1
|
Cai L, Li X, Qiu L, Wang Y, Wu L, Wu X, Xu R, Liu Y, Zhou Y. Age at menarche and asthma onset among US girls and women: findings from NHANES, 2001-2018. Ann Epidemiol 2023; 87:25-30. [PMID: 37598789 DOI: 10.1016/j.annepidem.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/17/2023] [Accepted: 08/13/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE To quantitatively estimate the association of age at menarche with the risk of childhood- and adult-onset asthma separately. METHODS A retrospective cohort study of 24,282 US girls and women was conducted using continuous National Health and Nutrition Examination Survey (NHANES) data from 2001 to 2018, and Cox proportional hazards regression models with censoring ages of 19 and 79 years were employed to separately estimate hazard ratios of childhood- and adult-onset asthma associated with age at menarche. RESULTS Each one-year increase in age at menarche was significantly associated with a 16% (hazard ratio [HR] = 0.84; 95% confidence interval [CI]: 0.77-0.91) decrease in the risk of childhood-onset asthma. Compared with age at menarche of 12-14 years, we observed a 56% (HR = 1.56; 95% CI: 1.19-2.04) increased risk of childhood-onset asthma for early menarche (age at menarche < 12 years) and a 40% (HR = 0.60; 95% CI: 0.32-1.10) decreased risk for late menarche (age at menarche ≥ 15 years). No significant association was noted between age at menarche and adult-onset asthma. CONCLUSIONS Early menarche may represent a risk factor for childhood-onset asthma, which indicates the need for timely and effective management of individuals with early menarche to prevent asthma.
Collapse
Affiliation(s)
- Li Cai
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Xun Li
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Lan Qiu
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Yaqi Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Li Wu
- Reproductive Medical Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaojie Wu
- Department of Respiratory and Critical Care Medicine, Wuhan No.1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, Hubei, China
| | - Ruijun Xu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yuewei Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yun Zhou
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; School of Public Health, Guangzhou Medical University, Guangzhou, China.
| |
Collapse
|
2
|
Merhej T, Zein JG. Epidemiology of Asthma: Prevalence and Burden of Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:3-23. [PMID: 37464114 DOI: 10.1007/978-3-031-32259-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma, a common airway disease, results in a significant burden to both patients and society worldwide. Yet, despite global political commitment backed by the United Nations, progress to reduce the burden of asthma remains inadequate. This is particularly true in low-income countries. To date, progress has been delayed by the lack of uniform data collection, imperfect surveillance methods, inadequate resources, poor access to effective therapies, substandard asthma education, ineffective governmental policies, rapid urbanization, progressive increase in asthma prevalence, increased life expectancy and obesity rates worldwide, asthma heterogeneity and disease complexity, smoking, and environmental exposures to allergens and pollution. A thorough understanding of the challenges facing the international community is essential to define future strategies to improve the burden of asthma.
Collapse
Affiliation(s)
| | - Joe G Zein
- Respiratory Institute. Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
3
|
Han CH, Chung JH, Kim SR. STROBE: The relationship between asthma and early menarche in Korean adolescents. Medicine (Baltimore) 2022; 101:e29301. [PMID: 35608432 PMCID: PMC9276116 DOI: 10.1097/md.0000000000029301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/28/2022] [Indexed: 01/04/2023] Open
Abstract
We explored the relationship between asthma and early menarche in a representative sample of Korean adolescents.Web-based self-reported data collected from 2006 to 2015 by the Korean Youth Risk Behavior Web-based Survey were used. Menarche status was divided into "early" (<12 years of age, n = 69,520) and "not early" (≥12 years of age, n = 234,065).Adolescent girls with early menarche exhibited a higher incidence of asthma (8.1% vs 7.4%, P < .001), more frequent school absences because of asthma (10.8% vs 8.7%), and more frequent ≤4-day stretches of school absence (4.6% vs 2.4%) compared with girls with "not early" menarche (all P < .001). Multivariate analysis performed after adjusting for multiple confounders revealed a 1.04-fold (95% confidence interval [CI] 1.00-1.07) greater likelihood of asthma in the early menarche than not early menarche group. In addition, the odds ratios for missing school due to asthma for 1 to 3 and ≥4 days per year in the early menarche group were 1.00 (95% CI 1.00-1.02) and 1.21 (95% CI 1.01-1.46), respectively.Adolescents with early menarche exhibited increased incidences of asthma and severe asthma.
Collapse
Affiliation(s)
- Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jae ho Chung
- Department of Internal medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Soo Rim Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| |
Collapse
|
4
|
Role of Sex Hormones at Different Physiobiological Conditions and Therapeutic Potential in MBD2 Mediated Severe Asthma. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:7097797. [PMID: 35096261 PMCID: PMC8799366 DOI: 10.1155/2021/7097797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
Sex hormone has become a “hot topic” to evaluate the hormonal therapeutic potential in severe asthma. Th17 cell is one of the main influencing factors involved in the pathogenesis of severe asthma, hence also called as kernel of severe asthma, and Th17 subtype of non-T2 asthma is less responsive (resistance) to inhaled corticosteroid (ICS), so severe in nature. Methyl-CpG binding domain protein 2 (MBD2) is overexpressed and regulates the Th17 differentiation, showing the possibility of therapeutic target in treating Th17 mediated severe asthma. Sex hormone fluctuates at the different physiobiological conditions of the human body and affects the asthma pathobiology showing its role in asthma prevalence, severity, remission, and therapy. This review briefly overviews the sex hormones, their influence in asthma at the different physiobiological conditions of human body, and MBD2 severe asthma connection with the possible therapeutic potential of sex steroids in MBD2 mediated Th17 predominant severe asthma. Male sex hormone tends to show a beneficial effect and possibly downregulates the expression of Th17 cells via regulating MBD2 through a mechanism distinct from corticosteroid treatment and guides us towards discovery of new therapeutic agent, reduces the asthma-related complications, and promotes long-term survival by lowering the risk of therapy-resistant issues of old age severe asthma.
Collapse
|
5
|
Huq F, Obida M, Bornman R, Di Lenardo T, Chevrier J. Associations between prenatal exposure to DDT and DDE and allergy symptoms and diagnoses in the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), South Africa. ENVIRONMENTAL RESEARCH 2020; 185:109366. [PMID: 32299029 PMCID: PMC7336873 DOI: 10.1016/j.envres.2020.109366] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 03/06/2020] [Accepted: 03/08/2020] [Indexed: 06/11/2023]
Abstract
Dichlorodiphenyl trichloroethane (DDT) is an organochlorine insecticide that is banned internationally except for use as part of Indoor Residual Spraying (IRS) programs to control malaria. Although animal studies show that DDT and its breakdown product dichlorodiphenyl dichloroethylene (DDE) affect the immune system and may cause allergies, no studies have examined this question in populations where IRS is conducted. The aim of our study was to investigate whether prenatal exposure to DDT and DDE is associated with allergy symptoms and diagnose among South African children living in an area where IRS is conducted. To accomplish this aim, we used data from the Venda Health Examination of Mothers, Babies and their Environment (VHEMBE), an ongoing birth cohort study of 752 children born between 2012 and 2013 in the rural Vhembe district of Limpopo, South Africa. We measured maternal peripartum serum concentrations of DDT and DDE, and administered a questionnaire to the caregivers of 658 children aged 3.5 years to collect information on allergy symptoms and diagnoses as well as potential confounders using validated instruments. Using multiple logistic regression models, we found positive associations between DDT and DDE serum concentrations and most of the allergy symptoms and diagnoses. Maternal DDT (Odds Ratio [OR] = 1.5 per 10-fold increase, 95% Confidence interval, CI = 1.0, 2.3) and DDE (OR = 1.4, 95% CI = 0.8, 2.4) serum concentrations were most strongly associated with caregiver report of wheezing or whistling in the chest. Concentrations of DDT and/or DDE were also associated with increased odds of children's chests sounding wheezy during or after exercise, itchy rashes coming and going for at least six months, diagnosis of food allergy, and diagnosis of dust or dust mites allergy but confidence intervals crossed the null. Results suggest that prenatal exposure to DDT, and possibly DDE, is associated with elevated odds of wheezing among children from an IRS area.
Collapse
Affiliation(s)
- Fahmida Huq
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Muvhulawa Obida
- University of Pretoria School of Health Systems and Public Health, and Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa
| | - Riana Bornman
- University of Pretoria School of Health Systems and Public Health, and Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, South Africa
| | - Thomas Di Lenardo
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada.
| |
Collapse
|
6
|
Malitha JM, Islam MA, Islam S, Al Mamun ASM, Chakrabarty S, Hossain MG. Early age at menarche and its associated factors in school girls (age, 10 to 12 years) in Bangladesh: a cross-section survey in Rajshahi District, Bangladesh. J Physiol Anthropol 2020; 39:6. [PMID: 32204736 PMCID: PMC7092417 DOI: 10.1186/s40101-020-00218-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 03/11/2020] [Indexed: 11/10/2022] Open
Abstract
Background Early onset of menarche is one of the most important factors for breast cancer and other associated health hazards. The aim of this study was to investigate the early age at menarche and its associated factors in school girls (age, 10–12 years) in Rajshahi District, Bangladesh. Methods Data was collected from Rajshahi District, Bangladesh, using multistage random sampling. Independent sample t test and binary logistic regression model were used in this study. A total number of 386 school girls aged 10–12 years were considered as a sample for this study. Results This study revealed that more than 48% girls already attained menarche within the age of 12 years, among them 25.6%, 41.0%, and 58.3% girls experienced menarche at the age of 10, 11, and 12 years, respectively. It was observed that the menarcheal girls were significantly taller (p < 0.01) and heavier (p < 0.01) than non-menarcheal girls. The menarcheal girls’ mothers were heavier (p < 0.01), shorter (p < 0.01), had more BMI (p < 0.01), reached menarche (p < 0.05) earlier than non-menarcheal girls’ mothers. Menarcheal girls had less number of siblings (p < 0.01) and lower order of birth (p < 0.05) than non-menarcheal girls. After controlling the effect of other factors, multiple logistic regression model demonstrated that obese girls were more likely to attain menarche than under- [AOR = 0.279, CI 95% 0.075–0.986; p < 0.05] and normal [AOR = 0.248, CI 95% 0.082–0.755; p < 0.05] weight girls. Urban school girls had more chance to get menarche than rural school girls at same age (AOR = 0.012, 95% CI 0.003–0.047; p < 0.01). Conclusions Therefore, modern lifestyle changes may have the important factors for early age at menarche of the studied girls in Bangladesh.
Collapse
Affiliation(s)
| | - Md Ariful Islam
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh
| | - Saima Islam
- Australian Research Centre for Population Oral Health (ARCPOH), The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | | | - Suman Chakrabarty
- Department of Anthropology, Mrinalini Datta Mahavidyapith, Vidyapith Road, Birati, Kolkata, 700 051, India
| | - Md Golam Hossain
- Department of Statistics, University of Rajshahi, Rajshahi, 6205, Bangladesh.
| |
Collapse
|
7
|
McCleary N, Nwaru BI, Nurmatov UB, Critchley H, Sheikh A. Endogenous and exogenous sex steroid hormones in asthma and allergy in females: A systematic review and meta-analysis. J Allergy Clin Immunol 2018; 141:1510-1513.e8. [PMID: 29305316 PMCID: PMC5883329 DOI: 10.1016/j.jaci.2017.11.034] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Nicola McCleary
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Bright I Nwaru
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom; Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ulugbek B Nurmatov
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom; Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Hilary Critchley
- Medical Research Council Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
8
|
Hansen S, Probst-Hensch N, Bettschart R, Pons M, Leynaert B, Gómez Real F, Rochat T, Dratva J, Schneider C, Keidel D, Schindler C, Zemp E. Early menarche and new onset of asthma: Results from the SAPALDIA cohort study. Maturitas 2017; 101:57-63. [PMID: 28539170 DOI: 10.1016/j.maturitas.2017.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 11/19/2022]
Abstract
RATIONALE The association between early menarche and new onset of asthma warrants further investigation in those aged >30 years. OBJECTIVES Using data from the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA), we investigated whether early menarche was associated with new onset of asthma in women aged 18-60 years at baseline. METHODS Our analysis included 2492 women with information on age at menarche and doctor-diagnosed asthma, who had been asthma free at the time of menarche and had complete covariate information. New onset of asthma was defined as newly reported doctor-diagnosed asthma which occurred at least one year after menarche. Asthma incidence and its association with early menarche was analysed using logistic regression, adjusting for age, atopy, smoking, BMI, parental asthma, urbanity, education and study area, and additionally stratifying by atopy and BMI. RESULTS After adjustment of relevant confounders, women with early menarche did not have a significantly higher risk of onset of asthma than women without early menarche (OR 1.23, 95% CI 0.85-1.80). Young atopic women with early menarche appeared to have an increased risk of asthma compared with non-atopic women (OR 2.21, 95% CI 0.90-5.43); however, our results did not reach statistical significance. CONCLUSION We could not substantiate an association of early menarche with new onset of asthma in this Swiss population-based cohort aged 18-60 years at baseline. Future studies may need to prospectively assess age of menarche to investigate the association with new onset of asthma in those aged >30 years.
Collapse
Affiliation(s)
- Sofie Hansen
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland.
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Robert Bettschart
- Lungenpraxis, Medizinische Klinik Hirslanden, Schanzweg 7, 5000 Aarau, Switzerland
| | - Marco Pons
- Sede Civico, Ospedale Regionale di Lugano, Via Tesserete 46, 6900 Lugano, Switzerland
| | - Bénédicte Leynaert
- INSERM, Faculty de Medicine X, Faculté de Médecine site Bichat, 16 Rue Henri Huchard, 75890 Paris cedex 18, France
| | - Francisco Gómez Real
- Department of Gynecology and Obstetrics, Haukeland University Hospital, Jonas Lies vei 71, N-5058 Bergen, Norway; Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Thierry Rochat
- Division of Pulmonary Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Switzerland; Hôpital du Valais (RSV) - Centre Hospitalier du Valais Romand, Av. du Grand Champsec 86, case postale 696, 1951 Sion, Wallis, Switzerland
| | - Julia Dratva
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Cornelia Schneider
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051 Basel, Switzerland; University of Basel, Klingelbergstrasse 50, 4056 Basel, Switzerland
| |
Collapse
|
9
|
Joseph G, Baptista Menezes AM, Wehrmeister FC. Early age at menarche and wheezing in adolescence. The 1993 Pelotas (Brazil) birth cohort study. CLINICAL RESEARCH IN PULMONOLOGY 2016; 3:1028. [PMID: 26870751 PMCID: PMC4747119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the effect of menarche before 11 years of age on the incidence of wheezing/asthma in girls 11 to 18 years of age. METHODS The study sample comprised 1,350 girls from a birth cohort that started in 1993 in the urban area of the city of Pelotas, southern Brazil; this cohort was followed until 18 years of age. We assessed wheezing by the question, "Have you ever had wheezing in the chest at any time in the past?," from the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Early menarche was defined as occurring before 11 years of age. We estimated the cumulative incidence of wheezing excluding from the analysis all those participants who reported wheezing before age of 11 years. We performed the chi-square test to assess the association between ever wheezing and independent variables. Poisson regression models with robust variance were used to estimate cumulative incidence ratios. RESULTS The average age at menarche in the cohort girls was 12 years (95% CI: 11.1-12.1). The prevalence of early menarche before 11 years of age was 11% (95% CI: 9.7-12.3). The cumulative incidence of wheezing from 11 to 18 years of age was 33.5% (95% CI: 30.9- 36.0). The crude association between ever wheezing in adolescence and early menarche before age 11 was 1.19 (95% CI: 0.96-1.48). After adjusting for early childhood and contemporaneous variables, no significant association for early menarche before 11 years of age and wheezing during adolescence was found (CIR: 1.18; CI95%: 0.93-1.49). CONCLUSION Early menarche before 11 years of age is not associated with an increased risk of wheezing during adolescence.
Collapse
Affiliation(s)
- Gary Joseph
- Post-Graduate Program in Epidemiology, Federal University of Pelotas (UFPEL), Brazil
| | | | | |
Collapse
|
10
|
Abstract
Gender differences in asthma incidence, prevalence and severity have been reported worldwide. After puberty, asthma becomes more prevalent and severe in women, and is highest in women with early menarche or with multiple gestations, suggesting a role for sex hormones in asthma genesis. However, the impact of sex hormones on the pathophysiology of asthma is confounded by and difficult to differentiate from age, obesity, atopy, and other gender associated environmental exposures. There are also gender discrepancies in the perception of asthma symptoms. Understanding gender differences in asthma is important to provide effective education and personalized management plans for asthmatics across the lifecourse.
Collapse
|