-economic areas of Merseyside. Main outcome measures were prevalence of doctor diagnosed asthma (DDA) and the symptom triad of cough, wheeze and breathlessness (C+W+B+). RESULTS Between 1991 and 1998 prevalence of DDA increased (P < 0.001), but in 2006 this decreased from 29.8 to 19.4% (P < 0.001). Prevalence of C+W+B+ increased from 7.8 to 8.0% by 1998, then decreased to 6.7% in 2006 (P = 0.39). Between 1998 and 2006, childhood hospital admissions for respiratory illness decreased from 11.3 to 9.7% (P = 0.23). During this period paternal asthma prevalence increased from 8.6 to 10.7% (P = 0.001) and maternal asthma from 11.2 to 13.4% (P = 0.09). CONCLUSIONS An increase in the prevalence of DDA and asthmatic respiratory symptoms occurred in children prior to 1998, but this had decreased by 2006. Prevalence of parental asthma increased during the same period.
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Affiliation(s)
- Gibby Koshy
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Matheson MC, Haydn Walters E, Burgess JA, Jenkins MA, Giles GG, Hopper JL, Abramson MJ, Dharmage SC. Childhood immunization and atopic disease into middle-age--a prospective cohort study. Pediatr Allergy Immunol 2010; 21:301-6. [PMID: 20003161 DOI: 10.1111/j.1399-3038.2009.00950.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The association between childhood immunizations and risk of atopic diseases is unclear. No study has examined possible associations between childhood immunizations and such diseases in middle age. The Tasmanian Longitudinal Health Study (TAHS) is a population based cohort study of respiratory disease. The TAHS participants were followed from 7 to 44 yrs of age. Immunizations during childhood were examined for any association with asthma and atopic disease at age 44 yrs. Multivariable regression models were used to estimate relative risks while adjusting for confounders. Cox regression was used to estimate the association between childhood immunizations and asthma developing after the age of 7 yrs. We found no association between any childhood immunization (Diphtheria, Tetanus, Pertussis, Polio, Smallpox) and asthma (ORs ranged from 0.87 to 1.17 p > 0.05), eczema (ORs ranged from 0.99 to 1.07 p > 0.05), food allergy (ORs ranged from 0.97 to 1.11 p > 0.05), or hay fever (ORs ranged from 1.02 to 1.05 p > 0.05) at age 44. Nor did we find any association between childhood immunizations and an increased risk of incident asthma after the age of 7 yrs (Diphtheria HR = 1.06, 95% CI 0.82, 1.36; Tetanus HR = 1.13, 95% CI 0.88, 1.44; Pertussis HR = 1.03, 95% CI 0.81, 1.30; Polio HR = 1.15, 95% CI 0.86, 1.54; Smallpox HR = 1.21, 95% CI 0.99, 1.48; DTP HR = 1.05, 95% CI 0.85, 1.30). Our analysis does not support any association between common childhood immunizations and risk of asthma and atopic disease in middle-age. Our findings should provide reassurance that in terms of life time risk of asthma and atopic disease, childhood immunization is safe.
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Affiliation(s)
- Melanie C Matheson
- Centre for MEGA Epidemiology, The University of Melbourne, Melbourne, Vic, Australia.
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Covar RA, Strunk R, Zeiger RS, Wilson LA, Liu AH, Weiss S, Tonascia J, Spahn JD, Szefler SJ. Predictors of remitting, periodic, and persistent childhood asthma. J Allergy Clin Immunol 2010; 125:359-366.e3. [PMID: 20159245 PMCID: PMC2844768 DOI: 10.1016/j.jaci.2009.10.037] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 10/13/2009] [Accepted: 10/26/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND The course of mild to moderate persistent asthma in children is not clearly established. OBJECTIVE To determine the rate and predictors for remitting, periodic, and persistent asthma in adolescence. METHODS The Childhood Asthma Management Program (CAMP) was a 4.3-year randomized, double-masked, multicenter trial in children with mild to moderate persistent asthma that compared continuous therapy with either budesonide or nedocromil, each to placebo, followed by a 4-year observational follow-up period. Asthma activity during the observation period included remitting (no asthma activity in the last year), persistent (asthma activity in every quarter), and periodic asthma (neither remitting nor persistent). RESULTS Asthma was identified as remitting in 6%, periodic in 39%, and persistent in 55% of the 909 participants, with no effect noted from earlier anti-inflammatory treatment during the CAMP trial. Within all 3 asthma activity categories, improvements in airway hyperresponsiveness, eosinophilia, and asthma morbidity were observed over time. Features at entry into CAMP associated with remitting versus persistent asthma were lack of allergen sensitization and exposure to indoor allergens (odds ratio [OR], 3.23; P < .001), milder asthma (OR, 2.01; P = .03), older age (OR, 1.23; P = .01), less airway hyperresponsiveness (higher log methacholine FEV(1) PC(20) (OR, 1.39; P = .03), higher prebronchodilator FEV(1) percent predicted (OR, 1.05; P = .02), and lower forced vital capacity percent predicted (OR, 0.96; P = .04). CONCLUSION Remission of asthma in adolescence is infrequent and not affected by 4 years of anti-inflammatory controller therapy. Factors such as sensitization and exposure, low lung function, and airway greater hyperresponsiveness decrease the likelihood of remitting asthma.
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