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Sang B, Wen H, Junek G, Neveu W, Di Francesco L, Ayazi F. An Accelerometer-Based Wearable Patch for Robust Respiratory Rate and Wheeze Detection Using Deep Learning. BIOSENSORS 2024; 14:118. [PMID: 38534225 DOI: 10.3390/bios14030118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024]
Abstract
Wheezing is a critical indicator of various respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD). Current diagnosis relies on subjective lung auscultation by physicians. Enabling this capability via a low-profile, objective wearable device for remote patient monitoring (RPM) could offer pre-emptive, accurate respiratory data to patients. With this goal as our aim, we used a low-profile accelerometer-based wearable system that utilizes deep learning to objectively detect wheezing along with respiration rate using a single sensor. The miniature patch consists of a sensitive wideband MEMS accelerometer and low-noise CMOS interface electronics on a small board, which was then placed on nine conventional lung auscultation sites on the patient's chest walls to capture the pulmonary-induced vibrations (PIVs). A deep learning model was developed and compared with a deterministic time-frequency method to objectively detect wheezing in the PIV signals using data captured from 52 diverse patients with respiratory diseases. The wearable accelerometer patch, paired with the deep learning model, demonstrated high fidelity in capturing and detecting respiratory wheezes and patterns across diverse and pertinent settings. It achieved accuracy, sensitivity, and specificity of 95%, 96%, and 93%, respectively, with an AUC of 0.99 on the test set-outperforming the deterministic time-frequency approach. Furthermore, the accelerometer patch outperforms the digital stethoscopes in sound analysis while offering immunity to ambient sounds, which not only enhances data quality and performance for computational wheeze detection by a significant margin but also provides a robust sensor solution that can quantify respiration patterns simultaneously.
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Affiliation(s)
- Brian Sang
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Haoran Wen
- StethX Microsystems Inc., Atlanta, GA 30308, USA
| | | | - Wendy Neveu
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Lorenzo Di Francesco
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Farrokh Ayazi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
- StethX Microsystems Inc., Atlanta, GA 30308, USA
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Yurenko AV, Antonyuk MV, Mineeva EE, Gvozdenko TA. Predictors of dysfunction of the small respiratory tract in patients with asthma. TERAPEVT ARKH 2022; 94:389-395. [DOI: 10.26442/00403660.2022.03.201400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022]
Abstract
Aim. To identify predictors of development of small respiratory tract (SRT) dysfunction in patients with asthma of mild severity, partially controlled course.
Materials and methods. One hundred and fourteen patients with asthma of mild severity, partially controlled course, were examined. The control group consisted of 27 healthy volunteers. The main risk factors for the development of AD were revealed by questioning in all patients, an ACQ-5 test was used to determine the level of disease control, functional research was carried out using spirography and bodyplethysmography methods. To assess the relative risk, the odds ratio calculation was used.
Results. 55% of all examined patients with asthma indicated 3 or more risk factors. Bronchial obstruction occurred in 26.3% of cases. According to the functional examination, patients are divided into 2 groups: 94 patients without dysfunction of the SRT and 20 patients with dysfunction of the SRT (17.5% of cases). The significance of differences in the development of dysfunction of the SRT depending on the impact of the risk factor between groups of patients was assessed. Among the traditional risk factors for asthma, the most negatively affecting the development of dysfunction of the SRT in patients were identified. It has been established that the duration of asthma disease for more than 5 years, the symptoms of bronchial obstruction diagnosed in patients increase the risk of dysfunction of the SRT by 4.95 and 4.83 times, respectively, the presence of extrapulmonary allergic diseases, namely allergic rhinitis by 4.31 times, urticaria 3.58 times.
Conclusion. It has been shown that the most significant factors affecting the occurrence of dysfunction of the SRT in patients with asthma of mild severity are the duration of asthma for more than 5 years, the presence of extrapulmonary allergic diseases in patients (allergic rhinitis and urticaria) and bronchial obstruction in patients.
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Association between vesicoureteral reflux, urinary tract infection and antibiotics exposure in infancy and risk of childhood asthma. PLoS One 2021; 16:e0257531. [PMID: 34547047 PMCID: PMC8454937 DOI: 10.1371/journal.pone.0257531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background The use of antibiotics for treating infection in childhood and their association with increased risk of asthma remain controversial. Infants diagnosed with vesicoureteral reflux (VUR) belong to a unique population who are administered antibiotics for a long time and are susceptible to recurrent UTI. It is interesting to study the risk of asthma in these infants with or without VUR. Methods Taiwanese children born between 2000 and 2007 were enrolled in population-based birth cohort study. Participants diagnosed with VUR and UTI within first year were classified into four groups (VUR, UTI, VUR and UTI, and control). We calculated follow-up person-years for each participant from the index date until the asthma diagnosis, their withdrawal from the insurance system (because of death or loss to follow-up), or till the end of 2008. The risk of asthma was compared between the 4 cohorts by using Cox proportional hazards model analysis, adjusted hazard ratio (aHR), and 95% confidence interval (95% CI). Results Children diagnosed with VUR (n = 350), UTI (n = 15542), VUR and UTI (n = 1696), and randomly selected controls (n = 17588) were enrolled. The overall rate of incidence of asthma was found to be 1.64-fold, 1.45-fold, and 1.17-fold higher in the UTI, VUR/UTI, and VUR cohorts than in the controls (5.60, 5.07, and 4.10 vs. 3.17 per 100 person-years), respectively. After adjusting the potential factors, the overall risk of asthma remained the highest in UTI (aHR: 1.74, 95% CI : 1.65 to 1.80) followed by VUR/UTI (aHR: 1.56, 95% CI : 1.40 to 1.75) and VUR cohorts (aHR: 1.25, 95% CI: 0.96 to 1.62). The incidence of asthma was higher in boys than in girls. Conclusion The nationwide retrospective cohort study demonstrated that short-term therapeutic dose of antibiotics for UTI in infants with or without VUR has a positive correlation with the prevalence of childhood asthma. Significant risk of childhood asthma was not observed when VUR cohort was exposed to long-term low-dose of prophylactic antibiotics.
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Rodriguez-Martinez C, Sossa-Briceño M, Castro-Rodriguez J. Direct medical costs of pediatric asthma exacerbations requiring hospital attendance in a middle-income country. Allergol Immunopathol (Madr) 2020; 48:142-148. [PMID: 31601499 DOI: 10.1016/j.aller.2019.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/05/2019] [Accepted: 06/25/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES With the aim of making informed decisions on resource allocation, there is a critical need for studies that provide accurate information on hospital costs for treating pediatric asthma exacerbations, mainly in middle-income countries (MICs). The aim of the present study was to evaluate the direct medical costs associated with pediatric asthma exacerbations requiring hospital attendance in Bogota, Colombia. PATIENTS AND METHODS We reviewed the available electronic medical records (EMRs) for all pediatric patients who were admitted to the Fundacion Hospital de La Misericordia with a discharge principal diagnosis pediatric asthma exacerbation over a 24-month period from January 2016 to December 2017. Direct medical costs of pediatric asthma exacerbations were retrospectively collected by dividing the patients into four groups: those admitted to the emergency department (ED) only; those admitted to the pediatric ward (PW); those admitted to the pediatric intermediate care unit (PIMC); and those admitted to the pediatric intensive care unit (PICU). RESULTS A total of 252 patients with a median (IQR) age of 5.0 (3.0-7.0) years were analyzed, of whom 142 (56.3%) were males. Overall, the median (IQR) cost of patients treated in the ED, PW, PIMC, and PICU was US$38.8 (21.1-64.1) vs. US$260.5 (113.7-567.4) vs. 1212.4 (717.6-1609.6) vs. 2501.8 (1771.6-3405.0), respectively: this difference was statistically significant (p<0.001). CONCLUSIONS The present study helps to further our understanding of the economic burden of pediatric asthma exacerbations requiring hospital attendance among pediatric patients in a MIC.
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Kytikova OY, Antonyuk MV, Gvozdenko TA, Novgorodtseva TР. Metabolic aspects of the relationship of asthma and obesity. OBESITY AND METABOLISM 2019. [DOI: 10.14341/omet9578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Asthma and obesity are serious medical and social world problems, and their combined course is characterized by a decrease in the quality of life, an increase in the frequency and duration of hospitalization. The present review summarizes the current views on the mechanisms of formation of asthma phenotype combined with obesity, role of leptin and adiponectin imbalance in the development of systemic inflammation in obesity in the pathophysiology of asthma, its interrelations with metabolic syndrome. We present data that shows that syndrome is closely related not only to the debut of asthma, but also to a decrease in its control. Along with obesity, the role of other components of metabolic syndrome, in particular insulin resistance, as a predictor of asthma development is considered. Insulin resistance may be the most likely factor in the relationship between asthma and obesity, independent of other components of the metabolic syndrome. Insulin resistance associated with obesity can lead to disruption of nitric oxide synthesis. We reveal common mechanism of metabolic disorders of nitric oxide and arginine in metabolic syndrome and asthma and show that insulin resistance treatment can be therapeutically useful in patients with asthma in combination with obesity.
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Alzaabi A, Idrees M, Behbehani N, Khaitov MR, Tunceli K, Urdaneta E, Awad N, Safwat M. Cross-sectional study on Asthma Insights and Management in the Gulf and Russia. Allergy Asthma Proc 2018; 39:430-436. [PMID: 30326990 DOI: 10.2500/aap.2018.39.4180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Asthma is a chronic and complex lung disease that is not completely understood. It involves airway inflammation, reversible airflow obstruction, and bronchial hyperresponsiveness. The most common symptoms are recurrent wheezing, chest tightness, shortness of breath, and coughing. Objective: The Asthma Insights and Management study gathered information on the burden of asthma in the Gulf region (United Arab Emirates, Kuwait, Saudi Arabia) and Russia. Methods: This was a cross-sectional, multinational, noninterventional, two-phase study that collected data from patients ages ≥ 12 years, through interviews and a survey questionnaire. Phase 1 consisted of survey questions focused on estimating the asthma prevalence in the community. Phase 2 was designed to assess the level of asthma control, asthma-related perceptions and behaviors, and presentation patterns. Data were summarized by using descriptive analyses. Results: Analysis of data of 711 patients revealed that the prevalence of asthma among patients who lived in the community was 7.9% and that 66% subjectively perceived their asthma as being controlled. However, 97% of the patients' asthma were partially controlled or uncontrolled based on the Global initiative for Asthma control classification. Troubling symptoms were daytime coughing (33.3%) and shortness of breath (20.3%). With respect to medications for asthma, 76.2% of the patients reported the use of quick relief medication and 80.8% of maintenance medication during the past 4 weeks. Asthma exacerbation in the past year was reported by 40% of adults and adolescents in the study. Conclusion: The results showed that a significant proportion of the patients experienced bothersome symptoms and that many had a lack of knowledge about asthma control and treatment recommendations, which indicated that there is a need for improvements in patient education and asthma care in the Gulf and Russia regions.
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Affiliation(s)
- Ashraf Alzaabi
- From the Division of Respirology, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Majdy Idrees
- Pulmonary Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Naser Behbehani
- Department of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Musa R. Khaitov
- Immunology Department, National Research Center Institute of Immunology, Federal Medical Biological Agency, Moscow, Russia
| | - Kaan Tunceli
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, New Jersey
| | - Eduardo Urdaneta
- Global Medical Affairs, Merck & Co. Inc., Kenilworth, New Jersey
| | - Nancy Awad
- Real-World & Analytics Solutions, IQVIA, Dubai, United Arab Emirates
| | - Mohamed Safwat
- Real-World & Analytics Solutions, IQVIA, Dubai, United Arab Emirates
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Dai X, Bowatte G, Lowe AJ, Matheson MC, Gurrin LC, Burgess JA, Dharmage SC, Lodge CJ. Do Glutathione S-Transferase Genes Modify the Link between Indoor Air Pollution and Asthma, Allergies, and Lung Function? A Systematic Review. Curr Allergy Asthma Rep 2018; 18:20. [PMID: 29557517 DOI: 10.1007/s11882-018-0771-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Glutathione S-transferase (GST) genes are involved in oxidative stress management and may modify the impact of indoor air pollution. We aimed to assess the influence of GST genes on the relationship between indoor air pollution and allergy/lung function. RECENT FINDINGS Our systematic review identified 22 eligible studies, with 15 supporting a gene-environment interaction. Carriers of GSTM1/T1 null and GSTP1 val genotypes were more susceptible to indoor air pollution exposures, having a higher risk of asthma and lung function deficits. However, findings differed in terms of risk alleles and specific exposures. High-exposure heterogeneity precluded meta-analysis. We found evidence that respiratory effects of indoor air pollution depend on the individual's GST profile. This may help explain the inconsistent associations found when gene-environment interactions are not considered. Future studies should aim to improve the accuracy of pollution assessment and investigate this finding in different populations.
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Affiliation(s)
- Xin Dai
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3 207 Bouverie Street, Melbourne, 3010, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3 207 Bouverie Street, Melbourne, 3010, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3 207 Bouverie Street, Melbourne, 3010, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Melanie C Matheson
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3 207 Bouverie Street, Melbourne, 3010, Australia
| | - Lyle C Gurrin
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3 207 Bouverie Street, Melbourne, 3010, Australia
| | - John A Burgess
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3 207 Bouverie Street, Melbourne, 3010, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3 207 Bouverie Street, Melbourne, 3010, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Level 3 207 Bouverie Street, Melbourne, 3010, Australia. .,Murdoch Childrens Research Institute, Melbourne, Australia.
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Maio S, Baldacci S, Bresciani M, Simoni M, Latorre M, Murgia N, Spinozzi F, Braschi M, Antonicelli L, Brunetto B, Iacovacci P, Roazzi P, Pini C, Pata M, La Grasta L, Paggiaro P, Viegi G. RItA: The Italian severe/uncontrolled asthma registry. Allergy 2018; 73:683-695. [PMID: 29072882 DOI: 10.1111/all.13342] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND The Italian severe/uncontrolled asthma (SUA) web-based registry encompasses demographic, clinical, functional, and inflammatory data; it aims to raise SUA awareness, identifying specific phenotypes and promoting optimal care. METHODS Four hundred and ninety three adult patients from 27 Italian centers (recruited in 2011-2014) were analyzed. RESULTS Mean age was 53.8 years. SUA patients were more frequently female (60.6%), with allergic asthma (83.1%). About 30% showed late onset of asthma diagnosis/symptoms (>40 years); the mean age for asthma symptoms onset was 30.2 years and for asthma diagnosis 34.4 years. 97.1% used ICS (dose 2000 BDP), 93.6% LABA in association with ICS, 53.3% LTRAs, 64.1% anti-IgE, 10.7% theophylline, and 16.0% oral corticosteroids. Mean FEV1 % pred of 75.1%, median values of 300/mm3 of blood eosinophil count, 323 kU/L of serum total IgE, and 24 ppb of FENO were shown. Most common comorbidities were allergic rhinitis (62.4%), gastroesophageal reflux (42.1%), sinusitis (37.9%), nasal polyposis (30.2%), and allergic conjunctivitis (30.2%). 55.7% of SUA patients had exacerbations in the last 12 months, 9.7% emergency department visits, and 7.3% hospitalizations. Factors associated with exacerbation risk were obesity (OR, 95% CI 2.46, 1.11-5.41), psychic disorders (2.87, 0.89-9.30-borderline), nasal polyps (1.86, 0.88-3.89-borderline), partial/poor asthma treatment adherence (2.54, 0.97-6.67-borderline), and anti-IgE use in a protective way (0.26, 0.12-0.53). Comparisons to severe asthma multicenter studies and available registries showed data consistency across European and American populations. CONCLUSIONS An international effort in the implementation of SUA patients' registries could help to better understand the clinical features and to manage severe asthma, representing a non-negligible socioeconomic burden for health services.
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Affiliation(s)
- S. Maio
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - S. Baldacci
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Bresciani
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Simoni
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
| | - M. Latorre
- Cardio-Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - N. Murgia
- Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - F. Spinozzi
- Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - M. Braschi
- Allergy Unit; Internal Medicine Department; AOU Ospedali Riuniti; Ancona Italy
| | - L. Antonicelli
- Allergy Unit; Internal Medicine Department; AOU Ospedali Riuniti; Ancona Italy
| | - B. Brunetto
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - P. Iacovacci
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - P. Roazzi
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - C. Pini
- Immunology Department; Italian National Health Institute (ISS); Roma Italy
| | - M. Pata
- Roche S.p.A.; Monza Milano Italy
| | | | - P. Paggiaro
- Cardio-Thoracic and Vascular Department; University of Pisa; Pisa Italy
| | - G. Viegi
- Pulmonary Environmental Epidemiology Unit; CNR Institute of Clinical Physiology; Pisa Italy
- Institute of Biomedicine and Molecular Immunology (IBIM) “A. Monroy”; CNR; Palermo Italy
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Youssef MM, El-Din E, AbuShady MM, El-Baroudy NR, Abd El Hamid TA, Armaneus AF, El Refay AS, Hussein J, Medhat D, Latif YA. Urinary bisphenol A concentrations in relation to asthma in a sample of Egyptian children. Hum Exp Toxicol 2018; 37:1180-1186. [PMID: 29441827 DOI: 10.1177/0960327118758150] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Bronchial asthma is one of the top disabling diseases in pediatrics. Limited research has been studied the association of the widely used plastic monomer bisphenol A (BPA) with childhood asthma. OBJECTIVE To compare the levels of urinary BPA in asthmatic and control children and to investigate the implication of BPA among other risk factors for the development of asthma. SUBJECTS AND METHODS This case-control study included 97 children (45 asthmatic and 52 healthy controls) aged 3-8 years. Asthmatic children were diagnosed according to Global initiative for asthma (GINA) guidelines. Sociodemographic factors were assessed and urinary levels of BPA were determined in spot urine samples using high-performance liquid chromatography. The contribution of BPA among predictors for developing asthma was studied in asthmatic children. RESULTS Median total urinary BPA levels were significantly higher in asthmatic children than in control group (1.56 ng/mL in asthmatic children compared to 0.790 ng/mL in control group, p = 0.001). Children who had total urinary BPA levels >1.3 ng/mL were more likely to be asthmatic (odds ratio: 2.84, 95% confidence interval 1.22-6.59, p = 0.015). Multiple logistic regression analysis for predictors of asthma showed the importance of higher levels of BPA (>1.3 ng/mL) as a more significant predictor than passive smoking ( p = 0.006 for BPA categories vs. p = 0.049 for passive smoking). CONCLUSION Association of higher levels of urinary BPA with the diagnosis of asthma in children may indicate the potential risk of BPA exposure in the precipitation of bronchial asthma. Further clinical and biochemical research are needed to clarify the proper mechanism explaining this association.
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Affiliation(s)
- M M Youssef
- 1 Department of Child Health, National Research Centre (NRC), Cairo, Egypt
| | - Ems El-Din
- 1 Department of Child Health, National Research Centre (NRC), Cairo, Egypt
| | - M M AbuShady
- 1 Department of Child Health, National Research Centre (NRC), Cairo, Egypt
| | - N R El-Baroudy
- 2 Department of Pediatric, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - T A Abd El Hamid
- 2 Department of Pediatric, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - A F Armaneus
- 1 Department of Child Health, National Research Centre (NRC), Cairo, Egypt
| | - A S El Refay
- 1 Department of Child Health, National Research Centre (NRC), Cairo, Egypt
| | - J Hussein
- 3 Department of Medical Biochemistry, Medical Division, National Research Centre (NRC), Cairo, Egypt
| | - D Medhat
- 3 Department of Medical Biochemistry, Medical Division, National Research Centre (NRC), Cairo, Egypt
| | - Y A Latif
- 3 Department of Medical Biochemistry, Medical Division, National Research Centre (NRC), Cairo, Egypt
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Xie MY, Ni H, Zhao DS, Wen LY, Li KS, Yang HH, Wang SS, Zhang H, Su H. Exposure to bisphenol A and the development of asthma: A systematic review of cohort studies. Reprod Toxicol 2016; 65:224-229. [PMID: 27542534 DOI: 10.1016/j.reprotox.2016.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 07/04/2016] [Accepted: 08/13/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is conflicting evidence about the association between bisphenol A (BPA) exposure and childhood asthma risk. We aimed to review the epidemiological literature on the relationship between prenatal or postnatal exposure to BPA and the risk of childhood asthma/wheeze. METHODS The PubMed database was systematically searched, and additional studies were found by searching reference lists of relevant articles. RESULTS Six studies fulfilled the eligibility criteria. Three studies found that prenatal BPA exposure is associated with an increased risk of childhood wheeze, while another study reported a reduced risk of wheeze. Regarding the postnatal BPA exposure, three studies demonstrated an increased risk of childhood asthma/wheeze. CONCLUSIONS The mean prenatal BPA was associated with the risk of childhood wheeze/asthma. Besides, the influence of BPA exposure during the second trimester of pregnancy on the prevalence of childhood wheeze was marked. Further studies are urgently needed to explore the underlying mechanism about adverse effect of BPA exposure on childhood wheeze/asthma.
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Affiliation(s)
- Ming-Yu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Hong Ni
- Anhui Province Children's hospital, Hefei, Anhui 230051, China
| | - De-Sheng Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Li-Ying Wen
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Ke-Sheng Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Hui-Hui Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Shu-Si Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Heng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui 230032, China.
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Wei Y, Abduwaki M, Li M, Luo Q, Sun J, Lv Y, Nurahmat M, Dong J. Loki zupa (Luooukezupa) decoction reduced airway inflammation in an OVA-induced asthma mouse model. Chin Med 2016; 11:22. [PMID: 27134644 PMCID: PMC4851804 DOI: 10.1186/s13020-016-0094-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/20/2016] [Indexed: 12/22/2022] Open
Abstract
Background Loki zupa (Luooukezupa) decoction, consisting of the roots of Hyssopuscuspidatus Boriss (Shenxiangcao) and Irishalophila Pall root (Yuanweigen), is commonly used in Uygur medicine to treat asthma. However, the mode of action of this material has yet to be elucidated. This study aims to investigate the effects of Loki zupa decoction on the airway inflammation of an ovalbumin (OVA)-induced asthma mouse model. Methods Mice were divided into normal control (NC), asthma (A), high, medium and low doses of Loki zupa decoction (L 14.0, L 7.0, L 3.5), water extract (LW), n-butanol extract (LN), ethyl acetate extract (LE) and dexamethasone (DEX) groups. Antiasthmatic model was induced by OVA sensitization and challenged using BALB/c mice. Airway hyperresponsiveness (AHR) toward methacholine (Mch) was assessed using Buxco equipment. Lung inflammation was measured by hematoxylin and eosin staining and bronchoalveolar lavage fluid (BALF) cell count and classification. Inflammatory cytokines in BALF and serum were analyzed by Bio-Plex assay, and mRNA levels were investigated by qPCR analysis. The roots of H. Boriss (250 g) and I. Pall (250 g) were decocted, concentrated and diluted to 14.0, 7.0 and 3.5 g crude herb/kg body weight. The LW, LN and LE of the Loki zupa decoction were prepared and diluted to a dose equivalent to 7 g of crude herb/kg body weight. Results Loki zupa decoction and its extracts significantly attenuated the AHR towards Mch (all P < 0.05). Treatment with Loki zupa decoction and its extracts relieved the infiltration of inflammatory cells in and around the airways, and reduced the total white blood cell (all P < 0.05), neutrophil (all P < 0.05), monocyte (all P < 0.05) and eosinophil (all P < 0.05) counts in the BALF. The BALF samples collected from the mice treated with the Loki zupa decoction and its extracts had lower levels of IL-1β (all P < 0.05), TNF-α (all P < 0.05), IL-2 (all P < 0.05), IL-4 (P = 0.047) and IL-5 (all P < 0.05). The serum samples of these mice also had lower IL-1β (all P < 0.05), TNF-α (all P < 0.05), IL-4 (all P < 0.05) and IL-5 (all P < 0.05) levels and higher levels of IFN-γ (P < 0.001) compared with the OVA-induced asthma mouse model. qPCR analysis revealed that Loki zupa decoction and its extracts inhibited mRNA expression of IL-4 (all P < 0.05), IL-5 (all P < 0.05) and IL-13 (all P < 0.05) and promoted mRNA expression of IFN-γ (all P < 0.05) in asthmatic mice. Conclusion Loki zupa decoction reduced AHR, attenuated airway inflammation, promoted Th1 and suppressed Th2 cell functions in an OVA-induced asthma mouse model. Electronic supplementary material The online version of this article (doi:10.1186/s13020-016-0094-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ying Wei
- Department of Integrative Medicine, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China.,Institute of Integrated Traditional Chinese and Western Medicine, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Muhammadjan Abduwaki
- Department of Integrative Medicine, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China.,Xinjiang Uygur Medical College, 370 West Beijing Road, Hotan, Xinjiang, 848000 China
| | - Mihui Li
- Department of Integrative Medicine, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China.,Institute of Integrated Traditional Chinese and Western Medicine, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Qingli Luo
- Department of Integrative Medicine, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China.,Institute of Integrated Traditional Chinese and Western Medicine, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Jing Sun
- Department of Integrative Medicine, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China.,Institute of Integrated Traditional Chinese and Western Medicine, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Yubao Lv
- Department of Integrative Medicine, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China.,Institute of Integrated Traditional Chinese and Western Medicine, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
| | - Mammat Nurahmat
- Department of Integrative Medicine, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China.,Xinjiang Uygur Medical College, 370 West Beijing Road, Hotan, Xinjiang, 848000 China
| | - Jingcheng Dong
- Department of Integrative Medicine, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China.,Institute of Integrated Traditional Chinese and Western Medicine, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040 China
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Dong M, Xie SY, Li FC, Lv N, Wei XP. Is acupuncture better than sham acupuncture for attenuated airway inflammation and regulated cytokines produced by diverse Th subtypes in chronic OVA inhalation in asthma induced mice. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Ekström S, Magnusson J, Kull I, Lind T, Almqvist C, Melén E, Bergström A. Maternal body mass index in early pregnancy and offspring asthma, rhinitis and eczema up to 16 years of age. Clin Exp Allergy 2015; 45:283-91. [PMID: 24807420 PMCID: PMC4296237 DOI: 10.1111/cea.12340] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 04/15/2014] [Accepted: 04/23/2014] [Indexed: 01/20/2023]
Abstract
Background Maternal obesity has been linked to offspring asthma; however, other allergy-related diseases, as well as the association beyond early school age, are largely unstudied. Objective To examine the associations between maternal body mass index (BMI) in pregnancy and offspring asthma, rhinitis, eczema and sensitization up to 16 years of age. Methods A total of 3294 children from the Swedish birth cohort BAMSE were included in the analyses. Maternal BMI was assessed around week 10 in pregnancy. Information on asthma, rhinitis, eczema, lifestyle factors and environmental exposures was obtained by parental questionnaires at 1, 2, 4, 8, 12 and 16 years. Sensitization was defined from IgE levels of inhalant allergens at 4, 8 and 16 years in a subsample of 2850 children. Generalized estimated equation models were used to analyse the associations between maternal BMI and the outcomes at 1–16 years. Results Maternal BMI was positively associated with overall risk of asthma up to age of 16 years (adj OR per 5 kg/m2 increase: 1.23; 95% CI 1.07–1.40 for prevalent asthma) excluding underweight mothers. In contrast, no significant associations were found for rhinitis, eczema or sensitization. The association with asthma was restricted to obese, rather than overweight mothers, but was attenuated when adjusting for overweight in the offspring. A causal inference test at 16 years further indicated that the child’s own overweight is a mediator in the suggested association between maternal BMI and offspring asthma at 16 years. Conclusions and Clinical Relevance Maternal BMI is associated with an increased risk of asthma, but not rhinitis, eczema or sensitization; however, overweight in the offspring seems to have a mediating role. Prevention strategies of maternal pre-pregnancy and childhood obesity might be important to reduce the prevalence of childhood asthma.
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Affiliation(s)
- S Ekström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Association between Val66Met polymorphisms in brain-derived neurotrophic factor gene and asthma risk: a meta-analysis. Inflamm Res 2015; 64:875-83. [PMID: 26289094 DOI: 10.1007/s00011-015-0869-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/03/2015] [Accepted: 08/11/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The Val66Met polymorphisms in brain-derived neurotrophic factor (BDNF) gene have been reported to be associated with asthma risk, while the results are inconclusive. Considering a single study may lack the power to provide reliable conclusion, we performed a meta-analysis to investigate the association between the Val66Met polymorphisms and asthma susceptibility. METHODS A comprehensive literature search of PubMed, Embase, China National Knowledge Infrastructure (CNKI) and Wanfang databases was conducted before February 12, 2015. The pooled odds ratio (OR) with 95 % confidence intervals (CIs) were calculated. RESULTS Six eligible studies with a total of 3501 subjects were finally included in this meta-analysis. Overall, a significantly increased risk was detected in the Val66Met G allele (G vs. A: OR 1.33, 95 % CI 1.19-1.49, P = 5.61E-07; GG vs. GA + AA: OR 1.48, 95 % CI 1.20-1.83, P = 3.14E-04; GG vs. GA: OR 1.48, 95 % CI 1.17-1.89, P = 0.001; GG vs. AA: OR 1.62, 95 % CI 1.20-2.19, P = 0.002). Moreover, stratification by ethnicity indicated marked association between the Val66Met G allele and asthma risk in Caucasians (G vs. A: OR 1.29, 95 % CI 1.12-1.49, P = 0.001; GG + GA vs. AA: OR 1.59, 95 % CI 1.03-2.46, P = 0.039; GG vs. GA + AA: OR 1.32, 95 % CI 1.11-1.57, P = 0.001; GG vs. GA: OR 1.28, 95 % CI 1.07-1.53, P = 0.007; GG vs. AA: OR 1.72, 95 % CI 1.11-2.68, P = 0.015). CONCLUSION Our present meta-analysis suggests that the Val66Met polymorphisms in BDNF gene are potentially associated with asthma risk in Caucasians. Further well-designed case-control studies with larger sample size and more ethnic groups are needed to confirm these conclusions.
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15
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Hoy HM, O'Keefe LC. Practical guidance on the recognition of uncontrolled asthma and its management. J Am Assoc Nurse Pract 2015; 27:466-75. [PMID: 26119777 DOI: 10.1002/2327-6924.12284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/12/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE To highlight the significance of asthma in primary care and offer a practitioner-friendly interpretation of the asthma guidelines for the busy provider, while introducing new treatment options currently in clinical trials, such as the once-daily long-acting anticholinergic bronchodilator tiotropium Respimat. DATA SOURCES Articles with relevant adult data published between 2004 and 2015 were identified via PubMed. Additional references were obtained by reviewing bibliographies from selected articles. CONCLUSIONS In the United States, uncontrolled or symptomatic asthma is common, with rates of 46%-78% in primary care. Uncontrolled asthma has a substantial impact on patients' quality of life and represents a significant healthcare burden. Nurse practitioners can improve patients' asthma control through education, monitoring, assessment, and treatment. Although asthma management guidelines are readily available, the authors recognize that nurse practitioners see patients with multiple comorbidities, all of which have treatment guidelines of their own. IMPLICATIONS FOR PRACTICE Nurse practitioners have a compelling opportunity as frontline caregivers and patient educators to recognize and assess uncontrolled asthma, along with determining the steps necessary to help patients gain and maintain symptom control.
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Affiliation(s)
- Haley M Hoy
- College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama
| | - Louise C O'Keefe
- College of Nursing, University of Alabama in Huntsville, Huntsville, Alabama
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Su N, Lin J, Liu G, Yin K, Zhou X, Shen H, Chen P, Chen R, Liu C, Wu C, Zhao J, Lin Y. Asthma with allergic rhinitis management in China: a nationwide survey of respiratory specialists at tertiary hospitals. Int Forum Allergy Rhinol 2014; 5:221-32. [PMID: 25400200 DOI: 10.1002/alr.21449] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 09/26/2014] [Accepted: 10/07/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many asthmatic patients have coexisting allergic rhinitis (AR). This study aims to investigate the compliance of physicians with respiratory medicine specialty (PRMs) to Global Initiative for Asthma (GINA) and Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines during the management of their asthma-AR patients. METHODS This cross-sectional questionnaire study surveyed the diagnostic methods and treatment patterns for asthma-AR comorbidity by PRMs from 98 hospitals across China. RESULTS PRMs reported an estimated prevalence of asthma-AR comorbidity of >30% at their clinics. PRMs with greater work experience and a higher professional title estimated treating a significantly higher proportion of patients with AR within the previous month (p = 0.002 and p < 0.001, respectively); they also estimated a higher incidence of patients with AR in the autumn (p < 0.001 and p < 0.001). A higher percentage of PRMs with ≥11 years work experience prescribed nasal steroids for AR as compared to those with 1 to 10 years experience (56.9% vs 44.7%, p = 0.002). A greater proportion of chief physicians used leukotriene modifiers and a lower proportion used antihistamine H1 -receptor blockers for AR as compared to residents (resident vs assistant chief: 27.5% vs 11.6%, p = 0.002; and resident vs chief PRMs: 27.5% vs 9.5%, p = 0.001). CONCLUSION PRMs in China demonstrated an up-to-date comprehension of asthma management (>90%); however, knowledge gaps existed in their concepts of AR and asthma-AR comorbidity. Thus, further education is warranted for PRMs regarding the importance of AR in asthma patients, definitive diagnosis (allergy tests), classifications of AR, and treatment guidelines for the asthma-AR comorbidity.
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Affiliation(s)
- Nan Su
- Department of Respiratory Diseases, China-Japan Friendship Hospital, Peking University, Beijing, China
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Bisphenol A exposure and asthma development in school-age children: a longitudinal study. PLoS One 2014; 9:e111383. [PMID: 25356742 PMCID: PMC4214730 DOI: 10.1371/journal.pone.0111383] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/23/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Although the effect of bisphenol A on various health outcomes has been extensively examined, few studies have investigated its effect on asthma. OBJECTIVE We hypothesized that exposure to bisphenol A in school-age children was associated with wheezing and asthma. METHODS Participants included 127 children aged 7-8 years without a previous asthma diagnosis in an elementary school in Seoul, Korea. Three surveys were conducted, each 2 years apart. Bisphenol A concentration was measured at the baseline survey, and PC20, which is defined as the methacholine concentration that induces a decrease in FEV1 of 20% from baseline, was measured at every survey. Associations between bisphenol A concentration at 7-8 years of age and wheezing, asthma, and PC20 at ages up to 11-12 years were examined using generalized estimating equations, a marginal Cox regression model, and a linear mixed model. RESULTS The log-transformed creatinine-adjusted urinary bisphenol A concentration at 7-8 years was positively associated with wheezing (odds ratio, 2.48; 95% confidence interval, 1.15-5.31; P = .02) and asthma (hazard ratio, 2.13; 95% confidence interval, 1.51-3.00; P<.001) at ages up to 11-12 years. Bisphenol A was also negatively associated with PC20 (ß = -2.33; P = .02). When stratified by sex, the association between bisphenol A and asthma remained significant only in girls (hazard ratio, 2.45; 95% confidence interval, 2.18-2.76; P<.001). CONCLUSION Increased urinary bisphenol A concentrations at 7-8 years old were positively associated with wheezing and asthma and negatively associated with PC20 at ages up to 11-12 years.
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Zhao YF, Luo YM, Xiong W, Wu XL. Genetic variation in ORMDL3 gene may contribute to the risk of asthma: a meta-analysis. Hum Immunol 2014; 75:960-7. [PMID: 25167772 DOI: 10.1016/j.humimm.2014.08.202] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/18/2014] [Accepted: 08/18/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Since the first genome-wide association study report of an association between the ORMDL3 rs7216389 polymorphism and asthma, many studies have been carried out to establish its role in asthma susceptibility among different ethnic groups. However, results have not been consistent across all studies, compelling us to conduct the present meta-analysis. METHODS A literature search for eligible studies published before January 20, 2014 was conducted in the MEDLINE, EMBASE, and CNKI databases. The association was assessed using pooled crude odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). RESULTS A total of 18 individual studies in 15 publications (total 7904 asthma patients and 10,874 healthy controls) were included in the meta-analysis. A meta-analysis of all included studies suggested that there was a highly significant risk effect conferred by the rs7216389*T allele on asthma susceptibility. In addition, we performed stratified analyses to evaluate ethnicity-specific and age-specific effects. Our subgroup analyses based on ethnicity and age-of-onset confirmed the role of the ORMDL3 rs7216389 polymorphism in conferring susceptibility to both childhood- and adult-onset asthma, especially in Caucasians and Asians. CONCLUSIONS The results of this meta-analysis firmly established that genetic variation at the rs7216389 locus, which controls the expression of the ORMDL3, may be a major, independent predisposing factor for asthma in ethnically diverse populations. However, further systematic studies are needed to determine the underlying mechanisms of this association.
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Affiliation(s)
- Yun-Feng Zhao
- Department of Respiratory Medicine, Pudong New Area Gongli Hospital, Shanghai, China
| | - Yi-Min Luo
- Diagnostics Teaching and Research Section, Southeast University Medical College, Nanjing 210009, China
| | - Wei Xiong
- Department of Respiratory Medicine, Pudong New Area Gongli Hospital, Shanghai, China
| | - Xue-Ling Wu
- Institute of Respiratory Medicine, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
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Cai J, Zhao A, Zhao J, Chen R, Wang W, Ha S, Xu X, Kan H. Acute effects of air pollution on asthma hospitalization in Shanghai, China. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2014; 191:139-44. [PMID: 24836410 DOI: 10.1016/j.envpol.2014.04.028] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 04/22/2014] [Accepted: 04/24/2014] [Indexed: 05/24/2023]
Abstract
Air pollution has been accepted as an important contributor to asthma development and exacerbation. However, the evidence is limited in China. In this study, we investigated the acute effect of air pollution on asthma hospitalization in Shanghai, China. We applied over-dispersed generalized additive model adjusted for weather conditions, day of the week, long-term and seasonal trends. An interquartile range increase in the moving average concentrations of PM10, SO2, NO2 and BC on the concurrent day and previous day corresponded to 1.82%, 6.41%, 8.26% and 6.62% increase of asthmatic hospitalization, respectively. The effects of SO2 and NO2 were robust after adjustment for PM10. The associations appeared to be more evident in the cool season than in the warm season. Our results contribute to the limited data in the scientific literature on acute effects of air pollution on asthma in high exposure settings, which are typical in developing countries.
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Affiliation(s)
- Jing Cai
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Ang Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Jinzhuo Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China; Research Institute for the Changing Global Environment and Fudan Tyndall Centre, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, 130 Dong-An Road, Shanghai 200433, China
| | - Weibing Wang
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Sandie Ha
- Department of Epidemiology, College of Public Health and Health Professional and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Xiaohui Xu
- Department of Epidemiology, College of Public Health and Health Professional and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China; Research Institute for the Changing Global Environment and Fudan Tyndall Centre, Fudan University, Shanghai, China; Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP(3)), Fudan University, 130 Dong-An Road, Shanghai 200433, China.
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