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Melaram R. Early life exposures of childhood asthma and allergies-an epidemiologic perspective. FRONTIERS IN ALLERGY 2024; 5:1445207. [PMID: 39247214 PMCID: PMC11377413 DOI: 10.3389/falgy.2024.1445207] [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: 06/06/2024] [Accepted: 08/02/2024] [Indexed: 09/10/2024] Open
Abstract
Children around the world are continuing to develop and suffer from chronic lung diseases such as asthma. Childhood asthma commonly presents with recurrent episodes of cough, shortness of breath, and wheezing, all of which can lead to missed school days and hospitalization admissions. The role of environmental pollutants and aeroallergens has been increasingly recognized in relation to asthma etiology. We showcase the impacts of air pollution and pollen exposures in early life on childhood asthma and allergies through an epidemiologic perspective. We also examine the effects of indoor microbial exposures such as endotoxin and glucan on allergic diseases in schoolchildren as many spend most of their time in a household or classroom setting. Findings of this work can assist in the identification of key environmental factors in critical life periods and improve clinicians' diagnoses of asthma during early childhood.
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Affiliation(s)
- Rajesh Melaram
- College of Nursing and Health Sciences, Texas A&M University-Corpus Christi, Corpus Christi, TX, United States
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Patti MA, Henderson NB, Phipatanakul W, Jackson-Browne M. Recommendations for Clinicians to Combat Environmental Disparities in Pediatric Asthma: A Review. Chest 2024:S0012-3692(24)04845-1. [PMID: 39059578 DOI: 10.1016/j.chest.2024.07.143] [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: 02/06/2024] [Revised: 07/04/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024] Open
Abstract
TOPIC IMPORTANCE Asthma is a common and complex lung disease in children, with disproportionally higher prevalence and related adverse outcomes among children in racial and ethnic minority groups, and of lower socioeconomic position. Environmental factors, including unhealthy housing and school-based exposures, can contribute to increased asthma morbidity and widening disparities. This underscores a significant environmental justice issue and suggests the need for clinical interventions to reduce sources of environmental exposures and ultimately diminish the observed disparities in childhood asthma. REVIEW FINDINGS Unhealthy housing conditions, including secondhand tobacco smoke, allergen exposure, and indoor air pollution, can exacerbate asthma symptoms in children. Although unhealthy housing can occur anywhere, such situations most frequently occur in urban, low-income environments where renting is common. To reduce environmental triggers, clinicians can recommend smoking cessation, cleaning techniques to mitigate exposure, and even directly contacting landlords to address poor housing conditions. Children spend much of their time in schools, where this built environment is also a source of asthma triggers (eg, poor ventilation) and allergens (eg, mold and pests, chemicals). As such, a multidisciplinary approach is needed to adequately address the burden of childhood asthma to equitably reduce disparities to both harmful exposures and negative health outcomes. SUMMARY Racial, ethnic, and socioeconomic disparities exist in asthma morbidity in children, and such disparities are driven in part by environmental factors at the housing and school level. Clinicians can make evidence-based recommendations to drive effective exposure reduction strategies to mitigate asthma morbidity and reduce observed disparities.
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Affiliation(s)
- Marisa A Patti
- AJ Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Noelle B Henderson
- Department of Environmental Health, Boston University School of Public Health, Boston, MA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Moore CM, Thornburg J, Secor EA, Hamlington KL, Schiltz AM, Freeman KL, Everman JL, Fingerlin TE, Liu AH, Seibold MA. Breathing zone pollutant levels are associated with asthma exacerbations in high-risk children. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.22.23295971. [PMID: 37790375 PMCID: PMC10543064 DOI: 10.1101/2023.09.22.23295971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Indoor and outdoor air pollution levels are associated with poor asthma outcomes in children. However, few studies have evaluated whether breathing zone pollutant levels associate with asthma outcomes. Objective Determine breathing zone exposure levels of NO 2 , O 3 , total PM 10 and PM 10 constituents among children with exacerbation-prone asthma, and examine correspondence with in-home and community measurements and associations with outcomes. Methods We assessed children's personal breathing zone exposures using wearable monitors. Personal exposures were compared to in-home and community measurements and tested for association with lung function, asthma control, and asthma exacerbations. Results 81 children completed 219 monitoring sessions. Correlations between personal and community levels of PM 10 , NO 2 , and O 3 were poor, whereas personal PM 10 and NO 2 levels correlated with in-home measurements. However, in-home monitoring underdetected brown carbon (Personal:79%, Home:36.8%) and ETS (Personal:83.7%, Home:4.1%) personal exposures, and detected black carbon in participants without these personal exposures (Personal: 26.5%, Home: 96%). Personal exposures were not associated with lung function or asthma control. Children experiencing an asthma exacerbation within 60 days of personal exposure monitoring had 1.98, 2.21 and 2.04 times higher brown carbon (p<0.001), ETS (p=0.007), and endotoxin (p=0.012), respectively. These outcomes were not associated with community or in-home exposure levels. Conclusions Monitoring pollutant levels in the breathing zone is essential to understand how exposures influence asthma outcomes, as agreement between personal and in-home monitors is limited. Inhaled exposure to PM 10 constituents modifies asthma exacerbation risk, suggesting efforts to limit these exposures among high-risk children may decrease their asthma burden. CLINICAL IMPLICATIONS In-home and community monitoring of environmental pollutants may underestimate personal exposures. Levels of inhaled exposure to PM 10 constituents appear to strongly influence asthma exacerbation risk. Therefore, efforts should be made to mitigate these exposures. CAPSULE SUMMARY Leveraging wearable, breathing-zone monitors, we show exposures to inhaled pollutants are poorly proxied by in-home and community monitors, among children with exacerbation-prone asthma. Inhaled exposure to multiple PM 10 constituents is associated with asthma exacerbation risk.
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Banzon TM, Greco KF, Li L, Mukharesh L, Vieira CLZ, Steiner MK, Hauptman M, Ratchataswan T, Koutrakis P, Phipatanakul W, Gaffin JM. Effect of radon exposure on asthma morbidity in the School Inner-City Asthma study. Pediatr Pulmonol 2023; 58:2042-2049. [PMID: 37083192 PMCID: PMC10330665 DOI: 10.1002/ppul.26429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Radon may have a role in obstructive lung disease outside its known carcinogenicity. Little is known about radon's effects on asthma morbidity. OBJECTIVE To determine the effect of radon on fractional exhaled nitric oxide (FE NO), asthma symptom-days, and lung function in inner-city asthmatic school children. METHODS Two hundred ninety-nine school-aged asthmatic children enrolled in the School Inner-City Asthma Study (SICAS-1) were followed. One and two-month averaged radon was assessed using a spatiotemporal model predicting zip code-specific monthly exposures. FE NO and spirometry were measured twice during the academic year. Asthma symptoms were assessed four times during the academic year. The interaction between indoor radon exposure (Bq/m3 ) and seasonality predicting log-transformed FE NO, forced expiratory volume in 1 s (FEV1 ) % predicted, forced vital capacity (FVC) % predicted, FEV1 /FVC, and asthma symptom-days was evaluated. RESULTS Participants with high radon exposure had greater change in FE NO from warm to cold periods compared to low radon exposure (interaction p = 0.0013). Participants with >50th percentile radon exposure experience significant FE NO increase from warm to cold weather (β $\beta $ = 0.29 [95% confidence interval [CI]: 0.04-0.54], p = 0.0240). We report a positive association between radon 1-month moving average (incidence rate ratio [IRR] = 1.01, p = 0.0273) and 2-month moving average (IRR = 1.01, p = 0.0286) with maximum asthma symptom-days (n = 299, obs = 1167). CONCLUSIONS In asthmatic children, radon may be associated with increased asthma morbidity, suggesting radon may be a modifiable environmental risk factor for airway inflammation.
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Affiliation(s)
- Tina M. Banzon
- Division of Allergy and Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kimberly F. Greco
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA
| | - Longxiang Li
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Lana Mukharesh
- Division of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | | | - M. Kathryn Steiner
- Department of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, USA
| | - Marissa Hauptman
- Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children’s Hospital
| | | | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan M. Gaffin
- Division of Pulmonary Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Ruran HB, Tourigny L, Thorne PS, Metwali N. Innovative compounds to reduce β-D-glucans, endotoxin, and allergens newly discovered on smartphones. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:79-83. [PMID: 36873732 PMCID: PMC9979623 DOI: 10.1016/j.jacig.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Eight-four percent of people own smartphones and view them 14 billion times daily, making them potential vectors for environmental hazards such as allergens, β-D-glucans (BDGs), and endotoxin. Whether these toxins are prevalent and the effectiveness of cleaning solutions targeting these agents on smartphones have not been studied. OBJECTIVE We sought to determine (1) whether phones are reservoirs of allergen, endotoxin, and BDGs and (2) if present, whether their levels can be effectively reduced by using specific cleaning methods. METHODS Electrostatic wipes used to wipe the phones of 15 volunteers were tested to determine their allergen, BDG, and endotoxin levels. Cleaning interventions were done on simulated phone models; 70% isopropyl alcohol, 0.184% benzyl and ethyl benzyl ammonium chloride (Clorox nonbleach [The Chlorox Company, Oakland, Calif]), 0.12% chlorhexidine, 0.05% cetylpyridinium, 3% benzyl benzoate, and 3% tannic acid wipes were used and compared with wipes with no solution (the control). RESULTS The smartphones showed high and variable levels of BDG and endotoxin. Cat and dog allergens were found mostly on the smartphones of pet owners. The combination of chlorhexidine and cetylpyridinium significantly reduced BDG levels (mean 269 ng/wipe vs 1930 ng/wipe for the control [P < .05]) and endotoxin, (mean 349 vs 1320 endotoxin units/wipe for the control [P < .05]). The combination of benzyl benzoate and tannic acid significantly reduced the levels of cat and dog allergens (dog, mean level of 14 ng/wipe versus 407 ng/wipe for the control [P < .001]; cat, mean level of 55 ng/wipe versus 1550 ng/wipe for the control [P < .001]). The combination mixture solutions had the greatest reductions compared with the control. CONCLUSIONS There are elevated levels of BDG, allergens, and endotoxin on smartphones. The combination of chlorhexidine and cetylpyridinium was the most effective in reducing BDG and endotoxin levels, and the combination of benzyl benzoate and tannic acid was most effective in reducing cat and dog allergen levels on smartphones.
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Affiliation(s)
| | | | - Peter S. Thorne
- University of Iowa, Department of Occupational and Environmental Health, Iowa City
| | - Nervana Metwali
- University of Iowa, Department of Occupational and Environmental Health, Iowa City
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Zhou X, Zhang P, Tan H, Dong B, Jing Z, Wu H, Luo J, Zhang Y, Zhang J, Sun X. Progress in diagnosis and treatment of difficult-to-treat asthma in children. Ther Adv Respir Dis 2023; 17:17534666231213637. [PMID: 38069568 PMCID: PMC10710755 DOI: 10.1177/17534666231213637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
At present, medications containing inhaled corticosteroids (ICS-containing) are the keystones of asthma treatment. The majority of asthmatic children can significantly improve clinical outcomes with little worsening by standardized inhaled glucocorticoid treatment, but there is still a small proportion of children who are unable to achieve good symptom control even after the maximum standardized treatment, known as 'children with difficult-to-treat asthma (DA)'. The high heterogeneity of DA makes therapy challenging and expensive, which poses a serious risk to children's health and makes it extremely difficult for clinical physicians to accurately identify and treat children with DA. This article reviews the definition, evaluation, and treatment of this asthma in order to provide a reference for optimal clinical decision-making.
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Affiliation(s)
- Xuehua Zhou
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Panpan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Hong Tan
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Bo Dong
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zenghui Jing
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Huajie Wu
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jianfeng Luo
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yao Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Juan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, No. 127, Changle West Road, Xi’an, Shaanxi 710032, China
| | - Xin Sun
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, No. 127, Changle West Road, Xi’an, Shaanxi 710032, China
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Mukharesh L, Greco KF, Banzon T, Koutrakis P, Li L, Hauptman M, Phipatanakul W, Gaffin JM. Environmental radon and childhood asthma. Pediatr Pulmonol 2022; 57:3165-3168. [PMID: 36101499 PMCID: PMC9682467 DOI: 10.1002/ppul.26143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Lana Mukharesh
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly F Greco
- Institutional Centers for Clinical and Translational Research (ICCTR), Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tina Banzon
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Longxiang Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Marissa Hauptman
- Harvard Medical School, Boston, Massachusetts, USA.,Department of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Grant TL, Wood RA. The influence of urban exposures and residence on childhood asthma. Pediatr Allergy Immunol 2022; 33:e13784. [PMID: 35616896 PMCID: PMC9288815 DOI: 10.1111/pai.13784] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
Children with asthma who live in urban neighborhoods experience a disproportionately high asthma burden, with increased incident asthma and increased asthma symptoms, exacerbations, and acute visits and hospitalizations for asthma. There are multiple urban exposures that contribute to pediatric asthma morbidity, including exposure to pest allergens, mold, endotoxin, and indoor and outdoor air pollution. Children living in urban neighborhoods also experience inequities in social determinants of health, such as increased poverty, substandard housing quality, increased rates of obesity, and increased chronic stress. These disparities then in turn can increase the risk of urban exposures and compound asthma morbidity as poor housing repair is a risk factor for pest infestation and mold exposure and poverty is a risk factor for exposure to air pollution. Environmental interventions to reduce in-home allergen concentrations have yielded inconsistent results. Population-level interventions including smoking bans in public places and legislation to decrease traffic-related air pollution have been successful at reducing asthma morbidity and improving lung function growth. Given the interface and synergy between urban exposures and social determinants of health, it is likely population and community-level changes will be needed to decrease the excess asthma burden in children living in urban neighborhoods.
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Affiliation(s)
- Torie L Grant
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Wood
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Sander I, Lotz A, Liebers V, Zahradnik E, Sauke-Gensow U, Petersen J, Raulf M. Comparing the concentration levels of allergens and endotoxins in employees' homes and offices. Int Arch Occup Environ Health 2021; 95:573-588. [PMID: 34738178 PMCID: PMC8938351 DOI: 10.1007/s00420-021-01794-9] [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: 04/12/2021] [Accepted: 08/01/2021] [Indexed: 11/11/2022]
Abstract
Objective The aim of the study was to find out whether allergen and endotoxin concentrations in offices differ from those measured at the homes of employees, and identify the parameters that influence exposure. Methods Electrostatic dust collectors (EDCs) were placed in five office buildings (68 rooms, 436 EDCs), as well as the homes of the office workers (145 rooms, 405 EDCs) for 14 days, four times a year. In addition, surface samples were collected from the offices four times a year by vacuuming the carpeted floors. Domestic mite (DM), and the major cat and dog allergens (Fel d 1 and Can f 1) were quantified in all samples using fluorescence enzyme immunoassays. Endotoxin was measured in the EDC samples, using the Limulus amoebocyte lysate assay. The allergen and endotoxin concentrations were log transformed and analysed with multilevel models. Results Endotoxin concentrations were significantly higher in personal homes compared to levels measured in the offices, and depended on the number of persons living in each household, as well as the presence of a dog. DM allergens were significantly higher in households than in offices, and were significantly higher in bedrooms compared to living rooms. Offices occupied by cat owners had significantly higher Fel d 1 concentrations than offices or homes without. Additionally, Can f 1 concentrations were significantly higher in offices occupied by dog owners compared to those without. Conclusions Pet owners appear to transfer cat and dog allergens to their offices. Therefore, in case of allergy complaints at the office, employers and physicians might consider possible contamination by cat and dog allergens. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-021-01794-9.
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Affiliation(s)
- Ingrid Sander
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Anne Lotz
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Verena Liebers
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Eva Zahradnik
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Ulrich Sauke-Gensow
- Verwaltungsberufsgenossenschaft (VBG), German Social Accident Insurance, Hamburg, Germany
| | - Jens Petersen
- Verwaltungsberufsgenossenschaft (VBG), German Social Accident Insurance, Hamburg, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
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Abstract
Inner-city children with asthma are known to have high disease mortality and morbidity. Frequently, asthma in this high-risk population is difficult to control and more severe in nature. Several factors, including socioeconomic hardship, ability to access to health care, adherence to medication, exposure to certain allergens, pollution, crowd environment, stress, and infections, play an important role in the pathophysiology of inner-city asthma. Comprehensive control of home allergens and exposure to tobacco smoke, the use of immune based therapies, and school-based asthma programs have shown promising results in asthma control in this population.
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Affiliation(s)
- Divya Seth
- Division of Allergy/Immunology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI 48201, USA.
| | - Shweta Saini
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pavadee Poowuttikul
- Division of Allergy/Immunology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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Gunnlaugsson S, Abul MH, Wright L, Petty CR, Permaul P, Gold DR, Gaffin JM, Phipatanakul W. Associations of Snoring and Asthma Morbidity in the School Inner-City Asthma Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3679-3685.e1. [PMID: 34102347 PMCID: PMC8511301 DOI: 10.1016/j.jaip.2021.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Inner-city children are disproportionately affected by asthma and sleep-disordered breathing (SDB). However, little is known about the association of SDB symptoms with asthma morbidity in this vulnerable population. OBJECTIVE Assess the relationship between snoring frequency and asthma morbidity. METHODS This study was part of the School Inner-City Asthma Study, a longitudinal prospective cohort study of children with persistent asthma who attended schools in the Northeast United States from 2008 to 2013. Participants had baseline assessments of asthma symptoms, snoring, and allergy status. Caregivers completed quarterly surveys for 12 months on symptoms of asthma, snoring, and health care outcomes. Snoring frequency (non-, rare-, sometimes-, habitual-snoring) and its relationship with asthma symptoms and asthma morbidity were assessed by mixed-effects models. RESULTS There were 1186 observations from 339 subjects. Mean age was 7.9 years; roughly half were male, and most were of minority race. Half were overweight or obese, and 65.5% had atopy. At initial snoring assessment, 24.8% reported habitual snoring, but report of snoring frequency varied over the study period. Multivariate analyses revealed increased odds of maximum asthma symptom days for habitual snoring compared with nonsnoring (1.58; 95% CI, 1.19-2.10; P < .002) and all other snoring categories. Habitual snoring was associated with greater odds of health care utilization (incidence rate ratio, 1.72; 95% CI, 1.10-2.69; P = .02) and worse asthma control (odds ratio, 1.49; 95% CI, 1.05-2.11; P = .03) compared with nonsnoring. CONCLUSIONS Snoring is common among inner-city school-age children with asthma, and habitual snoring is associated with increased asthma symptom burden and health care utilization.
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Affiliation(s)
- Sigfus Gunnlaugsson
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Mehtap Haktanir Abul
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lakiea Wright
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Perdita Permaul
- Division of Pulmonology, Allergy and Immunology, NY-Presbyterian Hospital/Weill Cornell Medicine, Weill Cornell Medical College, New York, NY
| | - Diane R Gold
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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12
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Fakunle AG, Jafta N, Naidoo RN, Smit LAM. Association of indoor microbial aerosols with respiratory symptoms among under-five children: a systematic review and meta-analysis. Environ Health 2021; 20:77. [PMID: 34210330 PMCID: PMC8252236 DOI: 10.1186/s12940-021-00759-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 06/18/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND Despite the recognition of the importance of indoor microbial exposures on children's health, the role of different microbial agents in development and aggravation of respiratory symptoms and diseases is only poorly understood. This study aimed to assess whether exposure to microbial aerosols within the indoor environment are associated with respiratory symptoms among children under-5 years of age. METHODS A systematic literature search was conducted on PubMed, Web of Science, GreenFILE, ScienceDirect, EMBASE and Cochrane library through February 2020. Studies that investigated the exposure-response relationship between components of the indoor microbial communities and respiratory symptoms among under-five children were eligible for inclusion. A random-effect meta-analysis was applied to estimate pooled relative risk (RR) and 95% confidence interval (CI) for study specific high versus low microbial exposures. The potential effect of individual studies on the overall estimate was evaluated using leave-one-out analysis, while heterogeneity was evaluated by I2 statistics using RevMan 5.3. RESULTS Fifteen studies were eligible for inclusion in a meta-analysis. The pooled risk estimate suggested that increased microbial exposure was associated with an increased risk of respiratory symptoms [pooled relative risk (RR): 1.24 (1.09, 1.41), P = 0.001]. The association was strongest with exposure to a combination of Aspergillus, Penicillium, Cladosporium and Alternaria species [pooled RR: 1.73 (1.30, 2.31), P = 0.0002]. Stratified analysis revealed an increased risk of wheeze [pooled RR: 1.20 (1.05, 1.37), P = 0.007 and allergic rhinitis [RR: 1.18 (0.94, 1.98), P = 0.16] from any microbial exposure. CONCLUSIONS Microbial exposures are, in general, associated with risk of respiratory symptoms. Future studies are needed to study the indoor microbiome more comprehensively, and to investigate the mechanism of these associations.
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Affiliation(s)
- Adekunle Gregory Fakunle
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Department of Medicine, University of Ibadan, Ibadan, 200284 Nigeria
| | - Nkosana Jafta
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Rajen N. Naidoo
- Discipline of Occupational and Environmental Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lidwien A. M. Smit
- Institute for Risk Assessment Sciences, Environmental Epidemiology Division (IRAS-EEPI), Utrecht University, Utrecht, The Netherlands
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13
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Ruran HB, Adamkiewicz G, Cunningham A, Petty CR, Greco KF, Gunnlaugsson S, Stamatiadis N, Sierra G, Vallarino J, Alvarez M, Hayden LP, Sheils CA, Weller E, Phipatanakul W, Gaffin JM. Air quality, Environment and Respiratory Outcomes in Bronchopulmonary Dysplasia, the AERO-BPD cohort study: design and adaptation during the SARS-CoV-2 pandemic. BMJ Open Respir Res 2021; 8:e000915. [PMID: 34193433 PMCID: PMC8249170 DOI: 10.1136/bmjresp-2021-000915] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Almost half of all school-age children with bronchopulmonary dysplasia (BPD) have asthma-like symptoms and more suffer from lung function deficits. While air pollution and indoor respiratory irritants are known to affect high-risk populations of children, few studies have objectively evaluated environmental contributions to long-term respiratory morbidity in this population. This study aimed to examine the role of indoor environmental exposures on respiratory morbidity in children with BPD. METHODS AND ANALYSIS The Air quality, Environment and Respiratory Ouctomes in BPD (AERO-BPD) study is a prospective, single-centre observational study that will enrol a unique cohort of 240 children with BPD and carefully characterise participants and their indoor home environmental exposures. Measures of indoor air quality constituents will assess the relationship of nitrogen dioxide (NO2), particulate matter (PM2.5), nitric oxide (NO), temperature and humidity, as well as dust concentrations of allergens, with concurrently measured respiratory symptoms and lung function.Adaptations to the research protocol due to the SARS-CoV-2 pandemic included remote home environment and participant assessments. ETHICS AND DISSEMINATION Study protocol was approved by the Boston Children's Hospital Committee on Clinical Investigation. Dissemination will be in the form of peer-reviewed publications and participant information products. TRIAL REGISTRATION NUMBER NCT04107701.
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Affiliation(s)
- Hana B Ruran
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Amparito Cunningham
- Boston Children's Hospital Division of Immunology, Boston, Massachusetts, USA
| | - Carter R Petty
- Boston Children's Hospital, Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts, USA
| | - Kimberly F Greco
- Boston Children's Hospital, Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts, USA
| | - Sigfus Gunnlaugsson
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Stamatiadis
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
| | - Gabriella Sierra
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
| | - Jose Vallarino
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Marty Alvarez
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Lystra P Hayden
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Catherine A Sheils
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Edie Weller
- Boston Children's Hospital, Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Wanda Phipatanakul
- Boston Children's Hospital Division of Immunology, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Boston Children's Hospital Division of Pulmonary and Respiratory Diseases, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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14
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Indoor Microbial Exposures and Chronic Lung Disease: From Microbial Toxins to the Microbiome. Clin Chest Med 2021; 41:777-796. [PMID: 33153695 DOI: 10.1016/j.ccm.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Effects of environmental microbial exposures on human health have long been of interest. Microbes were historically assumed to be harmful, but data have suggested that microbial exposures can modulate the immune system. We focus on the effects of indoor environmental microbial exposure on chronic lung diseases. We found contradictory data in bacterial studies using endotoxin as a surrogate for bacterial exposure. Contradictory data also exist in studies of fungal exposure. Many factors may modulate the effect of environmental microbial exposures on lung health, including coexposures. Future studies need to clarify which method of assessing environmental microbial exposures is most relevant.
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15
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Niu M, Shen F, Zhou F, Zhu T, Zheng Y, Yang Y, Sun Y, Li X, Wu Y, Fu P, Tao S. Indoor air filtration could lead to increased airborne endotoxin levels. ENVIRONMENT INTERNATIONAL 2020; 142:105878. [PMID: 32580116 DOI: 10.1016/j.envint.2020.105878] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/21/2020] [Accepted: 06/04/2020] [Indexed: 05/13/2023]
Abstract
Stand-alone portable air purifiers (APs) have become an increasingly popular method of controlling individual inhalation exposure. Exposure to bacterial endotoxins has a causative role in respiratory inhalation health. Here, we studied the changes in endotoxin levels in indoor air before and after purification by a portable AP equipped with HEPA (high-efficiency particulate air) filters. An increase in endotoxins was observed when a previously used AP was turned on to clean the air. Replacing the HEPA filters in the AP helped to mitigate the increase in endotoxins of larger sizes but not endotoxins of smaller sizes. Consequently, the use of APs could lead to increased endotoxin deposition in airways, especially in the alveolar region. The endotoxin concentrations on the HEPA filters were well correlated with the free DNA concentrations on the HEPA filters. This correlation indicates that the disrupted bacteria, which released free DNA, could also release endotoxins, thus making HEPA filters a source of indoor airborne endotoxins. Our results illustrate a potential endotoxin inhalation risk associated with HEPA-APs as an air cleaning strategy and highlight the importance of composition-specific air cleaning while reducing the particle number/mass.
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Affiliation(s)
- Mutong Niu
- School of Space and Environment, Beijing Key Laboratory of Bio-Inspired Energy Materials and Devices, Beihang University, Beijing 100191, China
| | - Fangxia Shen
- School of Space and Environment, Beijing Key Laboratory of Bio-Inspired Energy Materials and Devices, Beihang University, Beijing 100191, China.
| | - Feng Zhou
- School of Space and Environment, Beijing Key Laboratory of Bio-Inspired Energy Materials and Devices, Beihang University, Beijing 100191, China
| | - Tianle Zhu
- School of Space and Environment, Beijing Key Laboratory of Bio-Inspired Energy Materials and Devices, Beihang University, Beijing 100191, China
| | - Yunhao Zheng
- Institute of Environment and Sustainable Development in Agriculture, Chinese Academy of Agricultural Sciences, Beijing 100081, China
| | - Yi Yang
- School of Space and Environment, Beijing Key Laboratory of Bio-Inspired Energy Materials and Devices, Beihang University, Beijing 100191, China
| | - Ye Sun
- School of Space and Environment, Beijing Key Laboratory of Bio-Inspired Energy Materials and Devices, Beihang University, Beijing 100191, China
| | - Xinghua Li
- School of Space and Environment, Beijing Key Laboratory of Bio-Inspired Energy Materials and Devices, Beihang University, Beijing 100191, China
| | - Yan Wu
- School of Environmental Science and Engineering, Shandong University, Jinan 250100, China
| | - Pingqing Fu
- Institute of Surface-Earth System Science, Tianjin University, Tianjin 300072, China; State Key Laboratory of Atmospheric Boundary Layer Physics and Atmospheric Chemistry, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing 100029, China
| | - Shu Tao
- College of Urban and Environmental Sciences, Laboratory for Earth Surface Processes, Sino-French Institute for Earth System Science, Peking University, Beijing 100871, China
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16
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Vornanen-Winqvist C, Järvi K, Andersson MA, Duchaine C, Létourneau V, Kedves O, Kredics L, Mikkola R, Kurnitski J, Salonen H. Exposure to indoor air contaminants in school buildings with and without reported indoor air quality problems. ENVIRONMENT INTERNATIONAL 2020; 141:105781. [PMID: 32417615 DOI: 10.1016/j.envint.2020.105781] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/17/2020] [Accepted: 04/30/2020] [Indexed: 06/11/2023]
Abstract
Reported indoor air quality (IAQ) complaints are common even in relatively new or renovated school buildings in Finland. However, detecting the causes for complaints with commonly used indoor air measurements is difficult. This study presents data on perceived and measured IAQ in six comprehensive school buildings in Finland. The aim of this study was to discover the possible differences of perceived and measured IAQ between schools with reported IAQ complaints and schools without reported IAQ complaints. The initial categorisation of schools with ('problematic schools') and without ('comparison schools') complaints was ensured via a validated indoor climate survey and a recently developed online questionnaire, which were completed by 186 teachers and 1268 students from the six schools. IAQ measurements of physical parameters, gaseous pollutants, particulate matter and bioaerosols were conducted in four problematic school buildings (26 classrooms) and two comparison school buildings (12 classrooms). Using air sampling as well as exhaust air filters and classroom settled dust to detect the presence of elevated concentrations of airborne cultivable microbes and pathogenic, toxigenic and mycoparasitic Trichoderma strains were the most indicative methods in distinguishing problematic schools from comparison schools. Other IAQ-related measurements did not detect clear differences between problematic and comparison schools, as the concentration levels were very low. The results indicate that the complaints reported by occupants could have been related to excess moisture or mould problems that had not been found or repaired. Ventilation pressure condition investigations and simultaneous exhaust and supply air filter dust culture should be addressed precisely in future studies.
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Affiliation(s)
| | - Kati Järvi
- Aalto University, Department of Civil Engineering, PO Box 12100, FI-00076 Aalto, Finland
| | - Maria A Andersson
- Aalto University, Department of Civil Engineering, PO Box 12100, FI-00076 Aalto, Finland
| | - Caroline Duchaine
- Université Laval, Département de Biochimie, de Microbiologie et de Bio-informatique, 2325, rue de l'Université, Québec G1V 0A6, Canada; Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725, chemin Sainte-Foy, Québec G1V 4G5, Canada
| | - Valérie Létourneau
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725, chemin Sainte-Foy, Québec G1V 4G5, Canada
| | - Orsolya Kedves
- University of Szeged, Faculty of Science and Informatics, Department of Microbiology, Közép fasor 52, H-6726 Szeged, Hungary
| | - László Kredics
- University of Szeged, Faculty of Science and Informatics, Department of Microbiology, Közép fasor 52, H-6726 Szeged, Hungary
| | - Raimo Mikkola
- Aalto University, Department of Civil Engineering, PO Box 12100, FI-00076 Aalto, Finland
| | - Jarek Kurnitski
- Aalto University, Department of Civil Engineering, PO Box 12100, FI-00076 Aalto, Finland; Tallinn University of Technology, Department of Civil Engineering and Architecture, Ehitajate tee 5, 19086 Tallinn, Estonia
| | - Heidi Salonen
- Aalto University, Department of Civil Engineering, PO Box 12100, FI-00076 Aalto, Finland
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Yen YC, Yang CY, Wang TN, Yen PC, Ho CK, Mena KD, Lee TC, Chen KS, Lin YC, Chen PS. Household airborne endotoxin associated with asthma and allergy in elementary school-age children: a case-control study in Kaohsiung, Taiwan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:19502-19509. [PMID: 32212084 PMCID: PMC7244453 DOI: 10.1007/s11356-020-07899-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
To evaluate the association between the presence of asthma and allergy, and airborne endotoxin in homes of school-age children in Kaohsiung City, Taiwan, with a case-control study design by matching the age and class exposure. Data collection of home visits included an interviewer-administered questionnaire and air sampling of participants' homes for endotoxin, bacteria, and fungi, as well as temperature and relative humidity measurements. Endotoxin was detected in all air samples with a median value of 0.67 EU m-3. In the adjusted logistic regression model, household airborne endotoxin was associated with higher prevalence of asthma and allergy; OR = 4.88 (95% CI 1.16-20.55) for Q3 (between 0.67 and 1.97 EU m -3) vs. Q1 (< 0.31 EU m -3), with statistical significance. Airborne fungi were associated with higher prevalence of asthma and allergy; OR = 4.47 (95% CI 1.13-17.69) for Q3 (between 314 and 699 CFU m -3) vs. Q1 (< 159 CFU m -3) in adjusted logistic regression models. Airborne endotoxin and fungi were significantly associated with children's asthma and allergy.
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Affiliation(s)
- Yu-Chuan Yen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Chun Yen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Kung Ho
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kristina D Mena
- Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Tzu-Chi Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Kang-Shin Chen
- Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yuan-Chung Lin
- Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Pei-Shih Chen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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18
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Abstract
PURPOSE OF REVIEW Recent evidence suggests that environmental exposures change the adult human microbiome. Here, we review recent evidence on the impact of the work microbiome and work-related chemical, metal and particulate exposures on the human microbiome. RECENT FINDINGS Prior literature on occupational microbial exposures has focused mainly on the respiratory effects of endotoxin, but a recent study suggests that not all endotoxin is the same; endotoxin from some species is proinflammatory, whereas endotoxin from other species is anti-inflammatory. Work with animals can change the adult human microbiome, likely through colonization. Early studies in military personnel and animal models of gulf war illness show that military exposures change the gut microbiome and increase gut permeability. Heavy metal and particulate matter exposure, which are often elevated in occupational settings, also change the gut microbiome. SUMMARY An emerging body of literature shows that work-related exposures can change the human microbiome. The health effects of these changes are currently not well studied. If work exposures lead to disease through alterations in the human microbiome, exposure cessation without addressing changes to the human microbiome may be ineffective for disease prevention and treatment.
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Tsuang A, Grishin A, Grishina G, Do AN, Sordillo J, Chew GL, Bunyavanich S. Endotoxin, food allergen sensitization, and food allergy: A complementary epidemiologic and experimental study. Allergy 2020; 75:625-635. [PMID: 31535385 DOI: 10.1111/all.14054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/02/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Household endotoxin levels have been variably associated with risk for asthma and atopy. METHODS We studied participants from the 2005-2006 National Health and Nutrition Examination Survey (NHANES, n = 6963), a large cohort representative of the US population (aged 1-84 years). We built logistic regression models to test for associations between house dust endotoxin and sensitization to specific foods (milk, egg, and peanut). To experimentally explore the detected epidemiologic associations, peripheral blood mononuclear cells (PBMCs) were collected from 21 children (aged 1-19 years) mono-food allergic (ie, sensitized and clinically reactive) to milk, egg, or peanut and nonallergic controls for stimulation with endotoxin and secreted cytokine measurement. For each food allergy, linear mixed-effects models were built to test the association between endotoxin stimulation and cytokine level. RESULTS Among NHANES subjects, the geometric mean household endotoxin level was 15.5 EU/mg (GSE 0.5). Prevalence of food allergen sensitization (sIgE ≥ 0.35 kUA /L) varied by food: milk 5.7%, egg 4.0%, and peanut 7.9%. In models adjusted for potential confounders (age, race, country of birth, total people per household, US region, and history of wheezing in the past year), household endotoxin level was associated with sensitization to milk (OR 1.7, 95% CI 1.2-2.1) and egg (OR 1.4, 95% CI 1.01-1.9), but not peanut (OR 0.98, 95% CI 0.8-1.2). Interferon-γ levels of endotoxin-stimulated PBMCs from children allergic to milk or egg, but not peanut, were significantly lower compared to controls in linear mixed-effects models adjusted for repeated measures, experimental variables, age, and inter-individual variability (P-values .007, .018, and .058, respectively). CONCLUSION Higher household endotoxin is associated with increased odds of milk and egg sensitization. Altered cytokine responsiveness to endotoxin is also observed in PBMCs from individuals with milk and egg allergy.
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Affiliation(s)
- Angela Tsuang
- Division of Allergy & Immunology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Alexander Grishin
- Division of Allergy & Immunology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Galina Grishina
- Division of Allergy & Immunology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York NY USA
| | - Anh N. Do
- Department of Genetics & Genomic Sciences Icahn School of Medicine at Mount Sinai New York NY USA
| | - Joanne Sordillo
- Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston MA USA
| | - Ginger L. Chew
- Department of Environmental Health Sciences Mailman School of Public Health Columbia University New York NY USA
| | - Supinda Bunyavanich
- Division of Allergy & Immunology Department of Pediatrics Icahn School of Medicine at Mount Sinai New York NY USA
- Department of Genetics & Genomic Sciences Icahn School of Medicine at Mount Sinai New York NY USA
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20
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Yen YC, Yang CY, Ho CK, Yen PC, Cheng YT, Mena KD, Lee TC, Chen PS. Indoor ozone and particulate matter modify the association between airborne endotoxin and schoolchildren's lung function. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 705:135810. [PMID: 31972944 DOI: 10.1016/j.scitotenv.2019.135810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND To date, the effect of household airborne pollutants on the association between airborne endotoxin and lung function of schoolchildren is unknown. OBJECTIVES The objective of this study is to evaluate whether indoor air pollutants such as carbon monoxide (CO), carbon dioxide (CO2), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), particulate matter with aerodynamic diameter <10 and 2.5 μm (PM10, PM2.5) can modify the association between airborne endotoxin and school children's lung function in a heavy industrial city in Taiwan. METHODS We recruited 120 elementary school-age children in Kaohsiung City, Taiwan. Aerosol samples were collected on a filter membrane for 24 h period and then analyzed for endotoxin. Air pollutants were measured for 24 h in living rooms while school children's lung function was measured. The modification of air pollutants on the relationship between airborne endotoxin and children's lung function was estimated after adjusting the gender, age, height, weight, and case-control status. RESULTS We found that both O3 and PM10 concentrations significantly modified the relationships between airborne endotoxin and school children's lung function. Among children living in homes with O3 ≥ 0.01 ppm or PM10 ≥ 62 μg/m3, airborne endotoxin was negatively associated with lung functions, whereas among those living in homes with O3 < 0.01 ppm or PM10 < 62 μg/m3, airborne endotoxin was positively associated with lung functions. CONCLUSIONS The indoor air pollutant concentration of O3 and PM10 modifies the association between airborne endotoxin and school children's lung function.
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Affiliation(s)
- Yu-Chuan Yen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chun-Yuh Yang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Chi-Kung Ho
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Pei-Chun Yen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yu-Ting Cheng
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Kristina D Mena
- Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, TX, United States
| | - Tzu-Chi Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Health Promotion and Health Education, National Taiwan Normal University, Taiwan
| | - Pei-Shih Chen
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung City, Taiwan; Institute of Environmental Engineering, College of Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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21
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Hauptman M, Gaffin JM, Petty CR, Sheehan WJ, Lai PS, Coull B, Gold DR, Phipatanakul W. Proximity to major roadways and asthma symptoms in the School Inner-City Asthma Study. J Allergy Clin Immunol 2020; 145:119-126.e4. [PMID: 31557500 PMCID: PMC6949366 DOI: 10.1016/j.jaci.2019.08.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 07/31/2019] [Accepted: 08/22/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Traffic proximity has been associated with adverse respiratory health outcomes. Less is known about the combined impact of residential and school exposures on pediatric asthma. OBJECTIVE We sought to use spatial analysis methodology to analyze residential and school proximity to major roadways and pediatric asthma morbidity. METHODS The School Inner-City Asthma Study (n = 350) recruited school-aged children with asthma. Each participant's school and home addresses were geocoded, and distances from major roadways were measured to calculate a composite measure accounting for both home and school traffic exposure. Generalized estimating equation models were clustered by subject and adjusted for age, race/ethnicity, sex, income, environmental tobacco smoke, controller medication, upper respiratory tract infections, and seasonality. RESULTS The majority of participants (62%) attended schools within 100 m from major roadways, and 40% also resided within 100 m of major roadways. In multivariate analyses major roadway proximity was independently associated with increased asthma symptom days. At greater than the threshold of 100 m, children had 29% less odds of a symptom day over the past 2 weeks for each 100-m increase in distance from a major roadway (odds ratio, 0.71; 95% CI, 0.58-0.87; P < .01). Children farther from a major roadway also had significantly less reported health care use (odds ratio, 0.63; 95% CI, 0.47-0.85; P < .01) and were significantly less likely to have poor asthma control (odds ratio, 0.80; 95% CI, 0.69-0.94; P < .01). There was not a meaningful association between distance to a major roadway and lung function outcomes. CONCLUSIONS Proximity to a major roadway, a composite measure of home and school exposure but primarily driven by home exposure, was associated with greater asthma morbidity. More studies are needed to evaluate the independent effect of school distance to a roadway on asthma morbidity.
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Affiliation(s)
- Marissa Hauptman
- Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, Mass; Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, and the Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - William J Sheehan
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass
| | - Brent Coull
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Diane R Gold
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Respiratory Epidemiology, Channing Laboratory, Brigham and Women's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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22
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Kakumanu S, Lemanske RF. Asthma in Schools: How School-Based Partnerships Improve Pediatric Asthma Care. Immunol Allergy Clin North Am 2019; 39:271-281. [PMID: 30954176 DOI: 10.1016/j.iac.2018.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Children with asthma experience frequent exacerbations that require careful care coordination among families, clinicians, and schools. Prior studies have shown that children with asthma miss more school each year compared with their healthy peers due to uncontrolled asthma symptoms. Successful school-based asthma programs have built strong partnerships among patients, their families, and clinicians to improve communication and the dissemination of asthma action plans and medications to schools. The widely endorsed School-based Asthma Management Program, consisting of 4 components, provides a comprehensive and expert-supported framework to coordinate care with schools.
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Affiliation(s)
- Sujani Kakumanu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, William S. Middleton Veterans Memorial Hospital, 600 Highland Avenue CSC 9988, Madison, WI 53792, USA.
| | - Robert F Lemanske
- Department of Pediatrics, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA; Department of Medicine, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA
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23
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Abstract
Childhood asthma affects many children placing them at significant risk for health care utilization and school absences. Several new developments relevant to the field of pediatric asthma have occurred over the last 5 years; yet, there is much more to learn. It is poorly understood how to prevent the disease, optimally address environmental challenges, or effectively manage poor adherence. Moreover, it is not clear how to customize therapy by asthma phenotype, age group, high risk groups, or severity of disease. Highlights of advances in pediatric asthma are reviewed and multiple essential areas for further exploration and research are discussed.
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Shahhosseini E, Naddafi K, Nabizadeh R, Shamsipour M, Namvar Z, Tayebi B, Shoormasti RS, Hassanvand MS, Yunesian M. Endotoxin and Der p1 allergen levels in indoor air and settled dust in day-care centers in Tehran, Iran. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2019; 17:789-795. [PMID: 32030152 PMCID: PMC6985405 DOI: 10.1007/s40201-019-00395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Allergens like endotoxin and mite allergen Der p 1 are associated with early wheezing and asthma morbidity. Day-care centers can be an important source of exposure to allergens. The aim of this study was to evaluate children's exposure to endotoxin and mite allergen (Der p 1) associated with total suspended particulate matter (TSP) and settled dust in day-care centers in two phases in years of 2015 and 2016 in Tehran city, Iran. METHODS Endotoxin and mite allergen Der p 1 in TSP and settled dust were measured in 23 day-care centers in Tehran. After collecting dust samples and weighting them, and then their extraction, Endotoxin and Der p 1 allergen were determined using QCL-1000 Endpoint chromogenic LAL Assay and ELISA, respectively. RESULTS The mean concentrations of endotoxin and mite allergen Der p 1 in settled dust were 0.3 EU/mg and 0.2 ng/mg, respectively. The mean concentration of endotoxin and mite allergen Der p 1 in indoor air TSP were 0.8 EU/m3 and 0.4 ng/m3, respectively. A significant negative correlation was found between endotoxin both in settled dust and in TSP with measured relative humidity in winter. Also, moderate correlation was observed between Der p 1 in settled dust and relative humidity in winter; however, the correlation between allergen in TSP and relative humidity was not significant. CONCLUSION Day-care centers can be an important source of endotoxin and Der p 1 allergen, so, implementation of proper interventions in these places can reduce exposure to them.
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Affiliation(s)
- Elahe Shahhosseini
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Namvar
- Department of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnoosh Tayebi
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Sadegh Hassanvand
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
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Howard E, Orhurhu V, Huang L, Guthrie B, Phipatanakul W. The Impact of Ambient Environmental Exposures to Microbial Products on Asthma Outcomes from Birth to Childhood. Curr Allergy Asthma Rep 2019; 19:59. [PMID: 31781873 PMCID: PMC7088961 DOI: 10.1007/s11882-019-0890-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose of Review Asthma is a chronic respiratory condition with increasing domestic and worldwide prevalence that burdens individuals and the healthcare system with high costs associated with long-term treatments and acute emergency room (ER) visits. It can be triggered by ambient microbes, including bacteria, viruses, and fungi. In this review, we examine the outcomes of asthma patients in relation to environmental exposures to ambient microbe products, focusing on whether exposure leads to asthma development from birth to childhood and if particular microbes are associated with worsened asthma exacerbations. Recent Findings Bacterial endotoxin is more prominent in homes with pets and may cause cytokine cascades that lead to asthma exacerbation. However, some studies have demonstrated a protective effect with early exposure. Patients with positive Aspergillus skin testing are more prone to moderate-severe or severe-uncontrolled asthma. Fungal sensitization is also associated with earlier onset of asthma and demonstrates a dose-dependent relationship of symptom severity and duration. Among viruses, rhinovirus has the greatest association with decreased lung function, severe asthma, and asthma-related hospital admissions. Distribution of microbial products and associated asthma symptoms depends on the geographical climate. Genetic variations among individuals also mitigate the effects of microbial products on asthma development and symptom severity. Summary Microbial products of bacteria, fungi, and viruses are associated with the development of asthma, more severe asthma symptoms, and worse outcomes. However, some early exposure studies have also demonstrated a protective effect. Bacterial and fungal products are related to decreased lung function and earlier onset of asthma. Viral products are related to asthma-associated hospital admissions; and the climate and patient genetics can also temper or intensify the relationships between microbial products, asthma development, and asthma symptom severity. Further research should focus on the effects of early microbe exposure and its interaction with human immune systems and asthma-related outcomes.
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Affiliation(s)
- Evin Howard
- Bouvé College of Health Sciences, Graduate School of Nursing, Northeastern University, Boston, MA, USA
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lisa Huang
- Department of Anesthesia, Critical Care, & Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Barbara Guthrie
- Bouvé College of Health Sciences, Graduate School of Nursing, Northeastern University, Boston, MA, USA
| | - Wanda Phipatanakul
- Division of Asthma, Allergy, & Immunology, Harvard Medical School, Children's Hospital Boston, Boston, MA, USA.
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Abstract
Inner-city children with asthma are known to have high disease mortality and morbidity. Frequently, asthma in this high-risk population is difficult to control and more severe in nature. Several factors, including socioeconomic hardship, ability to access to health care, adherence to medication, exposure to certain allergens, pollution, crowd environment, stress, and infections, play an important role in the pathophysiology of inner-city asthma. Comprehensive control of home allergens and exposure to tobacco smoke, the use of immune based therapies, and school-based asthma programs have shown promising results in asthma control in this population.
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Affiliation(s)
- Divya Seth
- Division of Allergy/Immunology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI 48201, USA.
| | - Shweta Saini
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Pavadee Poowuttikul
- Division of Allergy/Immunology, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
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Abstract
Asthma in inner-city children is often severe and difficult to control. Residence in poor and urban areas confers increased asthma morbidity even after adjusting for ethnicity, age, and gender. Higher exposure to household pests, such as cockroaches and mice, pollutants and tobacco smoke exposure, poverty, material hardship, poor-quality housing, differences in health care quality, medication compliance, and heath care access also contribute to increased asthma morbidity in this population. Since 1991, the National Institutes of Allergy and Infectious Diseases established research networks: the National Cooperative Inner-City Asthma Study (NCICAS), the Inner-City Asthma Study (ICAS), and the Inner-City Asthma Consortium (ICAC), to improve care for this at risk population. The most striking finding of the NCICAS is the link between asthma morbidity and the high incidence of allergen sensitization and exposure, particularly cockroach. The follow-up ICAS confirmed that reductions in household cockroach and dust mite were associated with reduction in the inner-city asthma morbidity. The ICAC studies have identified that omalizumab lowered fall inner-city asthma exacerbation rate; however, the relationship between inner-city asthma vs immune system dysfunction, respiratory tract infections, prenatal environment, and inner-city environment is still being investigated. Although challenging, certain interventions for inner-city asthma children have shown promising results. These interventions include family-based interventions such as partnering families with asthma-trained social workers, providing guidelines driven asthma care as well as assured access to controller medication, home-based interventions aim at elimination of indoor allergens and tobacco smoke exposure, school-based asthma programs, and computer/web-based asthma programs.
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Shamsollahi HR, Ghoochani M, Jaafari J, Moosavi A, Sillanpää M, Alimohammadi M. Environmental exposure to endotoxin and its health outcomes: A systematic review. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2019; 174:236-244. [PMID: 30831472 DOI: 10.1016/j.ecoenv.2019.02.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/11/2019] [Accepted: 02/13/2019] [Indexed: 06/09/2023]
Abstract
Exposure to endotoxin occurs environmentally and occupationally. There are several differences between them in terms of the variety and severity of health outcomes, possible exposed groups and type and route of exposure. Occupational exposures caused adverse health outcomes in almost all cases, but there is disparity in the incidence of significant health outcomes due to environmental exposure to endotoxin. This study has therefore endeavoured to investigate health outcomes from environmental exposure to endotoxin. A systematic review was conducted of three databases and non-occupational studies reporting the environmental concentration of endotoxin, and observed health outcomes in exposed groups were included in the review (n = 27). The studies showed that first exposure to endotoxin occurs in infancy by the inhalation route. Inhalation is the only exposure route that can induce inflammation as the main symptom of exposure to endotoxin. The studies included were conducted using four approaches: molecular immunology, measurement of lung volumes, clinical sensitisation test and diagnosis of asthmatic and respiratory symptoms such as wheezing. By the immunological approach, all the included studies reported that environmental exposure to endotoxin, especially at a younger age, has a protective effect on the incidence of asthma in adolescence. The main disparity observed was in studies using the approach of diagnosed asthma. Overall, however, they confirm the protective effect of exposure to endotoxin although, in the case of children with non-atopic asthma, the results could be different.
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Affiliation(s)
- Hamid Reza Shamsollahi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mahboobeh Ghoochani
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jalil Jaafari
- Department of Environmental Health Engineering, School of Health, Guilan University of Medical Sciences, Rasht, Iran.
| | - Azam Moosavi
- Department of Biochemistry, School of Medicine, Alborz University of Medical Sciences, Alborz, Iran.
| | - Mika Sillanpää
- Laboratory of Green Chemistry, School of Engineering Science, Lappeenranta University of Technology, Sammonkatu 12, Mikkeli, Finland.
| | - Mahmood Alimohammadi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Center for Water Quality Research (CWQI), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran; Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran.
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Abstract
Severe asthma accounts for only a small proportion of the children with asthma but a disproportionately high amount of resource utilization and morbidity. It is a heterogeneous entity and requires a step-wise, evidence-based approach to evaluation and management by pediatric subspecialists. The first step is to confirm the diagnosis by eliciting confirmatory history and objective evidence of asthma and excluding possible masquerading diagnoses. The next step is to differentiate difficult-to-treat asthma, asthma that can be controlled with appropriate management, from asthma that requires the highest level of therapy to maintain control or remains uncontrolled despite management optimization. Evaluation of difficult-to-treat asthma includes an assessment of medication delivery, the home environment, and, if possible, the school and other frequented locations, the psychosocial situation, and comorbid conditions. Once identified, aggressive management of issues related to poor adherence and drug delivery, remediation of environmental triggers, and treatment of comorbid conditions is necessary to characterize the degree of control that can be achieved with standard therapies. For the small proportion of patients whose disease remains poorly controlled with these interventions, the clinician may assess steroid responsiveness and determine the inflammatory pattern and eligibility for biologic therapies. Management of severe asthma refractory to traditional therapies involves considering the various biologic and other newly approved treatments as well as emerging therapies based on the individual patient characteristics.
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Louisias M, Ramadan A, Naja AS, Phipatanakul W. The Effects of the Environment on Asthma Disease Activity. Immunol Allergy Clin North Am 2019; 39:163-175. [PMID: 30954168 PMCID: PMC6452888 DOI: 10.1016/j.iac.2018.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is highly prevalent and causes significant morbidity in children. The development of asthma depends on complex relationships between genetic predisposition and environmental modifiers of immune function. The biological and physical environmental factors include aeroallergens, microbiome, endotoxin, genetics, and pollutants. The psychosocial environment encompasses stress, neighborhood safety, housing, and discrimination. They all have been speculated to influence asthma control and the risk of developing asthma. Control of the factors that contribute to or aggravate symptoms, interventions to eliminate allergen exposure, guidelines-based pharmacologic therapy, and education of children and their caregivers are of paramount importance.
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Affiliation(s)
- Margee Louisias
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 6th floor, Boston, MA 02115, USA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Amira Ramadan
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Fegan Building, 6th Floor, Boston, MA 02115, USA; Beth Israel Deaconess Medical Center, Boston, MA
| | - Ahmad Salaheddine Naja
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Fegan Building, 6th Floor, Boston, MA 02115, USA; Lebanese American University, Beirut, Lebanon
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 6th floor, Boston, MA 02115, USA.
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Asthma in inner city children: recent insights: United States. Curr Opin Allergy Clin Immunol 2019; 18:139-147. [PMID: 29406360 DOI: 10.1097/aci.0000000000000423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Children living in US inner cities experience disparate burdens of asthma, especially in severity, impairment, exacerbations, and morbidity. Investigations seeking to better understand the factors and mechanisms underlying asthma prevalence, severity, and exacerbation in children living in these communities can lead to interventions that can narrow asthma disparities and potentially benefit all children with asthma. This update will focus on recent (i.e. late 2016-2017) advances in the understanding of asthma in US inner city children. RECENT FINDINGS Studies published in the past year expand understanding of asthma prevalence, severity, exacerbation, and the outcomes of guidelines-based management of these at-risk children, including: asthma phenotypes in US inner city children that are severe and difficult-to-control; key environmental determinants and mechanisms underlying asthma severity and exacerbations (e.g. allergy-mediated exacerbation susceptibility to rhinovirus); the importance of schools as a place for provocative exposures (e.g. mouse allergen, nitrogen dioxide) as well as a place where asthma care and outcomes can be improved; and the development and validation of clinically useful indices for gauging asthma severity and predicting exacerbations. SUMMARY These recent studies provide a trove of actionable findings that can improve asthma care and outcomes for these at-risk children.
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Haktanir Abul M, Phipatanakul W. Severe asthma in children: Evaluation and management. Allergol Int 2019; 68:150-157. [PMID: 30648539 DOI: 10.1016/j.alit.2018.11.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022] Open
Abstract
Severe asthma in children is associated with significant morbidity. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. It is important to differentiate between severe therapy resistant asthma and difficult-to-treat asthma due to comorbidities. The most common problems that need to be excluded before a diagnosis of severe asthma can be made are poor medication adherence, poor medication technique or incorrect diagnosis of asthma. Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities are clearly addressed. Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard Step 4 asthma therapies according to the guidelines1,2, should be referred to an asthma specialist with expertise in severe asthma.
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Affiliation(s)
- Mehtap Haktanir Abul
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, MA, USA; Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.
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33
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Baxi SN, Sheehan WJ, Sordillo JE, Muilenberg ML, Rogers CA, Gaffin JM, Permaul P, Lai PS, Louisias M, Petty CR, Fu C, Gold DR, Phipatanakul W. Association between fungal spore exposure in inner-city schools and asthma morbidity. Ann Allergy Asthma Immunol 2019; 122:610-615.e1. [PMID: 30904580 DOI: 10.1016/j.anai.2019.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Home fungus exposures may be associated with development or worsening of asthma. Little is known about the effects of school/classroom fungus exposures on asthma morbidity in students. OBJECTIVE To evaluate the association of school-based fungus exposures on asthma symptoms in both fungus-sensitized and nonsensitized students with asthma. METHODS In this prospective study, 280 children with asthma from 37 inner-city schools were phenotypically characterized at baseline and followed-up for 1 year. Fungal spores were collected by using a Burkard air sampler twice during the school year. Clinical outcomes were evaluated throughout the school year and linked to classroom-specific airborne spore sampling. The primary outcome was days with asthma symptoms per 2-week period. RESULTS Fungal spores were present in all classroom samples. The geometric mean of the total fungi was 316.9 spores/m3 and ranged from 15.0 to 59,345.7 spores/m3. There was variability in total fungus quantity between schools and classrooms within the same school. Mitospores were the most commonly detected fungal grouping. Investigation of the individual mitospores revealed that exposure to Alternaria was significantly associated with asthma symptom days in students sensitized to Alternaria (OR = 3.61, CI = 1.34-9.76, P = .01), but not in children not sensitized to Alternaria (OR = 1.04, CI = 0.72-1.49, P = .85). Students sensitized to Alternaria and exposed to high levels (≥75th percentile exposure) had 3.2 more symptom days per 2-week period as compared with students sensitized but exposed to lower levels. CONCLUSION Children with asthma who are sensitized to Alternaria and exposed to this fungus in their classroom may have significantly more days with asthma symptoms than those who were sensitized and not exposed. CLINICAL TRIAL REGISTRATION Clinicaltrials.govNCT01756391.
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Affiliation(s)
- Sachin N Baxi
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William J Sheehan
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Joanne E Sordillo
- Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael L Muilenberg
- Division of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Christine A Rogers
- Division of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Division of Respiratory Diseases, Boston, Massachusetts
| | - Perdita Permaul
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, Massachusetts
| | - Peggy S Lai
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, Massachusetts
| | | | - Carter R Petty
- Brigham and Women's Hospital, Boston, Massachusetts; Boston Children's Hospital, Clinical Research Center Boston, Massachusetts
| | - Chunxia Fu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Diane R Gold
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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34
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School exposure and asthma. Ann Allergy Asthma Immunol 2019; 120:482-487. [PMID: 29407419 DOI: 10.1016/j.anai.2018.01.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To provide a comprehensive overview of common school exposures and the association between school exposures and pediatric asthma morbidity. DATA SOURCES A comprehensive literature review was performed using PubMed. STUDY SELECTIONS Full-length, peer-reviewed studies published in English were considered for review. In vivo, in vitro, and animal studies were excluded. Studies of school exposure to cockroach, mouse, dust mite, dog, cat, molds, pollution, and endotoxin associated with asthma and asthma morbidity were considered. RESULTS The current literature establishes an association between school exposure and pediatric asthma morbidity. There is a need for ongoing research to evaluate the effects of school-based environmental interventions on asthma morbidity. CONCLUSION It is evident that the indoor school environment is a significant reservoir of allergens, molds, pollutants, and endotoxin and that there is an association between school exposure and pediatric asthma morbidity. School-based interventions have the potential for substantial individual, community, and public health benefit. It is important that researchers continue to study the health effects associated with school exposures and assess cost-effectiveness of multifaceted school-based interventions.
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Gaffin JM, Hauptman M, Petty CR, Sheehan WJ, Lai PS, Wolfson JM, Gold DR, Coull BA, Koutrakis P, Phipatanakul W. Nitrogen dioxide exposure in school classrooms of inner-city children with asthma. J Allergy Clin Immunol 2018; 141:2249-2255.e2. [PMID: 28988796 PMCID: PMC5886827 DOI: 10.1016/j.jaci.2017.08.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/27/2017] [Accepted: 08/24/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ambient and home exposure to nitrogen dioxide (NO2) causes asthma symptoms and decreased lung function in children with asthma. Little is known about the health effects of school classroom pollution exposure. OBJECTIVE We aimed to determine the effect of indoor classroom NO2 on lung function and symptoms in inner-city school children with asthma. METHODS Children enrolled in the School Inner-City Asthma Study were followed for 1 academic year. Subjects performed spirometry and had fraction of exhaled nitric oxide values measured twice during the school year at school. Classroom NO2 was collected by means of passive sampling for 1-week periods twice per year, coinciding with lung function testing. Generalized estimating equation models assessed lung function and symptom relationships with the temporally nearest classroom NO2 level. RESULTS The mean NO2 value was 11.1 ppb (range, 4.3-29.7 ppb). In total, exposure data were available for 296 subjects, 188 of whom had complete spirometric data. At greater than a threshold of 8 ppb of NO2 and after adjusting for race and season (spirometry standardized by age, height, and sex), NO2 levels were associated highly with airflow obstruction, such that each 10-ppb increase in NO2 level was associated with a 5% decrease in FEV1/forced vital capacity ratio (β = -0.05; 95% CI, -0.08 to -0.02; P = .01). Percent predicted forced expiratory flow between the 25th and 75th percentile of forced vital capacity was also inversely associated with higher NO2 exposure (β = -22.8; 95% CI, -36.0 to -9.7; P = .01). There was no significant association of NO2 levels with percent predicted FEV1, fraction of exhaled nitric oxide, or asthma symptoms. Additionally, there was no effect modification of atopy on lung function or symptom outcomes. CONCLUSION In children with asthma, indoor classroom NO2 levels can be associated with increased airflow obstruction.
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Affiliation(s)
- Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Marissa Hauptman
- Harvard Medical School, Boston, Mass; Division of General Pediatrics, Boston Children's Hospital, Boston, Mass
| | - Carter R Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Mass
| | - William J Sheehan
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Massachusetts General Hospital, Boston, Mass; Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Jack M Wolfson
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Diane R Gold
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass; Channing Institute of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Brent A Coull
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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36
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Lai PS, Kolde R, Franzosa EA, Gaffin JM, Baxi SN, Sheehan WJ, Gold DR, Gevers D, Xavier RJ, Phipatanakul W. The classroom microbiome and asthma morbidity in children attending 3 inner-city schools. J Allergy Clin Immunol 2018. [PMID: 29518428 DOI: 10.1016/j.jaci.2018.02.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Peggy S Lai
- Massachusetts General Hospital, Boston, Mass; Harvard T.H. Chan School of Public Health, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Raivo Kolde
- Massachusetts General Hospital, Boston, Mass
| | | | - Jonathan M Gaffin
- Harvard Medical School, Boston, Mass; Boston Children's Hospital, Boston, Mass
| | - Sachin N Baxi
- Harvard Medical School, Boston, Mass; Boston Children's Hospital, Boston, Mass
| | - William J Sheehan
- Harvard Medical School, Boston, Mass; Boston Children's Hospital, Boston, Mass
| | - Diane R Gold
- Harvard T.H. Chan School of Public Health, Boston, Mass; Harvard Medical School, Boston, Mass; Brigham and Women's Hospital, Boston, Mass
| | - Dirk Gevers
- Broad Institute of MIT and Harvard University, Cambridge, Mass
| | - Ramnik J Xavier
- Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Broad Institute of MIT and Harvard University, Cambridge, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Broad Institute of MIT and Harvard University, Cambridge, Mass.
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37
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Farokhi A, Heederik D, Smit LAM. Respiratory health effects of exposure to low levels of airborne endotoxin - a systematic review. Environ Health 2018; 17:14. [PMID: 29422043 PMCID: PMC5806377 DOI: 10.1186/s12940-018-0360-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/30/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Elevated endotoxin levels have been measured in ambient air around livestock farms, which is a cause of concern for neighbouring residents. There is clear evidence that occupational exposure to high concentrations of airborne endotoxin causes respiratory inflammation, respiratory symptoms and lung function decline. However, health effects of exposure to low levels of endotoxin are less well described. The aim of this systematic review is to summarize published associations between exposure to relatively low levels of airborne endotoxin and respiratory health endpoints. METHODS Studies investigating respiratory effects of measured or modelled exposure to low levels of airborne endotoxin (average < 100 EU/m3) were eligible for inclusion. In total, 1362 articles were identified through a Pubmed database search, of which 31 articles were included in this review. Studies were included up to February 2017. Overview tables and forest plots were created, and study quality was assessed. RESULTS Twenty-two included studies had a cross-sectional design, others were designed as longitudinal observational (n = 7) or experimental (n = 2) studies. Most studies (n = 23) were conducted in an occupational setting, some involved domestic or experimental exposure. Several studies reported statistically significant effects of exposure to low levels of endotoxin on respiratory symptoms and lung function. However, considerable heterogeneity existed in the outcomes of the included studies and no overall estimate could be provided by meta-analysis to quantify the possible relationship. Instead, a best evidence synthesis was performed among studies examining the exposure-response relationship between endotoxin and respiratory outcomes. Significant exposure-response relationships between endotoxin and symptoms and FEV1 were shown in several studies, with no conflicting findings in the studies included in the best evidence synthesis. Significantly different effects of endotoxin exposure were also seen in vulnerable subgroups (atopics and patients with broncho-obstructive disease) and smokers. CONCLUSIONS Respiratory health effects of exposure to low levels of airborne endotoxin (< 100 EU/m3) seem plausible. Future studies are needed to investigate ambient exposure to endotoxin and potential respiratory health effects, especially in vulnerable subgroups of the population.
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Affiliation(s)
- Azadèh Farokhi
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.178, 3508TD, Utrecht, The Netherlands
| | - Dick Heederik
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.178, 3508TD, Utrecht, The Netherlands
| | - Lidwien A M Smit
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, P.O. Box 80.178, 3508TD, Utrecht, The Netherlands.
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Permaul P, Phipatanakul W. School Environmental Intervention Programs. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:22-29. [PMID: 29310758 PMCID: PMC5773264 DOI: 10.1016/j.jaip.2017.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 12/30/2022]
Abstract
Exposure to indoor allergens and pollutants plays a significant part in the development of asthma and its associated morbidity. Inner-city children with asthma are disproportionately affected by these exposures with increased asthma morbidity. Although years of previous research have linked exposures in the urban home environment with significant childhood asthma disease, many of these allergens are also present in inner-city school environments. Therefore, evaluation of the school environment of patients with asthma is also essential. School-based environmental interventions may offer benefit for this problem and has the potential to help many children with asthma at once in a cost-effective manner. It is important that environmental health researchers continue to assess which interventions are most practical and result in the greatest measurable improvements.
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Affiliation(s)
- Perdita Permaul
- Division of Pediatric Allergy and Immunology, Massachusetts General Hospital for Children, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Harvard Medical School, Boston, Mass; Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass.
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Gene-environment interaction between an IL4R variant and school endotoxin exposure contributes to asthma symptoms in inner-city children. J Allergy Clin Immunol 2017; 141:794-796.e3. [PMID: 28943468 DOI: 10.1016/j.jaci.2017.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/17/2017] [Accepted: 08/31/2017] [Indexed: 11/21/2022]
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Burbank AJ, Duran CG, Pan Y, Burns P, Jones S, Jiang Q, Yang C, Jenkins S, Wells H, Alexis N, Kesimer M, Bennett WD, Zhou H, Peden DB, Hernandez ML. Gamma tocopherol-enriched supplement reduces sputum eosinophilia and endotoxin-induced sputum neutrophilia in volunteers with asthma. J Allergy Clin Immunol 2017; 141:1231-1238.e1. [PMID: 28736267 DOI: 10.1016/j.jaci.2017.06.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/05/2017] [Accepted: 06/14/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND We and others have shown that the gamma tocopherol (γT) isoform of vitamin E has multiple anti-inflammatory and antioxidant actions and that γT supplementation reduces eosinophilic and endotoxin (LPS)-induced neutrophilic airway inflammation in animal models and healthy human volunteers. OBJECTIVE We sought to determine whether γT supplementation reduces eosinophilic airway inflammation and acute neutrophilic response to inhaled LPS challenge in volunteers with asthma. METHODS Participants with mild asthma were enrolled in a double-blinded, placebo-controlled crossover study to assess the effect of 1200 mg of γT daily for 14 days on sputum eosinophils, mucins, and cytokines. We also assessed the effect on acute inflammatory response to inhaled LPS challenge following γT treatment, focusing on changes in sputum neutrophilia, mucins, and cytokines. Mucociliary clearance was measured using gamma scintigraphy. RESULTS Fifteen subjects with mild asthma completed both arms of the study. Compared with placebo, γT notably reduced pre-LPS challenge sputum eosinophils and mucins, including mucin 5AC and reduced LPS-induced airway neutrophil recruitment 6 and 24 hours after challenge. Mucociliary clearance was slowed 4 hours postchallenge in the placebo group but not in the γT treatment group. Total sputum mucins (but not mucin 5AC) were reduced at 24 hours postchallenge during γT treatment compared with placebo. CONCLUSIONS When compared with placebo, γT supplementation for 14 days reduced inflammatory features of asthma, including sputum eosinophils and mucins, as well as acute airway response to inhaled LPS challenge. Larger scale clinical trials are needed to assess the efficacy of γT supplements as a complementary or steroid-sparing treatment for asthma.
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Affiliation(s)
- Allison J Burbank
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC; Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC.
| | - Charity G Duran
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Yinghao Pan
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Patricia Burns
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Susan Jones
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Qing Jiang
- Department of Nutrition Science, Purdue University, West Lafayette, Ind
| | - Chao Yang
- Department of Nutrition Science, Purdue University, West Lafayette, Ind
| | - Sha'Leema Jenkins
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Heather Wells
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Neil Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC; Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Mehmet Kesimer
- Department of Pathology and Laboratory Medicine, Cystic Fibrosis/Pulmonary Research and Treatment Center, Marsico Lung Institute, University of North Carolina, Chapel Hill, NC
| | - William D Bennett
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC
| | - Haibo Zhou
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - David B Peden
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC; Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Michelle L Hernandez
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina, Chapel Hill, NC; Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
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Phipatanakul W, Koutrakis P, Coull BA, Kang CM, Wolfson JM, Ferguson ST, Petty CR, Samnaliev M, Cunningham A, Sheehan WJ, Gaffin JM, Baxi SN, Lai PS, Permaul P, Liang L, Thorne PS, Adamkiewicz G, Brennan KJ, Baccarelli AA, Gold DR. The School Inner-City Asthma Intervention Study: Design, rationale, methods, and lessons learned. Contemp Clin Trials 2017; 60:14-23. [PMID: 28619649 DOI: 10.1016/j.cct.2017.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/31/2017] [Accepted: 06/10/2017] [Indexed: 02/08/2023]
Abstract
Asthma is the most common chronic disease of childhood in the United States, causes significant morbidity, particularly in the inner-city, and accounts for billions of dollars in health care utilization. Home environments are established sources of exposure that exacerbate symptoms and home-based interventions are effective. However, elementary school children spend 7 to 12h a day in school, primarily in one classroom. From the observational School Inner-City Asthma Study we learned that student classroom-specific exposures are associated with worsening asthma symptoms and decline in lung function. We now embark on a randomized, blinded, sham-controlled school environmental intervention trial, built on our extensively established school/community partnerships, to determine the efficacy of a school-based intervention to improve asthma control. This factorial school/classroom based environmental intervention will plan to enroll 300 students with asthma from multiple classrooms in 40 northeastern inner-city elementary schools. Schools will be randomized to receive either integrated pest management versus control and classrooms within these schools to receive either air purifiers or sham control. The primary outcome is asthma symptoms during the school year. This study is an unprecedented opportunity to test whether a community of children can benefit from school or classroom environmental interventions. If effective, this will have great impact as an efficient, cost-effective intervention for inner city children with asthma and may have broad public policy implications.
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Affiliation(s)
- Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Petros Koutrakis
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Brent A Coull
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Choong-Min Kang
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Jack M Wolfson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Stephen T Ferguson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Carter R Petty
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Mihail Samnaliev
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Amparito Cunningham
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States
| | - William J Sheehan
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jonathan M Gaffin
- Boston Children's Hospital, Division of Respiratory Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Sachin N Baxi
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Peggy S Lai
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, MA, United States
| | - Perdita Permaul
- Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, MA, United States
| | - Liming Liang
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Peter S Thorne
- University of Iowa, Department of Occupational and Environmental Health, Iowa City, United States
| | - Gary Adamkiewicz
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Kasey J Brennan
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Andrea A Baccarelli
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Diane R Gold
- Harvard Medical School, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Channing Laboratory, Brigham and Women's Hospital, Boston, MA, United States
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Casas L, Espinosa A, Pekkanen J, Asikainen A, Borràs-Santos A, Jacobs J, Krop EJM, Täubel M, Hyvärinen A, Heederik D, Zock JP. School attendance and daily respiratory symptoms in children: influence of moisture damage. INDOOR AIR 2017; 27:303-310. [PMID: 27224645 DOI: 10.1111/ina.12311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 05/20/2016] [Indexed: 06/05/2023]
Abstract
We investigated the effect of weekends and school holidays on the daily frequency and severity of respiratory and other symptoms among children attending schools with (index) or without (reference) moisture damage in Spain, the Netherlands, and Finland. Throughout 1 year, parents of 419 children with a respiratory condition attending index (n=15) or reference (n=10) primary schools completed three symptom diaries. We assessed associations between lower respiratory tract, upper respiratory tract or allergy, and other symptom scores and school day, weekend, or summer holiday using mixed regression models stratified by country and moisture damage. We evaluated interactions between moisture damage and type of day. We combined country-specific estimates (incidence rate ratios [IRRs] and 95% confidence interval [CI]) in meta-analyses. Symptom scores were lower during weekends and holiday. Lower respiratory tract symptoms were statistically significantly less common during holiday with strongest effect in index schools (IRR=0.7; CI=0.6-0.8). Reporting of other symptoms was more reduced during holiday in index (IRR=0.6; CI=0.4-0.9) than in reference (IRR=0.95; CI=0.8-1.2) schools (interaction P<.01). In conclusion, symptoms were less frequent and/or severe during summer holiday and weekends. This pattern was stronger among children attending moisture-damaged schools, suggesting potential improvement in moisture damage-related symptoms during school breaks.
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Affiliation(s)
- L Casas
- Department of Public Health and Primary Care-Centre for Environment and Health, KU Leuven, Leuven, Belgium
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- University Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - A Espinosa
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- University Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J Pekkanen
- Department Health Protection, National Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - A Asikainen
- Department Health Protection, National Institute for Health and Welfare, Kuopio, Finland
| | - A Borràs-Santos
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- University Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- CIBER Respiratorio (CIBERES), Madrid, Spain
| | - J Jacobs
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - E J M Krop
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - M Täubel
- Department Health Protection, National Institute for Health and Welfare, Kuopio, Finland
| | - A Hyvärinen
- Department Health Protection, National Institute for Health and Welfare, Kuopio, Finland
| | - D Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - J-P Zock
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- University Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Recent advances in environmental controls outside the home setting. Curr Opin Allergy Clin Immunol 2016; 16:135-41. [PMID: 26859366 DOI: 10.1097/aci.0000000000000250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW It has been well studied that aeroallergen, mold, and airborne pollutant exposure in the inner-city home environment is associated with significant childhood asthma morbidity. Although the home environment has been extensively studied, the school environment is less well understood. RECENT FINDINGS In this article, we discuss the relationship between environmental exposures within the school and daycare environment and pediatric asthma morbidity and novel environmental interventions designed to help mitigate pediatric asthma morbidity. SUMMARY Studies assessing environmental exposures outside the home environment and interventions to mitigate these exposures have the potential to reduce pediatric asthma morbidity. Further study in this area should focus on the complex cost benefit analyses of environmental interventions outside the home setting, while controlling for the home environment.
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Paulson JA, Barnett CL. Public Health Stops at the School House Door. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:A171-A175. [PMID: 27689395 PMCID: PMC5047782 DOI: 10.1289/ehp530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In the United States, all children of appropriate age are required to attend school, and many parents send their children to child care. Many school and day care buildings have been found to have environmental health problems that impact children’s health and diminish their ability to learn. No federal agency has the capacity or authority to identify, track, or remediate these problems. A recent meeting, coordinated by Healthy Schools Network, Inc., has developed a set of recommendations to begin to deal with the issue of environmental health problems in schools.
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Affiliation(s)
- Jerome A. Paulson
- Pediatrics and Environmental and Occupational Health, George Washington University School of Medicine and Health Science, and
- Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
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Fisk WJ, Paulson JA, Kolbe LJ, Barnett CL. Significance of the School Physical Environment - A Commentary. THE JOURNAL OF SCHOOL HEALTH 2016; 86:483-487. [PMID: 27246672 DOI: 10.1111/josh.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/01/2016] [Accepted: 03/26/2016] [Indexed: 06/05/2023]
Affiliation(s)
- William J Fisk
- Indoor Environment Group, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, CA 94720.
| | - Jerome A Paulson
- Pediatrics and Environmental and Occupational Health, George Washington University School of Medicine and Health Sciences and George Washington, University Milken Institute School of Public Health, 1113 N Howard Street, Alexandria, VA 2203-1627.
| | - Lloyd J Kolbe
- Applied Health Science, Indiana University School of Public Health, Bloomington, 1205 Street, Georges Lane, Vero Beach, FL 32967.
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Abstract
PURPOSE OF REVIEW Asthma is prevalent in inner-city populations, exhibiting significant morbidity and mortality. This review focuses on the consequential findings of recent literature, providing insight into onset of asthma, complicating factors, prediction of exacerbations, and novel treatment strategies. RECENT FINDINGS Analyses of environmental influence on inner-city children demonstrated novel interactions, implicating potentially protective benefits from early life exposures to pests and pets and isolating detrimental effects of air pollution on asthma morbidity. Through detailed characterization of inner-city asthmatics, predictors of seasonal exacerbations surfaced. Focused, season-specific treatment of inner-city asthmatics with omalizumab identified those most likely to benefit from season-tailored therapy. Comparative studies of urban and rural populations revealed that race and household income, rather than location of residence, impose the greatest risk for increased asthma prevalence and morbidity. SUMMARY Challenging previously conceived exposure-disease relationships, recent literature has elucidated new avenues in the complex interplay between immunologically active exposures and their effects on inner-city asthma. These findings, and improved understanding of other relevant exposures, could steer the direction of primary (and secondary) disease prevention research. Moreover, careful identification of asthma characteristics has effectively established predictors of exacerbations, highlighting individuals for which additional therapies are warranted and for whom such treatments are most likely to be effective.
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Affiliation(s)
- Cullen M Dutmer
- aAllergy and Immunology bPulmonary Medicine Sections, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Hwang SH, Park DJ, Park WM, Park DU, Ahn JK, Yoon CS. Seasonal variation in airborne endotoxin levels in indoor environments with different micro-environmental factors in Seoul, South Korea. ENVIRONMENTAL RESEARCH 2016; 145:101-108. [PMID: 26656510 DOI: 10.1016/j.envres.2015.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/18/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
This study evaluated the variation over a year in airborne endotoxin levels in the indoor environment of five university laboratories in Seoul, South Korea, and examined the micro-environmental factors that influenced endotoxin levels. These included temperature, relative humidity, CO2, CO, illumination, and wind velocity. A total of 174 air samples were collected and analyzed using the kinetic limulus amebocyte lysate assay. Endotoxin levels ranged from <0.001 to 8.90EU/m(3), with an overall geometric mean of 0.240EU/m(3). Endotoxin levels showed significantly negative correlation with temperature (r=-0.529, p<0.001), CO2 (r=-0.213, p<0.001) and illumination (r=-0.538, p<0.001). Endotoxin levels tended to be higher in winter. Endotoxin levels in laboratories with rabbits were significantly higher than those of laboratories with mice. Multivariate regression analysis showed that the environmental factors affecting endotoxin levels were temperature (coefficient=-0.388, p<0.001) and illumination (coefficient=-0.370, p<0.001). Strategies aimed at reducing airborne endotoxin levels in the indoor environments may be most effective if they focus on illumination.
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Affiliation(s)
- Sung Ho Hwang
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, South Korea
| | - Dong Jin Park
- Occupational Safety and Health Research, Ulsan, South Korea
| | - Wha Me Park
- Institute of Environmental and Industrial Medicine, Hanyang University, Seoul, South Korea
| | - Dong Uk Park
- Department of Environmental Health, Korea National Open University, Seoul, South Korea
| | - Jae Kyoung Ahn
- Research Institute of Standards for Environmental Testing, Seoul, South Korea
| | - Chung Sik Yoon
- Institute of Health and Environment, School of Public Health, Seoul National University, Gwanak ,1 Gwanak-ro, Seoul, South Korea.
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