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Agache I, Ricci-Cabello I, Canelo-Aybar C, Annesi-Maesano I, Cecchi L, Biagioni B, Chung KF, D'Amato G, Damialis A, Del Giacco S, De Las Vecillas L, Dominguez-Ortega J, Galán C, Gilles S, Giovannini M, Holgate S, Jeebhay M, Nadeau K, Papadopoulos N, Quirce S, Sastre J, Traidl-Hoffmann C, Walusiak-Skorupa J, Salazar J, Sousa-Pinto B, Colom M, Fiol-deRoque MA, Gorreto López L, Malih N, Moro L, Pardo MG, Pazo PG, Campos RZ, Saletti-Cuesta L, Akdis M, Alonso-Coello P, Jutel M, Akdis CA. The impact of exposure to tobacco smoke and e-cigarettes on asthma-related outcomes: Systematic review informing the EAACI guidelines on environmental science for allergic diseases and asthma. Allergy 2024. [PMID: 38783343 DOI: 10.1111/all.16151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/12/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
To inform the clinical practice guidelines' recommendations developed by the European Academy of Allergy and Clinical Immunology systematic reviews (SR) assessed using GRADE on the impact of environmental tobacco smoke (ETS) and active smoking on the risk of new-onset asthma/recurrent wheezing (RW)/low lung function (LF), and on asthma-related outcomes. Only longitudinal studies were included, almost all on combustion cigarettes, only one assessing e-cigarettes and LF. According to the first SR (67 studies), prenatal ETS increases the risk of RW (moderate certainty evidence) and may increase the risk of new-onset asthma and of low LF (low certainty evidence). Postnatal ETS increases the risk of new-onset asthma and of RW (moderate certainty evidence) and may impact LF (low certainty evidence). Combined in utero and postnatal ETS may increase the risk of new-onset asthma (low certainty evidence) and increases the risk of RW (moderate certainty evidence). According to the second SR (24 studies), ETS increases the risk of severe asthma exacerbations and impairs asthma control and LF (moderate certainty evidence). According to the third SR (25 studies), active smoking increases the risk of severe asthma exacerbations and of suboptimal asthma control (moderate certainty evidence) and may impact asthma-related quality-of-life and LF (low certainty evidence).
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Ignacio Ricci-Cabello
- Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- CIBER Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Centre, Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Isabella Annesi-Maesano
- Institute Desbrest of Epidemiology and Public Health, INSERM, University Hospital, University of Montpellier, Montpellier, France
| | - Lorenzo Cecchi
- SOSD Allergy and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Benedetta Biagioni
- Allergy and Clinical Immunology Unit San Giovanni di Dio Hospital, Florence, Italy
| | | | - Gennaro D'Amato
- Respiratory Disease Department, Hospital Cardarelli, Naples, Italy
- Medical School of Respiratory Allergy, University of Naples Federico II, Naples, Italy
| | - Athanasios Damialis
- Terrestrial Ecology and Climate Change, Department of Ecology, School of Biology, Faculty of Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Leticia De Las Vecillas
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Javier Dominguez-Ortega
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Carmen Galán
- Inter-University Institute for Earth System Research (IISTA), International Campus of Excellence on Agrifood (ceiA3), University of Córdoba, Córdoba, Spain
| | - Stefanie Gilles
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Stephen Holgate
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mohamed Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, University of Cape Town, Cape Town, South Africa
| | - Kari Nadeau
- John Rock Professor of Climate and Population Studies Chair, Department of Environmental Health, Interim Director, Center for Climate, Health, and the Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nikolaos Papadopoulos
- Allergy and Clinical Immunology Unit, Second Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Joaquin Sastre
- Allergy Service, Fundación Jiménez Díaz, Faculty of Medicine Universidad Autónoma de Madrid and CIBERES, Instituto Carlos III, Ministry of Science and Innovation, Madrid, Spain
| | - Claudia Traidl-Hoffmann
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Munich - German Research Center for Environmental Health, Augsburg, Germany
- Christine-Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | | | - Bernardo Sousa-Pinto
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Miquel Colom
- Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Maria A Fiol-deRoque
- Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
- Prevention and Health Promotion Research Network (redIAPP)/Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Lucía Gorreto López
- Iberoamerican Cochrane Centre, Barcelona, Spain
- Gabinete técnico de atención primaria de Mallorca, Balearic Islands Health Services, Palma, Spain
| | - Narges Malih
- Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Laura Moro
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Marina García Pardo
- Iberoamerican Cochrane Centre, Barcelona, Spain
- Servicio de urgencias de atención primaria de Inca, Balearic Islands Health Services, Palma, Spain
| | - Patricia García Pazo
- Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Rocío Zamanillo Campos
- Research Group in Primary Care and Promotion - Balearic Islands Community (GRAPP-caIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | | | - Mubeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
| | - Pablo Alonso-Coello
- CIBER Biomedical Research Center in Epidemiology and Public Health (CIBERESP), Health Institute Carlos III (ISCIII), Madrid, Spain
- Iberoamerican Cochrane Centre, Barcelona, Spain
- Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, ALL-MED Medical Research Institute, Wroclaw, Poland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University Zurich, Davos, Switzerland
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Kamga A, Rochefort-Morel C, Guen YL, Ouksel H, Pipet A, Leroyer C. Asthma and smoking: A review. Respir Med Res 2022; 82:100916. [DOI: 10.1016/j.resmer.2022.100916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
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The Role of Smoking in Asthma and Chronic Obstructive Pulmonary Disease Overlap. Immunol Allergy Clin North Am 2022; 42:615-630. [DOI: 10.1016/j.iac.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Gao H, Niu Y, Wang Q, Shan G, Ma C, Wang H, Hu Y, Guan K, Gu J, Wang J, Wang T, Zhao H, Han H, Chen H, Ruan W, Zhang H, Cong C, Wang L, Liu Y. Analysis of Prevalence and Risk Factors of Adult Self-Reported Allergic Rhinitis and Asthma in Plain Lands and Hilly Areas of Shenmu City, China. Front Public Health 2022; 9:749388. [PMID: 35059372 PMCID: PMC8765605 DOI: 10.3389/fpubh.2021.749388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: The main aim of this study was to investigate the prevalence and risk factors of adult self-reported allergic rhinitis and asthma in plain lands and hilly areas of Shenmu City in China, and analyze the differences between regions. Methods: The multi-stage stratified random sampling was applied in a cross-sectional survey of adult residents in Shenmu City, from September to December 2019. The unconditional logistic regression analysis was used to screen the influence factors of allergic rhinitis and asthma. Results: 4,706 adults participated in the survey, and 99% (4,655 in 4,706) completed the questionnaires. The prevalence of allergic rhinitis was 25.4%, and the prevalence of asthma was 9.4%. The prevalence of the allergic rhinitis without asthma, asthma without allergic rhinitis, and the combined allergic rhinitis with asthma were 18.9, 2.9, and 6.5%, respectively. The prevalence of allergic rhinitis and asthma existed regional differences. The prevalence of adult self-reported allergic rhinitis was 41.5% in plain lands areas and 22.1% in hilly areas. The prevalence of adult self-reported asthma was 12.8% in plain lands and 8.8% in hilly areas. The prevalence of allergic rhinitis and asthma existed seasonal differences, with the highest prevalence from July to September. The analysis of risk factors showed that higher education [middle and high school (OR 1.72, 95%CI 1.42–2.07); college and above (OR 2.67, 95%CI 1.99–3.59)], comorbidities of other allergic diseases (OR 3.90, 95%CI 3.23–4.70), family history of allergies (OR 2.89, 95%CI 2.36–3.53), and plain lands areas (OR 2.51, 95%CI 2.06–3.05) were the risk factors for the allergic rhinitis without asthma. Aging [40–49 years old (OR 4.29, 95%CI 1.02–18.13); 50–59 years old (OR 5.89, 95%CI 1.40–24.76); ≥60 years old: (OR 6.14, 95%CI 1.41–26.71)], never-smokers (OR 1.66, 95%CI 0.99–2.80), comorbidities of other allergic disorders (OR 2.17, 95%CI 1.42–3.32), and family history of allergies (OR 2.20, 95%CI 1.40–3.47) were the risk factors for the asthma without allergic rhinitis. Advanced age [30–39 years (OR 2.16, 95%CI 1.23–3.82); 40–49 years (OR 2.86, 95%CI 1.56 to 5.25); 50–59 years (OR 2.95, 95%CI 1.58–5.51); ≥60 years old (OR 2.27, 95%CI 1.09–4.72)], higher education [middle and high school (OR 2.23, 95%CI 1.62–3.07); college and above (OR 4.28, 95%CI 2.72–6.74)], non-agricultural workers (OR 1.70, 95%CI 1.18–2.43),never-smokers (OR 2.26, 95%CI 1.51–3.39), comorbidities of other allergic diseases (OR 4.45, 95%CI 3.37–5.88), family history of allergies (OR 5.27, 95%CI 3.98–6.97), and plain lands areas (OR 2.07, 95%CI 1.51–2.86) were the risk factors for the combined allergic rhinitis with asthma. Conclusions: The prevalence of allergic rhinitis and asthma in Shenmu City was relatively high, with regional differences. Genetic and environmental factors were the important risk factors associated with allergic rhinitis and asthma. Our research would provide data support for preventing and controlling allergic rhinitis and asthma in this region in the future, and appropriate prevention and control programs should be formulated according to the characteristics of different regions.
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Affiliation(s)
- Huiping Gao
- Shenmu Hospital, The Affiliated Shenmu Hospital of Northwest University, Shenmu, China
| | - Yongliang Niu
- Shenmu Hospital, The Affiliated Shenmu Hospital of Northwest University, Shenmu, China
| | - Qiang Wang
- Shenmu Hospital, The Affiliated Shenmu Hospital of Northwest University, Shenmu, China
| | - Guangliang Shan
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Ma
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Haiying Wang
- Shenmu Hospital, The Affiliated Shenmu Hospital of Northwest University, Shenmu, China
| | - Yaoda Hu
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Kai Guan
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianqing Gu
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Wang
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Wang
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongmei Zhao
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Han
- Shenmu Hospital, The Affiliated Shenmu Hospital of Northwest University, Shenmu, China
| | - Haiyuan Chen
- Shenmu Hospital, The Affiliated Shenmu Hospital of Northwest University, Shenmu, China
| | - Wenxia Ruan
- Shenmu Hospital, The Affiliated Shenmu Hospital of Northwest University, Shenmu, China
| | - Hanlin Zhang
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Cong Cong
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yonglin Liu
- Shenmu Hospital, The Affiliated Shenmu Hospital of Northwest University, Shenmu, China
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Racine G, Forget A, Moullec G, Jiao T, Blais L, Lemiere C. Predictors of Asthma Control and Exacerbations: A Real-World Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2802-2811.e2. [PMID: 33962067 DOI: 10.1016/j.jaip.2021.04.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 04/12/2021] [Accepted: 04/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Achieving optimal asthma control and minimizing the risk of exacerbation are the main goals of asthma treatment. OBJECTIVE This study aimed to assess the predictors of poor asthma control and asthma exacerbations within a population of moderate to severe asthmatic patients treated in a tertiary-care center. METHODS We conducted a cohort study assessing 738 patients enrolled in the Quebec registry in respiratory health (RESP) with a diagnosis of asthma confirmed by a respirologist and treated in a tertiary care center from April 2010 to March 2016. Sociodemographic and clinical data, including Asthma Control Questionnaire score, were collected at enrollment in the registry (ie, cohort entry) and patients were followed for a 2-year period thereafter. The information regarding exacerbations that occurred during follow-up was collected in administrative databases (Régie d l'assurance médicale du Québec [RAMQ], Maintenance et exploitation des données pour l'étude de la clientèle hospitalière [MED-ECHO], and medication data registry [reMed]). RESULTS We assessed 738 subjects (64% women). Psychological distress (odds ratio [OR] 1.91; 95% confidence interval [95% CI] 1.21-3.02), smoking (OR 3.72; 95% CI 1.72-8.05]), and poor lung function, forced expiratory volume in 1 second less than 50% (OR 4.1; 95% CI 1.48-11.34]) appeared as significant factors associated with uncontrolled asthma. Occurrence of previous asthma exacerbations (hazard ratio [HR] 6.25; 95% CI 4.01-9.75]), poor asthma control (HR 1.60; 95% CI 1.07-2.38]), forced expiratory volume in 1 second between 50% and 80% (HR 2.25; 95% CI 1.58-3.34]), and older age (HR 2.26; 95% CI 1.37-3.74]) were associated with asthma exacerbations. Adherence to asthma treatment was very low in patients with (44.4% ± 34.4%) and without asthma exacerbations (37.5% ± 33.0%). CONCLUSIONS Psychological distress and current smoking are modifiable factors that need to be addressed in tailored behavioral interventions to improve asthma control. Asthma exacerbations are mostly associated with the intrinsic severity of the disease.
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Affiliation(s)
- Geneviève Racine
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
| | - Amélie Forget
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
| | - Grégory Moullec
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
| | - Tianze Jiao
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Lucie Blais
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada
| | - Catherine Lemiere
- CIUSSS du nord de l'île de Montréal, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada.
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Zheng XY, Li ZL, Li C, Guan WJ, Li LX, Xu YJ. Effects of cigarette smoking and biomass fuel on lung function and respiratory symptoms in middle-aged adults and the elderly in Guangdong province, China: A cross-sectional study. INDOOR AIR 2020; 30:860-871. [PMID: 32249960 DOI: 10.1111/ina.12671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
We sought to investigate the association between active cigarette smoking (ex- and current smokers) with or without exposure to biomass fuels and respiratory symptoms/lung function in middle-aged adults and the elderly. In the chronic obstructive pulmonary disease surveillance conducted in six cities of Guangdong province, China, we surveyed 1986 residents aged 40-93 years. We recorded respiratory symptoms, smoking status, use of biomass fuel, and other covariates by using a structured questionnaire. All models were adjusted for second-hand smoking. Active smoking with or without exposure to biomass fuels was significantly associated with wheezing, chronic cough, and phlegm (all P < .05). Active smoking alone with or without exposure to biomass fuels was associated with 2.5% and 0.6% reduction in the mean forced vital capacity predicted, 6.8% and 4.2% reduction in the mean forced expiratory volume in one second predicted, and 9.0% and 4.7% reduction in the mean maximal mid-expiratory flow predicted compared with the exposure to neither smoking nor biomass fuels, respectively. However, exposure to biomass fuel alone was associated with neither greater lung function impairment nor respiratory symptoms except for chronic cough. Efforts should be made to protect home owners and their family from adverse effects of indoor air pollution.
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Affiliation(s)
- Xue-Yan Zheng
- Institute of Non-Communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangdong, China
| | - Zhang-Long Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Chuan Li
- Institute of Non-Communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangdong, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Li-Xia Li
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yan-Jun Xu
- Institute of Non-Communicable Disease Control and Prevention, Guangdong Provincial Center for Disease Control and Prevention, Guangdong, China
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Masjedi MR, Ainy E, Fakharian A, Eslaminejad A, Paydar R. Role of Common Variables: Age, Gender, BMI, Rhinosinusitis, and Smoking among Asthmatic and Severe Asthmatic Patients. TANAFFOS 2020; 19:195-200. [PMID: 33815539 PMCID: PMC8008413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study was done to determine the role of common variables, including age, gender, body mass index (BMI), rhinosinusitis, and smoking among a group of asthmatic and severe asthmatic patients in 2016. MATERIALS AND METHODS This retrospective study was carried out from mid-June to the end of September 2016. Of 678 patients with asthma referred to private asthma clinics in Tehran, 163 subjects were selected. Severe asthma (SA) cases were diagnosed according to the SA definition (severe shortness of breath, chest tightness or pain, and coughing or wheezing, low peak expiratory flow (PEF) using a peak flow meter, and more than two days of wheezing and coughing per week). Patients with the presence of concomitant diseases, such as gastroesophageal reflux disease, sleep apnea, hypo- and hyperthyroidism, as well as users of nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded.According to the signs and symptoms and classic criteria of asthma, the subjects with SA were assigned to the case group and subjects with asthma to the control group. Besides, general information, including age, gender, BMI, smoking history, and the presence of Rhinosinusitis was collected. RESULTS Of 163 subjects, 92 patients (56.4%) were in the control, and 71 patients (43.6%) in the case group. The rate of SA among 678 patients was 10.47%. The mean age of the case group was 49.08 ±11.66 and the control group was 50.05 ±15.65 years. There was a significant difference in BMI between the case and control groups (p=0.034), especially among females in the case group (p=0.001). BMI was significantly higher in females than in males (p=0.002). Also, smoking status was not significant between the case and control groups (p=0.751). Rhinosinusitis was significantly higher in the case groups compared with the control groups (p= .014). CONCLUSION Rhinosinusitis was higher in SA patients (case group). SA was more observed among females than males and those who were more overweight. It seems that rhinosinusitis and obesity are more important risk factors. Moreover, obese female patients require more serious attention.
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Affiliation(s)
- Mohammad Reza Masjedi
- Department of Pulmonology and Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran,, Cancer Control Research Center, Cancer Control Foundation, Iran University of Medical Sciences, Tehran, Iran,, Tobacco Control Research Center (TCRC), Iranian Anti-tobacco Association, Iran University of Medical Sciences, Tehran, Iran
| | - Elaheh Ainy
- Department of Vice Chancellor Research Affair of Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Fakharian
- Chorionic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Eslaminejad
- Chorionic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roghayeh Paydar
- Department of Pulmonology and Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Schuers M, Chapron A, Guihard H, Bouchez T, Darmon D. Impact of non-drug therapies on asthma control: A systematic review of the literature. Eur J Gen Pract 2019; 25:65-76. [PMID: 30849253 PMCID: PMC6493294 DOI: 10.1080/13814788.2019.1574742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Despite growing access to effective therapies, asthma control still needs improvement. Many non-drug factors, such as allergens, air pollutants and stress also affect asthma control and patient quality of life, but an overview of the effectiveness of non-drug interventions on asthma control was lacking. Objectives: To identify non-drug interventions likely to improve asthma control. Methods: A systematic review of the available literature in Medline and the Cochrane Library was conducted in March 2017, without any time limit. Initial searching identified 884 potentially relevant clinical trial reports, literature reviews and meta-analyses, which were screened for inclusion using criteria of quality, relevance, and reporting outcomes based on asthma control. Results: Eighty-two publications met the inclusion criteria. In general, the quality of the studies was low. Patient education programmes (22 studies) significantly improved asthma control. Multifaceted interventions (10 studies), which combined patient education programmes with decreasing exposure to indoor allergens and pollutants, significantly improved asthma control based on clinically relevant outcomes. Renovating homes to reduce exposure to allergens and indoor pollutants improved control (two studies). Air filtration systems (five studies) were effective, especially in children exposed to second-hand smoke. Most measures attempting to reduce exposure to dust mites were ineffective (five studies). Dietary interventions (eight studies) were ineffective. Promoting physical activity (five studies) tended to yield positive results, but the results did not attain significance. Conclusion: Twenty-six interventions were effective in asthma control. Simultaneously combining several action plans, each focusing on different aspects of asthma management, seems most likely to be effective.
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Affiliation(s)
- Matthieu Schuers
- a Department of General Medicine , Rouen University , Rouen , France
| | - Anthony Chapron
- b Department of General Medicine , Rennes University , Rennes , France
| | - Hugo Guihard
- a Department of General Medicine , Rouen University , Rouen , France
| | - Tiphanie Bouchez
- c Department of General Medicine , Nice University , Nice , France
| | - David Darmon
- c Department of General Medicine , Nice University , Nice , France
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Fernandes AGO, de Souza-Machado C, Pinheiro GP, de Oliva ST, Mota RCL, de Lima VB, Cruz CS, Chatkin JM, Cruz ÁA. Dual exposure to smoking and household air pollution is associated with an increased risk of severe asthma in adults in Brazil. Clin Transl Allergy 2018; 8:48. [PMID: 30555680 PMCID: PMC6287342 DOI: 10.1186/s13601-018-0235-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background The relationship between smoking, household pollution, dual exposure and severity of asthma in adults has not been sufficiently studied. We examined and compared the effects of cigarette smoking, domestic wood burning pollution and dual exposure (tobacco and wood burning) upon asthma severity in adults. Methods This was a cross-sectional study performed with 452 individuals with mild to moderate asthma and 544 patients with severe asthma (previously untreated). Smoking and exposure to wood smoke were identified and quantified through questionnaires to evaluate current and/or previous exposure; objective determination of cigarette exposure was obtained through the measurement of urinary cotinine. Asthma control was evaluated through Asthma Control Questionnaire; and severity was classified according to the Global Initiative for Asthma criteria. Subjects were grouped according to exposure type into 4 groups: smokers, household pollution, dual-exposure and no-exposure. Chi square, Mann-Whitney, and Kruskal-Wallis tests were used for comparisons between groups. Results Out of 996 included individuals, 78 (7.8%) were exposed to cigarette smoking alone, 358 (35.9%) to household pollution alone, 155 (15.6%) to the two exposures combined and 405 (40.7%) were not exposed. Compared to unexposed individuals, exposure to household pollution resulted in poorer asthma control, higher proportion of severe asthma, and worse indicators of lung function. The double-exposed individuals were worse off in all the evaluated parameters, and they were significantly worse than subjects with single exposure to household air pollution in relation to asthma severity and lung function. These subjects were predominantly females, older, with longer residence time in rural areas, lower income and lower schooling levels. Multivariate analysis showed that exposure to household pollution and double exposure were predictive factors associated with lack of control and increased severity of asthma. Conclusions Exposure to household pollution is associated with poorer control, greater severity, and poorer pulmonary function; double-exposed individuals have a greater risk of severe asthma and decreased lung function than those exposed only to household pollution.
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Affiliation(s)
- Andréia Guedes Oliva Fernandes
- 1Programa para o Controle da Asma na Bahia (ProAR) e Programa de Pós-graduação em Medicina e Saúde, Centro de Saúde Carlos Gomes, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Rua Carlos Gomes 270, 7° andar, Salvador, Bahia 40060-330 Brazil
| | - Carolina de Souza-Machado
- 2Programa para o Controle da Asma na Bahia (ProAR) e Programa de Pós-graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Escola de Enfermagem da Universidade Federal da Bahia, UFBA, Rua Dr Augusto Vianna. 2 andar. Campus Canela, Salvador, Bahia 40110-060 Brazil
| | - Gabriela Pimentel Pinheiro
- 1Programa para o Controle da Asma na Bahia (ProAR) e Programa de Pós-graduação em Medicina e Saúde, Centro de Saúde Carlos Gomes, Faculdade de Medicina da Bahia, Universidade Federal da Bahia (UFBA), Rua Carlos Gomes 270, 7° andar, Salvador, Bahia 40060-330 Brazil
| | - Sergio Telles de Oliva
- 3Laboratório de Química Analítica Ambiental, Departamento de Química Analítica, Instituto de Química, Universidade Federal da Bahia, Brazil, Rua Barão de Jeremoabo, 147. Campus de Ondina, Salvador, Bahia 40170-115 Brazil
| | - Raquel Cristina Lins Mota
- 4Serviço de Endoscopia Digestiva do Hospital das Clínicas de Universidade de São Paulo, PAMB, Prédio dos Ambulatórios, Av. Dr. Enéas Carvalho de Aguiar, 155 - 6°. Andar, Sala 3, São Paulo, SP CEP 05403-900 Brazil
| | - Valmar Bião de Lima
- 5Programa para o Controle da Asma na Bahia (ProAR), UFBA - Centro de Saúde Carlos Gomes, Rua Carlos Gomes 270, 7° andar, Salvador, Bahia 40060-330 Brazil
| | - Constança Sampaio Cruz
- Programa de Pós-Graduação em Medicina e Saúde Humana. Escola Bahiana de Medicina e Saúde Pública (EBMSP), Obras Sociais Irmã Dulce. Hospital Santo Antônio - Avenida Bonfim, 161 Largo de Roma, Salvador, Bahia 40420-415 Brazil
| | - José Miguel Chatkin
- 7Escola de Medicina da Pontifícia, Universidade Católica do Rio Grande do Sul, Brazil, Av. Ipiranga, 6690, Porto Alegre, Rio Grande do Sul 90610-000 Brazil
| | - Álvaro A Cruz
- 5Programa para o Controle da Asma na Bahia (ProAR), UFBA - Centro de Saúde Carlos Gomes, Rua Carlos Gomes 270, 7° andar, Salvador, Bahia 40060-330 Brazil
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10
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Thomson NC. Challenges in the management of asthma associated with smoking-induced airway diseases. Expert Opin Pharmacother 2018; 19:1565-1579. [PMID: 30196731 DOI: 10.1080/14656566.2018.1515912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Smoking-induced airway diseases such as chronic bronchitis, emphysema, and small airway dysfunction contribute to the chronic respiratory symptoms experienced by adults with asthma, including those with spirometric chronic obstructive pulmonary disease (COPD), termed asthma-COPD overlap (ACO). Drug treatment of symptomatic smokers with asthma or ACO is uncertain due to their exclusion from most clinical trials. AREAS COVERED This review summarizes evidence for the efficacy of small molecule drugs used in the clinic to treat current and former smokers with a diagnostic label of asthma or ACO. Other therapeutic interventions are reviewed, including smoking cessation and biologics. EXPERT OPINION Clinical trials and observational studies suggest that smoking cessation and approved drugs used to treat non-smokers with asthma produce clinical benefits in smokers with asthma or ACO, although the overall quality of evidence is low. The efficacy of some treatments for asthma is altered in current smokers, including reduced responsiveness to short-term inhaled corticosteroids and possibly improved responsiveness to leukotriene receptor antagonists. Preliminary findings suggest that low-dose theophylline, statins, and biologics, such as omalizumab, mepolizumab, and dupilumab, may improve clinical outcomes in smokers with asthma or ACO. Improved phenotyping and endotyping of asthma and smoking-induced airway diseases should lead to better targeted therapies.
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Affiliation(s)
- Neil C Thomson
- a Institute of Infection, Immunity & Inflammation , University of Glasgow , Glasgow , UK
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11
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Lewis K, Morgan M, Jenkins DR. Slowing Progression of Airway Diseases by Smoking Cessation and Reducing Infections. EUROPEAN MEDICAL JOURNAL 2018. [DOI: 10.33590/emj/10310522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The prevalence of respiratory diseases, including asthma and chronic obstructive pulmonary disease, has increased in recent decades, placing a significant burden on healthcare systems and economies around the world. As these diseases are largely incurable, the aim of treatment is to control symptoms and improve quality of life. Aside from stopping smoking and reducing biomass fuel exposure, arguably the most effective strategy in the long-term management of chronic respiratory diseases is the prevention or control of respiratory infections via vaccines and antimicrobial agents. By preventing these infections or reducing exposure to some of the major risk factors, we can reduce further lung damage in these patients, thereby slowing disease progression. This review looks at maintaining long-term respiratory health in patients with asthma and chronic obstructive pulmonary disease, primarily through smoking cessation, reducing exposure to allergens and air pollutants, and infection control.
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Affiliation(s)
- Keir Lewis
- Swansea University, Swansea, UK; Hywel Dda University Health Board, UK
| | - Mike Morgan
- Department of Respiratory Medicine, Allergy and Thoracic Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK; University of Leicester, Leicester, UK
| | - David R. Jenkins
- University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
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12
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Qu J, Li Y, Zhong W, Gao P, Hu C. Recent developments in the role of reactive oxygen species in allergic asthma. J Thorac Dis 2017; 9:E32-E43. [PMID: 28203435 DOI: 10.21037/jtd.2017.01.05] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Allergic asthma has a global prevalence, morbidity, and mortality. Many environmental factors, such as pollutants and allergens, are highly relevant to allergic asthma. The most important pathological symptom of allergic asthma is airway inflammation. Accordingly, the unique role of reactive oxygen species (ROS) had been identified as a main reason for this respiratory inflammation. Many studies have shown that inhalation of different allergens can promote ROS generation. Recent studies have demonstrated that several pro-inflammatory mediators are responsible for the development of allergic asthma. Among these mediators, endogenous or exogenous ROS are responsible for the airway inflammation of allergic asthma. Furthermore, several inflammatory cells induce ROS and allergic asthma development. Airway inflammation, airway hyper-responsiveness, tissue injury, and remodeling can be induced by excessive ROS production in animal models. Based on investigations of allergic asthma and ROS formation mechanisms, we have identified several novel anti-inflammatory therapeutic treatments. This review describes the recent data linking ROS to the pathogenesis of allergic asthma.
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Affiliation(s)
- Jingjing Qu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China;; Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yuanyuan Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wen Zhong
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Peisong Gao
- Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
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13
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Perret JL, Bonevski B, McDonald CF, Abramson MJ. Smoking cessation strategies for patients with asthma: improving patient outcomes. J Asthma Allergy 2016; 9:117-28. [PMID: 27445499 PMCID: PMC4928655 DOI: 10.2147/jaa.s85615] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as "lung age" should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large.
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Affiliation(s)
- Jennifer L Perret
- Allergy and Lung Health Unit, The University of Melbourne, Melbourne, VIC
- Institute for Breathing & Sleep, Melbourne, VIC
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, VIC
| | - Billie Bonevski
- School of Medicine & Public Health, University of Newcastle, NSW
| | - Christine F McDonald
- Institute for Breathing & Sleep, Melbourne, VIC
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, VIC
- Department of Medicine, The University of Melbourne, Melbourne, VIC
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC
- Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, Melbourne, VIC, Australia
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14
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Sekiya K, Nakatani E, Fukutomi Y, Kaneda H, Iikura M, Yoshida M, Takahashi K, Tomii K, Nishikawa M, Kaneko N, Sugino Y, Shinkai M, Ueda T, Tanikawa Y, Shirai T, Hirabayashi M, Aoki T, Kato T, Iizuka K, Homma S, Taniguchi M, Tanaka H. Severe or life-threatening asthma exacerbation: patient heterogeneity identified by cluster analysis. Clin Exp Allergy 2016; 46:1043-55. [PMID: 27041475 DOI: 10.1111/cea.12738] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Severe or life-threatening asthma exacerbation is one of the worst outcomes of asthma because of the risk of death. To date, few studies have explored the potential heterogeneity of this condition. OBJECTIVES To examine the clinical characteristics and heterogeneity of patients with severe or life-threatening asthma exacerbation. METHODS This was a multicentre, prospective study of patients with severe or life-threatening asthma exacerbation and pulse oxygen saturation < 90% who were admitted to 17 institutions across Japan. Cluster analysis was performed using variables from patient- and physician-orientated structured questionnaires. RESULTS Analysis of data from 175 patients with severe or life-threatening asthma exacerbation revealed five distinct clusters. Cluster 1 (n = 27) was younger-onset asthma with severe symptoms at baseline, including limitation of activities, a higher frequency of treatment with oral corticosteroids and short-acting beta-agonists, and a higher frequency of asthma hospitalizations in the past year. Cluster 2 (n = 35) was predominantly composed of elderly females, with the highest frequency of comorbid, chronic hyperplastic rhinosinusitis/nasal polyposis, and a long disease duration. Cluster 3 (n = 40) was allergic asthma without inhaled corticosteroid use at baseline. Patients in this cluster had a higher frequency of atopy, including allergic rhinitis and furred pet hypersensitivity, and a better prognosis during hospitalization compared with the other clusters. Cluster 4 (n = 34) was characterized by elderly males with concomitant chronic obstructive pulmonary disease (COPD). Although cluster 5 (n = 39) had very mild symptoms at baseline according to the patient questionnaires, 41% had previously been hospitalized for asthma. CONCLUSIONS & CLINICAL RELEVANCE This study demonstrated that significant heterogeneity exists among patients with severe or life-threatening asthma exacerbation. Differences were observed in the severity of asthma symptoms and use of inhaled corticosteroids at baseline, and the presence of comorbid COPD. These findings may contribute to a deeper understanding and better management of this patient population.
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Affiliation(s)
- K Sekiya
- Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan.,Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - E Nakatani
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - Y Fukutomi
- Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - H Kaneda
- Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, Japan
| | - M Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - M Yoshida
- Department of Internal Medicine, National Hospital Organization Fukuoka Hospital, Fukuoka, Japan
| | - K Takahashi
- Department of Respiratory Diseases and Chest Surgery, Otsu Red Cross Hospital, Otsu, Japan
| | - K Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - M Nishikawa
- Department of Respiratory Medicine, Fujisawa City Hospital, Fujisawa, Japan
| | - N Kaneko
- Department of Pulmonary Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Y Sugino
- Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan
| | - M Shinkai
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - T Ueda
- The Department of Respiratory Medicine, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Y Tanikawa
- Department of Respiratory Medicine and Clinical Immunology, Toyota Kosei Hospital, Toyota, Japan
| | - T Shirai
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - M Hirabayashi
- Department of Respiratory Diseases, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan
| | - T Aoki
- Department of Internal Medicine, Respiratory Division, Tokai University School of Medicine, Isehara, Japan
| | - T Kato
- Department of Respiratory Medicine and Allergology, Kariya Toyota General Hospital, Kariya, Japan
| | - K Iizuka
- Internal Medicine, Public Tomioka General Hospital, Tomioka, Japan
| | - S Homma
- Department of Respiratory Medicine, Toho University Omori Medical Center, Tokyo, Japan
| | - M Taniguchi
- Clinical Research Center for Allergology and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - H Tanaka
- NPO Sapporo Cough Asthma and Allergy Center, Sapporo, Japan
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15
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Cooke A, Fergeson J, Bulkhi A, Casale TB. The Electronic Cigarette: The Good, the Bad, and the Ugly. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:498-505. [PMID: 26164573 DOI: 10.1016/j.jaip.2015.05.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 01/16/2023]
Abstract
Electronic cigarettes (EC) are battery-powered nicotine delivery systems that have increased in popularity since they entered the US market. EC has been reported to contain less carcinogens than traditional cigarettes, cause less acute lung effects in healthy individuals, and may help with smoking cessation. It has also been viewed as a potential safer alternative for asthmatic smokers, but its effects on lung functions are unclear. However, EC do carry some harmful aspects as they contain formaldehyde and formaldehyde-forming hemiacetals as well as potentially toxic particulate matter that deposits on surfaces. EC are an increasingly popular device that could serve as a gateway into traditional cigarette smoking or illicit drugs. The popularity of EC has brought with it money from large tobacco corporations and mass marketing. Lack of regulation has generated product inconsistency and potential health hazards. This review highlights what is known and what still needs to be answered about EC.
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Affiliation(s)
- Andrew Cooke
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Fla
| | - Jennifer Fergeson
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Fla
| | - Adeeb Bulkhi
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Fla; Department of Internal Medicine, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida, Tampa, Fla.
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16
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Bucchieri F, Marino Gammazza A, Pitruzzella A, Fucarino A, Farina F, Howarth P, Holgate ST, Zummo G, Davies DE. Cigarette smoke causes caspase-independent apoptosis of bronchial epithelial cells from asthmatic donors. PLoS One 2015; 10:e0120510. [PMID: 25793769 PMCID: PMC4368206 DOI: 10.1371/journal.pone.0120510] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/23/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Epidemiologic studies have demonstrated important links between air pollution and asthma. Amongst these pollutants, environmental cigarette smoke is a risk factor both for asthma pathogenesis and exacerbation. As the barrier to the inhaled environment, the bronchial epithelium is a key structure that is exposed to cigarette smoke. OBJECTIVES Since primary bronchial epithelial cells (PBECs) from asthmatic donors are more susceptible to oxidant-induced apoptosis, we hypothesized that they would be susceptible to cigarette smoke-induced cell death. METHODS PBECs from normal and asthmatic donors were exposed to cigarette smoke extract (CSE); cell survival and apoptosis were assessed by fluorescence-activated cell sorting, and protective effects of antioxidants evaluated. The mechanism of cell death was evaluated using caspase inhibitors and immunofluorescent staining for apoptosis-inducing factor (AIF). RESULTS Exposure of PBEC cultures to CSE resulted in a dose-dependent increase in cell death. At 20% CSE, PBECs from asthmatic donors exhibited significantly more apoptosis than cells from non-asthmatic controls. Reduced glutathione (GSH), but not ascorbic acid (AA), protected against CSE-induced apoptosis. To investigate mechanisms of CSE-induced apoptosis, caspase-3 or -9 inhibitors were tested, but these failed to prevent apoptosis; in contrast, CSE promoted nuclear translocation of AIF from the mitochondria. GSH reduced the number of nuclear-AIF positive cells whereas AA was ineffective. CONCLUSION Our results show that PBECs from asthmatic donors are more susceptible to CSE-induced apoptosis. This response involves AIF, which has been implicated in DNA damage and ROS-mediated cell-death. Epithelial susceptibility to CSE may contribute to the impact of environmental tobacco smoke in asthma.
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Affiliation(s)
- Fabio Bucchieri
- Academic Unit of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC), University of Palermo, Palermo, Italy
- Istituto Euro-Mediterraneo di Scienza e Tecnologia (IEMEST), Palermo, Italy
- Institute of Biomedicine and Molecular Immunology (IBIM), Italian National Research Council (CNR), Palermo, Italy
| | - Antonella Marino Gammazza
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC), University of Palermo, Palermo, Italy
- Istituto Euro-Mediterraneo di Scienza e Tecnologia (IEMEST), Palermo, Italy
| | - Alessandro Pitruzzella
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC), University of Palermo, Palermo, Italy
- Istituto Euro-Mediterraneo di Scienza e Tecnologia (IEMEST), Palermo, Italy
| | - Alberto Fucarino
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC), University of Palermo, Palermo, Italy
- Istituto Euro-Mediterraneo di Scienza e Tecnologia (IEMEST), Palermo, Italy
| | - Felicia Farina
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC), University of Palermo, Palermo, Italy
| | - Peter Howarth
- Academic Unit of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
- Southampton National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Sir Henry Wellcome Laboratories, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
| | - Stephen T. Holgate
- Academic Unit of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
- Southampton National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Sir Henry Wellcome Laboratories, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
| | - Giovanni Zummo
- Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche (BIONEC), University of Palermo, Palermo, Italy
| | - Donna E. Davies
- Academic Unit of Clinical and Experimental Sciences, Sir Henry Wellcome Laboratories, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
- Southampton National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Sir Henry Wellcome Laboratories, University of Southampton Faculty of Medicine, University Hospital Southampton, Southampton, United Kingdom
- * E-mail:
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To T, Guan J, Zhu J, Lougheed MD, Kaplan A, Tamari I, Stanbrook MB, Simatovic J, Feldman L, Gershon AS. Quality of asthma care under different primary care models in Canada: a population-based study. BMC FAMILY PRACTICE 2015; 16:19. [PMID: 25886504 PMCID: PMC4336688 DOI: 10.1186/s12875-015-0232-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/26/2015] [Indexed: 11/24/2022]
Abstract
Background Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models. Methods Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators. Results All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group. Conclusions Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0232-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Teresa To
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - Jingqin Zhu
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada.
| | - M Diane Lougheed
- Department of Medicine, Queen's University, Kingston, Canada. .,ICES - Queen's, Kingston, Canada.
| | - Alan Kaplan
- Family Physician Airways Group of Canada, Warwick, Canada.
| | | | - Matthew B Stanbrook
- Institute for Clinical Evaluative Sciences, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Toronto Western Research Institute, University Health Network, Toronto, Canada.
| | - Jacqueline Simatovic
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada.
| | - Laura Feldman
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Andrea S Gershon
- Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Sunnybrook Health Sciences Centre, Toronto, Canada.
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18
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Park TJ, Park JS, Cheong HS, Park BL, Kim LH, Heo JS, Kim YK, Kim KU, Uh ST, Lee HS, Na JO, Seo KH, Choi JS, Kim YH, Kim MS, Park CS, Shin HD. Genome-wide association study identifies ALLC polymorphisms correlated with FEV₁ change by corticosteroid. Clin Chim Acta 2014; 436:20-6. [PMID: 24792382 DOI: 10.1016/j.cca.2014.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/16/2014] [Accepted: 04/18/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Asthma can be suppressed by inhaled corticosteroids (ICS). However, response to ICS shows marked inter-individual variability. This study is aimed to identify the genetic variants associated with the change in the percentage of forced expiratory volume in 1second (%ΔFEV1) following ICS treatment. METHODS A genome-wide association study was performed in a Korean asthmatic cohort. To further investigate these genetic associations, 11 additional single-nucleotide polymorphisms (SNPs) on the allantoicase (ALLC) gene were selected from the HapMap database and genotyped in the same asthmatic patients in the follow-up study. RESULTS In a genome-wide study, we identified the lowest P-value in ALLC, but none of the SNPs met the genome-wide association criteria (P<1.0×10(-8)). However, among 25 SNPs on ALLC in the follow-up study, 6 variants showed significant associations with the mean %ΔFEV1 in the study subjects (P<3.73×10(-6)). CONCLUSIONS Although the associated signals could not overcome the genome-wide multiple correction due to small sample size (n=189), our results suggest that associated SNPs of ALLC might be genetic predictors of response to ICS, at least with respect to ΔFEV1 in Korean asthmatics.
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Affiliation(s)
- Tae-Joon Park
- Department of Life Science, Sogang University, 35, Baekbeom-ro, Mapo-gu, Seoul 121-742, Republic of Korea
| | - Jong-Sook Park
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, 1174, Jung-dong, Wonmi-gu, Gyeonggi-do 420-020, Republic of Korea
| | - Hyun Sub Cheong
- Department of Genetic Epidemiology, SNP Genetics, Inc., 35, Baekbeom-ro, Mapo-gu, Seoul 121-742, Republic of Korea
| | - Byung-Lae Park
- Department of Genetic Epidemiology, SNP Genetics, Inc., 35, Baekbeom-ro, Mapo-gu, Seoul 121-742, Republic of Korea
| | - Lyoung Hyo Kim
- Department of Genetic Epidemiology, SNP Genetics, Inc., 35, Baekbeom-ro, Mapo-gu, Seoul 121-742, Republic of Korea
| | - Jeong Seok Heo
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, 1174, Jung-dong, Wonmi-gu, Gyeonggi-do 420-020, Republic of Korea
| | - Yang Ki Kim
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 140-887, Republic of Korea
| | - Ki-Up Kim
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 140-887, Republic of Korea
| | - Soo-Taek Uh
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Seoul Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 140-887, Republic of Korea
| | - Ho Sung Lee
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Cheonan Hospital, 23-20, Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 330-721, Republic of Korea
| | - Joo-Ock Na
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Cheonan Hospital, 23-20, Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 330-721, Republic of Korea
| | - Ki-Hyun Seo
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Cheonan Hospital, 23-20, Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 330-721, Republic of Korea
| | - Jae-Sung Choi
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Cheonan Hospital, 23-20, Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 330-721, Republic of Korea
| | - Yong Hoon Kim
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Cheonan Hospital, 23-20, Byeongmyeong-dong, Dongnam-gu, Cheonan, Chungcheongnam-do 330-721, Republic of Korea
| | - Myung-Sin Kim
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Gumi Hospital, 250, Gongdan-dong, Gumi, Kyungsangbook-do 730-706, Republic of Korea
| | - Choon-Sik Park
- Division of Allergy and Respiratory Medicine, Soonchunhyang University Bucheon Hospital, 1174, Jung-dong, Wonmi-gu, Gyeonggi-do 420-020, Republic of Korea.
| | - Hyoung Doo Shin
- Department of Life Science, Sogang University, 35, Baekbeom-ro, Mapo-gu, Seoul 121-742, Republic of Korea; Department of Genetic Epidemiology, SNP Genetics, Inc., 35, Baekbeom-ro, Mapo-gu, Seoul 121-742, Republic of Korea.
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Ryan D, Murphy A, Ställberg B, Baxter N, Heaney LG. 'SIMPLES': a structured primary care approach to adults with difficult asthma. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:365-73. [PMID: 23974674 PMCID: PMC6442837 DOI: 10.4104/pcrj.2013.00075] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The substantial majority of patients with asthma can expect minimal breakthrough symptoms on standard doses of inhaled corticosteroids with or without additional add-on therapies. SIMPLES is a structured primary care approach to the review of a person with uncontrolled asthma which encompasses patient education monitoring, lifestyle and pharmacological management and addressing support needs which will achieve control in most patients. The small group of patients presenting with persistent asthma symptoms despite being prescribed high levels of treatment are often referred to as having 'difficult asthma'. Some will have difficult, 'therapy resistant' asthma, some will have psychosocial problems which make it difficult for them to achieve asthma control and some may prove to have an alternative diagnosis driving their symptoms. A few patients will benefit from referral to a 'difficult asthma' clinic. The SIMPLES approach, aligned with close co-operation between primary and specialist care, can identify this patient group, avoid inappropriate escalation of treatment, and streamline clinical assessment and management.
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Affiliation(s)
- Dermot Ryan
- General Practitioner, Woodbrook Medical Centre, Loughborough, UK; Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
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Gratziou C, Florou A, Ischaki E, Eleftheriou K, Sachlas A, Bersimis S, Zakynthinos S. Smoking cessation effectiveness in smokers with COPD and asthma under real life conditions. Respir Med 2014; 108:577-83. [PMID: 24560410 DOI: 10.1016/j.rmed.2014.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 01/01/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Although smoking cessation is strongly indicated by international guidelines as an effective therapeutic tool for patients with COPD and Asthma, a large proportion of them do not quit smoking and they are regarded as a "difficult" target group. AIM To study the effectiveness of an intensive smoking cessation program in smokers with COPD and asthma under real-life conditions. METHODS 166 smokers with COPD, 120 smokers with asthma and 1854 control smokers attended the smoking cessation program in the out-patient patient Smoking Cessation Clinic of the Pulmonary Department in Athens University. Continuous Abstinence Rate (CAR) was evaluated in 3, 6, 9 and 12 months after the target quit date. RESULTS Short-term CAR (in 3 months) was 49.4% for COPD smokers, 51.7% for asthmatic smokers and 48.0% for the control group of smokers. 12 months after the initial visit the CAR was 13.9%, 18.3% and 15.9%, respectively. No statistically significant differences between groups at any study period were found. Smokers with good compliance with the program had higher long-term CAR after 12 months: 37.7% in COPD smokers, 40.0% in asthmatic smokers and 39.3% in control smokers. High CAR was observed at all stages of COPD severity. CONCLUSION The results support the view that smokers with respiratory obstructive airway diseases of any severity should be offered an intensive smoking cessation program with regular and long-term follow-up. This will help them to achieve high abstinence rates and prevent relapses.
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Affiliation(s)
- Ch Gratziou
- Smoking Cessation Clinic, Pulmonary and Critical Care Department, Medical School, University of Athens, Athens, Greece.
| | - A Florou
- Smoking Cessation Clinic, Pulmonary and Critical Care Department, Medical School, University of Athens, Athens, Greece
| | - E Ischaki
- Pulmonary and Critical Care Department, Medical School, Evaggelismos Hospital, University of Athens, Athens, Greece
| | - K Eleftheriou
- Pulmonary and Critical Care Department, Medical School, Evaggelismos Hospital, University of Athens, Athens, Greece
| | - A Sachlas
- Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece
| | - S Bersimis
- Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece
| | - S Zakynthinos
- Pulmonary and Critical Care Department, Medical School, Evaggelismos Hospital, University of Athens, Athens, Greece
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21
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The gender-specific association between asthma and the need to smoke tobacco. Heart Lung 2013; 43:77-83. [PMID: 24238774 DOI: 10.1016/j.hrtlng.2013.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the associations between multidimensional tobacco dependence and youths' asthma status with gender as an effect modifier. BACKGROUND Despite the adverse respiratory effects, some adolescents with asthma smoke tobacco. Girls and boys have been shown to have different motivations for tobacco use. METHODS Secondary analyses were conducted of data obtained from 1248 adolescents who completed the British Columbia Youth Survey of Smoking and Health II. The sample was limited to youth who reported current or experimental tobacco use and who provided asthma status information. Tobacco dependence was assessed with the modified-Fagerström Tolerance Questionnaire and four-dimension Adolescents' Need for Smoking Scale (ANSS), which assesses social dependence, physical dependence, emotional dependence, and sensory dependence on tobacco. All analyses were stratified by gender. RESULTS The sample was 535 boys and 713 girls who were 15.9 years of age (SD = 1.5), on average. Gender was associated with both self-reported asthma status and the physical dependence dimension of the ANSS. Multiple linear regression analyses revealed that girls with asthma, compared with girls without asthma, had higher physical tobacco dependence scores, after adjusting for demographic and other factors. None of the tobacco dependence dimensions was associated with the asthma status of boys. CONCLUSIONS Asthmatic girls who report smoking may be doing so because they develop physical dependence relatively quickly and lose their autonomy with respect to tobacco use. They may require significant support for smoking cessation, including cognitive behavioral therapy and nicotine replacement therapy.
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Wang D, Xiao W, Ma D, Zhang Y, Wang Q, Wang C, Ji X, He B, Wu X, Chen H, Zhang Y, Jiang Y, Yin J. Cross-sectional epidemiological survey of asthma in Jinan, China. Respirology 2013; 18:313-22. [PMID: 23121025 DOI: 10.1111/resp.12005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence and control of asthma in all ages are seldom known in Jinan, China. This study aims to determine the prevalence, related factors and control of asthma in populations of all ages in Jinan, China. METHODS A cross-sectional epidemiological questionnaire survey was performed with all members from approximately 4500 randomly selected families from 60 communities in the urban area and in 40 villages in the rural area. The completed questionnaires were focused on asthma, asthma-like respiratory symptoms and asthma control. RESULTS A total of 13,645 individuals were interviewed in the survey, and the number of effective questionnaires reached 13,419. The asthma prevalence of all ages in Jinan was 1.1%. Atopy, asthma family history, household size and age were independent factors related to asthma. The control of asthma in Jinan was suboptimal in a high proportion of patients and even worse in the rural area. CONCLUSIONS The asthma prevalence for all ages in Jinan was relatively low compared with that in western countries; however, local asthma control fell markedly short from the goals of the Global Initiative for Asthma (GINA) criteria for asthma management, which may be attributed to the poor adherence to GINA guidelines, especially the underuse of preventative medication of inhaled corticosteroids.
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Affiliation(s)
- Dexiang Wang
- Department of Respiratory Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, China
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