Dual exposure to smoking and household air pollution is associated with an increased risk of severe asthma in adults in Brazil

The association of asthma and air pollution: Evidence from India

In the last two decades, air pollution has increased throughout India resulting in the deterioration of air quality. This paper estimates the prevalence of self-reported asthma in women aged 15-49 years and examines the link between outdoor air pollution and disease prevalence in India by combining satellite data on particulate matter (PM2.5) and the National Family Health Survey (NFHS-4), 2015-16. The results indicate that both indoor pollution as well as outdoor air pollution are important risk factors for asthma in women as both independently increase the probability of asthma among this group. Strategies around the prevention of asthma need to recognize the role of both indoor as well as outdoor air pollution. The other significant risk factors for asthma are smoking, second-hand smoking, type of diet and obesity.

Immunologic, genetic, and ecological interplay of factors involved in allergic diseases

An allergic or type I hypersensitivity reaction involves a misdirected immune overreaction to innocuous environmental and dietary antigens called allergens. The genetic predisposition to allergic disease, referred to as atopy, can be expressed as a variety of manifestations-e.g., allergic rhinitis, allergic conjunctivitis, atopic dermatitis, allergic asthma, anaphylaxis. Globally, allergic diseases are one the most common types of chronic conditions. Several factors have been identified to contribute to the pathogenesis and progression of the disease, leading to distinctively variable clinical symptoms. The factors which can attenuate or exacerbate allergic reactions can range from genetic heterozygosity, the prominence of various comorbid infections, and other factors such as pollution, climate, and interactions with other organisms and organism-derived products, and the surrounding environment. As a result, the effective prevention and control of allergies remains to be one of the most prominent public health problems. Therefore, to contextualize the current knowledge about allergic reactions, this review paper attempts to synthesize different aspects of an allergic response to describe its significance in the global health scheme. Specifically, the review shall characterize the biomolecular mechanisms of the pathophysiology of the disease based on underlying disease theories and current findings on ecologic interactions and describe prevention and control strategies being utilized. An integrated perspective that considers the underlying genetic, immunologic, and ecologic aspects of the disease would enable the development of more effective and targeted diagnostic tools and therapeutic strategies for the management and control of allergic diseases.

Issue 2 - "Update on adverse respiratory effects of indoor air pollution". Part 2): Indoor air pollution and respiratory diseases: Perspectives from Italy and some other GARD countries

OBJECTIVE

to synthesize the Italian epidemiological contribution to knowledge on indoor pollution respiratory impact, and to analyze the perspective of some GARD countries on the health effects of indoor air pollution.

RESULTS

Italian epidemiological analytical studies confirmed a strong relationship between indoor air pollution and health in general population. Environmental tobacco smoke, biomass (wood/coal) fuel for cooking/heating and indoor allergens (house dust mites, cat and dog dander, mold/damp) are the most relevant indoor pollution sources and are related to respiratory and allergic symptoms/diseases in Italy and in other GARD countries such as Mexico, Brazil, Vietnam, India, Nepal and Kyrgyzstan. Community-based global health collaborations are working to improve prevention, diagnosis and care of respiratory diseases around the world, specially in low- and middle-income countries, through research and education.

CONCLUSIONS

in the last thirty years, the scientific evidence produced on respiratory health effects of indoor air pollution has been extensive, but the necessity to empower the synergies between scientific community and local administrations remains a challenge to address in order to implement effective interventions. Based on abundant evidence of indoor pollution health effect, WHO, scientific societies, patient organizations and other members of the health community should work together to pursue the GARD vision of "a world where all people breathe freely" and encourage policy makers to increase their engagement in advocacy for clean air.

2030 Agenda: discussion on Brazilian priorities facing air pollution and climate change challenges

The advance of human activities in a disorderly way has accelerated in recent decades, intensifying the environmental impacts directly linked to these practices. The atmosphere, essential for the maintenance of life, is increasingly saturated with pollutants, offering risks to practically all the inhabitants of the planet, a process that, in addition to causing illness and early mortality, is related to serious financial losses (including in the production of goods), dangerous temperature increase and severe natural disasters. Although this perception is not recent, the global initiative to control the different mechanisms that trigger the commitment of biodiversity and irreversible climate changes arising from pollution is still very incipient, given that global initiatives on the subject emerged just over 50 years ago. Brazil is a territory that centralizes many of these discussions, as it still faces both political and economic obstacles in achieving a sustainable growth model as it was agreed through the United Nations 2030 Agenda. Even though there is little time left for the completion of these goals, much remains to be done, and despite the fulfillment of this deadline, the works will certainly need to be extended for much longer until an effective reorientation of consciousness occurs. Scientific researches and discussions are fundamental tools to the understanding of issues still little explored in this field.

Identification of Modifiable Risk Factors of Exacerbations Chronic Respiratory Diseases with Airways Obstruction, in Vietnam

OBJECTIVES

to determine modifiable risk factors of exacerbations in chronic respiratory diseases with airways obstruction (i.e., asthma and COPD) in southern Vietnam.

METHODS

an environmental and health-related behavioural questionnaire was submitted to patients with both chronic respiratory symptoms and airways obstruction. An exacerbation was defined as any acute worsening in clinical symptoms requiring a change in treatment, in a patient receiving prophylactic therapy.

RESULTS

235 patients were evaluated, including 131 (56%) chronic obstructive pulmonary disease (COPD) and 104 (44%) asthmatics. There were 75% males and 69% smokers. Occupational exposure accounted for 66%, mainly among construction and industry workers. Smoking was associated with more severe airways obstruction. Respiratory exacerbations were reported in 56/235 patients (24%). The risk of exacerbation was increased in patients with a lower education level, exposure to occupational pollutants, cumulative smoking ≥ 20 pack year, housing space < 10 m², and poorly ventilated housing. Based on multivariate analysis, the risk of exacerbation remained significantly higher among patients with occupational exposure and low housing space per person.

CONCLUSIONS

besides smoking cessation, more supportive policies, including improvement of occupational environment and housing design for better ventilation, are needed to prevent the severity of chronic respiratory diseases in Vietnam.

Asthma and Tobacco Smoking

Asthma is a prevalent chronic pulmonary condition with significant morbidity and mortality. Tobacco smoking is implicated in asthma pathophysiology, diagnosis, prognosis and treatment. Smokers display increased prevalence and incidence of asthma, but a causal association cannot be claimed using existing evidence. Second-hand smoking and passive exposure to tobacco in utero and early life have also been linked with asthma development. Currently, approximately one-fourth of asthma patients are smokers. Regular smokers with asthma might display accelerated lung function decline and non-reversible airflow limitation, making their distinction from chronic obstructive pulmonary disease patients challenging. Asthma patients who smoke typically have uncontrolled disease, as shown by increased symptoms, more exacerbations and impaired quality of life. On the other hand, smoking cessation improves lung function and asthma severity. Thus, asthma patients and their caregivers should be actively questioned about their smoking status at each medical encounter, and smoking cessation ought to be strongly encouraged both for patients with asthma and their close contacts. Smokers with asthma should be provided with comprehensive smoking cessation interventions on top of other anti-asthma medications.

A comparative analysis of biomass and clean fuel exposure on pulmonary function during cooking among rural women in Tamilnadu, India

It is of interest to document data on the comparative analysis of biomass and clean fuel exposure on pulmonary function during cooking among rural women. The study consisted of 100 biomass and 100 LPG fuel using women with no smoking habits and other related illness Parameters such as FVC, FEV1, FEV1/FVC, PEFR, FEF25-75%were obtained using the computerized spirometry to assess the pulmonary function in these subjects. The collected data were analyzed using the Student t-test method and Pearson correlation. The exposure index for biomass fuel users is 69.78±27.25 showing high exposure duration during cooking. The parameters for pulmonary functions significantly declined in FVC (42.34±13.6), FEV1 (45.55±15.98), PEFR (34.11±14.78) and FEF25-75% (45.56±23.00) for biomass fuel user. However, this is not true for FEV1/FVC ratio (107.56±16.9). The increase in PFT suggests the restrictive and obstructive patterns of pulmonary diseases. There was a negative correlation between increased duration of cooking and the value of FEV1/FVC (r = -0.2961), FEF25-75% (r = -0.3519) and PEFR (r = -0.2868). Thus, the deformation of pulmonary function due to extended exposure of biomass fuel for cooking women in rural Tamilnadu is shown using parameter features such as high exposure index, overcrowded area and improper ventilated houses.

Association of quality of life and disease control with cigarette smoking in patients with severe asthma

More information is needed on asthma control and health-related quality of life (HRQoL) in smokers with severe asthma. The main study objective was to characterize the association of HRQoL and disease control with cigarette smoking in individuals with severe asthma. A secondary objective was to analyze subject characteristics according to asthma onset: asthma that developed before smoking initiation versus asthma that developed after smoking initiation. This cross-sectional study included subjects with severe asthma aged 18-65 years. HRQoL was assessed using the Asthma Quality of Life Questionnaire (AQLQ) and asthma control was assessed using the Asthma Control Test (ACT) and Global Initiative for Asthma (GINA) criteria. Of the 87 patients studied, 58 (66.7%) were classified as asthmatics who had never smoked and 29 (33.3%) as asthmatics with smoking exposure. The proportion of subjects with uncontrolled asthma was higher in the asthma and smoking group (GINA criteria: P=0.032 and ACT criteria: P=0.003. There were no between-group differences in overall AQLQ score (P=0.475) or AQLQ domain scores (P>0.05). Fifty-eight subjects (66.7%) were nonsmokers, 20 (23%) had asthma onset before smoking, and 9 (10.3%) had asthma onset after smoking. Asthma onset before smoking was associated with uncontrolled asthma (P=0.013). In subjects with severe asthma, smoking was associated with a higher rate of uncontrolled disease but not with HRQoL scores.

Household Air Pollution and Respiratory Symptoms a Month Before and During the Stringent COVID-19 Lockdown Levels 5 and 4 in South Africa

Background:

Household air pollution (HAP) is associated with adverse human health impacts. During COVID-19 Lockdown Levels 5 and 4 (the most stringent levels), South Africans remained at home, potentially increasing their exposure to HAP.

Objectives:

To investigate changes in fuel use behaviours/patterns of use affecting HAP exposure and associated HAP-related respiratory health outcomes during COVID-19 Lockdown Levels 5 and 4.

Methods:

This was a cross-sectional online and telephonic survey of participants from an existing database. Logistic regression and McNemar’s test were used to analyse household-level data.

Results:

Among 2 505 participants, while electricity was the main energy source for cooking and heating the month before and during Lockdown Levels 5 and 4, some households used less electricity during Lockdown Levels 5 and 4 or switched to “dirty fuels.” One third of participants reported presence of environmental tobacco smoke in the home, a source of HAP associated with respiratory illnesses. Prevalence of HAP-related respiratory health outcomes were <10% (except dry cough). Majority of households reported cooking more, cleaning more and spending more time indoors during Lockdown Levels 5 and 4 – potentially exposed to HAP.

Conclusion:

Should South Africa return to Lockdown Levels 5 or 4, awareness raising about the risks associated with HAP as well as messaging information for prevention of exposure to HAP, including environmental tobacco smoke, and associated adverse health impacts will be necessary.

Impact of polluting fuels for cooking on diabetes mellitus and glucose metabolism in south urban China

We hypothesized that exposure to polluting fuels for cooking was associated with abnormality of glucose metabolism and diabetes mellitus (DM) in south urban China. 3414 residents were surveyed in 14 urban areas of Guangdong Province in 2018. We recorded polluting fuels for cooking exposure, different DM status (DM, prediabetes), fasting blood glucose (FBG), oral glucose tolerance test (OGTT), glycated hemoglobin (HbA_1c ), and other covariates by using a structured questionnaire. We conducted logistic regression model and multivariate linear regression model based on propensity-score method (inverse probability of weighting) to examine the effect of polluting fuels for cooking exposure on DM and glucose metabolism. Exposure to polluting fuels for cooking was associated with DM (odds ratio: 2.57, 95% confidence interval: 1.71 to 3.86) and prediabetes (odds ratio: 1.98, 95% confidence interval: 1.52 to 2.58) in both the adjusted and unadjusted models (all p < 0.05). Exposure to polluting fuels for cooking was significantly associated with an increase of FBG (β: 0.30 mmol/L, 95% confidence interval: 0.22 to 0.38 mmol/L). Sensitivity analysis showed that the results were not substantially changed. There was an increased risk of DM, prediabetes and high levels of FBG, OGTT, and HbA_1c among participants aged ≥ 40 years with exposure to polluting fuels for cooking. We demonstrated that exposure to polluting fuels for cooking was associated with higher levels of FBG, which contributed to the increased risk of DM and prediabetes in middle-aged elderly Chinese population living in urban areas.

Exposure to biomass fuel is associated with high blood pressure and fasting blood glucose impairment in females in southern rural China

OBJECTIVES

We sought to investigate the association between household exposure to biomass fuel and metabolic syndrome (MetS) and its components including blood pressure, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG) and waist circumference among females in southern rural China.

METHODS

We surveyed 1664 residents in the Chronic Disease and Risk Factors Surveillance, conducted in 14 districts of Guangdong province. We recorded the use of biomass fuel, MetS and its components, and other covariates by using a structured questionnaire. Logistic regression model and multivariate linear regression model were adopted for analysis.

RESULTS

Exposure to biomass fuel was significantly associated with an increase of systolic blood pressure (SBP) (β: 2.15, 95% confidence interval: 0.13 to 4.17) and FBG (β: 0.19, 95% confidence interval: 0.01 to 0.37) in the adjusted and unadjusted models (all P < 0.05). Among participants with exposure to biomass fuel, being overweight or obese was associated with an increased risk of having hypertension (odds ratio: 3.19, 95% confidence interval: 2.13 to 4.76) and higher FBG levels (odds ratio: 2.10, 95% confidence interval: 1.46 to 3.02). Exposure to biomass fuel was significantly associated with a decrease of the prevalence of central obesity (P < 0.05). However, exposure to biomass fuel was not associated with MetS, diastolic blood pressure and TG (all P > 0.05).

CONCLUSIONS

Exposure to biomass fuel is associated with an increase in blood pressure and FBG levels, but not MetS per se. Efforts should be made to protect females in southern rural China from the adverse effects associated with biomass fuel pollution.

Impact of long-term exposure to ambient air pollution on the incidence of chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

It is well known that air pollution causes respiratory morbidity and mortality by inducing airway inflammation. However, whether long-term exposure to air pollution is associated with increased incidence of chronic obstructive pulmonary disease (COPD) is controversial.

METHODS

We conducted a systematic review and meta-analysis with a random-effects model to calculate the pooled risk estimates of COPD development per 10 μg/m³ increase in individual air pollutants. PubMed, Embase, and Cochrane Library were searched from the date of their inception to August 2019 to identify long-term (at least three years of observation) prospective longitudinal studies that reported the risk of COPD development due to exposure to air pollutants. The air pollutants studied included particulate matter (PM_2.5 and PM₁₀) and nitrogen dioxide (NO₂).

RESULTS

Of the 436 studies identified, seven met our eligibility criteria. Among the seven studies, six, three, and five had data on PM_2.5, PM₁₀, and NO₂, respectively. The meta-analysis results showed that a 10 μg/m³ increase in PM_2.5 is associated with increased incidence of COPD (pooled HR 1.18, 95% CI 1.13-1.23). We also noted that a 10 μg/m³ increase in NO₂ is marginally associated with increased incidence of COPD (pooled HR 1.07, 95% CI 1.00-1.16). PM₁₀ seems to have no significant impact on the incidence of COPD (pooled HR 0.95, 95% CI 0.83-1.08), although the number of studies was too small. Meta-regression analysis found no significant effect modifiers.

CONCLUSIONS

Long-term exposure to PM_2.5 and NO₂ can be associated with increased incidence of COPD.

Independent and combined associations of solid-fuel use and smoking with obesity among rural Chinese adults

Although solid-fuel use or smoking is associated with obesity measured by body mass index (BMI), research on their interactive effects on general and central obesity is limited. Data of 20,140 individuals in the Henan Rural Cohort Study was examined the independent and combined associations of solid-fuel use and smoking with prevalent obesity, which was measured by BMI, waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body fat percentage (BFP), and visceral fat index (VFI). Multiple adjusted logistic regression models showed that the OR (95% CI) of prevalent obesity measured by BMI associated with exposure to solid fuels alone or with smoking was 0.78 (0.70, 0.86) or 0.46 (0.32, 0.66), compared with neither smoking nor solid-fuel exposure. Similar results had been found in other obese anthropometric indices and in the results of linear regression analysis. The results indicated that solid-fuel use and smoking have a synergistic effect on reduction in obesity indices. The effects of household air pollution from solid-fuel use and smoking on obesity should be considered when exploring the influencing factors of obesity.

Exposure to household air pollution over 10 years is related to asthma and lung function decline

INTRODUCTION

We investigated if long-term household air pollution (HAP) is associated with asthma and lung function decline in middle-aged adults, and whether these associations were modified by glutathione S-transferase (GST) gene variants, ventilation and atopy.

MATERIALS AND METHODS

Prospective data on HAP (heating, cooking, mould and smoking) and asthma were collected in the Tasmanian Longitudinal Health Study (TAHS) at mean ages 43 and 53 years (n=3314). Subsamples had data on lung function (n=897) and GST gene polymorphisms (n=928). Latent class analysis was used to characterise longitudinal patterns of exposure. Regression models assessed associations and interactions.

RESULTS

We identified seven longitudinal HAP profiles. Of these, three were associated with persistent asthma, greater lung function decline and % reversibility by age 53 years compared with the "Least exposed" reference profile for those who used reverse-cycle air conditioning, electric cooking and no smoking. The "All gas" (OR 2.64, 95% CI 1.22-5.70), "Wood heating/smoking" (OR 2.71, 95% CI 1.21-6.05) and "Wood heating/gas cooking" (OR 2.60, 95% CI 1.11-6.11) profiles were associated with persistent asthma, as well as greater lung function decline and % reversibility. Participants with the GSTP1 Ile/Ile genotype were at a higher risk of asthma or greater lung function decline when exposed compared with other genotypes. Exhaust fan use and opening windows frequently may reduce the adverse effects of HAP produced by combustion heating and cooking on current asthma, presumably through increasing ventilation.

CONCLUSIONS

Exposures to wood heating, gas cooking and heating, and tobacco smoke over 10 years increased the risks of persistent asthma, lung function decline and % reversibility, with evidence of interaction by GST genes and ventilation.

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

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.

Impact of Air Pollution on Asthma Outcomes

Asthma is a chronic respiratory disease characterized by variable airflow obstruction, bronchial hyperresponsiveness, and airway inflammation. Evidence suggests that air pollution has a negative impact on asthma outcomes in both adult and pediatric populations. The aim of this review is to summarize the current knowledge on the effect of various outdoor and indoor pollutants on asthma outcomes, their burden on its management, as well as to highlight the measures that could result in improved asthma outcomes. Traffic-related air pollution, nitrogen dioxide and second-hand smoking (SHS) exposures represent significant risk factors for asthma development in children. Nevertheless, a causal relation between air pollution and development of adult asthma is not clearly established. Exposure to outdoor pollutants can induce asthma symptoms, exacerbations and decreases in lung function. Active tobacco smoking is associated with poorer asthma control, while exposure to SHS increases the risk of asthma exacerbations, respiratory symptoms and healthcare utilization. Other indoor pollutants such as heating sources and molds can also negatively impact the course of asthma. Global measures, that aim to reduce exposure to air pollutants, are highly needed in order to improve the outcomes and management of adult and pediatric asthma in addition to the existing guidelines.

Smoking status and second-hand smoke biomarkers in COPD, asthma and healthy controls

Introduction

Tobacco smoke worsens COPD and asthma. For healthy individuals, quantifying active and second-hand smoke (SHS) exposure clarifies the epidemiology of tobacco consumption and the efficacy of nonsmoking measures. Identifying tobacco exposure biomarkers and cut-offs might allow the creation of sensitive and specific tests.

Aim

We describe the state-of-the-art serum, urinary cotinine and exhaled carbon monoxide (CO) cut-offs for assessing smoking status and SHS exposure in adult patients with COPD or asthma, and healthy controls.

Methodology

After a keyword research in the PubMed database, we included papers reporting on the cut-offs of the investigated biomarkers in one of the populations of interest. Papers published before 2000, not in English, or reporting only data on nonadult subjects or on pregnant women were excluded from the analysis. 14 papers were included in the final analysis. We summarised diagnostic cut-offs for smoking status or SHS exposure in COPD, asthmatic and healthy control cohorts, reporting sensitivity and specificity when available.

Conclusion

Serum and urinary cotinine and exhaled CO are easy-to-standardise, affordable and objective tests for assessing smoking status and SHS exposure. Evidence on cut-offs with good sensitivity and specificity values is available mainly for healthy controls. For COPD and asthmatic patients, most of the currently available evidence focuses on exhaled CO, while studies on the use of cotinine with definite sensitivity and specificity values are still missing. Solid evidence on SHS exposure is available only for healthy controls. An integrated approach with a combination of these markers still needs evaluation.

Reliable cut-off values for smoking status in COPD and asthmatic adults are only available for exhaled COhttps://bit.ly/34lsHhD

Cardiovascular Effects of Indoor Air Pollution from Solid Fuel: Relevance to Sub-Saharan Africa

PURPOSE OF REVIEW

This research aims to summarize evidence on the cardiovascular effects of indoor air pollution (IAP) from solid fuel and identify areas for research and policy for low- and middle-income countries.

RECENT FINDINGS

IAP affects people from low socioeconomic status in Latin America, Asia, and Africa, who depend upon biomass as a fuel for cooking, heating, and lighting. In these settings, IAP disproportionately affects women, children, the elderly, and people with cardiopulmonary disease. The health effects of IAP include acute respiratory infections, chronic obstructive pulmonary disease, pneumoconiosis, cataract and blindness, pulmonary tuberculosis, adverse effects to pregnancy, cancer, and cardiovascular and cerebrovascular disease. New methods for assessing individual IAP exposure, exposing pathways of IAP-related cardiovascular disease, and performing qualitative research focusing on population preferences regarding strategies to reduce IAP exposure have been the most important developments in tackling the burden of IAP. Unfortunately, major disparities exist regarding research into the cardiovascular effects of IAP, with only few studies coming from sub-Saharan Africa, despite this region having the highest proportion of households using solid fuels. Premature cardiovascular deaths and disability can be averted in low-middle income countries by addressing biomass fuel usage by the most disadvantaged settings. While research is needed to uncover the mechanisms involved in cardiovascular outcomes linked to IAP, immediate action is needed to educate the most affected populations on IAP health hazards and to reduce their exposure to this environmental risk through promoting improved housing and better ventilation, as well as increasing access to affordable clean cooking energy.

Highlights and recent developments in airway diseases in EAACI journals (2018)

The European Academy of Allergy and Clinical Immunology (EAACI) supports three journals: Allergy, Pediatric Allergy and Immunology, and Clinical and Translational Allergy. EAACI's major goals include supporting the promotion of health, in which the prevention of allergy and asthma plays a critical role, and disseminating the knowledge of allergic disease to all stakeholders. In 2018, the remarkable progress in the identification of basic mechanisms of allergic and respiratory diseases as well as the translation of these findings into clinical practice were observed. Last year's highlights include publication of EAACI guidelines for allergen immunotherapy, many EAACI Position Papers covering important aspects for the specialty, better understanding of molecular and cellular mechanisms, identification of biomarkers for disease prediction and progress monitoring, novel prevention and intervention studies, elucidation of mechanisms of multimorbidities, introduction of new drugs to the clinics, recently completed phase three clinical studies, and publication of a large number of allergen immunotherapy studies and meta-analyses.

Asthma similarities across ProAR (Brazil) and U-BIOPRED (Europe) adult cohorts of contrasting locations, ethnicity and socioeconomic status

BACKGROUND

Asthma prevalence is 339 million globally. 'Severe asthma' (SA) comprises subjects with uncontrolled asthma despite proper management.

OBJECTIVES

To compare asthma from diverse ethnicities and environments.

METHODS

A cross-sectional analysis of two adult cohorts, a Brazilian (ProAR) and a European (U-BIOPRED). U-BIOPRED comprised of 311 non-smoking with Severe Asthma (SAn), 110 smokers or ex-smokers with SA (SAs) and 88 mild to moderate asthmatics (MMA) while ProAR included 544 SA and 452 MMA. Although these projects were independent, there were similarities in objectives and methodology, with ProAR adopting operating procedures of U-BIOPRED.

RESULTS

Among SA subjects, age, weight, proportion of former smokers and FEV₁ pre-bronchodilator were similar. The proportion of SA with a positive skin prick tests (SPT) to aeroallergens, the scores of sino-nasal symptoms and quality of life were comparable. In addition, blood eosinophil counts (EOS) and the % of subjects with EOS > 300 cells/μl were not different. The Europeans with SA however, were more severe with a greater proportion of continuous oral corticosteroids (OCS), worse symptoms and more frequent exacerbations. FEV₁/FVC pre- and post-bronchodilator were lower among the Europeans. The MMA cohorts were less comparable in control and treatment, but similar in the proportion of allergic rhinitis, gastroesophageal reflux disease and EOS >3%.

CONCLUSIONS

ProAR and U-BIOPRED cohorts, with varying severity, ethnicity and environment have similarities, which provide the basis for global external validation of asthma phenotypes. This should stimulate collaboration between asthma consortia with the aim of understanding SA, which will lead to better management.

Bidirectional Association Between GERD and Asthma: Two Longitudinal Follow-Up Studies Using a National Sample Cohort

BACKGROUND

A relation between gastroesophageal reflux disease (GERD) and asthma has been suggested; however, causality has not been investigated.

OBJECTIVE

This study aimed to delineate the causal relation between GERD and asthma.

METHODS

Participants of the Korean National Health Insurance Service-National Sample Cohort 2002-2013 who were ≥20 years old were selected for this study. In study I, 116,502 patients with GERD were matched in a 1:2 ratio to 233,004 control I participants, and the hazard ratio (HR) of asthma in patients with GERD was analyzed. In study II, 104,146 patients with asthma were matched in a 1:1 ratio to 104,146 control II participants, and the HR for GERD in patients with asthma was analyzed. A stratified Cox-proportional hazards model was used. Subgroup analyses were performed according to age and sex.

RESULTS

In study I, 12.5% (14,595 of 116,502) of the GERD group and 7.8% (18,135 of 233,004) of the control I group presented asthma (P < .001). The GERD group demonstrated a 1.46-fold higher HR for asthma than the control I group (95% confidence interval [CI] = 1.42-1.49, P < .001). In study II, 16.9% (17,582 of 104,146) of the asthma group and 11.9% (12,393 of 104,146) of the control II group presented GERD (P < .001). The asthma group showed a 1.36-fold higher HR for GERD than the control II group (95% CI = 1.33-1.39, P < .001). All age and sex subgroups presented consistent results.

CONCLUSION

GERD and asthma had a bidirectional relation in the study population.