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Ai T, Wu Y, Zhang L, Luo R, Liao H, Fan Y, Xia W, Xie C, Zhang L. Evaluation of the factors affecting lung function in pediatric patients with asthma. J Asthma 2023; 60:682-690. [PMID: 35674402 DOI: 10.1080/02770903.2022.2087670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to analyze the risk factors affecting lung function in children with asthma based on clinical data to advice on clinical treatment and prognosis. METHODS This study included newly diagnosed patients with asthma admitted to the Respiratory Department of Chengdu Women's and Children's Central Hospital in Sichuan from July 2020 to June 2021. The factors associated with lung function were analyzed using univariate and multivariate linear regression with the forward method, while factors affecting lung ventilation function were analyzed using multivariate logistic regression. RESULTS Sixty percent of the patients had normal lung function. Age was significantly negatively correlated with forced vital capacity (FVC)/FVCpredicted (B = -1.385, p = 0.001), FEV1/FEV1predicted (B = -2.092, p < 0.001), and FEV1%/FEV1%predicted (B = -0.834, p = 0.001). Body mass index (BMI) for age Z score (B = 1.661, p = 0.045) and cesarean delivery (B = 4.471, p = 0.013) were significantly positively correlated with FVC/FVCpredicted. Birth weight was significantly positively correlated with FEV1/FEV1predicted (B = 4.593, p = 0.027). Multivariate logistic regression analysis revealed that age ≥6 years and cough variant asthma (CVA) were risk factors for abnormal lung function. CONCLUSIONS Age, BMI for age Z score, mode of delivery, and birth weight were significantly correlated with lung function in children with asthma. Furthermore, children with asthma and normal lung function were more likely to be overlooked. More attention should be given to children with asthma and normal lung function, and CVA.
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Affiliation(s)
- Tao Ai
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Wu
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Lei Zhang
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ronghua Luo
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Huling Liao
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yinghong Fan
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wanmin Xia
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Cheng Xie
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Libing Zhang
- Department of Pediatric Pulmonology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Amnuaylojaroen T, Parasin N. Future Health Risk Assessment of Exposure to PM 2.5 in Different Age Groups of Children in Northern Thailand. TOXICS 2023; 11:291. [PMID: 36977056 PMCID: PMC10057456 DOI: 10.3390/toxics11030291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 06/18/2023]
Abstract
Particulate matter with a diameter less than 2.5 (PM2.5) is one of the major threats posed by air pollution to human health. It penetrates the respiratory system, particularly the lungs. In northern Thailand, the PM2.5 concentrations have significantly increased in the past decade, becoming a major concern for the health of children. This study aimed to assess the health risk of PM2.5 in different age groups of children in northern Thailand between 2020 and 2029. Based on the PM2.5 data from the simulation of the Nested Regional Climate Model with Chemistry (NRCM-Chem), the hazard quotient (HQ) was used to estimate the possible risk from PM2.5 exposure in children. In general, all age groups of children in northern Thailand will tend to experience the threat of PM2.5 in the future. In the context of age-related development periods, infants are at a higher risk than other groups (toddlers, young children, school age and adolescents), but adolescents also have a lower risk of exposure to PM2.5, albeit maintaining a high HQ value (>1). Moreover, the analysis of risk assessment in different age groups of children revealed that PM2.5 exposure might indeed affect adolescent risk differently depending on gender, with males generally at a heightened risk than females in adolescence.
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Affiliation(s)
- Teerachai Amnuaylojaroen
- Department of Environmental Science, School of Energy and Environment, University of Phayao, Phayao 56000, Thailand;
- Atmospheric Pollution and Climate Research Unit, School of Energy and Environment, University of Phayao, Phayao 56000, Thailand
| | - Nichapa Parasin
- School of Allied Health Science, University of Phayao, Phayao 56000, Thailand
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Jun T, Min IS. Air pollution, respiratory illness and behavioral adaptation: Evidence from South Korea. PLoS One 2019; 14:e0221098. [PMID: 31408479 PMCID: PMC6692036 DOI: 10.1371/journal.pone.0221098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/30/2019] [Indexed: 11/19/2022] Open
Abstract
Air pollution is closely associated with the development of respiratory illness. Behavioral adaptations of people to air pollution may influence its impact, yet this has not been investigated in the literature. Our hypothesis is that people experience and learn the underlying air quality to decide their adaptation, and they have a stronger incentive to behaviorally adapt to the air quality as it deteriorates. We tested our hypothesis on a sample of approximately 25,700 individuals from South Korea from 2002 to 2013 that contained information on daily doctor's visits due to respiratory disease. We matched individuals to the mean of the past seven-day concentration of the particulate matter of size between 2.5 and 10 micrometers (PM10) in their county of residence. We examined whether people living in counties with greater air pollution suffer less from respiratory disease when the concentration increases. For the analysis, we separated counties into quintiles based on their mean seven-day PM10, and regressed the binary indicator of a daily doctor's visit with a resulting diagnosis of respiratory disease on the seven-day PM10 concentration of the county of residence interacted with the quintile dummies. The key findings are that a 1-standard-deviation increase in the seven-day PM10 concentration in the two lowest quintiles is associated with an increase of 0.054 percentage points in the likelihood of a doctor's visit with a resulting diagnosis of respiratory disease, which is about 40% larger than the effect in higher quintiles, and the size of 1-standard-deviation gradually increases from 0.037 percentage points in the third quintile to 0.040 percentage points in the fifth quintile. The smaller increase in the likelihood of respiratory disease in more polluted locations can be explained by the behavioral adaptation to the environment, but the effectiveness of the adaptation seems limited among the highly polluted locations.
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Affiliation(s)
- Tackseung Jun
- Department of Economics, Kyung Hee University, Seoul, South Korea
- Department of Economics, Barnard College, Columbia University, New York, New York, United States of America
| | - In-sik Min
- Department of Economics, Kyung Hee University, Seoul, South Korea
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Schurz H, Kinnear CJ, Gignoux C, Wojcik G, van Helden PD, Tromp G, Henn B, Hoal EG, Möller M. A Sex-Stratified Genome-Wide Association Study of Tuberculosis Using a Multi-Ethnic Genotyping Array. Front Genet 2019; 9:678. [PMID: 30713548 PMCID: PMC6346682 DOI: 10.3389/fgene.2018.00678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 12/06/2018] [Indexed: 11/13/2022] Open
Abstract
Tuberculosis (TB), caused by Mycobacterium tuberculosis, is a complex disease with a known human genetic component. Males seem to be more affected than females and in most countries the TB notification rate is twice as high in males than in females. While socio-economic status, behavior and sex hormones influence the male bias they do not fully account for it. Males have only one copy of the X chromosome, while diploid females are subject to X chromosome inactivation. In addition, the X chromosome codes for many immune-related genes, supporting the hypothesis that X-linked genes could contribute to TB susceptibility in a sex-biased manner. We report the first TB susceptibility genome-wide association study (GWAS) with a specific focus on sex-stratified autosomal analysis and the X chromosome. A total of 810 individuals (410 cases and 405 controls) from an admixed South African population were genotyped using the Illumina Multi Ethnic Genotyping Array, specifically designed as a suitable platform for diverse and admixed populations. Association testing was done on the autosome (8,27,386 variants) and X chromosome (20,939 variants) in a sex stratified and combined manner. SNP association testing was not statistically significant using a stringent cut-off for significance but revealed likely candidate genes that warrant further investigation. A genome wide interaction analysis detected 16 significant interactions. Finally, the results highlight the importance of sex-stratified analysis as strong sex-specific effects were identified on both the autosome and X chromosome.
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Affiliation(s)
- Haiko Schurz
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Tuberculosis Bioinformatics Initiative, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Craig J. Kinnear
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chris Gignoux
- Colorado Center for Personalized Medicine, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Genevieve Wojcik
- Department of Genetics, Stanford University, Stanford, CA, United States
| | - Paul D. van Helden
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerard Tromp
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Tuberculosis Bioinformatics Initiative, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Centre for Bioinformatics and Computational Biology, Stellenbosch University, Cape Town, South Africa
| | - Brenna Henn
- Department of Anthropology, UC Davis Genome Center, University of California, Davis, Davis, CA, United States
| | - Eileen G. Hoal
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marlo Möller
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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5
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Yang M, Chu C, Bloom MS, Li S, Chen G, Heinrich J, Markevych I, Knibbs LD, Bowatte G, Dharmage SC, Komppula M, Leskinen A, Hirvonen MR, Roponen M, Jalava P, Wang SQ, Lin S, Zeng XW, Hu LW, Liu KK, Yang BY, Chen W, Guo Y, Dong GH. Is smaller worse? New insights about associations of PM 1 and respiratory health in children and adolescents. ENVIRONMENT INTERNATIONAL 2018; 120:516-524. [PMID: 30153645 DOI: 10.1016/j.envint.2018.08.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/27/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about PM1 effects on respiratory health, relative to larger size fractions (PM2.5). To address this literature gap, we assessed associations between PM1 exposure and asthmatic symptoms in Chinese children and adolescents, compared with PM2.5. METHODS A total of 59,754 children, aged 2-17 years, were recruited from 94 kindergartens, elementary and middle schools in the Seven Northeast Cities (SNEC) study, during 2012-2013. We obtained information on asthma and asthma-related symptoms including wheeze, persistent phlegm, and persistent cough using a standardized questionnaire developed by the American Thoracic Society. PM1 and PM2.5 concentrations were estimated using a spatial statistical model matched to the children's geocoded home addresses. To examine the associations, mixed models with school/kindergarten as random intercept were used, controlling for covariates. RESULTS Odds ratios (ORs) of doctor-diagnosed asthma associated with a 10-μg/m3 increase for PM1 and PM2.5 were 1.56 (95% CI: 1.46-1.66) and 1.50 (1.41-1.59), respectively, and similar pattern were observed for other outcomes. Interaction analyses indicated that boys and the individuals with an allergic predisposition may be vulnerable subgroups. For example, among children with allergic predisposition, the ORs for doctor diagnosed asthma per 10 μg/m3 increase in PM1 was 1.71 (95% CI: 1.60-1.83), which was stronger than in their counterparts (1.46; 1.37-1.56) (pfor interaction < 0.05). CONCLUSIONS This study indicated that long-term exposure to PM1 may increase the risk of asthma and asthma-related symptoms, especially among boys and those with allergic predisposition. Furthermore, these positive associations for PM1 were very similar to those for PM2.5.
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Affiliation(s)
- Mo Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chu Chu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Michael S Bloom
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Gongbo Chen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilian-University, Munich 80336, Germany; Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilian-University, Munich 80336, Germany
| | - Luke D Knibbs
- School of Public Health, The University of Queensland, Herston, Queensland 4006, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Mika Komppula
- Finnish Meteorological Institute, Kuopio 70211, Finland
| | - Ari Leskinen
- Finnish Meteorological Institute, Kuopio 70211, Finland; Department of Applied Physics, University of Eastern Finland, Kuopio 70211, Finland
| | - Maija-Riitta Hirvonen
- Department of Environmental and Biological Science, University of Eastern Finland, Kuopio 70211, Finland
| | - Marjut Roponen
- Department of Environmental and Biological Science, University of Eastern Finland, Kuopio 70211, Finland
| | - Pasi Jalava
- Department of Environmental and Biological Science, University of Eastern Finland, Kuopio 70211, Finland
| | - Si-Quan Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Shao Lin
- Department of Environmental Health Sciences and Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Xiao-Wen Zeng
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li-Wen Hu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
| | - Kang-Kang Liu
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen Chen
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Guang-Hui Dong
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Gao L, Urman R, Millstein J, Siegmund KD, Dubeau L, Breton CV. Association between AXL promoter methylation and lung function growth during adolescence. Epigenetics 2018; 13:1027-1038. [PMID: 30277126 PMCID: PMC6342069 DOI: 10.1080/15592294.2018.1529517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/19/2018] [Accepted: 09/22/2018] [Indexed: 12/26/2022] Open
Abstract
AXL is one of the TAM (TYRO3, AXL and MERTK) receptor tyrosine kinases and may be involved in airway inflammation. Little is known about how epigenetic changes in AXL may affect lung development during adolescence. We investigated the association between AXL DNA methylation at birth and lung function growth from 10 to 18 years of age in 923 subjects from the Children's Health Study (CHS). DNA methylation from newborn bloodspots was measured at multiple CpG loci across the regulatory regions of AXL using Pyrosequencing. Linear spline mixed-effects models were fitted to assess the association between DNA methylation and 8-year lung function growth. Findings were evaluated for replication in a separate population of 237 CHS subjects using methylation data from the Illumina HumanMethylation450 (HM450) array when possible. A 5% higher average methylation level of the AXL promoter region at birth was associated with a 48.4 ml decrease in mean FEV1 growth from 10 to 18 years of age in the primary study population (95% CI: -100.2, 3.4), and a 53.9 ml decrease in mean FEV1 growth from 11 to 15 years of age in the replication population (95% CI: -104.3, -3.5). One CpG locus in the promoter region, cg10564498, was significantly associated with decreased growth in FEV1, FVC and MMEF from 10 to 18 years of age and the negative associations were observed in a similar age range in the replication population. These findings suggest a potential association between AXL promoter methylation at birth and lower lung function growth during adolescence.
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Affiliation(s)
- Lu Gao
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Robert Urman
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Joshua Millstein
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Kimberly D. Siegmund
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Louis Dubeau
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Carrie V. Breton
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, CA, USA
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Nirel R, Schiff M, Paltiel O. Respiratory hospitalizations of children and residential exposure to traffic air pollution in Jerusalem. Int J Hyg Environ Health 2015; 218:34-40. [DOI: 10.1016/j.ijheh.2014.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/30/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
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Svendsen ER, Gonzales M, Mukerjee S, Smith L, Ross M, Walsh D, Rhoney S, Andrews G, Ozkaynak H, Neas LM. GIS-modeled indicators of traffic-related air pollutants and adverse pulmonary health among children in El Paso, Texas. Am J Epidemiol 2012; 176 Suppl 7:S131-41. [PMID: 23035137 DOI: 10.1093/aje/kws274] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Investigators examined 5,654 children enrolled in the El Paso, Texas, public school district by questionnaire in 2001. Exposure measurements were first collected in the late fall of 1999. School-level and residence-level exposures to traffic-related air pollutants were estimated using a land use regression model. For 1,529 children with spirometry, overall geographic information system (GIS)-modeled residential levels of traffic-related ambient air pollution (calibrated to a 10-ppb increment in nitrogen dioxide levels) were associated with a 2.4% decrement in forced vital capacity (95% confidence interval (CI): -4.0, -0.7) after adjustment for demographic, anthropomorphic, and socioeconomic factors and spirometer/technician effects. After adjustment for these potential covariates, overall GIS-modeled residential levels of traffic-related ambient air pollution (calibrated to a 10-ppb increment in nitrogen dioxide levels) were associated with pulmonary function levels below 85% of those predicted for both forced vital capacity (odds ratio (OR) = 3.10, 95% CI: 1.65, 5.78) and forced expiratory volume in 1 second (OR = 2.35, 95% CI: 1.38, 4.01). For children attending schools at elevations above 1,170 m, a 10-ppb increment in modeled nitrogen dioxide levels was associated with current asthma (OR = 1.56, 95% CI: 1.08, 2.50) after adjustment for demographic, socioeconomic, and parental factors and random school effects. These results are consistent with previous studies in Europe and California that found adverse health outcomes in children associated with modeled traffic-related air pollutants.
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Affiliation(s)
- Erik R Svendsen
- Department of Global Environmental Health Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
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Álvarez Puebla MJ, García Río F. [Physiology and physiopathology of the distal airways in asthma]. Arch Bronconeumol 2011; 47 Suppl 2:10-6. [PMID: 21640279 DOI: 10.1016/s0300-2896(11)70015-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The small airways are those with an internal diameter of less than 2 mm. The contribution of these airways to total airflow resistance is small in healthy individuals but can represent 50-90 % of total airflow resistance in asthmatics. Suspicion of small airways disease has been based on reduction of midexpiratory and instantaneous flows, although wide variability in their values and the absence of a sufficiently validated cut-off point has limited their clinical application. Static pulmonary volumes can provide indirect evidence of the state of the most distal airways, revealing two effects of their alteration: air trapping and dynamic hyperinflation. While determination of airway resistance by plethysmography and of respiratory system resistance measured by flow interruption are highly non-specific, the forced oscillation technique allows obstruction of the small airways to be distinguished from that of medium-caliber airways. The characteristic pattern of peripheral obstruction includes a decrease in frequency-dependent resistance, reduced reactivity and an increase in resonance frequency. Single-or multiple-breath nitrogen washout can also provide specific information on the small airways, although the apparatus required is less frequently available. Analysis through bicompartmental models of exhaled nitric oxide allows alveolar nitric oxide concentrations to be determined, which seems to provide information on inflammatory activity in the small airways.
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10
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Gender differences and effect of air pollution on asthma in children with and without allergic predisposition: northeast Chinese children health study. PLoS One 2011; 6:e22470. [PMID: 21811617 PMCID: PMC3139656 DOI: 10.1371/journal.pone.0022470] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 06/22/2011] [Indexed: 11/19/2022] Open
Abstract
Background Males and females exhibit different health responses to air pollution, but little is known about how exposure to air pollution affects juvenile respiratory health after analysis stratified by allergic predisposition. The aim of the present study was to assess the relationship between air pollutants and asthmatic symptoms in Chinese children selected from multiple sites in a heavily industrialized province of China, and investigate whether allergic predisposition modifies this relationship. Methodology/Principal Findings 30139 Chinese children aged 3-to-12 years were selected from 25 districts of seven cities in northeast China in 2009. Information on respiratory health was obtained using a standard questionnaire from the American Thoracic Society. Routine air-pollution monitoring data was used for particles with an aerodynamic diameter ≤10 µm (PM10), sulfur dioxide (SO2), nitrogen dioxides (NO2), ozone (O3) and carbon monoxide (CO). A two-stage regression approach was applied in data analyses. The effect estimates were presented as odds ratios (ORs) per interquartile changes for PM10, SO2, NO2, O3, and CO. The results showed that children with allergic predisposition were more susceptible to air pollutants than children without allergic predisposition. Amongst children without an allergic predisposition, air pollution effects on asthma were stronger in males compared to females; Current asthma prevalence was related to PM10 (ORs = 1.36 per 31 µg/m3; 95% CI, 1.08–1.72), SO2 (ORs = 1.38 per 21 µg/m3; 95%CI, 1.12–1.69) only among males. However, among children with allergic predisposition, more positively associations between air pollutants and respiratory symptoms and diseases were detected in females; An increased prevalence of doctor-diagnosed asthma was significantly associated with SO2 (ORs = 1.48 per 21 µg/m3; 95%CI, 1.21–1.80), NO2 (ORs = 1.26 per 10 µg/m3; 95%CI, 1.01–1.56), and current asthma with O3 (ORs = 1.55 per 23 µg/m3; 95%CI, 1.18–2.04) only among females. Conclusion/Significance Ambient air pollutions were more evident in males without an allergic predisposition and more associations were detected in females with allergic predisposition.
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11
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Carnieli DS, Yoshioka E, Silva LFF, Lanças T, Arantes FM, Perini A, Martins MA, Saldiva PHN, Dolhnikoff M, Mauad T. Inflammation and remodeling in infantile, juvenile, and adult allergic sensitized mice. Pediatr Pulmonol 2011; 46:650-65. [PMID: 21360835 DOI: 10.1002/ppul.21436] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 12/13/2010] [Accepted: 12/16/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Airway structural changes occur early in childhood asthma, but it is unknown whether the development of airway alterations in children is similar to that of adults. We compared inflammation and remodeling parameters in allergic sensitized infantile, juvenile, and adult mice. METHODS Infantile mice (18D) were sensitized with three intraperitoneal injections (i.p.) of ovalbumin (OVA) at days 5 and 7 and challenged with OVA at days 14-16. The 18D1 group received an additional challenge at days 9-11. The juvenile mice (40D) received challenges at days 22-24 and 36-38. Adult mice (100D) were sensitized at days 60-62 and received three inhalations at days 77-79 and 96-98. Animals were submitted to whole body plethysmography. Airway eosinophils, CD3+ T-lymphocytes, IL-5+ cells, mucus content, collagen and reticular fibers density, and smooth muscle thickness were quantified. RESULTS All sensitized animals presented with airway hyperresponsiveness, without differences in eosinophil cell density. The density of CD3+ T-cells was higher in the 100D and 18D1 groups than in the 18D and 40D groups. Infantile sensitized groups demonstrated increased interleukin-5 expression in the airways. Infantile mice demonstrated more mucus in the bronchiolar epithelium than the 40D and 100D mice. The 18D animals demonstrated less collagen than the 18D1 group. Juvenile and adult mice had increased airway smooth muscle thickness when compared to age-matched controls, but no differences were observed in the infantile groups. CONCLUSION We have shown that infantile mice develop inflammatory and structural alterations in the airways that are partially different from those developed in older animals.
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Affiliation(s)
- Denise S Carnieli
- Department of Pathology, School of Medicine, São Paulo University, São Paulo, Brazil
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12
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Clougherty JE. A growing role for gender analysis in air pollution epidemiology. CIENCIA & SAUDE COLETIVA 2011; 16:2221-38. [DOI: 10.1590/s1413-81232011000400021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 10/16/2009] [Indexed: 01/22/2023] Open
Abstract
Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification. Studies of children suggest stronger effects among boys in early life and among girls in later childhood. The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.
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13
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Zhang Y, McConnell R, Gilliland F, Berhane K. Ethnic differences in the effect of asthma on pulmonary function in children. Am J Respir Crit Care Med 2010; 183:596-603. [PMID: 20889910 DOI: 10.1164/rccm.200912-1863oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The impact of asthma on chronic lung function deficits is well known. However, there has been little study of ethnic differences in these asthma-associated deficits. OBJECTIVES To examine whether there are ethnic differences in the effects of asthma on children's lung function. METHODS We evaluated the impact of asthma on lung function in 3,245 Hispanic and non-Hispanic white school children (age 10-18 yr) in a longitudinal analysis of the Southern California Children's Health Study. Sex-specific mixed-effects regression spline models were fitted separately for each ethnic group. MEASUREMENTS AND MAIN RESULTS Large deficits in flows were observed among children with asthma diagnosed before age 4 years regardless of ethnicity. Hispanic girls with asthma had greater deficits in flows than non-Hispanic girls and were largest for maximal midexpiratory flow (-5.13% compared with -0.58%, respectively). A bigger impact of asthma in Hispanic girls was also found for FEV(1), FEF(75), and PEF (P value 0.04, 0.07, and 0.005, respectively). These ethnic differences were limited to girls diagnosed after age 4 years. In boys, asthma was also associated with greater deficits in flows among Hispanic than in non-Hispanic white children (differences that were not statistically significant). Ethnic differences in prevalence of pets and pests in the home, health insurance coverage, parental education, and smoking did not explain the pattern of lung function differences. CONCLUSIONS Larger asthma-associated lung function deficits in Hispanics, especially among girls, merit further investigation to determine public health implications and to identify causes amenable to intervention.
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Affiliation(s)
- Yue Zhang
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, 90033, USA
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14
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Clougherty JE. A growing role for gender analysis in air pollution epidemiology. ENVIRONMENTAL HEALTH PERSPECTIVES 2010; 118:167-76. [PMID: 20123621 PMCID: PMC2831913 DOI: 10.1289/ehp.0900994] [Citation(s) in RCA: 370] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 10/16/2009] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Epidemiologic studies of air pollution effects on respiratory health report significant modification by sex, although results are not uniform. Importantly, it remains unclear whether modifications are attributable to socially derived gendered exposures, to sex-linked physiological differences, or to some interplay thereof. Gender analysis, which aims to disaggregate social from biological differences between males and females, may help to elucidate these possible sources of effect modification. DATA SOURCES AND DATA EXTRACTION A PubMed literature search was performed in July 2009, using the terms "respiratory" and any of "sex" or "gender" or "men and women" or "boys and girls" and either "PM2.5" (particulate matter <or= 2.5 microm in aerodynamic diameter) or "NO2" (nitrogen dioxide). I reviewed the identified studies, and others cited therein, to summarize current evidence of effect modification, with attention to authors' interpretation of observed differences. Owing to broad differences in exposure mixes, outcomes, and analytic techniques, with few studies examining any given combination thereof, meta-analysis was not deemed appropriate at this time. DATA SYNTHESIS More studies of adults report stronger effects among women, particularly for older persons or where using residential exposure assessment. Studies of children suggest stronger effects among boys in early life and among girls in later childhood. CONCLUSIONS The qualitative review describes possible sources of difference in air pollution response between women and men, which may vary by life stage, coexposures, hormonal status, or other factors. The sources of observed effect modifications remain unclear, although gender analytic approaches may help to disentangle gender and sex differences in pollution response. A framework for incorporating gender analysis into environmental epidemiology is offered, along with several potentially useful methods from gender analysis.
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Affiliation(s)
- Jane E Clougherty
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Chu YT, Chen WY, Wang TN, Tseng HI, Wu JR, Ko YC. Extreme BMI predicts higher asthma prevalence and is associated with lung function impairment in school-aged children. Pediatr Pulmonol 2009; 44:472-9. [PMID: 19360851 DOI: 10.1002/ppul.21023] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The prevalence of obesity and asthma has increased in recent decades. We investigated the relationship between body mass index (BMI) and lung function, and also tried to determine if asthma prevalence differs between obese and non-obese children. METHODS An International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire survey that included 170,457 students in junior high school was conducted during a 1-year period. Using random selection, 15,761 students were selected for lung function testing; 14,654 (93.0%) completed the lung function tests. Multiple logistic regression analysis was used to analyze the risk factor of asthma, such as atopic diathesis, BMI, exercise habits, smoking and secondary smoking. The detailed comparison in lung functions was plotted by asthmatic versus non-asthmatic, and between both sexes. RESULTS The risk factor of ISAAC-identified asthma were male sex, atopy, elevated BMI, higher education levels of the parents (higher than senior high school), family smoking >or=1 pack/day, self-reported smoking. The prevalence of asthma increased as BMI elevated in both sex. The FEV1/FVC declined as BMI elevated in both sex. The thin and underweight male students had declined FEF 25-75% and PEF. CONCLUSIONS Extreme BMI is associated with different lung function impairment. This study showed that high BMI in both sexes was associated with low FEV1/FVC and low BMI in males are associated with poor PEF and FEF 25-75% and contributed to the symptoms of asthma.
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Affiliation(s)
- Yu-Te Chu
- The Pediatric Department, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, Republic of China
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16
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Delacourt C, Dubus JC, de Blic J. [Involvement of distal airways in asthma: lessons from pediatric cohorts]. Rev Mal Respir 2009; 26:147-52. [PMID: 19319110 DOI: 10.1016/s0761-8425(09)71592-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Prospective studies of paediatric cohorts contribute to our knowledge of changes in pulmonary function in children with asthma. STATE OF THE ART Asthma is associated with a significant impairment of the distal airways which is more pronounced when asthma has started early, before 5 years of age, or when asthma is persistent. In utero exposure to tobacco smoke allergenic sensitization and persistent bronchial hyperresponsiveness are the main factors associated with an unfavourable respiratory function outcome. This impairment may persist despite the disappearance of symptoms. Distal airway alterations are also poorly responsive to conventional inhaled corticosteroid therapy. This could be due to early remodelling phenomenon or non-optimal deposition of the drugs on distal airways. PERSPECTIVES AND CONCLUSIONS The medium and long term clinical implications of distal airway involvement in paediatric asthma and the impact of treatment need to be evaluated.
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Affiliation(s)
- C Delacourt
- Service de Pédiatrie, CHI de Créteil, France
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17
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Sahsuvaroglu T, Jerrett M, Sears MR, McConnell R, Finkelstein N, Arain A, Newbold B, Burnett R. Spatial analysis of air pollution and childhood asthma in Hamilton, Canada: comparing exposure methods in sensitive subgroups. Environ Health 2009; 8:14. [PMID: 19338672 PMCID: PMC2669065 DOI: 10.1186/1476-069x-8-14] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 04/01/2009] [Indexed: 05/26/2023]
Abstract
BACKGROUND Variations in air pollution exposure within a community may be associated with asthma prevalence. However, studies conducted to date have produced inconsistent results, possibly due to errors in measurement of the exposures. METHODS A standardized asthma survey was administered to children in grades one and eight in Hamilton, Canada, in 1994-95 (N approximately 1467). Exposure to air pollution was estimated in four ways: (1) distance from roadways; (2) interpolated surfaces for ozone, sulfur dioxide, particulate matter and nitrous oxides from seven to nine governmental monitoring stations; (3) a kriged nitrogen dioxide (NO2) surface based on a network of 100 passive NO2 monitors; and (4) a land use regression (LUR) model derived from the same monitoring network. Logistic regressions were used to test associations between asthma and air pollution, controlling for variables including neighbourhood income, dwelling value, state of housing, a deprivation index and smoking. RESULTS There were no significant associations between any of the exposure estimates and asthma in the whole population, but large effects were detected the subgroup of children without hayfever (predominately in girls). The most robust effects were observed for the association of asthma without hayfever and NO2LUR OR = 1.86 (95%CI, 1.59-2.16) in all girls and OR = 2.98 (95%CI, 0.98-9.06) for older girls, over an interquartile range increase and controlling for confounders. CONCLUSION Our findings indicate that traffic-related pollutants, such as NO2, are associated with asthma without overt evidence of other atopic disorders among female children living in a medium-sized Canadian city. The effects were sensitive to the method of exposure estimation. More refined exposure models produced the most robust associations.
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Affiliation(s)
- Talar Sahsuvaroglu
- School of Geography and Earth Sciences, 1280 King St West, Hamilton, L8S 4K1, Canada
| | - Michael Jerrett
- School of Public Health, University of California, Berkeley, 140 Warren Hall, Berkeley, CA, 94720-7360, USA
| | - Malcolm R Sears
- Firestone Institute for Respiratory Health, St. Joseph's Healthcare, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - Rob McConnell
- Department of Preventive Medicine, School of Medicine, University of Southern California, 1540 Alcazar Street, Los Angeles, CA, 90089-9010, USA
| | - Norm Finkelstein
- School of Geography and Earth Sciences, 1280 King St West, Hamilton, L8S 4K1, Canada
| | - Altaf Arain
- School of Geography and Earth Sciences, 1280 King St West, Hamilton, L8S 4K1, Canada
| | - Bruce Newbold
- School of Geography and Earth Sciences, 1280 King St West, Hamilton, L8S 4K1, Canada
| | - Rick Burnett
- Biostatistics and Epidemiology Division, Health Canada, Tunney's Pasture, Ottawa, ON, K1A 0T6, Canada
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18
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Margolis HG, Mann JK, Lurmann FW, Mortimer KM, Balmes JR, Hammond SK, Tager IB. Altered pulmonary function in children with asthma associated with highway traffic near residence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2009; 19:139-55. [PMID: 19370464 DOI: 10.1080/09603120802415792] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Cross-sectional analyses were conducted to evaluate the effects of exposure to highway traffic on pulmonary function in Fresno, California. Traffic and spirometry data were available for 214 children (enrollment ages six to 11 years). Multiple linear regression was used to evaluate the relations between pulmonary function and traffic parameters. Heavy-duty vehicle count was used as a surrogate measure for diesel-related exposures. Pulmonary function was non-significantly associated with longer distance-to-road and non-significantly associated with higher traffic intensity. Evaluation of effect modification by FEF(25-75)/FVC (a measure of intrinsic airway size) showed that all pulmonary function measures of flow were significantly inversely related to a traffic metric that incorporates traffic intensity and roadway proximity. The results indicate that residence proximity to highway traffic is associated with lower pulmonary function among children with asthma, and smaller airway size is an important modifier of the effect of traffic exposure on pulmonary function and a marker of increased susceptibility.
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Affiliation(s)
- Helene G Margolis
- Division of General Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, CA, USA
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19
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Berhane K, Molitor NT. A Bayesian approach to functional-based multilevel modeling of longitudinal data: applications to environmental epidemiology. Biostatistics 2008; 9:686-99. [PMID: 18349036 PMCID: PMC2733176 DOI: 10.1093/biostatistics/kxm059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 11/07/2007] [Accepted: 12/17/2007] [Indexed: 11/13/2022] Open
Abstract
Flexible multilevel models are proposed to allow for cluster-specific smooth estimation of growth curves in a mixed-effects modeling format that includes subject-specific random effects on the growth parameters. Attention is then focused on models that examine between-cluster comparisons of the effects of an ecologic covariate of interest (e.g. air pollution) on nonlinear functionals of growth curves (e.g. maximum rate of growth). A Gibbs sampling approach is used to get posterior mean estimates of nonlinear functionals along with their uncertainty estimates. A second-stage ecologic random-effects model is used to examine the association between a covariate of interest (e.g. air pollution) and the nonlinear functionals. A unified estimation procedure is presented along with its computational and theoretical details. The models are motivated by, and illustrated with, lung function and air pollution data from the Southern California Children's Health Study.
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Affiliation(s)
- Kiros Berhane
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033-9987, USA.
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20
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Abstract
A number of studies have shown gender differences in the prevalence of wheeze and asthma. The aim of this review was to examine published results on gender differences in childhood and adolescent asthma incidence and prevalence, define current concepts and to identify new research needs. A Medline search was performed with the search words (gender OR sex) AND (child OR childhood OR adolescence) AND (asthma). Articles that reported on absence or presence of gender differences in asthma were included and reviewed, and cross-references were checked. Boys are consistently reported to have more prevalent wheeze and asthma than girls. In adolescence, the pattern changes and onset of wheeze is more prevalent in females than males. Asthma, after childhood, is more severe in females than in males, and is underdiagnosed and undertreated in female adolescents. Possible explanations for this switch around puberty in the gender susceptibility to develop asthma include hormonal changes and gender-specific differences in environmental exposures. This aspect needs consideration of the doctors and allergists who diagnose and treat asthmatic individuals. In conclusion, sex hormones are likely to play an important role in the development and outcome of the allergic immune response and asthma in particular. By obtaining functional data from appropriate models, the exact underlying mechanisms can be unravelled. To examine the effect of gender-specific differences in environmental exposures and changes of asthma prevalence and severity in puberty, larger populations may need to be investigated.
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Affiliation(s)
- C Almqvist
- Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
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21
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van Dalen CJ, Harding E, Parkin J, Blakey K, Cheng S, Pearce NE, Douwes J. Asthma control in a random sample of New Zealand adolescent asthmatics. J Asthma 2007; 44:261-6. [PMID: 17530523 DOI: 10.1080/02770900701246873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Asthma control, defined by asthma symptoms and lung function, and asthma medication use, was assessed in 123 adolescent asthmatics. Sputum eosinophilia (>or= 2.5% eosinophils) and bronchial hyperresponsiveness (BHR) to hypertonic saline were also measured to assess whether these additional objective parameters might aid in determining asthma control; 54.5% of subjects had adequately controlled asthma; 50.4% of all subjects reported inhaled corticosteroid use in the preceding 12 months; however, only 22.3% reported regular use. Although BHR and median eosinophil numbers were significantly higher in the inadequately controlled asthmatics, BHR and sputum eosinophilia had poor sensitivity for detecting inadequate asthma control.
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Affiliation(s)
- C J van Dalen
- Centre for Public Health Research, Research School of Public Health, Massey University, Wellington, New Zealand.
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Abstract
PURPOSE OF REVIEW To review the changes in the asthma phenotype as children progress from childhood into young adulthood. RECENT FINDINGS Some children with asthma in the early school years improve symptomatically during adolescence and young adulthood, with less frequent remissions and increased relapse rates in those with severe symptoms. During remission of symptoms, lung function abnormalities, airway hyper-responsiveness, and airway inflammation often persist. New data from the Childhood Asthma Management Program cohort show progression of lung function abnormalities during adolescence. SUMMARY Most children with persistent asthma have persistent disease as adults, and lung function abnormalities continue to progress as these children age.
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Affiliation(s)
- Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, 1 Children's Place, St Louis, MO 63110, USA
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23
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Bottema RWB, Reijmerink NE, Koppelman GH, Kerkhof M, Postma DS. Phenotype definition, age, and gender in the genetics of asthma and atopy. Immunol Allergy Clin North Am 2006; 25:621-39. [PMID: 16257629 DOI: 10.1016/j.iac.2005.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When studying genetics of complex diseases it is important to have a clearly described and objective phenotype. When drawing conclusions in association studies, age and gender of the population should be considered. Until we know what causes phenotypic differences between males and females and between children and adults, we should try to study longitudinal cohorts with phenotype assessment at different time points and stratify our analyses for gender. To acquire sufficient power for these types of analyses, international collaboration may be the only way to elucidate the intricate, gene-environmental interactions in atopy and asthma in an age- and gender-dependent manor.
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Affiliation(s)
- R W B Bottema
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, The Netherlands.
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Abstract
INTRODUCTION Asthma, the most common chronic disease in paediatrics, is characterised by an inflammatory process involving the proximal and distal airways, with remodelling of the airways and changes in respiratory function. STATE OF THE ART Recent studies in children have provided evidence of damage to the small airways identical to that occurring in adults. In fact inflammatory cells as well as structural alterations of the airways have been found in both bronchial biopsies and broncho-alveolar lavage fluid in infants and young children. At the functional level this damage is manifest by a reduction in maximum expiratory flow rates between 25-75% of the vital capacity. It also shows itself by the demonstration of thick walled bronchi and hypodense bands on the high resolution CT scan. It appears that conventional inhaled treatments have no effect on the small airways. Finally the main prognostic factors for this distal damage are respiratory infections and exposure to tobacco in utero. PERSPECTIVES Damage to the small airways in childhood asthma indicates the need for new therapies aimed at this part of the respiratory system. CONCLUSION Inflammation and remodelling of the small airways develops early in an asthmatic child whose respiratory system is growing rapidly and persists throughout life.
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Affiliation(s)
- J-C Dubus
- Unité de Médecine-Infantile, CHU Timone-Enfants, UPRES 3287, IFR 125, Marseille Cedex 5
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Sunyer J, Basagaña X, Roca J, Urrutia I, Jaen A, Antó JM, Burney P. Relations between respiratory symptoms and spirometric values in young adults: the European community respiratory health study. Respir Med 2004; 98:1025-33. [PMID: 15481280 DOI: 10.1016/j.rmed.2004.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We aim to assess whether respiratory symptoms are associated with lung function in young adults, and whether any such relation is similar in those with asthma, in men and women, and in different countries. Study participants (aged 20-44 years) were randomly selected from the general population in 35 centres in 15 countries as part of the European Community Respiratory Health Study. In all, 12,541 subjects (47%) completed a respiratory symptoms questionnaire and spirometry, metacholine challenge and immunoglobulin E tests. Indicators of diagnosed asthma showed the largest association with airways obstruction (FEV1--maximal 1-s forced expiratory volume/forced vital capacity--FVC < 70%), followed by symptoms of wheezing or shortness of breath, in both genders. Among the 96% of subjects whose FEV1/FVC ratios were greater or equal to 70%, wheezing or shortness of breath was associated with lower FEV1 levels (-211 ml in men and -169 ml in women (P < 0.01)), independent of diagnosed asthma, smoking, atopy or bronchial responsiveness. This association was not explained by a lower FVC. Symptoms of chronic bronchial mucus hypersecretion (chronic phlegm) were unrelated to both airways obstruction and FEV1 levels. Findings were homogeneous across all centres. These results suggest that lung diseases that cause wheezing are generally associated with impaired lung function.
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Affiliation(s)
- Jordi Sunyer
- Institut Municipal Investigació Medica, Doctor Aiguader 80, Unitat de Recerca Respiratòria i Ambiental, 08003 Barcelona, Catalonia, Spain.
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Berhane K, Gauderman WJ, Stram DO, Thomas DC. Statistical Issues in Studies of the Long-Term Effects of Air Pollution: The Southern California Children’s Health Study. Stat Sci 2004. [DOI: 10.1214/088342304000000413] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rennie DC, Lawson JA, Cockcroft DW, Senthilselvan A, McDuffie HH. Differences in respiratory symptoms and pulmonary function in children in 2 Saskatchewan communities. Ann Allergy Asthma Immunol 2004; 92:52-9. [PMID: 14756465 DOI: 10.1016/s1081-1206(10)61710-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Asthma prevalence is known to vary among different geographical regions both nationally and internationally. However, there is limited understanding of the nature of differences within geographical regions. OBJECTIVE To evaluate the prevalence of asthma in 2 prairie communities and differences in the patterns of respiratory symptoms between the communities. METHODS A cross-sectional questionnaire survey was sent through schools in Estevan and Swift Current, Saskatchewan, to parents of 2,231 children in grades 1 to 6. Asthma prevalence was determined by questionnaire report of physician-diagnosed asthma. Pulmonary function tests (PFTs) using spirometry were conducted in children in grades 1 to 4. To evaluate respiratory morbidity without the use of a diagnostic label, similar comparisons were made between communities for respiratory symptoms. RESULTS The overall response rate to the survey questionnaire was 91.3%. The prevalence of ever asthma in Estevan was 21.4% (95% confidence interval [CI], 20.1%-22.7%) compared with 16.2% (95% CI, 15.1%-17.3%) in Swift Current. A higher proportion of girls in Estevan (19.7%; 95% CI, 17.9%-21.5%) compared with girls in Swift Current (12.5%; 95% CI, 11.1%-13.9%) reported a history of asthma. There was no difference found between towns for boys. These findings were supported by findings for respiratory symptoms, including wheeze and cough. For both boys and girls, the forced expiratory flow at 25% to 75% of forced vital capacity and the ratio of forced expiratory volume in 1 second to forced vital capacity were lower in Estevan compared with Swift Current. CONCLUSIONS Differences in the distribution of childhood asthma can be found within regions. These results are strengthened by PFTs and cannot be fully explained by diagnostic biases.
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Affiliation(s)
- Donna C Rennie
- College of Nursing, Institute of Agricultural, Rural and Environmental Health, University of Saskatchewan, Saskatoon, Canada.
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Künzli N, McConnell R, Bates D, Bastain T, Hricko A, Lurmann F, Avol E, Gilliland F, Peters J. Breathless in Los Angeles: the exhausting search for clean air. Am J Public Health 2003; 93:1494-9. [PMID: 12948969 PMCID: PMC1447999 DOI: 10.2105/ajph.93.9.1494] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Population growth and the proliferation of roadways in Southern California have facilitated a glut of mobile air pollution sources (cars and trucks), resulting in substantial atmospheric pollution. Despite successful efforts over the past 40 years to reduce pollution, an alarming set of health effects attributable to air pollution have been described in Southern California. The Children's Health Study indicates that reduced lung function growth, increased school absences, asthma exacerbation, and new-onset asthma are occurring at current levels of air pollution, with sizable economic consequences. We describe these findings and urge a more aggressive effort to reduce air pollution exposures to protect our children's health. Lessons from this "case study" have national implications.
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Affiliation(s)
- Nino Künzli
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 1540 Alcazar Street, CHP 236, Los Angeles, CA 90033, USA.
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Gilliland FD, Berhane K, Li YF, Rappaport EB, Peters JM. Effects of early onset asthma and in utero exposure to maternal smoking on childhood lung function. Am J Respir Crit Care Med 2003; 167:917-24. [PMID: 12480608 DOI: 10.1164/rccm.200206-616oc] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Both in utero exposures to maternal smoking and asthma are associated with chronic deficits in lung function. We hypothesized that in utero exposure affects lung function in children without asthma and synergistically affects children with early onset asthma. To investigate effects of in utero exposure and age at asthma diagnosis on lung function, we examined longitudinal medical history, tobacco smoke exposure, and lung function data from 5,933 participants in the Children's Health Study. We found that children exposed in utero, but without asthma, showed decreased FEV1/FVC, FEF25-75, and FEF25-75/FVC ratio. Among children without in utero exposure, early asthma diagnosis was associated with larger decreases in FEV1, FEF25-75, and FEV1/FVC ratio compared with later diagnosed asthma. Children with in utero exposure alone and early onset asthma showed deficits in FEV1 (-13.6%; 95% confidence interval [CI], -18.9 to -8.2) and FEF25-75 (-29.7%; 95% CI, -37.8 to -20.5) among boys; and FEF25-75 (-26.6%; 95% CI, -36.4 to -15.1) and FEV1/FVC (-9.3%; 95% CI, -12.9 to -5.4) among girls. The absolute differences in FEF25-75 associated with in utero exposure increased with age in children with early onset asthma. We found little evidence for effects from environmental tobacco smoke exposure alone. In summary, deficits in lung function were largest among children with in utero exposure and early onset asthma.
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Affiliation(s)
- Frank D Gilliland
- Department of Preventive Medicine, USC Keck School of Medicine, 1540 Alcazar Street, CHP 236, Los Angeles, CA 90033, USA.
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Herholz C, Straub R, Lüthi S, Imhof A, Busato A. Differences in pulmonary functional indices derived from the single-breath diagram for CO2 (SBD-CO2) in horses related to age, sex and usage. Vet Res Commun 2002; 26:467-78. [PMID: 12241100 DOI: 10.1023/a:1020542525785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although pulmonary function tests have been used to evaluate horses with clinically normal lungs and those with recurrent airway obstruction (RAO), comprehensive studies of equine respiratory function, considering factors such as sex, age and usage are not available. Studies on the influence of these factors on pulmonary function in healthy horses are required for interpretation of measurements made in those with respiratory disease. The study was performed with 63 warmblood horses and the status of their pulmonary health was evaluated by clinical examination. The functional aspect of pulmonary health was assessed by indices derived from the single-breath diagram for CO2 (SBD-CO2). Differences in pulmonary functional indices between the sexes, age groups and usage groups adjusted for pulmonary health were analysed with hierarchical linear models. It was shown that the effects on pulmonary function of age, sex and usage of a horse were significant and have to be considered when establishing the true pulmonary functional status of a horse suffering from RAO. The multivariate statistical model used included the covariates age, sex and sporting discipline of the horses and accounted for the complex, non-linear interactions between the different covariates.
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Affiliation(s)
- C Herholz
- Department of Equine Internal Medicine, Faculty of Veterinary Medicine, University of Berne, Switzerland
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Gilliland FD, Gauderman WJ, Vora H, Rappaport E, Dubeau L. Effects of glutathione-S-transferase M1, T1, and P1 on childhood lung function growth. Am J Respir Crit Care Med 2002; 166:710-6. [PMID: 12204870 DOI: 10.1164/rccm.2112065] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The effects of glutathione-S-transferase (GST) M1, GSTT1, and GSTP1 genotypes on lung function growth were investigated in 1,940 children enrolled in the Children's Health Study as fourth graders (aged 8-11 years) in two cohorts during 1993 and 1996 and were followed annually over a 4-year period. Genotypes for GSTM1 and GSTT1 and GSTP1 codon 105 variants (ile105 and val105) were determined using DNA from buccal cell specimens. We used two-level regression models to estimate the effects of GSTM1, GSTT1, and GSTP1 genotypes on the adjusted annual average lung function growth. GSTM1 null was associated with deficits in annual growth rates for FVC (-0.21%; 95% confidence interval [CI], -0.40, -0.03) and FEV(1) (-0.27%; 95% CI, -0.50, -0.04). Children who were homozygous for the GSTP1 val105 allele had slower lung function growth (FVC -0.35%; 95% CI, -0.62, -0.07; and FEV(1) -0.34%; 95% CI, -0.68, 0.00) than children with one or more ile105 alleles. Children with asthma who were homozygous for the GSTP1 val105 allele had substantially larger deficits in FVC, FEV(1), and maximal mid-expiratory flow than children without asthma. The deficits in FVC and FEV(1) growth associated with both GSTM1 null and the GSTP1 val105 allele were largest and were statistically significant in non-Hispanic white children. We conclude that GSTM1 and GSTP1 genotypes are associated with lung function growth in school children.
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Affiliation(s)
- Frank D Gilliland
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA.
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Avol EL, Gauderman WJ, Tan SM, London SJ, Peters JM. Respiratory effects of relocating to areas of differing air pollution levels. Am J Respir Crit Care Med 2001; 164:2067-72. [PMID: 11739136 DOI: 10.1164/ajrccm.164.11.2102005] [Citation(s) in RCA: 139] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We studied 110 children (59 boys and 51 girls, who were 10 yr of age at enrollment and 15 yr of age at follow-up) who had moved from communities participating in a 10-yr prospective study of respiratory health (The Children's Health Study [CHS]) to determine whether changes in air quality caused by relocation were associated with changes in annual lung function growth rates. The subjects were given health questionnaires and underwent spirometry in their homes across six western states, according to a protocol identical to evaluations performed annually on the CHS cohort in school. Changes in annual average exposure to particulate matter with a mean diameter of 10 microm (PM(10)) were associated with differences in annual lung function growth rates for FEV(1), maximal midexpiratory flow, and peak expiratory flow rate. As a group, subjects who had moved to areas of lower PM(10) showed increased growth in lung function and subjects who moved to communities with a higher PM(10) showed decreased growth in lung function. A stronger trend was found for subjects who had migrated at least 3 yr before the follow-up visit than for those who had moved in the previous 1 to 2 yr. We conclude that changes in air pollution exposure during adolescent growth years have a measurable and potentially important effect on lung function growth and performance.
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Affiliation(s)
- E L Avol
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA.
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Tobin MJ. Pediatrics, surfactant, and cystic fibrosis in AJRCCM 2000. Am J Respir Crit Care Med 2001; 164:1581-94. [PMID: 11719294 DOI: 10.1164/ajrccm.164.9.2108125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- M J Tobin
- Division of Pulmonary and Critical Care Medicine, Loyola University of Chicago Stritch School of Medicine and Hines Veterans Affairs Hospital, Hines, Illinois 60141, USA.
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Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of world-wide mortality and disability. On average approximately 5-15% of adults in industrialized countries have COPD defined by spirometry. In 1990, COPD was considered to be at the twelfth position world-wide as a cause of combined mortality and disability but is expected to become the fifth cause by the year 2020. COPD has a chronic long-lasting course characterized by irreversible decline of forced expiratory volume in one second (FEV1), increasing presence of dyspnoea and other respiratory symptoms, and progressive deterioration of health status. After diagnosis the 10-yr survival rate is approximately 50% with more than one-third of patients dying due to respiratory insufficiency. Several environmental exposures such as air pollution increase the risk of death in COPD patients. The aetiology of COPD is overwhelmingly dominated by smoking although many other factors could play a role. Particular genetic variants are likely to increase the susceptibility to environmental factors although little is known about which are the relevant genes. There is clear evidence about the role of the alpha-1-antitrypsin but the fraction of COPD attributable to the relevant variants is only 1%. Phenotypic traits that are considered to play a role in the development of COPD include sex, with females being at a higher risk, bronchial responsiveness and atopy. There is strong causal evidence regarding the relationship between smoking and COPD with decline in FEVI levelling off after smoking cessation. Passive smoking has been found to be associated with a small though statistically significant decline in FEV1. Other risk factors that are likely to be relevant in the development of COPD are occupation, low socioeconomic status, diet and possibly some environmental exposures in early life. Although there is accumulating evidence that oxygen therapy, pharmacological treatment and rehabilitation may improve the course of chronic obstructive pulmonary disease, preventing smoking continues to be the most relevant measure, not only to prevent chronic obstructive pulmonary disease, but also to arrest its development.
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Affiliation(s)
- J M Antó
- Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain
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Growth and development of the lung. Curr Opin Allergy Clin Immunol 2001. [DOI: 10.1097/00130832-200104000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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