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Fieten K, Cogo A, Rijssenbeek-Nouwens L, Taborda-Barata L, Charpin D. La climatothérapie d’altitude au cours de l’asthme de l’enfant : une approche thérapeutique encore vivante et scientifiquement prometteuse. REVUE FRANÇAISE D'ALLERGOLOGIE 2023. [DOI: 10.1016/j.reval.2022.103277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Nauwelaerts SJD, Van Goethem N, De Cremer K, Sierra NB, Vercauteren J, Stroobants C, Bernard A, Nawrot T, Roosens NHC, De Keersmaecker SCJ. Noninvasive integrative approach applied to children in the context of recent air pollution exposure demonstrates association between fractional exhaled nitric oxide (FeNO) and urinary CC16. ENVIRONMENTAL RESEARCH 2023; 216:114441. [PMID: 36191620 DOI: 10.1016/j.envres.2022.114441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Exposure to the air pollutant particulate matter (PM) is associated with increased risks of respiratory diseases and enhancement of airway inflammation in children. In the context of large scale air pollution studies, it can be challenging to measure fractional exhaled nitric oxide (FeNO) as indicator of lung inflammation. Urinary CC16 (U-CC16) is a potential biomarker of increased lung permeability and toxicity, increasing following short-term PM2.5 exposure. The single nucleotide polymorphism (SNP) CC16 G38A (rs3741240) affects CC16 levels and respiratory health. Our study aimed at assessing the use of U-CC16 (incl. CC16 G38A from saliva) as potential alternative for FeNO by investigating their mutual correlation in children exposed to PM. Samples from a small-scale study conducted in 42 children from urban (n = 19) and rural (n = 23) schools examined at two time points, were analysed. When considering recent (lag1) low level exposure to PM2.5 as air pollution measurement, we found that U-CC16 was positively associated with FeNO (β = 0.23; 95% CI [-0.01; 0.47]; p = 0.06) in an adjusted analysis using a linear mixed effects model. Further, we observed a positive association between PM2.5 and FeNO (β = 0.56; 95% CI [0.02; 1.09]; p = 0.04) and higher FeNO in urban school children as compared to rural school children (β = 0.72; 95% CI [0.12; 1.31]; p = 0.02). Although more investigations are needed, our results suggest that inflammatory responses evidenced by increased FeNO are accompanied by potential increased lung epithelium permeability and injury, evidenced by increased U-CC16. In future large scale studies, where FeNO measurement is less feasible, the integrated analysis of U-CC16 and CC16 G38A, using noninvasive samples, might be a suitable alternative to assess the impact of air pollution exposure on the respiratory health of children, which is critical for policy development at population level.
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Affiliation(s)
- Sarah J D Nauwelaerts
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium; Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, Brussels, Belgium
| | - Nina Van Goethem
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Koen De Cremer
- Platform Chromatography and Mass Spectrometry, Sciensano, Brussels, Belgium
| | | | | | - Christophe Stroobants
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium
| | - Alfred Bernard
- Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, Brussels, Belgium
| | - Tim Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan Building D, 3590, Diepenbeek, Belgium; Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Nancy H C Roosens
- Transversal Activities in Applied Genomics, Sciensano, Brussels, Belgium
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Cogo A, Piazza M, Costella S, Appodia M, Aralla R, Zanconato S, Carraro S, Piacentini G. A positive effect of a short period stay in Alpine environment on lung function in asthmatic children. Pediatr Pulmonol 2022; 57:2116-2121. [PMID: 35606932 PMCID: PMC9546332 DOI: 10.1002/ppul.25987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
Abstract
Lung function is a central issue in diagnosis and determination of asthma severity and asthma control has been previously reported to improve after a stay in mountain environment for at least 2 weeks. No data are available for shorter periods of stay, in particular for small airways during a stay at altitude. The aim of this study is to focus on changes in respiratory function, regarding both the central airways and the peripheral airways in the first 2 weeks of stay in a mountain environment in asthmatic children. In this study, 66 asthmatic children (age: 14 ± 2.8 years) were evaluated through spirometric and oscillometric tests at the time of arrival at the Istituto Pio XII, Misurina (BL), Italy, 1756 m above sea level (T0), after 24 h (T1), and 168 h (T2) of stay. FEV1%, FEF25%-75%, and FEV1/FVC increased significantly from T0 value both at T1 and T2 (respectively, p = 0.0002, p < 0.0001, p = 0.0002). Oscillometry showed a significant improvement in R5, R20, and R5-20 at both T1 and T2 as compared to T0 (respectively, p = 0.0001, p = 0.0002, and p = 0.049). Reactance at 5 Hz (X5) improved significantly at T2 versus T0, p = 0.0022. The area under reactance curve between Fres and 5 Hz (AX) was significantly reduced (p = 0.0001) both at T1 and T2 as compared to T0. This study shows an improvement in respiratory indices as soon as after 24 h of stay at altitude, persisting in the following week.
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Affiliation(s)
- Annalisa Cogo
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Michele Piazza
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Silvia Costella
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | | | - Raffaele Aralla
- Altitude Pediatric Asthma Centre in Misurina, Pio XII Institute, Belluno, Italy
| | - Stefania Zanconato
- Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - Silvia Carraro
- Women's and Children's Health Department, University Hospital of Padova, Padova, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Division, University of Verona, Verona, Italy
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Nauwelaerts SJD, De Cremer K, Bustos Sierra N, Gand M, Van Geel D, Delvoye M, Vandermassen E, Vercauteren J, Stroobants C, Bernard A, Saenen ND, Nawrot TS, Roosens NHC, De Keersmaecker SCJ. Assessment of the Feasibility of a Future Integrated Larger-Scale Epidemiological Study to Evaluate Health Risks of Air Pollution Episodes in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148531. [PMID: 35886381 PMCID: PMC9323067 DOI: 10.3390/ijerph19148531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 02/07/2023]
Abstract
Air pollution exposure can lead to exacerbation of respiratory disorders in children. Using sensitive biomarkers helps to assess the impact of air pollution on children’s respiratory health and combining protein, genetic and epigenetic biomarkers gives insights on their interrelatedness. Most studies do not contain such an integrated approach and investigate these biomarkers individually in blood, although its collection in children is challenging. Our study aimed at assessing the feasibility of conducting future integrated larger-scale studies evaluating respiratory health risks of air pollution episodes in children, based on a qualitative analysis of the technical and logistic aspects of a small-scale field study involving 42 children. This included the preparation, collection and storage of non-invasive samples (urine, saliva), the measurement of general and respiratory health parameters and the measurement of specific biomarkers (genetic, protein, epigenetic) of respiratory health and air pollution exposure. Bottlenecks were identified and modifications were proposed to expand this integrated study to a higher number of children, time points and locations. This would allow for non-invasive assessment of the impact of air pollution exposure on the respiratory health of children in future larger-scale studies, which is critical for the development of policies or measures at the population level.
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Affiliation(s)
- Sarah J. D. Nauwelaerts
- Transversal Activities in Applied Genomics, Sciensano, 1050 Brussels, Belgium; (S.J.D.N.); (M.G.); (D.V.G.); (M.D.); (E.V.); (N.H.C.R.)
- Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, 1200 Brussels, Belgium;
| | - Koen De Cremer
- Platform Chromatography and Mass Spectrometry, Sciensano, 1050 Brussels, Belgium;
| | | | - Mathieu Gand
- Transversal Activities in Applied Genomics, Sciensano, 1050 Brussels, Belgium; (S.J.D.N.); (M.G.); (D.V.G.); (M.D.); (E.V.); (N.H.C.R.)
| | - Dirk Van Geel
- Transversal Activities in Applied Genomics, Sciensano, 1050 Brussels, Belgium; (S.J.D.N.); (M.G.); (D.V.G.); (M.D.); (E.V.); (N.H.C.R.)
| | - Maud Delvoye
- Transversal Activities in Applied Genomics, Sciensano, 1050 Brussels, Belgium; (S.J.D.N.); (M.G.); (D.V.G.); (M.D.); (E.V.); (N.H.C.R.)
| | - Els Vandermassen
- Transversal Activities in Applied Genomics, Sciensano, 1050 Brussels, Belgium; (S.J.D.N.); (M.G.); (D.V.G.); (M.D.); (E.V.); (N.H.C.R.)
| | - Jordy Vercauteren
- Unit Air, Vlaamse Milieumaatschappij, 2000 Antwerpen, Belgium; (J.V.); (C.S.)
| | | | - Alfred Bernard
- Centre for Toxicology and Applied Pharmacology, University Catholique de Louvain, 1200 Brussels, Belgium;
| | - Nelly D. Saenen
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (N.D.S.); (T.S.N.)
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium; (N.D.S.); (T.S.N.)
- Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
| | - Nancy H. C. Roosens
- Transversal Activities in Applied Genomics, Sciensano, 1050 Brussels, Belgium; (S.J.D.N.); (M.G.); (D.V.G.); (M.D.); (E.V.); (N.H.C.R.)
| | - Sigrid C. J. De Keersmaecker
- Transversal Activities in Applied Genomics, Sciensano, 1050 Brussels, Belgium; (S.J.D.N.); (M.G.); (D.V.G.); (M.D.); (E.V.); (N.H.C.R.)
- Correspondence:
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The Effects of Climate Therapy on Cardiorespiratory Fitness and Exercise-Induced Bronchoconstriction in Children with Asthma. ATMOSPHERE 2021. [DOI: 10.3390/atmos12111486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We investigated whether a 1-week stay in the mountains may have a positive impact on Exercise-Induced Bronchoconstriction (EIB) and cardiorespiratory endurance in asthmatic children from an urban area. Spirometry was performed before and 10 min after a 20 m shuttle run test (20mSRT) on the first and seventh day of a summer asthma camp in the Italian Alps at 900 m of altitude. Spirometry z-scores were derived from the Global Lung Initiative 2012 prediction equations, and percentiles of the 20mSRT performance were assigned according to De Miguel-Etayo’s and Tomkinson’s predictive equations. A FEV1 decrease ≥10% after the exercise was defined as EIB. Particulate matter pollution was monitored during the camp and in the urban area of provenience. Twenty-four subjects (age range 7–16 years) were included. Frequency of EIB decreased from 58% (14/24) at day-1 to 33% (8/24) at the end of the camp (p = 0.08). Most subjects with a 20mSRT in the lowest quartile at day 1 had EIB (9/11). The proportion of children with a 20mSRT <25° percentile decreased from 45% (11/24) at day-1 to 16% (4/24) at day-7 (p = 0.02). Conclusion: One-week climate therapy in the mountains improved both bronchial hyperreactivity and cardiorespiratory endurance in our cohort of asthmatic children.
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Li S, Cao S, Duan X, Zhang Y, Gong J, Xu X, Guo Q, Meng X, Bertrand M, Zhang JJ. Children's lung function in relation to changes in socioeconomic, nutritional, and household factors over 20 years in Lanzhou. J Thorac Dis 2021; 13:4574-4588. [PMID: 34422383 PMCID: PMC8339784 DOI: 10.21037/jtd-20-2232] [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: 06/17/2020] [Accepted: 04/15/2021] [Indexed: 11/15/2022]
Abstract
Background Lanzhou has experienced rapid urbanization, leading to changes in socioeconomic, nutritional, and household factors. These changes may affect children’s lung function. Methods Two cross-sectional studies of school-age children (6–13 years of age) from the urban (Chengguan) (Period 1 in 1996 with n=390; Period 2 in 2017 with n=192) and the suburban (Xigu) (Period 1 n=344; Period 2 n=492) district were conducted. Demographic information, household factors, and nutrition status were obtained via a questionnaire survey. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) were measured in each period. Student’s t-test analysis of variance was used to assess the differences in FVC and FEV1 between Periods 1 and 2. Generalized linear models were used to analyze the associations between questionnaire derived factors and lung function. Analyses were done separately for girls and boys. Results Children had significantly lower mean FEV1 and FVC measures in Period 2 than in Period 1. This reduction was greater in children living in the urban area than those living in the suburban area. Obese children had significantly lower lung function but this was only statistically significant in Period 1. Conclusions Children’s lung function (FVC and FEV1) were lower in 2017 than in 1996. Rapid urbanization may have contributed to the decline of lung function. Obesity may be a risk factor for impaired lung function in children living in Lanzhou and possibly elsewhere.
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Affiliation(s)
- Sai Li
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Suzhen Cao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xiaoli Duan
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Yaqun Zhang
- Gansu Provincial Design and Research Institute of Environmental Science, Lanzhou, China
| | - Jicheng Gong
- Beijing Innovation Center for Engineering Science and Advanced Technology, State Key Joint Laboratory for Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, And Center for Environment and Health, Peking University, Beijing, China
| | - Xiangyu Xu
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Qian Guo
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Xin Meng
- Beijing Innovation Center for Engineering Science and Advanced Technology, State Key Joint Laboratory for Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, And Center for Environment and Health, Peking University, Beijing, China
| | - Mcswain Bertrand
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing, China
| | - Junfeng Jim Zhang
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, USA.,Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Fieten KB, John SM, Nowak D. Secondary and Tertiary Prevention: Medical Rehabilitation. Handb Exp Pharmacol 2021; 268:449-470. [PMID: 34196810 DOI: 10.1007/164_2021_511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Allergies are a major public health burden, and targeted measures are required in terms of prevention and treatment. The most common allergic conditions encompass atopic dermatitis (AD), food allergy (FA), allergic asthma (AA), and allergic rhino-conjunctivitis (AR). Primary prevention aims at preventing the onset of allergic disease, before the disease process begins. Secondary prevention aims at preventing progression and exacerbation of allergic disease whereas tertiary prevention aims at reducing disease burden in patients with established disease, by allergen immunotherapy (AIT) or medical rehabilitation. Rehabilitation programs are used for treatment of AA and AD and usually consist of extensive patient assessment, optimization of treatment management, patient education, and behavioral interventions, ideally involving a multidisciplinary treatment team and sometimes provided in a specific climate, usually alpine or maritime. Similarly, prevention of occupational skin diseases requires interdisciplinary approaches on the level of secondary and tertiary preventive intervention; if this is provided, then prevention programs have proven highly (cost-) effective. Unfortunately, the recently published Minimal Standards of Prevention of these dermatoses, underlining especially the importance of meticulous allergological diagnosis and subsequent multidisciplinary patient education, are so far being adhered to only in very few European countries.
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Affiliation(s)
- Karin B Fieten
- Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
| | | | - Dennis Nowak
- Munich Center of Health Sciences, Munich, Germany
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Blood Eosinophil Count as a Predictor of Lung Function Decline in Healthy Individuals. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:394-399.e1. [PMID: 32818699 DOI: 10.1016/j.jaip.2020.07.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/08/2020] [Accepted: 07/31/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the effect of blood eosinophil count (BEC) on a decline in lung function in healthy individuals. OBJECTIVE Using a well-established health screening database, we assessed the associations between BEC and a decline in lung function, measured as the forced expiratory volume in 1 second (FEV1). METHODS Serial BEC and FEV1 data were analyzed using linear mixed models adjusted for gender, height, and smoking status. The association between BEC consistency and a decline in FEV1 was evaluated in subpopulation analyses. RESULTS A total of 4634 individuals were enrolled. The mean number of health screenings was 7.49 over an average of 11.74 years of observation. A higher log2-transformed BEC was significantly associated with a greater decline in FEV1 that was stronger in nonsmokers (P = 8.56 × 10-8) than in smokers (P = 1.52 × 10-3). In subpopulation analyses of 2018 individuals with consistent BECs, those with BECs consistently ≥100/μL (P = 4.58 × 10-6), ≥200/μL (P = 3.53 × 10-7), and ≥300/μL (P = 1.12 × 10-3) had a significantly higher dose-dependent FEV1 decline than those with BECs consistently <100/μL. A BEC threshold of 100/μL in nonsmokers and 200/μL in smokers may predict an accelerated decline in FEV1. CONCLUSIONS BEC is associated with a decline in FEV1, and a consistently high BEC is an independent risk factor for an accelerated decline in FEV1. These results suggest the use of the BEC to identify healthy individuals at high risk for developing chronic lung disease, which in turn may enable a tailored preventive strategy.
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Broitman D, Portnov BA. Forecasting health effects potentially associated with the relocation of a major air pollution source. ENVIRONMENTAL RESEARCH 2020; 182:109088. [PMID: 31901630 DOI: 10.1016/j.envres.2019.109088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/22/2019] [Accepted: 12/23/2019] [Indexed: 06/10/2023]
Abstract
Epidemiological studies often focus on risk assessments associated with exposures to specific air pollutants or proximity to different air pollution sources. Although this information is essential for devising informed health policies, it is not always helpful when it comes to the estimation of potential health effects associated with the introduction or relocation of local health hazards. In this paper, we suggest a novel approach to forecasting the morbidity-reduction impact of hypothetical removal of a major air pollution source from a densely populated urban area. The proposed approach is implemented in three stages. First, we identify and measure the strength of association of individual environmental factors with local morbidity patterns. Next, we use the estimated models to simulate the impact of removal of the pollution source under analysis and its replacement by green areas. Using this assessment, we then estimate potential changes in the local morbidity rates by mutually comparing the observed risk surface of disease with the risk surface simulated by modelling. To validate the proposed approach empirically, we use childhood asthma morbidity data available for a major metropolitan area in Israel, which hosts a large petrochemical complex. According to our estimates, relocation of the petrochemical complex in question is expected to result in about 70% drop in the childhood asthma morbidity rate area-wide. To the best of our knowledge, the present study is the first that suggests an operational approach to incorporating epidemiological assessments as an input for urban development plans related to local sources of air pollution.
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Affiliation(s)
- Dani Broitman
- Faculty of Architecture and Town Planning, Technion - Israel Institute of Technology, Technion City, Haifa, 32000, Israel.
| | - Boris A Portnov
- Department of Natural Resources & Environmental Management, University of Haifa, Mount Carmel, Haifa, 31905, Israel.
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Saxer S, Schneider SR, Appenzeller P, Bader PR, Lichtblau M, Furian M, Sheraliev U, Estebesova B, Emilov B, Sooronbaev T, Bloch KE, Ulrich S. Asthma rehabilitation at high vs. low altitude: randomized parallel-group trial. BMC Pulm Med 2019; 19:134. [PMID: 31340793 PMCID: PMC6657156 DOI: 10.1186/s12890-019-0890-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 07/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background To investigate the effect of asthma rehabilitation at high altitude (3100 m, HA) compared to low altitude (760 m, LA). Methods For this randomized parallel-group trial insufficiently controlled asthmatics (Asthma Control Questionnaire (ACQ) > 0.75) were randomly assigned to 3-week in-hospital rehabilitation comprising education, physical-&breathing-exercises at LA or HA. Co-primary outcomes assessed at 760 m were between group changes in peak expiratory flow (PEF)-variability, and ACQ) from baseline to end-rehabilitation and 3 months thereafter. Results 50 asthmatics were randomized [median (quartiles) LA: ACQ 2.7(1.7;3.2), PEF-variability 19%(14;33); HA: ACQ 2.0(1.6;3.0), PEF-variability 17%(12;32)]. The LA-group improved PEF-variability by median(95%CI) -7%(− 14 to 0, p = 0.033), ACQ − 1.4(− 2.2 to − 0.9, p < 0.001), and after 3 months by − 3%(− 18 to 2, p = 0.103) and − 0.9(− 1.3 to − 0.3, p = 0.002). The HA-group improved PEF-variability by − 10%(− 21 to − 3, p = 0.004), ACQ − 1.1(− 1.3 to − 0.7, p < 0.001), and after 3 months by − 9%(− 10 to − 3, p = 0.003) and − 0.2(− 0.9 to 0.4, p = 0.177). The additive effect of HA vs. LA directly after the rehabilitation on PEF-variability was − 6%(− 14 to 2), on ACQ 0.3(− 0.4 to 1.1) and after 3 months − 5%(− 14 to 5) respectively 0.4(− 0.4 to 1.1), all p = NS. Conclusion Asthma rehabilitation is highly effective in improving asthma control in terms of PEF-variability and symptoms, both at LA and HA similarly. Trial registration Clinicaltrials.gov: NCT02741583, Registered April 18, 2016. Electronic supplementary material The online version of this article (10.1186/s12890-019-0890-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stéphanie Saxer
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland.,Department of Health Sciences & Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Simon R Schneider
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Paula Appenzeller
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Patrick R Bader
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Ulan Sheraliev
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Bermet Estebesova
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Berik Emilov
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Talant Sooronbaev
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Konrad E Bloch
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, UniversityHospital Zurich, Rämistrasse 100, CH-8091 , Zurich, Switzerland.
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Burden of lower respiratory infections in the Eastern Mediterranean Region between 1990 and 2015: findings from the Global Burden of Disease 2015 study. Int J Public Health 2018; 63:97-108. [PMID: 28776246 PMCID: PMC5973986 DOI: 10.1007/s00038-017-1007-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/08/2017] [Accepted: 06/28/2017] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES We used data from the Global Burden of Disease 2015 study (GBD) to calculate the burden of lower respiratory infections (LRIs) in the 22 countries of the Eastern Mediterranean Region (EMR) from 1990 to 2015. METHODS We conducted a systematic analysis of mortality and morbidity data for LRI and its specific etiologic factors, including pneumococcus, Haemophilus influenzae type b, Respiratory syncytial virus, and influenza virus. We used modeling methods to estimate incidence, deaths, and disability-adjusted life-years (DALYs). We calculated burden attributable to known risk factors for LRI. RESULTS In 2015, LRIs were the fourth-leading cause of DALYs, causing 11,098,243 (95% UI 9,857,095-12,396,566) DALYs and 191,114 (95% UI 170,934-210,705) deaths. The LRI DALY rates were higher than global estimates in 2015. The highest and lowest age-standardized rates of DALYs were observed in Somalia and Lebanon, respectively. Undernutrition in childhood and ambient particulate matter air pollution in the elderly were the main risk factors. CONCLUSIONS Our findings call for public health strategies to reduce the level of risk factors in each age group, especially vulnerable child and elderly populations.
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Mazenq J, Dubus JC, Gaudart J, Charpin D, Nougairede A, Viudes G, Noel G. Air pollution and children's asthma-related emergency hospital visits in southeastern France. Eur J Pediatr 2017; 176:705-711. [PMID: 28382539 DOI: 10.1007/s00431-017-2900-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/18/2017] [Accepted: 03/23/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED Children's asthma is multifactorial. Environmental factors like air pollution exposure, meteorological conditions, allergens, and viral infections are strongly implicated. However, place of residence has rarely been investigated in connection with these factors. The primary aim of our study was to measure the impact of particulate matter (PM), assessed close to the children's homes, on asthma-related pediatric emergency hospital visits within the Bouches-du-Rhône area in 2013. In a nested case-control study on 3- to 18-year-old children, each control was randomly matched on the emergency room visit day, regardless of hospital. Each asthmatic child was compared to 15 controls. PM10 and PM2.5, meteorological conditions, pollens, and viral data were linked to ZIP code and analyzed by purpose of emergency visit. A total of 68,897 visits were recorded in children, 1182 concerning asthma. Short-term exposure to PM10 measured near children's homes was associated with excess risk of asthma emergency visits (adjusted odds ratio 1.02 (95% CI 1.01-1.04; p = 0.02)). Male gender, young age, and temperature were other risk factors. Conversely, wind speed was a protective factor. CONCLUSION PM10 and certain meteorological conditions near children's homes increased the risk of emergency asthma-related hospital visits in 3- to 18-year-old children in Bouches-du-Rhône. What is Known: • A relationship between short-term exposure to air pollution and increase in emergency room visits or hospital admissions as a result of increased pollution levels has already been demonstrated. What is New: • This study confirms these results but took into account confounding factors (viral data, pollens, and meteorological conditions) and is based on estimated pollution levels assessed close to the children's homes, rather than those recorded at the hospital. • The study area, the Mediterranean, is favorable to creation of secondary pollutants in these sunny and dry seasons.
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Affiliation(s)
- Julie Mazenq
- Pediatric Pulmonology Department, Timone Children's Hospital, 264 rue Saint Pierre, 13005, Marseille, France.
| | - Jean-Christophe Dubus
- Pediatric Pulmonology Department, Timone Children's Hospital, 264 rue Saint Pierre, 13005, Marseille, France
| | - Jean Gaudart
- Aix-Marseille University, UMR912 SESSTIM (AMU-IRD-INSERM), Marseille, France
| | - Denis Charpin
- Pulmonology and Allergology Department, Hôpital Nord, Marseille, France
| | - Antoine Nougairede
- IRD French Institute of Research for Development, EHESP, French School of Public Health, EPV UMR_D 190 "Emergence des Pathologies Virales", Aix Marseille University, Marseille, France.,University Mediterranean Hospital Institute for Infections, Marseille, France
| | - Gilles Viudes
- Regional Emergencies Observatory, Provence-Alpes-Cote d'Azur region (ORU PACA), Hyères, France
| | - Guilhem Noel
- Regional Emergencies Observatory, Provence-Alpes-Cote d'Azur region (ORU PACA), Hyères, France.,Pediatric Emergency Department, Hôpital Nord, Marseille, France
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13
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Woolf AD, Sibrizzi C, Kirkland K. Pediatric Environmental Health Specialty Units: An Analysis of Operations. Acad Pediatr 2016; 16:25-33. [PMID: 26233834 DOI: 10.1016/j.acap.2015.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 1998 the Agency for Toxic Substances and Disease Registry (ATSDR) secured the first federal funding to develop an innovative network of public health-oriented entities: Pediatric Environmental Health Specialty Units (PEHSUs). PEHSU goals were to provide pediatric and environmental health education to health care providers and health profession students, to offer consultation to health care professionals, parents, and others regarding environmental health exposures, and to provide referrals to specialized medical resources when necessary. This report analyzes the productivity of US PEHSUs from 1999 to 2014. METHODS This was a retrospective analysis of federally mandated quarterly reports filed by each PEHSU. These reports document specific goal-related deliverables outlined under cooperative agreements awarded to the Association of Occupational and Environmental Clinics (AOEC) with funding from the Environmental Protection Agency (EPA) and ATSDR. Costs were obtained from grant budget information available from the administrator of the grants, AOEC. RESULTS Total EPA/ATSDR funding for PEHSUs paid to AOEC during 1999-2014 was $23,847,452. The average cost to the EPA/ATSDR of running each PEHSU in 2014 was $169,256. Through over 8000 consultations and educational activities, PEHSUs reached 702,506 people: 298,936 health professionals, 61,947 health professional trainees, 323,817 members of the public, and 17,806 public health officials and others. CONCLUSIONS PEHSUs have grown into an established, productive network of clinical and educational centers whose expertise and activities have benefited both the public and health care professionals alike. The federal contributions to the cost of operating these centers have been more than offset by the benefits PEHSUs have conferred on the communities they serve.
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Affiliation(s)
- Alan D Woolf
- Pediatric Environmental Health Center, Division of General Pediatrics, Boston Children's Hospital, Region 1 New England Pediatric Environmental Health Specialty Unit (PEHSU), and Harvard Medical School, Boston, Mass.
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14
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Zheng XY, Ding H, Jiang LN, Chen SW, Zheng JP, Qiu M, Zhou YX, Chen Q, Guan WJ. Association between Air Pollutants and Asthma Emergency Room Visits and Hospital Admissions in Time Series Studies: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0138146. [PMID: 26382947 PMCID: PMC4575194 DOI: 10.1371/journal.pone.0138146] [Citation(s) in RCA: 277] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 08/25/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Air pollution constitutes a significant stimulus of asthma exacerbations; however, the impacts of exposure to major air pollutants on asthma-related hospital admissions and emergency room visits (ERVs) have not been fully determined. OBJECTIVE We sought to quantify the associations between short-term exposure to air pollutants [ozone (O3), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and particulate matter ≤10 μm (PM10) and PM2.5] and the asthma-related emergency room visits (ERV) and hospitalizations. METHODS Systematic computerized searches without language limitation were performed. Pooled relative risks (RRs) and 95% confidence intervals (95%CIs) were estimated using the random-effect models. Sensitivity analyses and subgroup analyses were also performed. RESULTS After screening of 246 studies, 87 were included in our analyses. Air pollutants were associated with significantly increased risks of asthma ERVs and hospitalizations [O3: RR(95%CI), 1.009 (1.006, 1.011); I2 = 87.8%, population-attributable fraction (PAF) (95%CI): 0.8 (0.6, 1.1); CO: RR(95%CI), 1.045 (1.029, 1.061); I2 = 85.7%, PAF (95%CI): 4.3 (2.8, 5.7); NO2: RR(95%CI), 1.018 (1.014, 1.022); I2 = 87.6%, PAF (95%CI): 1.8 (1.4, 2.2); SO2: RR(95%CI), 1.011 (1.007, 1.015); I2 = 77.1%, PAF (95%CI): 1.1 (0.7, 1.5); PM10: RR(95%CI), 1.010 (1.008, 1.013); I2 = 69.1%, PAF (95%CI): 1.1 (0.8, 1.3); PM2.5: RR(95%CI), 1.023 (1.015, 1.031); I2 = 82.8%, PAF (95%CI): 2.3 (1.5, 3.1)]. Sensitivity analyses yielded compatible findings as compared with the overall analyses without publication bias. Stronger associations were found in hospitalized males, children and elderly patients in warm seasons with lag of 2 days or greater. CONCLUSION Short-term exposures to air pollutants account for increased risks of asthma-related ERVs and hospitalizations that constitute a considerable healthcare utilization and socioeconomic burden.
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Affiliation(s)
- Xue-yan Zheng
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Hong Ding
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Li-na Jiang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Shao-wei Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Jin-ping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Min Qiu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Ying-xue Zhou
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangdong, China
| | - Wei-jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
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15
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Brown PM, Schneeberger DL, Piedimonte G. Biomarkers of respiratory syncytial virus (RSV) infection: specific neutrophil and cytokine levels provide increased accuracy in predicting disease severity. Paediatr Respir Rev 2015; 16:232-40. [PMID: 26074450 PMCID: PMC4656140 DOI: 10.1016/j.prrv.2015.05.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 12/17/2022]
Abstract
Despite fundamental advances in the research on respiratory syncytial virus (RSV) since its initial identification almost 60 years ago, recurring failures in developing vaccines and pharmacologic strategies effective in controlling the infection have allowed RSV to become a leading cause of global infant morbidity and mortality. Indeed, the burden of this infection on families and health care organizations worldwide continues to escalate and its financial costs are growing. Furthermore, strong epidemiologic evidence indicates that early-life lower respiratory tract infections caused by RSV lead to the development of recurrent wheezing and childhood asthma. While some progress has been made in the identification of reliable biomarkers for RSV bronchiolitis, a "one size fits all" biomarker capable of accurately and consistently predicting disease severity and post-acute outcomes has yet to be discovered. Therefore, it is of great importance on a global scale to identify useful biomarkers for this infection that will allow pediatricians to cost-effectively predict the clinical course of the disease, as well as monitor the efficacy of new therapeutic strategies.
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Affiliation(s)
| | | | - Giovanni Piedimonte
- Center for Pediatric Research, Pediatric Institute and Children's Hospitals, The Cleveland Clinic.
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16
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Scarpa MC, Kulkarni N, Maestrelli P. The role of non-invasive biomarkers in detecting acute respiratory effects of traffic-related air pollution. Clin Exp Allergy 2015; 44:1100-18. [PMID: 25040251 DOI: 10.1111/cea.12373] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The role of non-invasive methods in the investigation of acute effects of traffic-related air pollution is not clearly established. We evaluated the usefulness of non-invasive biomarkers in detecting acute air pollution effects according to the age of participants, the disease status, their sensitivity compared with lung function tests and their specificity for a type of pollutant. Search terms lead to 535 titles, among them 128 had potentially relevant abstracts. Sixtynine full papers were reviewed, while 59 articles were excluded as they did not meet the selection criteria. Methods used to assess short-term effects of air pollution included analysis of nasal lavage (NAL) for the upper airways, and induced sputum (IS), exhaled breath condensate (EBC) and exhaled nitric oxide (FeNO) for central and lower airways. There is strong evidence that FeNO evaluation is useful independently from subject age, while IS analysis is suitable almost for adults. Biomarker changes are generally observed upon pollutant exposure irrespective of the disease status of the participants. None of the biomarkers identified are specific for a type of pollutant exposure. Based on experimental exposure studies, there is moderate evidence that IS analysis is more sensitive than lung function tests, whereas this is not the case for biomarkers obtained by NAL or EBC. Cells and some cytokines (IL-6, IL-8 and myeloperoxidase) have been measured both in the upper respiratory tract (NAL) and in the lower airways (IS). Overall, the response to traffic exposure seems different in the two compartments. In conclusion, this survey of current literature displays the complexity of this research field, highlights the significance of short-term studies on traffic pollution and gives important tips when planning studies to detect acute respiratory effects of air pollution in a non-invasive way.
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Affiliation(s)
- M C Scarpa
- Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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17
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Badyda AJ, Dąbrowiecki P, Czechowski PO, Majewski G. Risk of bronchi obstruction among non-smokers--review of environmental factors affecting bronchoconstriction. Respir Physiol Neurobiol 2014; 209:39-46. [PMID: 25447677 DOI: 10.1016/j.resp.2014.10.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 10/07/2014] [Accepted: 10/28/2014] [Indexed: 11/28/2022]
Abstract
In order to find relationship between exposure to traffic and traffic-related air pollutants, pulmonary function tests and a detailed questionnaire were conducted among 3997 selected inhabitants of Warsaw (Poland) and 988 residents of rural areas. Advanced statistical analyses (including GRM models, correspondence analysis and parametrical tests) have been completed. Statistically significant differences between average percentages of predicted values of pulmonary function parameters were found. Among urban area inhabitants the values of FEV1, MEF50 and FEV1/FVC were statistically significant (p<0.05) lower compared with the residents of rural areas (in the non-smoking group this differences were strong (p<0.001)). General linear regression models indicated that residence in the vicinity of urban busy roads fosters a decrease of spirometric parameters. Physical activity however has a positive effect on pulmonary function (exemplified by FEV1) and allows to reduce part of the negative health effects of traffic-related emissions. The results of the presented study demonstrate that long-term residence under the influence of heavy traffic and high concentrations of traffic-related air pollutants reduces respiratory function parameters, which may result in increased bronchial hyperresponsiveness.
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Affiliation(s)
- Artur Jerzy Badyda
- Warsaw University of Technology, Faculty of Environmental Engineering, Warsaw, Poland; Polish Federation of Asthma, Allergy and COPD Patients' Associations, Warsaw, Poland.
| | - Piotr Dąbrowiecki
- Military Institute of Medicine, Central Clinical Hospital of the Ministry of National Defence, Warsaw, Poland; Polish Federation of Asthma, Allergy and COPD Patients' Associations, Warsaw, Poland
| | | | - Grzegorz Majewski
- Warsaw University of Life Sciences, Faculty of Civil and Environmental Engineering, Warsaw, Poland
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18
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Meo SA, AlShehri KA, AlHarbi BB, Barayyan OR, Bawazir AS, Alanazi OA, Al-Zuhair AR. Effect of shisha (waterpipe) smoking on lung functions and fractional exhaled nitric oxide (FeNO) among Saudi young adult shisha smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:9638-48. [PMID: 25233010 PMCID: PMC4199040 DOI: 10.3390/ijerph110909638] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/02/2014] [Accepted: 09/03/2014] [Indexed: 12/15/2022]
Abstract
Shisha (waterpipe) smoking is becoming a more prevalent form of tobacco consumption, and is growing worldwide, particularly among the young generation in the Middle East. This cross-sectional study aimed to determine the effects of shisha smoking on lung functions and Fractional Exhaled Nitric Oxide (FeNO) among Saudi young adults. We recruited 146 apparently healthy male subjects (73 control and 73 shisha smokers). The exposed group consisted of male shisha smokers, with mean age 21.54 ± 0.41 (mean ± SEM) range 17-33 years. The control group consisted of similar number (73) of non-smokers with mean age 21.36 ± 0.19 (mean ± SEM) range 18-28 years. Between the groups we considered the factors like age, height, weight, gender, ethnicity and socioeconomic status to estimate the impact of shisha smoking on lung function and fractional exhaled nitric oxide. Lung function test was performed by using an Spirovit-SP-1 Electronic Spirometer. Fractional Exhaled Nitric Oxide (FeNO) was measured by using Niox Mino. A significant decrease in lung function parameters FEV1, FEV1/FVC Ratio, FEF-25%, FEF-50%, FEF-75% and FEF-75-85% was found among shisha smokers relative to their control group. There was also a significant reduction in the Fractional Exhaled Nitric Oxide among Shisha smokers compared to control group.
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Affiliation(s)
- Sultan Ayoub Meo
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Khaled Ahmed AlShehri
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Bader Bandar AlHarbi
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Omar Rayyan Barayyan
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Abdulrahman Salem Bawazir
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Omar Abdulmohsin Alanazi
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia.
| | - Ahmed Raad Al-Zuhair
- Department of Physiology, College of Medicine, King Saud University, P.O. Box 2925, Riyadh 11461 Saudi Arabia
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19
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Altuğ H, Gaga EO, Döğeroğlu T, Brunekreef B, Hoek G, Van Doorn W. Effects of ambient air pollution on respiratory tract complaints and airway inflammation in primary school children. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 479-480:201-9. [PMID: 24561926 DOI: 10.1016/j.scitotenv.2014.01.127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/25/2014] [Accepted: 01/30/2014] [Indexed: 05/13/2023]
Abstract
Respiratory health effects of ambient air pollution were studied in 605 school children 9 to 13 years in Eskişehir, Turkey. Each child performed a fractional exhaled nitric oxide (FENO) measurement and a lung function test (LFT). Self-reported respiratory tract complaints (having cold, complaints of throat, runny nose and shortness of breath/wheezing) in the last 7 days and on the day of testing were also recorded. As acute health outcomes were investigated, weekly average ambient concentrations of ozone (O3), nitrogen dioxide (NO2) and sulfur dioxide (SO2) were determined by passive sampling in the school playgrounds simultaneously with the health survey. Effects of air pollution on respiratory tract complaints and exhaled NO/lung function were estimated by multivariate logistic regression and multivariate linear mixed effects models, respectively. Upper respiratory tract complaints were significantly (p<0.05) associated with weekly average O3 concentrations during the health survey (adjusted odds ratios (OR) of 1.21 and 1.28 for a 10 μgm(-3) increment for having cold and a runny nose on day of testing, respectively). FENO levels were significantly (p<0.05) increased in children with various upper respiratory tract complaints (ratio in FENO varied between 1.16 and 1.40). No significant change in FENO levels was detected in association with any of the measured pollutants (p ≥ 0.05). Lung function was not associated with upper respiratory tract complaints and FENO levels. Peak Expiratory Flow (PEF) levels were negatively associated with weekly average O3 levels for children without upper respiratory tract complaints. In summary, elevated levels of air pollutants increased respiratory tract complaints in children.
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Affiliation(s)
- Hicran Altuğ
- Department of Environmental Engineering, Anadolu University, İki Eylül Campus, 26555 Eskişehir, Turkey.
| | - Eftade O Gaga
- Department of Environmental Engineering, Anadolu University, İki Eylül Campus, 26555 Eskişehir, Turkey.
| | - Tuncay Döğeroğlu
- Department of Environmental Engineering, Anadolu University, İki Eylül Campus, 26555 Eskişehir, Turkey.
| | - Bert Brunekreef
- IRAS Institute for Risk Assessment Sciences, Utrecht University, The Netherlands.
| | - Gerard Hoek
- IRAS Institute for Risk Assessment Sciences, Utrecht University, The Netherlands.
| | - Wim Van Doorn
- Royal Haskoning, Business line Industry and Energy, P.O. Box 151, 6500 AD Nijmegen, The Netherlands.
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20
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Liu C, Flexeder C, Fuertes E, Cyrys J, Bauer CP, Koletzko S, Hoffmann B, von Berg A, Heinrich J. Effects of air pollution on exhaled nitric oxide in children: Results from the GINIplus and LISAplus studies. Int J Hyg Environ Health 2014; 217:483-91. [DOI: 10.1016/j.ijheh.2013.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 12/21/2022]
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Abstract
Asthma is a complex condition that requires individualized interventions. The purpose of this article is to describe the relationship between the physical and social environments with asthma symptoms, present evidence that supports environmental interventions in asthma control and the implications for asthma management. There is evidence that indoor and outdoor allergens relate to asthma morbidity. Knowledge about which environmental exposures present risk is essential because many of these exposures can be modified, reduced, or eliminated. The community health nurse should provide care relative to the client's indoor and outdoor environment and existing allergens.
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Affiliation(s)
- Yvonne M Sterling
- LSU Health New Orleans School of Nursing, New Orleans, Louisiana 70112, USA.
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22
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Zhao Z, Huang C, Zhang X, Xu F, Kan H, Song W, Wieslander G, Norback D. Fractional exhaled nitric oxide in Chinese children with asthma and allergies--a two-city study. Respir Med 2012. [PMID: 23199703 DOI: 10.1016/j.rmed.2012.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic airway inflammation. Our aim was to study associations between FeNO in Chinese children in two cities and asthma, asthmatic symptoms, rhinitis, eczema, and selected childhood and home environmental factors. A random sample of children in Shanghai (n = 187) and Taiyuan (n = 127), and additional randomly selected children reporting current wheeze (n = 115) were invited for FeNO measurements by NIOX MINO. A questionnaire survey was performed among all subjects (12-14 y) in 59 classes in Shanghai and 44 in Taiyuan. Associations were studied using multiple linear regression using 10log transformed FeNO data and mutual adjustment. The geometric mean FeNO in the random sample (GM ± GSD) was higher in Shanghai (16.2 ± 1.9 ppb) as compared to Taiyuan (12.8 ± 1.6 ppb) (P < 0.001). In the total material (n = 429), Shanghai residency (P = 0.001), male gender (P = 0.02), parental asthma/allergy (P = 0.04), doctors' diagnosed asthma (DDA) (P < 0.001) and current wheeze (P < 0.001) were associated with higher FeNO levels. In non-wheezers (n = 291), Shanghai residency (P = 0.007), male gender (P = 0.002), DDA (P = 0.04), current rhinitis (P = 0.004) and reported pollen/furry pet allergy (P = 0.04) were positively associated with FeNO. In wheezers (n = 138), DDA was the only significant factor (P = 0.009). In conclusion, male gender, current wheeze, DDA, parental asthma/allergy, current rhinitis, pollen/furry pet allergy can be independent determinants of increased FeNO. The lower level of FeNO in Taiyuan is in agreement with previous studies showing lower prevalence of asthma and allergy in Taiyuan as compared to Shanghai.
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MESH Headings
- Adolescent
- Air Pollutants/adverse effects
- Air Pollutants/analysis
- Air Pollution/adverse effects
- Air Pollution/analysis
- Asthma/diagnosis
- Asthma/epidemiology
- Asthma/etiology
- Biomarkers/analysis
- Breath Tests/methods
- Child
- China/epidemiology
- Cross-Sectional Studies
- Dermatitis, Atopic/epidemiology
- Dermatitis, Atopic/etiology
- Environmental Monitoring/methods
- Female
- Humans
- Male
- Nitric Oxide/analysis
- Residence Characteristics
- Respiratory Sounds/etiology
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/etiology
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/etiology
- Risk Factors
- Sex Factors
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Affiliation(s)
- Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai, PR China.
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Residential proximity to a major roadway is associated with features of asthma control in children. PLoS One 2012; 7:e37044. [PMID: 22615884 PMCID: PMC3355164 DOI: 10.1371/journal.pone.0037044] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 04/12/2012] [Indexed: 11/19/2022] Open
Abstract
Background While several studies suggest that traffic-related air pollutants are detrimental for respiratory health, few studies have examined relationships between residential proximity to a major roadway and asthma control in children. Furthermore, a major limitation of existing research is reliance on self-reported outcomes. We therefore determined the spatial relationship between the distance from a major roadway and clinical, physiologic and inflammatory features of asthma in a highly characterized sample of asthmatic children 6–17 years of age across a wide range of severities. We hypothesized that a closer residential proximity to a major roadway would be associated with increased respiratory symptoms, altered pulmonary function and a greater magnitude of airway and systemic inflammation. Methodology/Principal Findings 224 children 6–17 years with confirmed asthma completed questionnaires and underwent spirometry, plethysmography, exhaled nitric oxide determination, exhaled breath condensate collection and venipuncture. Residential distance from a major roadway was determined by mapping the geographic coordinates of the residential address in Geographic Information System software. The distance between the home address and the nearest major roadway was calculated according to the shortest distance between the two points (i.e., “as the crow flies”). Asthmatic children living in closer proximity to a major roadway had an increased frequency of wheezing associated with increased medication requirements and more hospitalizations even after controlling for potential confounders. These children also had increased airway resistance, increased airway inflammation reflected by a lower breath condensate pH, and higher plasma EGF concentrations. Conclusions/Significance These findings suggest that closer residential proximity to a major roadway is associated with poorer asthma control in school-age children. Assessment of residential proximity to major roadways may be useful in the clinical evaluation of asthma in children.
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Gudelj I, Kobal IM, Škvorc HM, Miše K, Vrbica Ž, Plavec D, Tudorić N. Intraregional differences in asthma prevalence and risk factors for asthma among adolescents in Split-Dalmatia County, Croatia. Med Sci Monit 2012; 18:PH43-50. [PMID: 22460102 PMCID: PMC3560826 DOI: 10.12659/msm.882609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 10/10/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Our aim was to assess the differences in intraregional prevalence of asthma in adolescents in Split-Dalmatia County to determine asthma risk factors in our population and estimate the specificity and sensitivity of the questionnaire used. MATERIAL/METHODS We conducted the study using the European Community Respiratory Health Survey II short questionnaire supplemented by some questions from the International Study of Asthma in Childhood questionnaire. The participants suspected to have asthma were invited for examination by an asthma specialist who established the final diagnosis of asthma according to the medical history, physical examination, skin-prick tests, and peak flow measurements. RESULTS A total of 4027 students (51.2% male) participated in the study. According to the prevalence of wheezing during the last 12 months, asthma prevalence was estimated at 9.7%. The total prevalence of asthma confirmed by an asthma specialist in the selected population was 5.60% (95% CI, 4.93-6.36%); 6.18% in Split (95% CI, 5.37-7.09), 5.63% in Imotski (95% CI, 3.48-8.58), and 2.90% in Sinj (95% CI, 1.67-4.68) (P=0.0028). We found sensitization to aeroallergens and peanuts, and active smoking to be independent risk factors for asthma. CONCLUSIONS Split-Dalmatia County has moderate asthma prevalence, with a significant intraregional difference. Asthma prevalence estimated by a questionnaire (9.7%) overestimates the prevalence of asthma confirmed by an asthma specialist (5.6%) in adolescents in Croatia. Our data confirmed the need of a more complex questionnaire to evaluate the accurate prevalence of current asthma or the need for subsequent clinical evaluation of the questionnaire obtained data. Allergic sensitization to aeroallergens and active smoking were important risk factors for asthma.
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Affiliation(s)
- Ivan Gudelj
- Department of Pulmonary Diseases, University Hospital Center Split, University Split, Split, Croatia
| | - Iva Mrkić Kobal
- Children’s Hospital Srebrnjak, Reference Center for Clinical Pediatric Allergy of the Ministry of Health and Social Welfare, Zagreb, Croatia
| | - Helena Munivrana Škvorc
- Children’s Hospital Srebrnjak, Reference Center for Clinical Pediatric Allergy of the Ministry of Health and Social Welfare, Zagreb, Croatia
| | - Kornelija Miše
- Department of Pulmonary Diseases, University Hospital Center Split, University Split, Split, Croatia
| | - Žarko Vrbica
- Department of Pulmonary Diseases, County Hospital Dubrovnik, Dubrovnik, Croatia
| | - Davor Plavec
- Children’s Hospital Srebrnjak, Reference Center for Clinical Pediatric Allergy of the Ministry of Health and Social Welfare, Zagreb, Croatia
| | - Neven Tudorić
- Department of Pulmonary Diseases, University Hospital Dubrava, Zagreb, Croatia
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Abstract
Severe asthma is considered a heterogeneous disease in which a variety of clinical, physiological and inflammatory markers determine disease severity. Pivotal studies in the last 5 years have led to substantial progress in many areas, ranging from a more accurate definition of truly severe, refractory asthma, to classification of the disease into distinct clinical phenotypes, and introduction of new therapies. This review focuses on three common clinical phenotypes of severe asthma in adults (early onset severe allergic asthma, late onset non-atopic eosinophilic asthma, late onset non-eosinophilic asthma with obesity), and provides an overview of recent developments regarding treatment options that are best suited for each of these phenotypes.
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Affiliation(s)
- S Hashimoto
- Department of Respiratory Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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Environmental effects on fractional exhaled nitric oxide in allergic children. J Allergy (Cairo) 2011; 2012:916926. [PMID: 22162708 PMCID: PMC3228339 DOI: 10.1155/2012/916926] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 07/31/2011] [Accepted: 08/29/2011] [Indexed: 12/21/2022] Open
Abstract
Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of airway inflammation in asthma and respiratory allergy. Environmental factors, especially indoor and outdoor air quality, may play an important role in triggering acute exacerbations of respiratory symptoms. The authors have reviewed the literature reporting effects of outdoor and indoor pollutants on FeNO in children. Although the findings are not consistent, urban and industrial pollution-mainly particles (PM(2.5) and PM(10)), nitrogen dioxide (NO(2)), and sulfur dioxide (SO(2))-as well as formaldehyde and electric baseboard heating have been shown to increase FeNO, whilst ozone (O(3)) tends to decrease it. Among children exposed to Environmental Tobacco Smoke (ETS) with a genetic polymorphisms in nitric oxide synthase genes (NOS), a higher nicotine exposure was associated with lower FeNO levels. Finally, although more studies are needed in order to better investigate the effect of gene and environment interactions which may affect the interpretation of FeNO values in the management of children with asthma, clinicians are recommended to consider environmental exposures when taking medical histories for asthma and respiratory allergy. Further research is also needed to assess the effects of remedial interventions aimed at reducing/abating environmental exposures in asthmatic/allergic patients.
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Riguera D, André PA, Zanetta DMT. Sugar cane burning pollution and respiratory symptoms in schoolchildren in Monte Aprazível, Southeastern Brazil. Rev Saude Publica 2011; 45:878-86. [PMID: 21829978 DOI: 10.1590/s0034-89102011005000052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 03/30/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of respiratory symptoms and to analyze associated factors as well as peak expiratory flow measurements in schoolchildren. METHODS This is a descriptive cross-sectional study with schoolchildren aged 10-14 from the city of Monte Aprazível (Southeastern Brazil). Questionnaires containing the asthma and rhinitis components of the International Study of Asthma and Allergies in Childhood were administered. The questionnaires also approached sociodemographic characteristics, predisposing factors, and family and personal medical history. Repeated measures of peak expiratory flow in the children, and of black carbon and particulate matter (PM2,5) concentration levels were carried out. RESULTS The prevalence of asthma and rhinitis symptoms was 11% and 33.2%, respectively. Among asthmatic children, 10.6% presented four or more wheezing attacks in the past 12 months. Past family history of bronchitis and rhinitis was associated with presence of asthma (p=0.002 and p <0.001) and rhinitis (p <0.001 and p<0.001, respectively). Regarding rhinitis, there was association with presence of mold or cracks on the house (p=0.009). Rhinitis was most frequent from June to October, a period that matches the sugarcane harvest season. Daily prevalence of peak expiratory flow below 20% of the median of each child's measurements was higher in days with greater PM2,5 concentration. CONCLUSIONS The prevalence of asthma symptoms is below and that of rhinitis is above the national average. Although within acceptable levels, pollution in the cane trash burn season may contribute to the exacerbation of asthma and rhinitis episodes.
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Affiliation(s)
- Denise Riguera
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, SP, Brasil
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Halloran DR. Home environment, asthma, and obesity: how are they related? J Pediatr 2011; 159:3-4. [PMID: 21592493 DOI: 10.1016/j.jpeds.2011.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 04/04/2011] [Indexed: 02/03/2023]
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Gaston B. The biochemistry of asthma. Biochim Biophys Acta Gen Subj 2011; 1810:1017-24. [PMID: 21718756 DOI: 10.1016/j.bbagen.2011.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 05/18/2011] [Accepted: 06/15/2011] [Indexed: 01/27/2023]
Abstract
BACKGROUND Asthma is not one disease. Different patients have biochemically distinct phenotypes. SCOPE OF REVIEW Biomarker analysis was developed to identify inflammation in the asthmatic airway. It has led to a renewed interest in biochemical abnormalities in the asthmatic airway. The biochemical determinants of asthma heterogeneity are many. Examples include decreased activity of superoxide dismutases; increased activity of eosinophil peroxidase, S-nitrosoglutathione reductase, and arginases; decreased airway pH; and increased levels of asymmetric dimethyl arginine. MAJOR CONCLUSIONS New discoveries suggest that biomarkers such as exhaled nitric oxide reflect complex airway biochemistry. This biochemistry can be informative and therapeutically relevant. GENERAL SIGNIFICANCE Improved understanding of airway biochemistry will lead to new tests to identify biochemically unique subpopulations of patients with asthma. It will also likely lead to new, targeted treatments for these specific asthma subpopulations. This article is part of a Special Issue entitled Biochemistry of Asthma.
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Affiliation(s)
- Benjamin Gaston
- Universit of Virginia School of Medicine, Pediatric Respiratory Medicine, Charlottes, VA 22908-0386, USA.
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FENO Concentrations in World Trade Center Responders and Controls, 6 Years Post-9/11. Lung 2011; 189:295-303. [DOI: 10.1007/s00408-011-9307-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 05/27/2011] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW Studies over the last 2 years have added important new information on the relationship between air pollution and asthma incidence and severity. RECENT FINDINGS Outdoor air pollution has been associated with asthma exacerbations, including emergency department visits and hospitalizations, as well as with the onset of asthma. Possible mechanisms mediating both incidence and severity effects include the induction of oxidative stress, and/or allergic sensitization, as well as increased susceptibility to viral infections. Some of these mechanisms may be occurring in utero including epigenetic changes that may increase risk for development of asthma. Factors related to increased susceptibility for air pollution-related asthma severity include age, season and genetic polymorphisms related to antioxidant enzymes. SUMMARY Ambient pollution levels may be associated with both asthma incidence and severity. Susceptibility to air pollution may be higher in children with genetic polymorphisms related to the 'oxidant stress pathways'. Potential interventions for susceptible children at risk for asthma development and/or severity include decreased exposure on high air pollution days, especially in the summer months, and antioxidant supplementation. On the population level, changes in school and home zoning to increase distance from busy roadways may help reduce both asthma incidence and severity.
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Rijssenbeek-Nouwens LH, Bel EH. High-altitude treatment: a therapeutic option for patients with severe, refractory asthma? Clin Exp Allergy 2011; 41:775-82. [PMID: 21518039 DOI: 10.1111/j.1365-2222.2011.03733.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High-altitude treatment has been applied for more than a century in the treatment of pulmonary diseases including asthma. Many uncontrolled and controlled studies have shown its beneficial effects in children and adolescents with house dust mite allergic asthma. A recent study also showed an improvement in markers of airway inflammation in adult patients with severe intrinsic asthma, suggesting that factors other than HDM avoidance may contribute to the beneficial influence of the high-altitude climate therapy on asthma. The dry mountain climate not only has decreased levels of mite allergens but also decreased levels of pollens, fungal spores and air pollution, as well as high exposure to UV light with immunomodulatory and anti-inflammatory effects. Treatments targeting environmental control have never been investigated systematically in severe asthma, which is surprising, as environmental factors have been recognized as important contributors to asthma severity for many years and more evidence has been accumulating ever since. Preliminary evidence shows the beneficial effects of high-altitude treatment in patients with severe refractory asthma on symptoms, lung function and oral corticosteroid requirement, irrespective of atopic status. In this narrative review, we will discuss why high-altitude treatment might be a promising therapeutic option for patients who suffer from this disabling disease.
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Abstract
BACKGROUND Asthma, a chronic inflammatory disease of the airways, is associated with reversible airway obstruction and hyperresponsiveness to triggers; clinical symptoms include wheezing, episodic cough, shortness of breath, and increased mucous production. Ambient or outdoor environmental exposure to ozone, particulate matter, sulfur dioxide, and nitrogen oxides has been well documented to exacerbate asthma. Children appear to be most vulnerable to the harmful effects of ambient air pollutants. As their lungs are not completely developed, children may experience greater exposure to environmental pollutants than adults and the higher doses of varied composition may remain in their lungs for a greater duration. Altogether, the negative effects of air pollutants on pulmonary function place children at a greater risk of air pollutant-induced exacerbation of asthma for the duration of their lives. OBJECTIVES The aim of this review was to assess recently published literature regarding the influence of air pollution on asthma in children. METHODS For this work, we reviewed articles found in PubMed using the key words "outdoor air pollution, asthma, and children" which were published between 2006 and 2009. Only those articles that had a full version available in PubMed were analyzed. RESULTS We reviewed studies published between 2006 and 2009 examining the effect of outdoor air pollution on asthma in children. In total, we evaluated 25 articles; of these, 9 were published in 2006, 3 in 2007, 8 in 2008, and 5 in 2009. Of these 25 studies, 1 was a clinical trial, 6 were cross-sectional, 4 were case-control (2 with a case-crossover design), 12 were cohort prospective, and 2 were cohort retrospective studies with varied follow-up times ranging from 10 days to 7 years. The ages of children also differed, ranging from birth to 18 years of age. CONCLUSIONS All studies reviewed in this work indicate that outdoor air pollution affects the appearance and exacerbation of asthma in children. Although these findings are of great interest, the limitations of noted works make future investigations of the effect of air pollution on asthma in children essential.
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Affiliation(s)
- Lilian Tzivian
- Department of Epidemiology and Health Services Evaluation, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Air quality as respiratory health indicator — a critical review. Int J Occup Med Environ Health 2011; 24:241-8. [DOI: 10.2478/s13382-011-0028-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 05/17/2011] [Indexed: 11/21/2022] Open
Abstract
AbstractAs part of the European Public Health project IMCA II validity and practicability of “air pollution” as a respiratory health indicator were analyzed. The definitions of air quality as an indicator proposed by the WHO project ECOEHIS and by IMCA I were compared. The public availability of the necessary data was checked through access to web-based data-bases. Practicability and interpretation of the indicator were discussed with project partners and external experts. Air quality serves as a kind of benchmark for the good health-related environmental policy. In this sense, it is a relevant health indicator. Although air quality is not directly in the responsibility of health policy, its vital importance for the population’s health should not be neglected. In principle, data is available to calculate this IMCA indicator for any chosen area in Europe. The indicator is relevant and informative, but calculation and interpretation need input from local expert knowledge. The European health policy is well advised to take air quality into account. To that end, an interdisciplinary approach is warranted. The proposed definition of air quality as a (respiratory) health indicator is workable, but correct interpretation depends on expert and local knowledge.
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Berhane K, Zhang Y, Linn WS, Rappaport EB, Bastain TM, Salam MT, Islam T, Lurmann F, Gilliland FD. The effect of ambient air pollution on exhaled nitric oxide in the Children's Health Study. Eur Respir J 2010; 37:1029-36. [PMID: 20947676 DOI: 10.1183/09031936.00081410] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We assessed the effect of daily variations in ambient air pollutants on exhaled nitric oxide fraction (F(eNO)) using data from a cohort of school children with large differences in air pollutant exposures from the Children's Health Study. Based on a cohort of 2,240 school children from 13 Southern Californian communities, cumulative lagged average regression models were fitted to determine the association between F(eNO) and ambient air pollution levels from central site monitors with lags of up to 30 days prior to F(eNO) testing. Daily 24-h cumulative lagged averages of particles with a 50% cut-off aerodynamic diameter of 2.5 µm (PM₂.₅; over 1-8 days) and particles with a 50% cut-off aerodynamic diameter of 10 µm (PM₁₀; over 1-7 days), as well as 10:00-18:00 h cumulative lagged average of O₃ (over 1-23 days) were significantly associated with 17.42% (p<0.01), 9.25% (p<0.05) and 14.25% (p<0.01) higher F(eNO) levels over the interquartile range of 7.5 μg·m⁻³, 12.97 μg·m⁻³ and 15.42 ppb, respectively. The effects of PM₂.₅, PM₁₀ and O₃ were higher in the warm season. The particulate matter effects were robust to adjustments for effects of O₃ and temperature and did not vary by asthma or allergy status. In summary, short-term increases in PM₂.₅, PM₁₀ and O₃ were associated with airway inflammation independent of asthma and allergy status, with PM₁₀ effects significantly higher in the warm season.
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Affiliation(s)
- K Berhane
- Dept of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089-9011, USA.
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