Factors associated with asthma prevalence among racial and ethnic groups--United States, 2009-2010 behavioral risk factor surveillance system

Association of 1-bromopropane exposure with asthma prevalence: A Korean National health and Nutritional examination survey (2020-2021)-based study

Exposure to 1-bromopropane (1-BP) is an emerging environmental and health concern due to its increasing environmental prevalence. Although the health effects of 1-BP exposure have been under-recognized, current evidence suggests the possibility of adverse pulmonary health effects due to 1-BP exposure. However, the association between 1-BP exposure and asthma prevalence remains unclear. Thus, we aimed to examine the association between 1-BP exposure and asthma prevalence in the general population. Using nationally representative data, we explored the potential impacts of indoor air quality (IAQ)-related behavioral factors on the level of 1-BP exposure. This study included 1506 adults from the 2020-2021 Korea National Health and Nutrition Examination Survey. The prevalence of asthma was based on self-reported physician-diagnosed asthma. Urinary N-acetyl-S-(n-propyl)-L-cysteine (BPMA) levels were measured as a biomarker of 1-BP exposure, using high-performance liquid chromatography-mass spectrometry. Multiple logistic regression models were performed to investigate the associations between urinary BPMA metabolite and asthma prevalence after adjusting for potential confounders. Log-linear multiple regression models were used to examine the association between IAQ-related behavior and urinary BPMA concentration. Forty-seven individuals with asthma and 1459 without asthma were included. Individuals in the highest quartile of urinary BPMA concentration had a 2.9 times higher risk of asthma than those in the lowest quartile (odds ratio [OR]: 2.85, 95% confidence interval [CI]: 1.02-7.98). The combination of natural and mechanical ventilation was associated with a reduced urinary BPMA concentration. Our findings suggest that 1-BP exposure is associated with the prevalence of asthma in adults and revealed higher urinary levels of BPMA in our study population compared to those in other countries. Given the emerging importance of IAQ, actively managing and modifying behavioral patterns to reduce 1-BP exposure in indoor environments could substantially attenuate the risk of asthma-related to 1-BP exposure.

Predicting asthma using imbalanced data modeling techniques: Evidence from 2019 Michigan BRFSS data

Studies in the past have examined asthma prevalence and the associated risk factors in the United States using data from national surveys. However, the findings of these studies may not be relevant to specific states because of the different environmental and socioeconomic factors that vary across regions. The 2019 Behavioral Risk Factor Surveillance System (BRFSS) showed that Michigan had higher asthma prevalence rates than the national average. In this regard, we employ various modern machine learning techniques to predict asthma and identify risk factors associated with asthma among Michigan adults using the 2019 BRFSS data. After data cleaning, a sample of 10,337 individuals was selected for analysis, out of which 1,118 individuals (10.8%) reported having asthma during the survey period. Typical machine learning techniques often perform poorly due to imbalanced data issues. To address this challenge, we employed two synthetic data generation techniques, namely the Random Over-Sampling Examples (ROSE) and Synthetic Minority Over-Sampling Technique (SMOTE) and compared their performances. The overall performance of machine learning algorithms was improved using both methods, with ROSE performing better than SMOTE. Among the ROSE-adjusted models, we found that logistic regression, partial least squares, gradient boosting, LASSO, and elastic net had comparable performance, with sensitivity at around 50% and area under the curve (AUC) at around 63%. Due to ease of interpretability, logistic regression is chosen for further exploration of risk factors. Presence of chronic obstructive pulmonary disease, lower income, female sex, financial barrier to see a doctor due to cost, taken flu shot/spray in the past 12 months, 18-24 age group, Black, non-Hispanic group, and presence of diabetes are identified as asthma risk factors. This study demonstrates the potentiality of machine learning coupled with imbalanced data modeling approaches for predicting asthma from a large survey dataset. We conclude that the findings could guide early screening of at-risk asthma patients and designing appropriate interventions to improve care practices.

Factors associated with frequent physical activity among United States adults with asthma

Objective: This study investigated factors associated with frequent moderate-to-vigorous intensity physical activity among United States (US) adults with asthma.Methods: This retrospective cross-sectional study included US adults (≥18 years) with asthma in the 2019 Medical Expenditure Panel Survey data. Logistic regression models that added sequential groups of variables were used to assess associations between predisposing (age, gender, race), enabling (marital status, poverty level, education level, insurance coverage, employment status), and need (smoking status, co-morbidities, mental health, physical health, functional limitations) factors and doing ≥30 min moderate-to-vigorous intensity physical activity ≥ five times per week. The alpha level was 0.05.Results: The study included 2,410 individuals, of which 46.9% (95% confidence interval [CI] = 44.2-49.6) reported doing frequent moderate-to-vigorous intensity physical activity. In fully adjusted analyses, the following variables were associated with a greater odds of reporting frequent moderate-to-vigorous intensity physical activity: men vs. women (adjusted odds ratio [AOR] = 1.4, 95% CI = 1.1-1.7), white vs. other races (AOR = 1.3, 95% CI = 1.0-1.6), excellent/very good/good vs. fair/poor physical health (AOR = 2.3, 95% CI = 1.7-3.0), and functional limitations no vs. yes (AOR = 1.7, 95% CI = 1.3-2.2).Conclusions: The factors identified in this study (gender, race, health status, and limitation status) may be helpful to target interventions to raise awareness and increase physical activity among US adults with asthma. Studies that can demonstrate a temporal relationship are needed to further our understanding of this topic.

Racial/ethnic disparities in the association between fine particles and respiratory hospital admissions in San Diego county, CA

Ambient air pollution exposure is associated with exacerbating respiratory illnesses. Race/ethnicity (R/E) have been shown to influence an individual's vulnerability to environmental health risks such as fine particles (PM 2.5). This study aims to assess the R/E disparities in vulnerability to air pollution with regards to respiratory hospital admissions in San Diego County, California where most days fall below National Ambient Air Quality Standards (NAAQS) for daily PM 2.5 concentrations. Daily PM 2.5 levels were estimated at the zip code level using a spatial interpolation using inverse-distance weighting from monitor networks. The association between daily PM 2.5 levels and respiratory hospital admissions in San Diego County over a 15-year period from 1999 to 2013 was assessed with a time-series analysis using a multi-level Poisson regression model. Cochran Q tests were used to assess the effect modification of race/ethnicity on this association. Daily fine particle levels varied greatly from 1 μg/m³ to 75.86 μg/m³ (SD = 6.08 μg/m³) with the majority of days falling below 24-hour NAAQS for PM 2.5 of 35 μg/m³. For every 10 μg/m³ increase in PM 2.5 levels, Black and White individuals had higher rates (8.6% and 6.2%, respectively) of hospitalization for respiratory admissions than observed in the county as a whole (4.1%). Increases in PM 2.5 levels drive an overall increase in respiratory hospital admissions with a disparate burden of health effects by R/E group. These findings suggest an opportunity to design interventions that address the unequal burden of air pollution among vulnerable communities in San Diego County that exist even below NAAQS for daily PM 2.5 concentrations.

Are adults with asthma less physically active? A systematic review and meta-analysis

OBJECTIVE

To systematically review the evidence on whether having current, ever asthma and asthma control is associated with levels of total, moderate and vigorous physical activity.

METHODS

We searched EMBASE, MEDLINE, and CINAHL databases, limiting searches to English language papers from inception until Oct 2019. We synthesized the evidence comparing levels of total, moderate and vigorous physical activity between adults with and without current asthma or ever asthma by random effects meta-analyses.

RESULTS

A total of 25 studies were included, with 18 of these included in meta-analyses. A meta-analysis of 4 case-control studies found that adults with current asthma were less active, with 942.12 steps fewer per day, than adults without current asthma (SMD = -0.39, 95%CI: -0.54, -0.24, I² = 0). Meta-analysis of four-high quality cross-sectional studies found that those with current or ever asthma were more likely to be inactive than those without asthma (binary OR _{current asthma} = 0.85, 95%CI: 0.82, 0.89, I² = 45.6%, and binary OR _{ever asthma} = 0.83, 0.75, 0.91, I² = 0, respectively). Meta-analysis, inclusive of all 10 cross-sectional studies with binary ORs, supported this finding. There was also some evidence that adults with current asthma and ever asthma (6 studies with categorical ORs) were less likely to exercise moderately and vigorously, but these meta-analyses were limited by high heterogeneity. No synthesis of the studies considering asthma control was possible.

CONCLUSION

Adults with current or ever asthma had lower levels of total, moderate and vigorous physical activity than those without asthma and may be missing out on the health benefits of being physically active. The association between asthma control and physical activity warrants further investigation.

Association of two polymorphisms of miRNA-146a rs2910164 (G > C) and miRNA-499 rs3746444 (T > C) with asthma: a meta-analysis

OBJECTIVE

To conduct a meta-analysis to determine the association between two single nucleotide polymorphisms (SNPs) miRNA146a rs2910164 (G > C) and miRNA-499 rs3746444 (T > C) and asthma risk.

DATA SOURCES

PubMed and Embase (updated May 17, 2019).

KEYWORDS

(microRNA OR microRNAs) AND (polymorphism OR polymorphisms) AND (Asthmas OR Bronchial Asthma OR Asthma, Bronchial).

RESULTS

Six eligible case-control studies (2441 asthma cases and 3044 controls) met our inclusion criteria. A trend of increased asthma risk was indicated by the heterozygote model (miR-499: TC versus TT, OR = 1.38, 95% CI = 1.06-1.79, P < 0.01) and the dominant model (miR-499: TC + CC versus TT, OR = 1.60, 95% CI = 1.07-2.39, P < 0.01) of miRNA-499 rs3746444. Polymorphisms rs2910164 in miRNA-146a of the allele model (miR-146a: C versus G, OR = 0.84, 95% CI = 0.74-0.96, P = 0.238), homozygote model (miR-146a: CC versus GG, OR = 0.68, 95% CI = 0.51-0.91, P = 0.213), recessive model (miR-146a: CC versus GC + GG, OR = 0.75, 95% CI = 0.60-0.94, P = 0.149) indicated a decreased risk of asthma.

CONCLUSIONS

The miR-499 rs3746444 (T > C) polymorphism is associated with asthma susceptibility and miRNA-146a rs2910164 (G > C) polymorphism has a protective role against susceptibility to asthma.

Prevalence of Ever Self-Reported Asthma and Associated Factors among University Students in Iran: A Population-Based Study

Background:

Asthma is a chronic inflammatory airway disease with regressive episodic symptoms. This study aimed to assess the prevalence of asthma ever (lifetime prevalence of asthma) and the associated factors among newly entered students in public universities in Iran.

Methods:

This population-based cross-sectional study was part of the “Mental and Physical Health Assessment of University Students in Iran.” The target population included all newly admitted students (N = 151,671) in 74 public universities in 28 provinces (out of the 31 provinces) in Iran. STATA version 12 was used for calculating the descriptive statistics. Univariate and multivariate logistic regression models were employed to identify relationships between asthma and socioeconomic variables. The level of significance was set at 95% confidence interval.

Results:

Of a total of 79,277 participants, 55.23% (n = 43,785) and 44.77% (n = 35,492) were female and male, respectively. The prevalence of ever asthma among studied student was 1.89%. Of all the participants with asthma, 88.43% (85.49%–90.84%) were nonsmokers. More than 20% of the subjects were physically inactive. The respondents who revealed smoking >10 cigarettes/week were about 1.22 (1.036–1.437) times more likely to suffer from asthma disease (0.017), as compared with those who were not smoking.

Conclusions:

Our study provides valuable information about the prevalence of asthma ever symptoms among university students in Iran. In fact, the results of this study can fill information gaps concerning the affected groups in Iran, and even worldwide.

Evaluation of a Multidisciplinary Disease Management Program to Achieve Asthma Control in Seven Safety Net Hospitals in Louisiana

The objective was to evaluate a multidisciplinary guideline-driven disease management program focused on achievement of asthma control among sustained patients with confirmed asthma in Louisiana and to assess factors affecting achievement of asthma control. Data were extracted from the electronic health records of 1596 adults with confirmed asthma, sustained care for >1 year in the outpatient setting, and ≥2 recorded Asthma Control Test (ACT) scores. Multivariable logistic regression modeling was used to assess the association of demographic variables, comorbidities, and process measures with the best achieved asthma control as represented by the highest ACT score. Most subjects were female (81.1%) and African American (63.9%). Approximately half of them (48.9%) were able to achieve asthma control (ACT ≥20). The most prevalent comorbidities were hypertension (79.8%), rhinitis (55.3%), and obesity (50.5%). Most patients received pulmonary function testing (PFT) (88.6%), controller medication therapy (85.5%), or written asthma action plans (92.7%). Asthma control was positively associated with presence of PFT (OR = 1.63, 95% CI: 1.13, 2.37) and being a "never" smoker (OR = 1.49, 95% CI: 1.08, 2.04). Asthma control was less likely to be achieved by patients who were African American (OR = 0.68, 95% CI: 0.52, 0.87), had more comorbidities (OR = 0.89, 95% CI: 0.83, 0.96), or were on more medications (OR = 0.79, 95% CI: 0.72, 0.88). Asthma control was achieved in 48.9% of an adult, primarily African American population with the implementation of comprehensive guideline-driven care. Furthermore, this is the first study to observe that the presence of PFT may be associated with asthma control.

Asthma prevalence disparities and differences in sociodemographic associations with asthma, between Native Hawaiian/Other Pacific Islander, Asian, and White adults in Hawaii - Behavioral Risk Factor Surveillance System (BRFSS), 2001-2010

OBJECTIVES

Despite high asthma prevalence, relatively little is known about the epidemiology of asthma in Hawaii or among Native Hawaiian/Other Pacific Islanders (NHOPI). We sought to better characterize racial/ethnic differences in asthma prevalence and in sociodemographic factors associated with asthma among Hawaii adults.

DESIGN

We conducted multivariable logistic regression using 2001-2010 Behavioral Risk Factor Surveillance System data from Hawaii, and computed adjusted prevalence and ratios.

RESULTS

Asthma prevalence markedly varied between self-identified census categories of race in Hawaii, with NHOPI having the highest estimates of both lifetime (20.9%, 95% confidence interval [CI]: 19.5%-22.4%) and current (12.2%, CI: 11.2%-13.3%) asthma. Highest asthma prevalence among NHOPI persisted after controlling for potential confounders and within most sociodemographic categories. Among females Asians reported the lowest asthma prevalence, whereas among males point estimates of asthma prevalence were often lowest for Whites. Females often had greater asthma prevalence than males of the same race, but the degree to which gender modified asthma prevalence differed by both race and sociodemographic strata. Gender disparities in asthma prevalence were greatest and most frequent among Whites, and for current asthma among all races. Sociodemographic factors potentially predictive of adult asthma prevalence in Hawaii varied by race and gender.

CONCLUSION

Asthma disproportionately affects or is recognized more often among women and NHOPI adults in Hawaii, and occurs less or is under-reported among Asian women. The sociodemographic characteristics included in this study's model did not explain asthma disparities between races and/or gender. This investigation provides a baseline with which to plan additionally needed prevention programs, epidemiological investigations, and surveillance for asthma in Hawaii.

Optimizing community-level surveillance data for pediatric asthma management

Community-level approaches for pediatric asthma management rely on locally collected information derived primarily from two sources: claims records and school-based surveys. We combined claims and school-based surveillance data, and examined the asthma-related risk patterns among adolescent students. Symptom data collected from school-based asthma surveys conducted in Oakland, CA were used for case identification and determination of severity levels for students (high and low). Survey data were matched to Medicaid claims data for all asthma-related health care encounters for the year prior to the survey. We then employed recursive partitioning to develop classification trees that identified patterns of demographics and healthcare utilization associated with severity. A total of 561 students had complete matched data; 86.1% were classified as high-severity, and 13.9% as low-severity asthma. The classification tree consisted of eight subsets: three indicating high severity and five indicating low severity. The risk subsets highlighted varying combinations of non-specific demographic and socioeconomic predictors of asthma prevalence, morbidity and severity. For example, the subset with the highest class-prior probability (92.1%) predicted high-severity asthma and consisted of students without prescribed rescue medication, but with at least one in-clinic nebulizer treatment. The predictive accuracy of the tree-based model was approximately 66.7%, with an estimated 91.1% of high-severity cases and 42.3% of low-severity cases correctly predicted. Our analysis draws on the strengths of two complementary datasets to provide community-level information on children with asthma, and demonstrates the utility of recursive partitioning methods to explore a combination of features that convey asthma severity.

Asthma and its related socioeconomic factors: The Shiraz Adult Respiratory Disease Study 2015

OBJECTIVE

This study aimed to explore the association between the prevalence of asthma and the socioeconomic factors using data from the Shiraz Adult Respiratory Disease Study, 2015(SARDS).

METHODS

The SARDS was conducted from June to October 2015 among adult subjects of the general population of Shiraz, Iran. Current asthma was defined as the presence of at least 1 of the following factors in the preceding 12 months: (1) being awakened by an attack of shortness of breath, coughing, or chest tightness without any identifiable cause; (2) having an asthma attack; (3) currently using medication for asthma; or (4) having wheezing or whistling in the chest not associated with a cold or the flu. Information on individual socioeconomic status was derived from self-reported education level, occupation, income, and residence location. A value of P < .05 was considered statistically significant.

RESULTS

A total of 4582 respondents aged 20-60 years were included in the analysis. The overall prevalence of adult asthma was 7.8%. The prevalence of asthma was higher significantly among female and subjects with higher body mass index, allergic rhinitis, smokers, jobless, and individuals who live in suburban areas. In the adjusted logistic regression model, being jobless (odds ratio [OR], 2.256; 95% confidence interval [CI], 1.123-4.535) and living in a suburban area (OR, 1.735; 95% CI, 1.058-2.845) were the most significant socioeconomic predictive factors for adult current asthma.

CONCLUSIONS

It can be concluded that lower socioeconomic status is associated with higher adult current asthma prevalence. Target interventions are necessary to reduce disparities in healthcare systems.

A Systematic Review of Associations of Physical Activity and Sedentary Time with Asthma Outcomes

BACKGROUND

Physical inactivity and high sedentary time are associated with adverse health outcomes in several diseases. However, their impact in asthma is less clear.

OBJECTIVE

We aimed to synthesize the literature characterizing physical activity and sedentary time in adults with asthma, to estimate activity levels using meta-analysis, and to evaluate associations between physical activity and sedentary time and the clinical and physiological characteristics of asthma.

METHODS

Articles written in English and addressing the measurement of physical activity or sedentary time in adults ≥18 years old with asthma were identified using 4 electronic databases. Meta-analysis was used to estimate steps/day in applicable studies.

RESULTS

There were 42 studies that met the inclusion criteria. Physical activity in asthma was lower compared with controls. The pooled mean (95% confidence interval) steps/day for people with asthma was 8390 (7361, 9419). Physical activity tended to be lower in females compared with males, and in older people with asthma compared with their younger counterparts. Higher levels of physical activity were associated with better measures of lung function, disease control, health status, and health care use. Measures of sedentary time were scarce, and indicated a similar engagement in this behavior between participants with asthma and controls. High sedentary time was associated with higher health care use, and poorer lung function, asthma control, and exercise capacity.

CONCLUSIONS

People with asthma engage in lower levels of physical activity compared with controls. Higher levels of physical activity may positively impact on asthma clinical outcomes. Sedentary time should be more widely assessed.

Socioeconomic and air pollution correlates of adult asthma, heart attack, and stroke risks in the United States, 2010-2013

Asthma in the United States has become an important public health issue, with many physicians, regulators, and scientists elsewhere expressing concern that criterion air pollutants have contributed to a rising tide of asthma cases and symptoms. This paper studies recent associations (from 2008 to 2012) between self-reported asthma experiences and potential predictors, including age, sex, income, education, smoking, and county-level average annual ambient concentrations of ozone (O3) and fine particulate matter (PM2.5) levels recorded by the U.S. Environmental Protection Agency, for adults 50 years old or older for whom survey data are available from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS). We also examine associations between these variables and self-reported heart attack and stroke experience; all three health outcomes are positively associated with each other. Young divorced women with low incomes are at greatest risk of asthma, especially if they are ever-smokers. Income is an important confounder of other relations. For example, in logistic regression modeling, PM2.5 is positively associated (p<0.06) with both stroke risk and heart attack risk when these are regressed only against PM2.5, sex, age, and ever-smoking status, but not when they are regressed against these variables and income. In this data set, PM2.5 is significantly negatively associated with asthma risk in regression models, with a 10μg/m³ decrease in PM2.5 corresponding to about a 6% increase in the probability of asthma, possibly because of confounding by smoking, which is negatively associated with PM2.5 and positively associated with asthma risk. A variety of non-parametric methods are used to quantify these associations and to explore potential causal interpretations.

Gender-specific determinants of asthma among U.S. adults

BACKGROUND

Asthma, a chronic respiratory disease affecting over 18.7 million American adults, has marked disparities by gender, race/ethnicity and socioeconomic status. Our goal was to identify gender-specific demographic and socioeconomic determinants of asthma prevalence among U.S. adults using data from the Behavioral Risk Factors Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES).

METHODS

Gender-specific regression analyses were performed to model the relationship between asthma prevalence with age, race/ethnicity, income, education level, smoking status, and body mass index (BMI), while taking into account the study designs.

RESULTS

Based on BRFSS data from 1,003,894 respondents, weighted asthma prevalence was 6.2% in males and 10.6% in females. Asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese women was 2.5 and 3.5 times higher, respectively, while that in men was 1.7 and 2.4 times higher; asthma prevalence among current vs. never smoker women was 1.4 times higher, while that in men was 1.1 times higher. Similar results were obtained with NHANES data from 13,364 respondents: asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese respondents was 2.0 and 3.3 times higher for women, though there was no significant difference for men; asthma prevalence among current vs. never smokers was 1.8 times higher for women and not significantly different in men. Asthma prevalence by race/ethnicity and income levels did not differ considerably between men and women.

CONCLUSIONS

Our results underscore the importance of obesity and smoking as modifiable asthma risk factors that most strongly affect women.

Maryland environmental public health tracking outreach with Spanish-speaking persons living in Baltimore city or county

CONTEXT

The 2000 Pew reports became the impetus for the National Environmental Public Health Tracking (EPHT) Program, but there was no mention that Spanish-speaking persons are at increased risk of exposure to environmental hazards.

OBJECTIVE

To undertake successful EPHT outreach on Spanish-speaking persons (Hispanics), it is necessary to better understand their environmental health profile and barriers to health care access.

DESIGN

Behavioral Risk Factor Surveillance System (BRFSS) survey questions were administered orally in Spanish to Spanish-speaking study participants.

SETTING

Volunteers were tested at a non-for-profit social service and referral agency in Baltimore.

PARTICIPANTS

To control for acculturation, only Spanish-speaking persons who had lived in the United States for less than 10 years were selected.

MAIN OUTCOME MEASURES

Responses to 40 BRFSS survey questions asked during the assessment and completion of 3 intervention activities.

RESULTS

This study provides new information about Spanish-speaking persons, most of whom (85.3%) would not have been included in the landline administration of the BRFSS survey. Although 29.9% of the participants reported indoor pesticide use and another 9.2% reported outdoor pesticide use, lifetime (3.5%) and current (1.2%) asthma prevalence was significantly lower than asthma prevalence reported by Maryland Hispanics and all Maryland residents. There were significantly lower cholesterol screening (21.5%) and a significantly higher prevalence of diabetes (12.5%) in Spanish-speaking participants than in Maryland Hispanics and all Maryland residents. Among study participants, only 7.8% had health insurance and 39.9% reported that they could not see a doctor. Of the 3 outreach efforts completed, the most promising one involved asking Spanish-English-speaking health care professionals to distribute Spanish comic books about pesticides exposures and health outcomes in community settings where Spanish-only speakers and children were found.

CONCLUSIONS

The effectiveness of passive and community-based EPHT interventions directed toward Spanish-only speakers has to be evaluated.

Interaction between allergic asthma and atherosclerosis

Prior studies have established an essential role of mast cells in allergic asthma and atherosclerosis. Mast cell deficiency or inactivation protects mice from allergen-induced airway hyper-responsiveness and diet-induced atherosclerosis, suggesting that mast cells share pathologic activities in both diseases. Allergic asthma and atherosclerosis are inflammatory diseases that contain similar sets of elevated numbers of inflammatory cells in addition to mast cells in the airway and arterial wall, such as macrophages, monocytes, T cells, eosinophils, and smooth muscle cells. Emerging evidence from experimental models and human studies points to a potential interaction between the 2 seemingly unrelated diseases. Patients or mice with allergic asthma have a high risk of developing atherosclerosis or vice versa, despite the fact that asthma is a T-helper (Th)2-oriented disease, whereas Th1 immunity promotes atherosclerosis. In addition to the preferred Th1/Th2 responses that may differentiate the 2 diseases, mast cells and many other inflammatory cells also contribute to their pathogenesis by more than just T cell immunity. Here, we summarize the different roles of airway and arterial wall inflammatory cells and vascular cells in asthma and atherosclerosis and propose an interaction between the 2 diseases, although limited investigations are available to delineate the molecular and cellular mechanisms by which 1 disease increases the risk of the other. Results from mouse allergic asthma and atherosclerosis models and from human population studies lead to the hypothesis that patients with atherosclerosis may benefit from antiasthmatic medications or that the therapeutic regimens targeting atherosclerosis may also alleviate allergic asthma.

Characteristics and outcomes of older adults with long-standing versus late-onset asthma

OBJECTIVE

To examine the effect of age of onset on clinical characteristics and outcomes in a cohort of older patients with long-standing (LSA) and late-onset asthma (LOA).

METHODS

In all, 452 patients 60 years of age and older with persistent asthma were recruited. We defined LOA as asthma developing at age 40 or later and LSA as developing before age 40. We compared airway obstruction as assessed by spirometry, as well as asthma control using the Asthma Control Questionnaire (ACQ), quality of life using the Mini Asthma Quality of Life Questionnaire (AQLQ), and asthma-related emergency department visits and hospitalizations among patients with LSA vs. LOA.

RESULTS

Patients with LOA, were less likely to have FEV₁ <70% of predicted (23% vs. 40%, p = 0.0002), to have FEV₁/FVC<0.7 (27% vs. 38%, p = 0.01), or to have been intubated in the past (5% vs. 14%, p = 0.0007), and were also less likely to report a history of allergic conditions (64% vs 76%, p = 0.007). There was no significant difference in the level of asthma control, quality of life, or health care utilization.

CONCLUSIONS

Older adults with LOA have different clinical and physiological characteristics and outcomes compared to those with LSA. Some of these differences may represent sequelae of longstanding disease, however LOA may also represent a different clinical phenotype that could influence management approaches.

Allergic lung inflammation promotes atherosclerosis in apolipoprotein E-deficient mice

Inflammation drives asthma and atherosclerosis. Clinical studies suggest that asthmatic patients have a high risk of atherosclerosis. Yet this hypothesis remains uncertain, given that Th2 imbalance causes asthma whereas Th1 immunity promotes atherosclerosis. In this study, chronic allergic lung inflammation (ALI) was induced in mice by ovalbumin sensitization and challenge. Acute ALI was induced in mice by ovalbumin and aluminum sensitization and ovalbumin challenge. Atherosclerosis was produced in apolipoprotein E-deficient (Apoe(-/-)) mice with a Western diet. When chronic ALI and atherosclerosis were produced simultaneously, ALI increased atherosclerotic lesion size, lesion inflammatory cell content, elastin fragmentation, smooth muscle cell (SMC) loss, lesion cell proliferation, and apoptosis. Production of acute ALI before atherogenesis did not affect lesion size, but increased atherosclerotic lesion CD4(+) T cells, lesion SMC loss, angiogenesis, and apoptosis. Production of acute ALI after atherogenesis also did not change atherosclerotic lesion area, but increased lesion elastin fragmentation, cell proliferation, and apoptosis. In mice with chronic ALI and diet-induced atherosclerosis, daily inhalation of a mast cell inhibitor or corticosteroid significantly reduced atherosclerotic lesion T-cell and mast cell contents, SMC loss, angiogenesis, and cell proliferation and apoptosis, although these drugs did not affect lesion area, compared with those that received vehicle treatment. In conclusion, both chronic and acute ALI promote atherogenesis or aortic lesion pathology, regardless whether ALI occurred before, after, or at the same time as atherogenesis. Antiasthmatic medication can efficiently mitigate atherosclerotic lesion pathology.

Neighborhood and Individual Socioeconomic Status and Asthma Incidence in African American Women

OBJECTIVE

Individual socioeconomic status (SES) has been associated with asthma incidence but whether neighborhood SES has an influence is unknown. We assessed the contributions of neighborhood socioeconomic status (SES), neighborhood housing density, neighborhood racial composition, and individual SES to the development of adult-onset asthma in Black women, accounting for other known or suspected risk factors.

DESIGN AND PARTICIPANTS

Prospective cohort study conducted among 47,779 African American women followed with biennial health questionnaires from 1995 to 2011.

METHODS AND MAIN OUTCOME MEASURES

Incident asthma was defined as new self-report of doctor-diagnosed asthma with concurrent use of asthma medication. We assessed neighborhood SES, indicated by census variables representing income, education, and wealth, and housing density and % African American population, as well as individual SES, indicated by highest education of participant/spouse. Cox proportional hazards models were used to derive multivariable hazard ratios (HRs) and 95% CIs for the association of individual SES and neighborhood variables with asthma incidence.

RESULTS

During a 16-year follow-up period, 1520 women reported incident asthma. Neighborhood factors were not associated with asthma incidence after control for individual SES, body mass index, and other factors. Compared with college graduates, the multivariable HR for asthma was 1.13 (95% CI 1.00-1.28) for women with some college education and 1.23 (95% CI 1.05-1.44) for women with no more than a high school education.

CONCLUSIONS

Individual SES, but not neighborhood SES or other neighborhood factors, was associated with the incidence of adult-onset asthma in this population of African American women.

The prevalence of asthma risk and contributing factors in underserved Vietnamese children in Orange County, CA

OBJECTIVES

Vietnamese constitutes one of the fastest growing minority groups in America, with the largest concentration in Orange County (OC), CA. Yet, there are limited data on the prevalence of asthma in Vietnamese children. Our study evaluated the risk of asthma and key contributing factors among these children living in OC, CA.

METHOD

Five elementary schools in OC that were predominantly Vietnamese with low socioeconomic status were selected for participation. Validated surveys were sent to parents of all students ages 3-12 in these schools with materials available in English, Vietnamese and Spanish. Surveys included questions to identify the risk of asthma and related key factors. Surveys were completed by parents and returned to schools.

RESULTS

There were 1530 participants eligible for analysis. Asthma risk was 30.4%, and of these, 22.6% had no prior diagnosis. Contributing factors to identification of those at risk were male gender (p < 0.001), preferred use of the Vietnamese language (p = 0.004), longer duration in the United States (p = 0.019), and smoker in the household (p = 0.015).

CONCLUSIONS

The prevalence of asthma risk in our community of low socioeconomic status Vietnamese children was found to be higher than commonly appreciated. Furthermore, a considerable number of these children had not been previously diagnosed. Given the limited information in this population, our current findings of asthma risk and key contributing factors could affect health care policies that allow appropriate funding for programs dedicated to asthma care in this and other growing population.

Influence of ethnicity on response to asthma drugs

INTRODUCTION

Understanding variability in the response to asthma medications is essential to ensure appropriate prescribing. Given that there are increased asthma treatment failures observed in ethnic minorities receiving asthma therapeutics, it is fundamental to understand the factors related to ethnicity that can modify the response to asthma therapy.

AREAS COVERED

Race/ethnicity is an important determinant of drug response and therefore contributes to interindividual variability. It is generally recognized that its effects on drug response are determined by both genetic and environmental factors to a varying extent, depending on the ethnic groups and probe drugs studied. Also, adherence to therapy can influence pharmacological response to asthma therapeutics.

EXPERT OPINION

Health-care professionals might never use the treatment in their patients irrespective of their ethnicity and thus inadvertently increase ethnic health inequality. However, our understanding of whether and/or how ethnicity influences pharmacological response to asthma therapeutics is still very scarce. A holistic, integrative systems biology approach that combines large-scale molecular profiling traits (e.g., transcriptomic, proteomic, metabolomic traits) and genetic variants could help to personalize the treatment of asthmatic patients regardless of race/ethnicity.

Sparse modeling of spatial environmental variables associated with asthma

Geographically distributed environmental factors influence the burden of diseases such as asthma. Our objective was to identify sparse environmental variables associated with asthma diagnosis gathered from a large electronic health record (EHR) dataset while controlling for spatial variation. An EHR dataset from the University of Wisconsin's Family Medicine, Internal Medicine and Pediatrics Departments was obtained for 199,220 patients aged 5-50years over a three-year period. Each patient's home address was geocoded to one of 3456 geographic census block groups. Over one thousand block group variables were obtained from a commercial database. We developed a Sparse Spatial Environmental Analysis (SASEA). Using this method, the environmental variables were first dimensionally reduced with sparse principal component analysis. Logistic thin plate regression spline modeling was then used to identify block group variables associated with asthma from sparse principal components. The addresses of patients from the EHR dataset were distributed throughout the majority of Wisconsin's geography. Logistic thin plate regression spline modeling captured spatial variation of asthma. Four sparse principal components identified via model selection consisted of food at home, dog ownership, household size, and disposable income variables. In rural areas, dog ownership and renter occupied housing units from significant sparse principal components were associated with asthma. Our main contribution is the incorporation of sparsity in spatial modeling. SASEA sequentially added sparse principal components to Logistic thin plate regression spline modeling. This method allowed association of geographically distributed environmental factors with asthma using EHR and environmental datasets. SASEA can be applied to other diseases with environmental risk factors.

Asthma prevalence among Hispanic adults in Puerto Rico and Hispanic adults of Puerto Rican descent in the United States - results from two national surveys

Abstract Objective: To assess whether asthma prevalence differs between Hispanic adults living in Puerto Rico and Hispanic adults of Puerto Rican descent living in the United States.

METHODS

We used 2008-2010 Behavioral Risk Factor Surveillance System data, administered in Puerto Rico for Hispanic adults living in Puerto Rico (Hispanics in Puerto Rico), and 2008-2010 National Health Interview Survey data for Hispanic adults of Puerto Rican descent living in the United States (Puerto Rican Americans). We used 95% confidence intervals (CIs) to compare asthma prevalence between corresponding subgroups; non-overlapping CIs indicate statistical significance. Chi-square test and multivariate logistic regression were used to assess the association between current asthma status and socio-demographic factors and health risk behaviors within each Puerto Rican population.

RESULTS

Current asthma prevalence among Hispanics in Puerto Rico (7.0% [6.4%-7.7%]) was significantly lower than the prevalence among Puerto Rican Americans (15.6% [13.0%-18.1%]). The prevalence among almost all socio-demographic and health risk subgroups of Hispanics in Puerto Rico was significantly lower than the prevalence among the corresponding subgroups of Puerto Rican Americans. Adjusting for potential confounders did not alter the results. Asthma prevalence was significantly associated with obesity among Puerto Rican Americans (adjusted prevalence ratios [aPR]=1.5 [1.1-2.0]), and among Hispanics in Puerto Rico was associated with obesity (aPR=1.6 [1.3-1.9]), smoking (aPR=1.4 [1.1-1.9]) and being female (aPR=1.9 [1.5-2.4]).

CONCLUSION

Asthma was more prevalent among Puerto Rican Americans than Hispanics in Puerto Rico. Although the observed associations did not explain all variations in asthma prevalence between these two populations, they may lay the foundation for future research.

Vitamin E and D regulation of allergic asthma immunopathogenesis

Asthma occurs as complex interactions of the environmental and genetics. Clinical studies and animal models of asthma indicate dietary factors such as vitamin E and vitamin D as protective for asthma risk. In this review, we discuss opposing regulatory functions of tocopherol isoforms of vitamin E and regulatory functions of vitamin D in asthma and how the variation in global prevalence of asthma may be explained, at least in part, by these dietary components.

COPD in a nationally representative sample: sociodemographic factors and co-morbidity, diagnosis method, and healthcare utilization

INTRODUCTION

In 2011, the Centers for Disease Control and Prevention for the first time ever collected nationally representative prevalence data on chronic obstructive pulmonary disease (COPD), spirometry diagnosis, and healthcare utilization factors related to COPD. This research reports on that data and describes characteristics of adults with COPD who reported diagnosis by spirometry compared to those who did not report diagnosis by spirometry. Variables examined included basic elements of healthcare utilization such as emergency room visits, hospitalization or personal physician utilization.

METHODS

This is a cross-sectional study using novel data from the 2011 Behavioral Risk Factor Surveillance System COPD Module. Weighted multivariable logistic regression examined factors associated with (n = 13,484) and without spirometry (n = 3,131).

RESULTS

Spirometry to diagnose COPD was reported by 78% of adults and increased with age. In multivariable modeling, spirometry was more likely in: Black, non-Hispanic compared to white non-Hispanic; current and former compared to never smokers; adults with co-morbidity including asthma, depression, and cardiovascular disease; adults with a doctor; and those who had been to emergency room/hospital for COPD. Those less likely to receive a spirometry were: Hispanic and reported exercise in the past 30 days.

CONCLUSIONS

This study identified that adults diagnosed with COPD without a spirometry tended to be Hispanic, younger, healthier, and had less utilization of medical resources. This study is a first step in understanding the potential impact of COPD diagnosis made without spirometry.

Two faces of vitamin E in the lung

Asthma and allergic lung disease occur as complex environmental and genetic interactions. Clinical studies of asthma indicate a number of protective dietary factors, such as vitamin E, on asthma risk. However, these studies have had seemingly conflicting outcomes. In this perspective, we discuss opposing regulatory effects of tocopherol isoforms of vitamin E, mechanisms for tocopherol isoform regulation of allergic lung inflammation, association of vitamin E isoforms with outcomes in clinical studies, and how the variation in global prevalence of asthma may be explained, at least in part, by vitamin E isoforms.