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Forno E, Brandenburg DD, Castro-Rodriguez JA, Celis-Preciado CA, Holguin F, Licskai C, Lovinsky-Desir S, Pizzichini M, Teper A, Yang C, Celedón JC. Asthma in the Americas: An Update: A Joint Perspective from the Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, and American Thoracic Society. Ann Am Thorac Soc 2022; 19:525-535. [PMID: 35030062 PMCID: PMC8996271 DOI: 10.1513/annalsats.202109-1068cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/14/2022] [Indexed: 11/20/2022] Open
Abstract
Asthma affects a large number of people living in the Americas, a vast and diverse geographic region comprising 35 nations in the Caribbean and North, Central, and South America. The marked variability in the prevalence, morbidity, and mortality from asthma across and within nations in the Americas offers a unique opportunity to improve our understanding of the risk factors and management of asthma phenotypes and endotypes in children and adults. Moreover, a better assessment of the causes and treatment of asthma in less economically developed regions in the Americas would help diagnose and treat individuals migrating from those areas to Canada and the United States. In this focused review, we first assess the epidemiology of asthma, review known and potential risk factors, and examine commonalities and differences in asthma management across the Americas. We then discuss future directions in research and health policies to improve the prevention, diagnosis, and management of pediatric and adult asthma in the Americas, including standardized and periodic assessment of asthma burden across the region; large-scale longitudinal studies including omics and comprehensive environmental data on racially and ethnically diverse populations; and dissemination and implementation of guidelines for asthma management across the spectrum of disease severity. New initiatives should recognize differences in socioeconomic development and health care systems across the region while paying particular attention to novel or more impactful risk factors for asthma in the Americas, including indoor pollutants such as biomass fuel, tobacco use, infectious agents and the microbiome, and psychosocial stressor and chronic stress.
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Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine and Pediatric Asthma Center, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Diego D. Brandenburg
- Department of Pediatrics, Pediatric Pulmonology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos A. Celis-Preciado
- Pulmonary Unit, Internal Medicine Department, Hospital Universitario San Ignacio and Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Fernando Holguin
- Division of Pulmonary Sciences and Critical Care, University of Colorado Denver, Denver, Colorado
| | - Christopher Licskai
- Department of Medicine, Western University Canada, Schulich School of Medicine and Dentistry, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary Medicine, Columbia University Irving Medical Center, New York, New York
| | - Marcia Pizzichini
- Post-Graduate Program of Medical Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Alejandro Teper
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina; and
| | - Connie Yang
- Division of Respiratory Medicine, University of British Columbia, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine and Pediatric Asthma Center, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Sbaraini M, Cureau FV, Ritter JDA, Schuh DS, Madalosso MM, Zanin G, Goulart MR, Pellanda LC, Schaan BD. Prevalence of overweight and obesity among Brazilian adolescents over time: a systematic review and meta-analysis. Public Health Nutr 2021; 24:6415-6426. [PMID: 33821783 PMCID: PMC11148597 DOI: 10.1017/s1368980021001464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To estimate the burden of excess weight in Brazilian adolescents. DESIGN Systematic review with meta-analysis. SETTING We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimates and their 95 % CI. PARTICIPANTS Brazilian adolescents (10 to 19 years old). RESULTS One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8·2 % (95 % CI 7·7, 8·7) until year 2000, 18·9 (95 % CI 14·7, 23·2) from 2000 to 2009, and 25·1 % (95 % CI 23·4, 26·8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using International Obesity Task Force cut-off points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000. CONCLUSIONS The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.
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Affiliation(s)
- Mariana Sbaraini
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil
| | - Felipe Vogt Cureau
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Julianna do Amaral Ritter
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Daniela Schneid Schuh
- Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Mariana Migliavacca Madalosso
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
| | - Gabriella Zanin
- Universidade Luterana do Brasil (ULBRA), Porto Alegre, RS, Brazil
| | - Maíra Ribas Goulart
- Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Lucia Campos Pellanda
- Instituto de Cardiologia/Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Beatriz D Schaan
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências da Saúde: Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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Estanislau NRDA, Jordão EADOC, Abreu GDA, Bloch KV, Kuschnir MCC, Felix MMR, Kuschnir FC. Association between asthma and sleep hours in Brazilian adolescents: ERICA. J Pediatr (Rio J) 2021; 97:396-401. [PMID: 32956628 PMCID: PMC9432073 DOI: 10.1016/j.jped.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/10/2020] [Accepted: 07/24/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the association between asthma and sleep duration in participants of the Study of Cardiovascular Risks in Adolescents. MATERIALS AND METHODS Cross-sectional, national, school-based study, involving adolescents aged 12-17 years. In the period between 2013-14, data from 59,442 participants were analyzed. Bivariate analysis between current asthma and short sleep duration, defined as < 7 h/night, was performed separately with the other variables analyzed: sex, age group, type of school, weight categories, and common mental disorders. Then, different generalized linear models with Poisson family and logarithmic link functions were used to assess the independence of potential confounding covariates associated with both asthma and short sleep duration in the previous analysis. Crude and adjusted prevalence ratios and respective 95% confidence intervals were calculated, and a value of p < 0.05 was considered significant for all analyses performed. RESULTS Prevalence of current asthma was 13.4%, being significantly higher among students with short sleep duration (PR: 1.17; 95% CI: 1.01-1.35; p = 0.034). This remained significant even after adjusting for the other study covariates. CONCLUSION There was a positive association between the prevalence of current asthma and short sleep duration among Brazilian adolescents. Considering the high prevalence and morbidity of the disease in this age group, the promotion of sleep hygiene should be considered as a possible health strategy aimed at contributing to better control of asthma in this population.
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Affiliation(s)
| | | | | | - Katia Vergetti Bloch
- Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Estudos de Saúde Coletiva, Rio de Janeiro, RJ, Brazil
| | | | - Mara M R Felix
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | - Fabio Chigres Kuschnir
- Universidade do Estado do Rio de Janeiro (UERJ), Programa de Pós-Graduação em Ciências Médicas, Rio de Janeiro, RJ, Brazil
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Sousa AW, Cabral ALB, Martins MA, Carvalho CRF. Barriers to daily life physical activities for Brazilian children with asthma: a cross-sectional study. J Asthma 2019; 57:575-583. [PMID: 30919706 DOI: 10.1080/02770903.2019.1594249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BackgroundObjective: To identify barriers to daily life physical activities (DLPA) and to evaluate physical activity levels for children with asthma and without asthma.Method: This is a cross-sectional study that enrolled 130 children with asthma and 54 non-asthma, from 7 to 12 years old. All of the children in both groups used an accelerometer for 6 consecutive days to assess DLPA and completed a questionnaire to evaluate barriers to physical activity. Accelerometer was used to measure each child's total number of steps, as well as the number of steps and the time spent in moderate-to-vigorous physical activity (MVPA). The barrier questionnaire to DLPA included 11 questions, divided into three domains: personal, social and environmental.Results: The most commonly described barrier to DLPA in the asthma and non-asthma groups was an unsafe environment (23.6% vs 28.5%, respectively). The asthma group reported having asthma (19%) and lack of parental encouragement (17.3%) as being other important barriers to DLPA. It was also observed that the asthma and non-asthma groups presented similar values for the total number of steps (13,379 ± 3,837 vs 14,055 ± 3,914, respectively, p > 0.05), number of steps in MVPA (5,654 ± 1,988 vs. 6,025 ± 2,058, p > 0.05), and time spent in MVPA (46 ± 16 min vs. 50.8 ± 14.7 min, p > 0.05).Conclusions: An unsafe environment is the main barrier to physical activity for Brazilian children. Moreover, a lack of parental encouragement and having asthma were considered to be barriers to physical activity. And lastly, children have similar levels of physical activity whether they have asthma or do not have asthma.
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Affiliation(s)
- Andrey Wirgues Sousa
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Milton Arruda Martins
- Department of Clinical Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Celso R F Carvalho
- Department of Physical Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
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Joseph M, Elliott M, Zelicoff A, Qian Z, Trevathan E, Chang JJ. Racial disparity in the association between body mass index and self-reported asthma in children: a population-based study. J Asthma 2016; 53:492-7. [PMID: 26787188 DOI: 10.3109/02770903.2015.1116084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the racial disparity in the association between obesity and asthma in US children and adolescents. METHODS This study was based on a nationally representative, random-digit-dial sample of US households with children less than 18 years of age from the National Survey of Children's Health in 2011/2012 and 2007. The study sample included 88,668 children ages 10-17 with data on body mass index (BMI), parental reporting of asthma diagnosis, and potential confounders. Multiple logistic regression analysis was performed to estimate the crude and adjusted odds ratios stratified by child race/ethnicity. RESULTS The prevalence of overweight was 15.2% and obesity was 14.1%. Self-reported asthma diagnosis was 16.7% in our study sample. Obese children were 51% more likely to have asthma compared to normal weight children after controlling for child's sex, child age, socioeconomic status, environmental tobacco smoke (ETS), and neighborhood conditions. Our study also shows that the strength of this association varied by race/ethnicity after stratification. Being male, being non-Hispanic Black or Multi-racial, below the Federal Poverty Level, ETS and having detracting neighborhood elements were also significantly associated with higher odds of having a self-reported asthma diagnosis. CONCLUSION We observed a racial difference in the association between BMI and asthma in US children. Our findings have significant public health implications and may help public health practitioners to target children and adolescents at higher risk of prevention and intervention efforts.
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Affiliation(s)
- Michael Joseph
- a Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , St. Louis, MO , USA and
| | - Michael Elliott
- b Department of Biostatistics , College for Public Health and Social Justice, Saint Louis University , St. Louis, MO , USA
| | - Alan Zelicoff
- a Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , St. Louis, MO , USA and
| | - Zhengmin Qian
- a Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , St. Louis, MO , USA and
| | - Edwin Trevathan
- a Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , St. Louis, MO , USA and
| | - Jen Jen Chang
- a Department of Epidemiology , College for Public Health and Social Justice, Saint Louis University , St. Louis, MO , USA and
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Minghelli B, Oliveira R, Nunes C. Association of obesity with chronic disease and musculoskeletal factors. Rev Assoc Med Bras (1992) 2015; 61:347-54. [DOI: 10.1590/1806-9282.61.04.347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 09/16/2014] [Indexed: 03/14/2023] Open
Abstract
SummaryIntroduction:overweight and obesity in adolescents are major public health problems with particular interest, because of their potential association with risk factors for development of diseases. The study aimed to determine the prevalence of overweight and obesity in adolescents in southern Portugal and investigate the association with risk factors for development of cardiovascular, respiratory and musculoskeletal diseases.Methods:the sample consisted of 966 adolescents aged 10 to 16 years. The calculation of body mass index (BMI), evaluation of blood glucose, total cholesterol and triglycerides, blood pressure, spirometry and application of low back pain (LBP) questionnaire were performed.Results:178 (18.4%) adolescents were overweight and 52 (5.4%) obese. None of the variables revealed a statistically significant association with overweight and obesity. The presence of high blood pressure was observed in 200 (20.7%) individuals and hypertension in 158 (16.4%) adolescents. Overweight and obese adolescents are 2.3 times more likely to develop signs of pre-hypertension and hypertension. 559 (57.9%) students had restrictive respiratory disorders and 23 (2.4%) had obstructive disorders. Those who were overweight and obese had 0.64 probability of having restrictive respiratory disorders.Conclusion:there was a high prevalence of overweight and obesity in Portuguese adolescents and these showed a statistically significant relationship with the development of pre-hypertension and hypertension, and restrictive respiratory disorders.
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Mebrahtu TF, Feltbower RG, Greenwood DC, Parslow RC. Childhood body mass index and wheezing disorders: a systematic review and meta-analysis. Pediatr Allergy Immunol 2015; 26:62-72. [PMID: 25474092 DOI: 10.1111/pai.12321] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND It has been claimed that overweight/obesity, childhood asthma and wheezing disorders are associated, although the results of observational studies have remained inconsistent. We conducted a systematic review and meta-analysis to investigate this. METHODS An online search of published papers linking childhood asthma and wheezing with overweight/obesity up to May 2014 using EMBASE and MEDLINE medical research databases was carried out. Summary odds ratios (OR) were estimated using random-effects models. Subgroup meta-analyses were performed to assess the robustness of risk associations and between-study heterogeneity. RESULTS A total of 38 studies comprising 1,411,335 participants were included in our meta-analysis. The summary ORs of underweight (<5th percentile), overweight (>85th to <95th percentile) and obesity (≥ 95 th percentile) were 0.85 (95% CI: 0.75 to 0.97; p = 0.02), 1.23 (95% CI: 1.17 to 1.29; p < 0.001) and 1.46 (95% CI: 1.36 to 1.57, p < 0.001), respectively. Heterogeneity was significant and substantial in all three weight categories, and not accounted for by pre-defined study characteristics. CONCLUSION Our results suggest that underweight is associated with a reduced risk of childhood asthma, and overweight and obesity are associated with an increased risk of childhood asthma. Although our findings assert that overweight/obesity and childhood asthma are associated, the causal pathway and temporal aspects of this relationship remain unanswered and deserve further epidemiological investigation.
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Affiliation(s)
- Teumzghi F Mebrahtu
- Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK
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Raj D, Kabra SK, Lodha R. Childhood obesity and risk of allergy or asthma. Immunol Allergy Clin North Am 2014; 34:753-65. [PMID: 25282288 DOI: 10.1016/j.iac.2014.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The simultaneous increment in the prevalence of obesity and allergic diseases suggests a possible link between them. This review focuses on the consequences of obesity on allergic diseases, especially asthma in children and adolescents, and evaluates the available evidence on the possible mechanisms. Obesity is related more strongly to nonatopic than atopic asthma, suggesting non-eosinophilic inflammation and Th1 polarization. Among other allergic diseases, the association is more consistent with eczema compared to allergic rhinitis/rhinoconjunctivitis. The mechanisms of asthma in obese individuals could involve mechanical effects of obesity on lung function, adipokines-mediated inflammation, shared factors (diet, genetics, sedentary lifestyle) and comorbidities.
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Affiliation(s)
- Dinesh Raj
- Department of Pediatrics, Holy Family Hospital, Okhla, New Delhi 110025, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Liu PC, Kieckhefer GM, Gau BS. A systematic review of the association between obesity and asthma in children. J Adv Nurs 2013; 69:1446-65. [PMID: 23560878 DOI: 10.1111/jan.12129] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2013] [Indexed: 11/29/2022]
Abstract
AIM To provide a comprehensive integration of contemporary studies focusing on the relationship between obesity and asthma in paediatric populations. BACKGROUND The simultaneous increase in asthma and obesity prevalence has been widely discussed over the past 20 years. Although studies have discovered a positive correlation between the two, evidence-based findings are needed to develop nursing interventions. DESIGN A quantitative systematic review on the literature was conducted from June-December 2011. DATA SOURCES An electronic database search was conducted for studies published between January 1966-May 2011. Additional articles were identified through the reference lists of reviewed papers. REVIEW METHODS Inclusion/exclusion criteria and quality appraisal were applied to ensure research primarily designed to study the relationship between obesity and asthma in children was included. RESULTS The majority of studies support a positive association between obesity and asthma in children. Among correlates recognized as important effect modifiers, gender was the most prominent, with obese girls more likely to have asthma diagnoses than obese boys. Scrutinization of covariates in selected studies revealed that most related to children's demographic characteristics and were inconsistent across the studies. CONCLUSIONS This review was designed to integrate contemporary scientific findings on the association between obesity and asthma by including a large number of studies with variant research designs. To identify high-risk groups and develop nursing interventions to help children affected by both epidemics, more interdisciplinary and well-designed investigations focusing on an expanded spectrum of correlates including demographic and behavioural factors are warranted.
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Affiliation(s)
- Pei-Ching Liu
- Department of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
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Childhood Overweight/Obesity and Asthma: Is There a Link? A Systematic Review of Recent Epidemiologic Evidence. J Acad Nutr Diet 2013; 113:77-105. [DOI: 10.1016/j.jand.2012.08.025] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 08/22/2012] [Indexed: 11/23/2022]
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Iribarren C, Tolstykh IV, Miller MK, Sobel E, Eisner MD. Adult asthma and risk of coronary heart disease, cerebrovascular disease, and heart failure: a prospective study of 2 matched cohorts. Am J Epidemiol 2012; 176:1014-24. [PMID: 23139248 DOI: 10.1093/aje/kws181] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Asthma has been associated with increased cardiovascular disease (CVD) risk. The authors ascertained the association of asthma with CVD and the roles that sex, concurrent allergy, and asthma medications may play in this association. They assembled a cohort of 203,595 Northern California adults with asthma and a parallel asthma-free referent cohort (matched 1:1 on age, sex, and race/ethnicity); both cohorts were followed for incident nonfatal or fatal CVD and all-cause mortality from January 1, 1996, through December 31, 2008. Each cohort was 66% female and 47% white. After adjustment for age, sex, race/ethnicity, cardiac risk factors, and comorbid allergy, asthma was associated with a 1.40-fold (95% confidence interval (CI): 1.35, 1.45) increased hazard of coronary heart disease, a 1.20-fold (95% CI: 1.15, 1.25) hazard of cerebrovascular disease, a 2.14-fold (95% CI: 2.06, 2.22) hazard of heart failure, and a 3.28-fold (95% CI: 3.15, 3.41) hazard of all-cause mortality. Stronger associations were noted among women. Comorbid allergy predicted CVD but did not synergistically increase the CVD risk associated with asthma. Only asthma patients using asthma medications (particularly those on oral corticosteroids alone or in combination) were at enhanced risk of CVD. In conclusion, asthma was prospectively associated with increased risk of major CVD. Modifying effects were noted for sex and asthma medication use but not for comorbid allergy.
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Affiliation(s)
- Carlos Iribarren
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94612, USA.
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