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Petrie K, Abramson MJ, George J. Smoking, respiratory symptoms, lung function and life expectancy: A longitudinal study of ageing. Respirology 2024; 29:471-478. [PMID: 38403987 DOI: 10.1111/resp.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND OBJECTIVE Prognostic indices have been developed to predict various outcomes, including mortality. These indices and hazard ratios may be difficult for patients to understand. We investigated the association between smoking, respiratory symptoms and lung function with remaining life expectancy (LE) in older adults. METHODS Data were from the 2004/05 English Longitudinal Study of Ageing (ELSA) (n = 8930), participants aged ≥50-years, with mortality data until 2012. Respiratory symptoms included were chronic phlegm and shortness of breath (SOB). The association between smoking, respiratory symptoms and FEV1/FVC, and remaining LE was estimated using a parametric survival function and adjusted for covariates including age at baseline and sex. RESULTS The extent to which symptoms and FEV1/FVC predicted differences in remaining LE varied by smoking. Compared to asymptomatic never smokers with normal lung function (the reference group), in never smokers, only those with SOB had a significant reduction in remaining LE. In former and current smokers, those with respiratory symptoms had significantly lower remaining LE compared to the reference group if they had FEV1/FVC <0.70 compared to those with FEV1/FVC ≥0.70. Males aged 50-years, current smokers with SOB and FEV1/FVC <0.70, had a remaining LE of 19.2 (95%CI: 16.5-22.2) years, a decrease of 8.1 (5.3-10.8) years, compared to the reference group. CONCLUSION Smoking, respiratory symptoms and FEV1/FVC are strongly associated with remaining LE in older people. The use of remaining LE to communicate mortality risk to patients needs further investigation.
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Affiliation(s)
- Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Govindaraju T, Man M, Owen AJ, Carroll M, Borg BM, Smith CL, Gao CX, Brown D, Poland D, Allgood S, Ikin JF, Abramson MJ, McCaffrey TA, Lane TJ. Does diet quality moderate the long-term effects of discrete but extreme PM 2.5 exposure on respiratory symptoms? A study of the Hazelwood coalmine fire. Environ Res 2024; 252:119014. [PMID: 38685296 DOI: 10.1016/j.envres.2024.119014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
In 2014, a fire at an open cut coalmine in regional Victoria, Australia burned for 6 weeks. Residents of the nearby town of Morwell were exposed to smoke, which included high levels of fine particulate matter (PM2.5). We investigated whether the long-term effects of PM2.5 on respiratory health were moderated by diet quality. A cross-sectional analysis was conducted of data collected 8.5 years after the mine fire from 282 residents of Morwell and 166 residents from the nearby unexposed town of Sale. Primary outcomes were respiratory symptoms. Exposure was coalmine fire-related PM2.5 and diet quality was assessed as Australian Recommended Food Score (ARFS) derived using the Australian Eating Survey (AES). The moderating effect of diet quality on respiratory outcomes associated with PM2.5 was assessed using logistic regression models, adjusting for potential confounders. Diet quality was poor in this sample, with 60% in the lowest category of overall diet quality. Overall diet quality and fruit and vegetable quality significantly attenuated the association between PM2.5 and prevalence of chronic cough and phlegm. Sauce/condiment intake was associated with a greater effect of PM2.5 on COPD prevalence. No other moderating effects were significant. The moderating effects of overall diet quality and vegetable and fruit intake aligned with a priori hypotheses, suggesting potential protective benefits. While more evidence is needed to confirm these findings, improving diets, especially fruit and vegetable intake, may provide some protection against the effects of smoke exposure from fire events.
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Affiliation(s)
- Thara Govindaraju
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Martin Man
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew Carroll
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Brigitte M Borg
- Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David Brown
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Poland
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Shantelle Allgood
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tracy A McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Zeng R, Lodge CJ, Koplin JJ, Lopez DJ, Erbas B, Abramson MJ, Eyles D, Ponsonby AL, Wjst M, Allen K, Dharmage SC, Lowe AJ. Neonatal Vitamin D and Associations with Longitudinal Changes of Eczema up to 25 Years of Age. Nutrients 2024; 16:1303. [PMID: 38732550 PMCID: PMC11085504 DOI: 10.3390/nu16091303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Early-life vitamin D is a potentially modifiable risk factor for the development of eczema, but there is a lack of data on longitudinal associations. METHOD We measured 25(OH)D3 levels from neonatal dried blood spots in 223 high-allergy-risk children. Latent class analysis was used to define longitudinal eczema phenotype up to 25 years (4 subclasses). Skin prick tests (SPTs) to 6 allergens and eczema outcomes at 6 time points were used to define eczema/sensitization phenotypes. Associations between 25(OH)D3 and prevalent eczema and eczema phenotypes were assessed using logistic regression models. RESULTS Median 25(OH)D3 level was 32.5 nmol/L (P25-P75 = 23.1 nmol/L). Each 10 nmol/L increase in neonatal 25(OH)D3 was associated with a 26% reduced odds of early-onset persistent eczema (adjusted multinomial odds ratio (aMOR) = 0.74, 95% CI = 0.56-0.98) and 30% increased odds of early-onset-resolving eczema (aMOR = 1.30, 95% CI = 1.05-1.62) when compared to minimal/no eczema up to 12 years. Similar associations were seen for eczema phenotype up to 25 years. We did not see any strong evidence for the association between neonatal 25(OH)D3 and prevalent eczema or eczema/sensitization phenotype. CONCLUSIONS Higher neonatal 25(OH)D3 levels, a reflection of maternal vitamin D levels in pregnancy, may reduce the risk of early-onset persistent eczema.
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Affiliation(s)
- Rong Zeng
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia; (R.Z.); (C.J.L.); (D.J.L.); (A.J.L.)
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia; (R.Z.); (C.J.L.); (D.J.L.); (A.J.L.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.-L.P.); (K.A.)
- Centre for Food and Allergy Research, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Jennifer J. Koplin
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.-L.P.); (K.A.)
- Centre for Food and Allergy Research, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Child Health Research Centre, University of Queensland, Brisbane, QLD 4072, Australia;
| | - Diego J. Lopez
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia; (R.Z.); (C.J.L.); (D.J.L.); (A.J.L.)
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia;
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, VIC 3550, Australia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Darryl Eyles
- Queensland Brain Institute, University of Queensland, Brisbane, QLD 4072, Australia;
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, QLD 4076, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.-L.P.); (K.A.)
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Matthias Wjst
- Institut für Medizinische Informatik, Statistik und Epidemiologie, Technische Universität München, 80333 München, Germany;
| | - Katrina Allen
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.-L.P.); (K.A.)
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia; (R.Z.); (C.J.L.); (D.J.L.); (A.J.L.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.-L.P.); (K.A.)
- Centre for Food and Allergy Research, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3052, Australia; (R.Z.); (C.J.L.); (D.J.L.); (A.J.L.)
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (A.-L.P.); (K.A.)
- Centre for Food and Allergy Research, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
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Wadhwa V, Wurzel D, Dharmage SC, Abramson MJ, Lodge C, Russell M. Do early-life allergic sensitization and respiratory infection interact to increase asthma risk? J Asthma 2024:1-10. [PMID: 38551488 DOI: 10.1080/02770903.2024.2333473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/17/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The 'two-hit' hypothesis theorizes that early life allergic sensitization and respiratory infection interact to increase asthma risk. METHODS We sought to determine in a high allergy risk birth cohort whether interactions between early life allergic sensitization and respiratory infection were associated with increased risk for asthma at ages 6-7 years and 18 years. Allergic sensitization was assessed at 6, 12, and 24 months by skin prick testing to 3 food and 3 aeroallergens. Respiratory infection was defined as reported "cough, rattle, or wheeze" and assessed 4-weekly for 15 months, at 18 months, and age 2 years. Regression analysis was undertaken with parent-reported asthma at age 6-7 years and doctor diagnosed asthma at 18 years as distinct outcomes. Interactions between allergic sensitization and respiratory infection were explored with adjustment made for potential confounders. RESULTS Odds of asthma were higher in sensitized compared to nonsensitized children at age 6-7 years (OR = 14.46; 95% CI 3.99-52.4), There was no evidence for interactions between allergic sensitization and early life respiratory infection, with a greater frequency of respiratory infection up to 2 years of age associated with increased odds for asthma at age 6-7 years in both sensitized (OR = 1.13; 95% CI 1.02-1.25, n = 199) and nonsensitized children (OR = 1.31; 1.11-1.53, n = 211) (p interaction = 0.089). At age 18 years, these associations were weaker. CONCLUSIONS Our findings do not support 'two-hit' interactions between early life allergic sensitization and respiratory infection on asthma risk. Both early life respiratory infections and allergic sensitization were risk factors and children with either should be monitored closely for development of asthma.
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Affiliation(s)
- Vikas Wadhwa
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Danielle Wurzel
- Murdoch Children's Research Institute and Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Melissa Russell
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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5
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Ye T, Guo Y, Huang W, Zhang Y, Abramson MJ, Li S. Heat Exposure, Preterm Birth, and the Role of Greenness in Australia. JAMA Pediatr 2024; 178:376-383. [PMID: 38407915 PMCID: PMC10897824 DOI: 10.1001/jamapediatrics.2024.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/21/2023] [Indexed: 02/27/2024]
Abstract
Importance Preterm birth (PTB) is associated with adverse health outcomes. The outcomes of heat exposure during pregnancy and the moderating association of greenness with PTB remain understudied. Objective To investigate associations between heat exposure, greenness, and PTB, as well as interactions between these factors. Design, Setting, and Participants Included in this cohort study were births occurring in Sydney, New South Wales, Australia, between 2000 and 2020, retrieved from New South Wales Midwives Data Collection. Participants with incomplete or missing data on their residential address or those who resided outside of New South Wales during their pregnancy were excluded. Data were analyzed from March to October 2023. Exposures Greenness measured using normalized difference vegetation index (NDVI) and tree cover derived from satellite images. Daily extreme heat and nighttime extreme heat were defined as above the 95th percentile of community- and trimester-specific daily mean temperatures and nighttime temperatures. Main Outcomes and Measures Logistic regression models estimated the independent association of extreme heat with PTB, adjusting for individual- and area-level covariates, season of conception, and long-term trend. An interaction term between extreme heat exposure and greenness was included to explore potential modification. With a significant interaction observed, the number of preventable heat-associated PTBs that were associated with greenness was estimated. Results A total of 1 225 722 births (median [IQR] age, 39 [38-40] weeks; 631 005 male [51.5%]) were included in the analysis, including 63 144 PTBs (median [IQR] age, 35 [34-36] weeks; 34 822 male [55.1%]). Compared with those without heat exposure, exposure to daily extreme heat and nighttime extreme heat in the third trimester was associated with increased risks of PTB, with an adjusted odds ratio (OR) of 1.61 (95% CI, 1.55-1.67) and 1.51 (95% CI, 1.46-1.56]), respectively (PTB rates: exposed, 4615 of 61 338 [7.5%] vs unexposed, 56 440 of 1 162 295 [4.9%] for daily extreme heat and 4332 of 61 337 [7.1%] vs 56 723 of 1 162 296 [4.9%] for nighttime extreme heat). Disparities in associations between extreme heat exposure and PTB were observed, with lower odds of PTB among pregnant individuals residing in greener areas. The associations between extreme heat exposure and PTB could be mitigated significantly by higher greenness. Improving NDVI and tree cover could reduce daily extreme heat-associated PTB by 13.7% (95% CI, 2.3%-15.1%) and 20.9% (95% CI, 5.8%-31.5%), respectively. For nighttime extreme heat-associated PTB, reductions were 13.0% (0.2%-15.4%) and 17.2% (4.1%-27.0%), respectively. Conclusions and Relevance Results of this large birth cohort study suggest that extreme heat exposure was adversely associated with PTB, with greenness playing a moderating role. Increasing greenness levels in residential communities could prevent heat-associated PTBs. These findings emphasize the importance of integrating heat mitigation strategies and improving green space in urban planning and public health interventions.
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Affiliation(s)
- Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yiwen Zhang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J. Abramson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Hemstock EJ, Foong RE, Hall GL, Wheeler AJ, Dharmage SC, Dalton M, Williamson GJ, Gao C, Abramson MJ, Johnston FH, Zosky GR. Lung function changes in children exposed to mine fire smoke in infancy. Respirology 2024; 29:295-303. [PMID: 38219238 DOI: 10.1111/resp.14657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND OBJECTIVE Chronic, low-intensity air pollution exposure has been consistently associated with reduced lung function throughout childhood. However, there is limited research regarding the implications of acute, high-intensity air pollution exposure. We aimed to determine whether there were any associations between early life exposure to such an episode and lung growth trajectories. METHODS We conducted a prospective cohort study of children who lived in the vicinity of the Hazelwood coalmine fire. Lung function was measured using respiratory oscillometry. Z-scores were calculated for resistance (R5 ) and reactance at 5 Hz (X5 ) and area under the reactance curve (AX). Two sets of analyses were conducted: (i) linear regression to assess the cross-sectional relationship between post-natal exposure to mine fire-related particulate matter with an aerodynamic diameter of less than 2.5 micrometres (PM2.5 ) and lung function at the 7-year follow-up and (ii) linear mixed-effects models to determine whether there was any association between exposure and changes in lung function between the 3- and 7-year follow-ups. RESULTS There were no associations between mine fire-related PM2.5 and any of the lung function measures, 7-years later. There were moderate improvements in X5 (β: -0.37 [-0.64, -0.10] p = 0.009) and AX (β: -0.40 [-0.72, -0.08] p = 0.014), between the 3- and 7-year follow-ups that were associated with mean PM2.5 , in the unadjusted and covariance-adjusted models. Similar trends were observed with maximum PM2.5 . CONCLUSION There was a moderate improvement in lung stiffness of children exposed to PM2.5 from a local coalmine fire in infancy, consistent with an early deficit in lung function at 3-years after the fire that had resolved by 7-years.
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Affiliation(s)
- Emily J Hemstock
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Centre for Air Pollution, Energy and Health Research, NHMRC CRE, New South Wales, Australia
| | - Rachel E Foong
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - Graham L Hall
- Children's Lung Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia
| | - Amanda J Wheeler
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Commonwealth Scientific and Industrial Research Organization, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Centre for Air Pollution, Energy and Health Research, NHMRC CRE, New South Wales, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Marita Dalton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Grant J Williamson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Caroline Gao
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Youth Mental Health (Orygen), University of Melbourne, Parkville, Victoria, Australia
| | - Michael J Abramson
- Centre for Air Pollution, Energy and Health Research, NHMRC CRE, New South Wales, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Centre for Air Pollution, Energy and Health Research, NHMRC CRE, New South Wales, Australia
| | - Graeme R Zosky
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Centre for Air Pollution, Energy and Health Research, NHMRC CRE, New South Wales, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Yu W, Xu R, Ye T, Abramson MJ, Morawska L, Jalaludin B, Johnston FH, Henderson SB, Knibbs LD, Morgan GG, Lavigne E, Heyworth J, Hales S, Marks GB, Woodward A, Bell ML, Samet JM, Song J, Li S, Guo Y. Estimates of global mortality burden associated with short-term exposure to fine particulate matter (PM 2·5). Lancet Planet Health 2024; 8:e146-e155. [PMID: 38453380 DOI: 10.1016/s2542-5196(24)00003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/27/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The acute health effects of short-term (hours to days) exposure to fine particulate matter (PM2·5) have been well documented; however, the global mortality burden attributable to this exposure has not been estimated. We aimed to estimate the global, regional, and urban mortality burden associated with short-term exposure to PM2·5 and the spatiotemporal variations in this burden from 2000 to 2019. METHODS We combined estimated global daily PM2·5 concentrations, annual population counts, country-level mortality rates, and epidemiologically derived exposure-response functions to estimate the mortality attributable to short-term PM2·5 exposure from 2000 to 2019, in the continental regions and in 13 189 urban centres worldwide at a spatial resolution of 0·1° × 0·1°. We tested the robustness of our mortality estimates with different theoretical minimum risk exposure levels, lag effects, and exposure-response functions. FINDINGS Approximately 1 million (95% CI 690 000-1·3 million) premature deaths per year from 2000 to 2019 were attributable to short-term PM2·5 exposure, representing 2·08% (1·41-2·75) of total global deaths or 17 (11-22) premature deaths per 100 000 population. Annually, 0·23 million (0·15 million-0·30 million) deaths attributable to short-term PM2·5 exposure were in urban areas, constituting 22·74% of the total global deaths attributable to this cause and accounting for 2·30% (1·56-3·05) of total global deaths in urban areas. The sensitivity analyses showed that our worldwide estimates of mortality attributed to short-term PM2·5 exposure were robust. INTERPRETATION Short-term exposure to PM2·5 contributes a substantial global mortality burden, particularly in Asia and Africa, as well as in global urban areas. Our results highlight the importance of mitigation strategies to reduce short-term exposure to air pollution and its adverse effects on human health. FUNDING Australian Research Council and the Australian National Health and Medical Research Council.
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Affiliation(s)
- Wenhua Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Bin Jalaludin
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Sarah B Henderson
- Environmental Health Services, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Luke D Knibbs
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Public Health Unit, Sydney Local Health District, Sydney, NSW, Australia
| | - Geoffrey G Morgan
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; University Centre for Rural Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eric Lavigne
- Air Health Science Division, Health Canada, Ottawa, ON, Canada
| | - Jane Heyworth
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Simon Hales
- Department of Public Health, University of Otago, Wellington South, New Zealand
| | - Guy B Marks
- Medicine & Health, University of New South Wales, Sydney, NSW, Australia
| | - Alistair Woodward
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, USA
| | | | - Jiangning Song
- Monash Biomedicine Discovery Institute, Department of Biochemistry and Molecular Biology, Monash University, Melbourne, VIC, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Pan H, Jarvis D, Potts J, Casas L, Nowak D, Heinrich J, Aymerich JG, Urrutia I, Martinez-Moratalla J, Gullón JA, Pereira-Vega A, Raherison C, Chanoine S, Demoly P, Leynaert B, Gislason T, Probst N, Abramson MJ, Jõgi R, Norbäck D, Sigsgaard T, Olivieri M, Svanes C, Fuertes E. Gas cooking indoors and respiratory symptoms in the ECRHS cohort. Int J Hyg Environ Health 2024; 256:114310. [PMID: 38183794 DOI: 10.1016/j.ijheh.2023.114310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/22/2023] [Accepted: 12/12/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Gas cooking is an important source of indoor air pollutants, and there is some limited evidence that it might adversely be associated with respiratory health. Using repeated cross-sectional data from the multi-centre international European Community Respiratory Health Survey, we assessed whether adults using gas cookers have increased risk of respiratory symptoms compared to those using electric cookers and tested whether there was effect modification by a priori selected factors. METHODS Data on respiratory symptoms and gas cooking were collected from participants at 26-55 and 38-67 years (median time between examinations 11.4 years) from interviewer-led questionnaires. Repeated associations between gas cooking (versus electric) and respiratory symptoms were estimated using multivariable mixed-effects logistic regression models adjusted for age, sex, study arm, smoking status, education level, and included random intercepts for participants within study centres. Analyses were repeated using a 3-level variable for type of cooker and gas source. Effect modification by ventilation habits, cooking duration, sex, age atopy, asthma, and study arm were examined. RESULTS The sample included 4337 adults (43.7% males) from 19 centres in 9 countries. Gas cooking increased the risk of "shortness of breath whilst at rest" (OR = 1.38; 95%CI: 1.06-1.79) and "wheeze with breathlessness" (1.32; 1.00-1.74). For several other symptoms, effect estimates were larger in those who used both gas hobs and ovens, had a bottled gas source and cooked for over 60 min per day. Stratifying results by sex and age found stronger associations in females and younger adults. CONCLUSION This multi-centre international study, using repeat data, suggested using gas cookers in the home was more strongly associated than electric cookers with certain respiratory symptoms in adults. As gas cooking is common, these results may play an important role in population respiratory health.
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Affiliation(s)
- Holly Pan
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Lidia Casas
- Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
| | - Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Isabel Urrutia
- Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain
| | - Jesus Martinez-Moratalla
- Servicio de Neumología del Complejo Hospitalario Universitario de Albacete. (CHUA) Albacete, Spain; Servicio de Salud de Castilla - La Mancha (SESCAM), Spain; Facultad de Medicina de Albacete. Universidad de Castilla - La Mancha, Albacete, Spain
| | | | | | | | | | - Pascal Demoly
- University Hospital of Montpellier, IDESP, Univ Montpellier - Inserm, Montpellier, France
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP), Integrative Respiratory Epidemiology Team, 94807, Villejuif, France; Landspitali University Hospital, Department of Sleep, Reykjavik Iceland
| | - Thorarinn Gislason
- University of Iceland, Medical Faculty, Reykjavik, Iceland; Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Rain Jõgi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Dan Norbäck
- Occupational and Environmental Medicine, Department of Medical Science, University Hospital, Uppsala University, 75237, Uppsala, Sweden
| | - Torben Sigsgaard
- Department of Public Health, Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Mario Olivieri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, Policlinico "G. Rossi", Verona, Italy; Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK.
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Ye T, Xu R, Abramson MJ, Guo Y, Zhang Y, Saldiva PHN, Coelho MSZS, Li S. Maternal greenness exposure and preterm birth in Brazil: A nationwide birth cohort study. Environ Pollut 2024; 343:123156. [PMID: 38142032 DOI: 10.1016/j.envpol.2023.123156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
In the dynamic landscape of maternal and child health, understanding the intricate interplay between environmental factors and pregnancy outcomes is of paramount importance. This study investigates the relationship between maternal greenness exposure and preterm births in Brazil using data spanning from 2010 to 2019. Satellite-derived indices, including the Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI), were employed to assess greenness exposure during whole pregnancy in maternal residential area. Employing Cox proportional hazard models, we calculated the hazard ratios (HRs) with 95% confidence intervals (CIs) for changes in NDVI, while adjusting for individual and area-level covariates. In total, 24,010,250 live births were included. Prevalence of preterm birth was 11.5%, with a modest but statistically significant decreasing trend (p = 0.013) observed across the nation over the study period. The findings reveal a significant association between greenness exposure and a reduced risk of preterm birth. Specifically, for every 0.1 increase in NDVI, there was a 2.0% decrease in the risk of preterm birth (95%CI: 1.9%-2.2%). Stratified analyses based on maternal education and ethnicity indicated potential effect modifications, with stronger protective effects observed among younger mothers and those with less years of education. Sensitivity analyses using EVI yielded consistent results. In conclusion, this study suggests that higher maternal greenness exposure is linked to a decreased risk of preterm birth in Brazil. These findings imply that enhancing residential greenspaces could be a valuable public health strategy to promote maternal and child health in Brazil.
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Affiliation(s)
- Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Michael J Abramson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yiwen Zhang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Paulo H N Saldiva
- Urban Health Laboratory University of São Paulo, Faculty of Medicine/INSPER, São Paulo, 01246-903, Brazil
| | - Micheline S Z S Coelho
- Urban Health Laboratory University of São Paulo, Faculty of Medicine/INSPER, São Paulo, 01246-903, Brazil
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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10
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Petrie K, Abramson MJ, George J. Case-Finding and Treatment Effects in COPD: Secondary Analysis of an Interdisciplinary Intervention Trial. Int J Chron Obstruct Pulmon Dis 2024; 19:451-458. [PMID: 38374818 PMCID: PMC10875182 DOI: 10.2147/copd.s436690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/26/2023] [Indexed: 02/21/2024] Open
Abstract
Background US Preventive Services Taskforce recommends against screening for COPD in asymptomatic adults due to limited evidence on the efficacy of treatments for this population. However, global and Australian guidelines recommend a case-finding approach where those with symptoms and/or risk factors, including smoking, are screened. This study aims to explore patient characteristics by time of COPD diagnosis and the effectiveness of early treatment in those with or without symptoms. Methods Secondary analysis of a randomised controlled trial that included those with a pre-existing (n=130) or new diagnosis (n=142) of COPD. Those randomised to the intervention arm received an interdisciplinary intervention of smoking cessation support, home medicines review and home-based pulmonary rehabilitation, while controls received usual care. The primary outcome was health-related quality of life (HR-QoL) measured using St George's Respiratory Questionnaire. To estimate the impact of early treatment, we compared the effectiveness of treatment versus control at 6- and 12-months for the new versus pre-existing diagnosis groups, and those symptomatic versus asymptomatic or minimally symptomatic based on COPD Assessment Test score. Results Approximately half of those newly diagnosed with COPD were already symptomatic. Early treatment in those diagnosed via case-finding had a positive non-significant impact on HR-QoL. The size of the treatment effects generally favoured the pre-existing diagnosis group when compared to case-finding and favoured those symptomatic when compared to those asymptomatic. Conclusion Despite useful insights into the impacts of case-finding and early treatments, this study, like most others, was not sufficiently powered. Further larger studies or combining sub-groups across studies are required.
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Affiliation(s)
- Kate Petrie
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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11
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Zhang J, Lodge CJ, Walters EH, Chang AB, Bui DS, Lowe AJ, Hamilton GS, Thomas PS, Senaratna CV, James AL, Thompson BR, Erbas B, Abramson MJ, Perret JL, Dharmage SC. Association of novel adult cough subclasses with clinical characteristics and lung function across six decades of life in a prospective, community-based cohort in Australia: an analysis of the Tasmanian Longitudinal Health Study (TAHS). Lancet Respir Med 2024; 12:129-140. [PMID: 38109918 DOI: 10.1016/s2213-2600(23)00340-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Cough is a common yet heterogeneous condition. Little is known about the characteristics and course of cough in general populations. We aimed to investigate cough subclasses, their characteristics from childhood across six decades of life, and potential treatable traits in a community-based cohort. METHODS For our analysis of the Tasmanian Longitudinal Health Study (TAHS), a prospective, community-based cohort study that began on Feb 23, 1968, and has so far followed up participants in Tasmania, Australia, at intervals of 10 years from a mean age of 7 years to a mean age of 53 years, we used data collected as part of the TAHS to distinguish cough subclasses among current coughers at age 53 years. For this analysis, participants who answered Yes to at least one cough-related question via self-report questionnaire were defined as current coughers and included in a latent class analysis of cough symptoms; participants who answered No to all nine cough-related questions were defined as non-coughers and excluded from this analysis. Two groups of longitudinal features were assessed from age 7 years to age 53 years: previously established longitudinal trajectories of FEV1, forced vital capacity [FVC], FEV1/FVC ratio, asthma, and allergies-identified via group-based trajectory analysis or latent class analysis-and symptoms at different timepoints, including asthma, current productive cough, ever chronic productive cough, current smoking, and second-hand smoking. FINDINGS Of 8583 participants included at baseline in the TAHS, 6128 (71·4%) were traced and invited to participate in a follow-up between Sept 3, 2012, and Nov 8, 2016; 3609 (58·9%) of these 6128 returned the cough questionnaire. The mean age of participants in this analysis was 53 years (SD 1·0). 2213 (61·3%) of 3609 participants were defined as current coughers and 1396 (38·7%) were categorised as non-coughers and excluded from the latent class analysis. 1148 (51·9%) of 2213 participants in this analysis were female and 1065 (48·1%) were male. Six distinct cough subclasses were identified: 206 (9·3%) of 2213 participants had minimal cough, 1189 (53·7%) had cough with colds only, 305 (13·8%) had cough with allergies, 213 (9·6%) had intermittent productive cough, 147 (6·6%) had chronic dry cough, and 153 (6·9%) had chronic productive cough. Compared with people with minimal cough, and in contrast to other cough subclasses, people in the chronic productive cough and intermittent productive cough subclasses had worse lung function trajectories (FEV1 persistent low trajectory 2·9%, 6·4%, and 16·1%; p=0·0011, p<0·0001; FEV1/FVC early low-rapid decline trajectory 2·9%, 12·1%, and 13·0%; p=0·012, p=0·0007) and a higher prevalence of cough (age 53 years 0·0%, 32·4% [26·1-38·7], and 50·3% [42·5-58·2]) and asthma (age 53 years 6·3% [3·7-10·6], 26·9% [21·3-33·3], and 41·7% [24·1-49·7]) from age 7 years to age 53 years. INTERPRETATION We identified potential treatable traits for six cough subclasses (eg, asthma, allergies, and active and passive smoking for productive cough). The required management of productive cough in primary care (eg, routine spirometry) might differ from that of dry cough if our findings are supported by other studies. Future population-based studies could apply our framework to address the heterogeneity and complexity of cough in the community. FUNDING The National Health and Medical Research Council of Australia, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, Victorian Asthma Foundation, Queensland Asthma Foundation, Tasmanian Asthma Foundation, The Royal Hobart Hospital Research Foundation, the Helen MacPherson Smith Trust, GlaxoSmithKline, and the China Scholarship Council.
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Affiliation(s)
- Jingwen Zhang
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Monash University, Clayton, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Paul S Thomas
- Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia; Respiratory Medicine, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Chamara V Senaratna
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Bruce R Thompson
- Melbourne School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Heidelberg, VIC, Australia; Respiratory and Sleep Medicine, Austin Hospital, Heidelberg, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
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12
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Tan DJ, Lodge CJ, Walters EH, Bui DS, Pham J, Lowe AJ, Bowatte G, Vicendese D, Erbas B, Johns DP, James AL, Frith P, Hamilton GS, Thomas PS, Wood-Baker R, Han MK, Washko GR, Abramson MJ, Perret JL, Dharmage SC. Can We Use Lung Function Thresholds and Respiratory Symptoms to Identify Pre-COPD? A Prospective, Population-based Cohort Study. Am J Respir Crit Care Med 2024. [PMID: 38236192 DOI: 10.1164/rccm.202212-2330oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/16/2024] [Indexed: 01/19/2024] Open
Abstract
RATIONALE The term 'pre-COPD' refers to individuals at high-risk of developing Chronic Obstructive Pulmonary Disease (COPD) who do not meet conventional spirometric criteria for airflow obstruction. New approaches to identifying these individuals are needed, particularly in younger populations. OBJECTIVE To determine whether lung function thresholds and respiratory symptoms can be used to identify individuals at-risk of developing COPD. METHODS The Tasmanian Longitudinal Health Study is a population-based cohort first studied in 1968 (age 7). Respiratory symptoms, pre- and post-bronchodilator (BD) spirometry, diffusing capacity and static lung volumes were measured on a subgroup at age 45, and incidence of COPD was assessed at age 53. For each lung function measure, z-scores were calculated using Global Lung Initiative references. The optimal threshold for best discrimination of COPD incidence was determined by the unweighted Youden Index. MEASUREMENTS AND MAIN RESULTS Among 801 participants who did not have COPD at age 45, the optimal threshold for COPD incidence by age 53 was pre-BD FEV1/FVC z-score < -1.264, corresponding to the lowest 10th percentile. Those below this threshold had 36-fold increased risk of developing COPD over an eight-year follow-up period (RR 35.8, 95%CI 8.88 to 144), corresponding to a risk difference of +16.4% (95%CI 3.7-67.4). The sensitivity was 88% and specificity 87%. Positive and negative likelihood ratios were 6.79 and 0.14, respectively. Respiratory symptoms, post-BD spirometry, diffusing capacity and static lung volumes did not improve on the classification achieved by pre-BD FEV1/FVC alone. CONCLUSION Our findings support the inclusion of pre-BD spirometry in the physiological definition of pre-COPD and indicate that pre-BD FEV1/FVC at the 10th percentile accurately identifies individuals at high-risk of developing COPD in community-based settings.
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Affiliation(s)
- Daniel J Tan
- The University of Melbourne, 2281, Melbourne, Victoria, Australia
| | | | - E Haydn Walters
- Tasmanian School of Medicine, Discipline of Medicine, HOBART, Tasmania, Australia
| | - Dinh S Bui
- The University of Melbourne - Parkville Campus, 2281, School of Population and Global Health, Melbourne, Victoria, Australia
| | | | - Adrian J Lowe
- The Univerity of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- The University of Melbourne, Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Don Vicendese
- The University of Melbourne School of Population and Global Health, 50066, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne, Victoria, Australia
- La Trobe University, 2080, Department of Mathematics and Statistics, Melbourne, Victoria, Australia
| | - Bircan Erbas
- La Trobe University, Bundoora, Victoria, Australia
| | - David P Johns
- The University of Melbourne School of Population and Global Health, 50066, Allergy and Lung Health Unit, Melbourne, Victoria, Australia
| | - Alan L James
- Sir Charles Gairdner Hospital, 5728, West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Nedlands, Western Australia, Australia
- University of Western Australia, School of Medicine and Pharmacology, Nedlands, Western Australia, Australia
| | - Peter Frith
- Repatriation General Hospital, 60110, Respiratory Medicine, Daw Park, South Australia, Australia
- Unley, South Australia, Australia
| | - Garun S Hamilton
- Monash University & Hospital, Monash Lung & Sleep, Melbourne, Victoria, Australia
- Hudson Institute, Melbourne, Victoria, Australia
| | | | - Richard Wood-Baker
- University of Tasmania School of Medicine, 117153, Hobart, Tasmania, Australia
| | - MeiLan K Han
- University of Michigan, Internal Medicine, Ann Arbor, Michigan, United States
| | - George R Washko
- Brigham and Women's Hospital, 1861, Division of Pulmonary and Critical Care Medicine, Boston, Massachusetts, United States
| | - Michael J Abramson
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
| | - Jennifer L Perret
- The University of Melbourne, Melbourne School of Population and Global Health, Carlton, Victoria, Australia
| | - Shaymali C Dharmage
- The University of Melbourne, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Parkville, Victoria, Australia;
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13
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Ivey MA, Smith SM, Benke G, Toelle BG, Hunter ML, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Abramson MJ. COPD in Never-Smokers: BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2024; 19:161-174. [PMID: 38249822 PMCID: PMC10800088 DOI: 10.2147/copd.s439307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors. Methods We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio <0.70 and secondarily as the ratio less than the lower limit of normal (LLN). Results The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1-12.1%) [ratio Conclusion COPD was prevalent in this population of never-smokers aged 40 years and over. This finding highlights the significance of risk factors other than smoking in the development of COPD.
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Affiliation(s)
- Marsha A Ivey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Sheree M Smith
- School of Nursing and Midwifery, Campbelltown Campus, Western Sydney University, Penrith, NSW, 2751, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Brett G Toelle
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- Sydney Local Health District, Sydney, NSW, 2050, Australia
| | - Michael L Hunter
- School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, 6009, Australia
| | - Graeme P Maguire
- Curtin Medical School, Curtin University, Perth, WA, 6102, Australia
| | - Richard Wood-Baker
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Guy B Marks
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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14
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Lane TJ, Carroll M, Borg BM, McCaffrey TA, Smith CL, Gao CX, Brown D, Poland D, Allgood S, Ikin J, Abramson MJ. Long-term effects of extreme smoke exposure on COVID-19: A cohort study. Respirology 2024; 29:56-62. [PMID: 37681548 DOI: 10.1111/resp.14591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND In 2014, the Hazelwood coalmine fire shrouded the regional Australian town of Morwell in smoke and ash for 6 weeks. One of the fire's by-products, PM2.5 , is associated with an increased risk of COVID-19 and severe disease. However, it is unclear whether the effect persisted for years after exposure. In this study, we surveyed a cohort established prior to the pandemic to determine whether PM2.5 from the coalmine fire increased long-term vulnerability to COVID-19 and severe disease. METHODS From August to December 2022, 612 members of the Hazelwood Health Study's adult cohort, established in 2016/17, participated in a follow-up survey that included standardized items to capture COVID-19 cases, as well as questions about hospitalization and vaccinations. Associations were evaluated in crude and adjusted logistic regression models. RESULTS A total of 268 (44%) participants self-reported or met symptom criteria for having had COVID-19 at least once. All models found a positive association, with odds of COVID-19 increasing by between 4% and 30% for a 10 μg/m3 increase in coalmine fire-related PM2.5 exposure. However, the association was significant in only 2 of the 18 models. There were insufficient hospitalizations to examine severity (n = 7; 1%). CONCLUSION The findings are inconclusive on the effect of coalmine fire-related PM2.5 exposure on long-term vulnerability to COVID-19. Given the positive association that was robust to modelling variations as well as evidence for a causal mechanism, it would be prudent to treat PM2.5 from fire events as a long-term risk factor until more evidence accumulates.
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Affiliation(s)
- Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Matthew Carroll
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Brigitte M Borg
- Respiratory Medicine, The Alfred Health, Melbourne, Victoria, Australia
| | - Tracy A McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David Brown
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Poland
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Shantelle Allgood
- Monash Rural Health Churchill, Monash University, Churchill, Victoria, Australia
| | - Jillian Ikin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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15
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Senaratna CV, Lowe A, Walters EH, Abramson MJ, Bui D, Lodge C, Erbas B, Burgess J, Perret JL, Hamilton GS, Dharmage SC. Associations of early life and childhood risk factors with obstructive sleep apnoea in middle-age. Respirology 2024; 29:63-70. [PMID: 37733623 PMCID: PMC10952926 DOI: 10.1111/resp.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/25/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Early-life risk factors for obstructive sleep apnoea (OSA) are poorly described, yet this knowledge may be critical to inform preventive strategies. We conducted the first study to investigate the association between early-life risk factors and OSA in middle-aged adults. METHODS Data were from population-based Tasmanian Longitudinal Health Study cohort (n = 3550) followed from 1st to 6th decades of life. Potentially relevant childhood exposures were available from a parent-completed survey at age 7-years, along with previously characterized risk factor profiles. Information on the primary outcome, probable OSA (based on a STOP-Bang questionnaire cut-off ≥5), were collected when participants were 53 years old. Associations were examined using logistic regression adjusting for potential confounders. Analyses were repeated using the Berlin questionnaire. RESULTS Maternal asthma (OR = 1.5; 95% CI 1.1-2.0), maternal smoking (OR = 1.2; 1.05, 1.5), childhood pleurisy/pneumonia (OR = 1.3; 1.04, 1.7) and frequent bronchitis (OR = 1.2; 1.01, 1.5) were associated with probable OSA. The risk-factor profiles of 'parental smoking' and 'frequent asthma and bronchitis' were also associated with probable OSA (OR = 1.3; 1.01, 1.6 and OR = 1.3; 1.01-1.9, respectively). Similar associations were found for Berlin questionnaire-defined OSA. CONCLUSIONS We found novel temporal associations of maternal asthma, parental smoking and frequent lower respiratory tract infections before the age of 7 years with adult OSA. While determination of their pathophysiological and any causal pathways require further research, these may be useful to flag the risk of OSA within clinical practice and create awareness and vigilance among at-risk groups.
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Affiliation(s)
- Chamara V. Senaratna
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Faculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
- Non‐Communicable Diseases Research CentreUniversity of Sri JayewardenepuraNugegodaSri Lanka
| | - Adrian Lowe
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - E. Haydn Walters
- School of Medicine and Menzies InstituteThe University of TasmaniaHobartTasmaniaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Dinh Bui
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
| | - Caroline Lodge
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Bircan Erbas
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
- Violet Vines Marshman Centre for Rural Health ResearchLa Trobe UniversityBendigoVictoriaAustralia
| | - John Burgess
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
| | - Jennifer L. Perret
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Institute for Breathing and Sleep (IBAS)HeidelbergVictoriaAustralia
| | - Garun S. Hamilton
- Department of Lung, Sleep, Allergy and ImmunologyMonash HealthClaytonVictoriaAustralia
- School of Clinical SciencesMonash UniversityClaytonVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy & Lung Health Unit, Melbourne School of Population & Global HealthThe University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
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16
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Respiratory Symptoms, Disease Burden, and Quality of Life in Australian Adults According to GOLD Spirometry Grades: Data from the BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2023; 18:2839-2847. [PMID: 38053919 PMCID: PMC10695119 DOI: 10.2147/copd.s425202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose Population data on the burden of chronic obstructive pulmonary disease (COPD) are often based on patient-reported diagnoses of COPD, emphysema or chronic bronchitis, without spirometry. We aimed to investigate the relationship between health burden, quality of life and severity of airway obstruction in Australian adults aged ≥40 years. Methods We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites to reflect the sociodemographic and geographic diversity of the Australian population (n = 3522). Participants with post-bronchodilator airflow limitation (ratio of forced expiratory volume in 1 second FEV1 to forced vital capacity <0.7) were grouped by GOLD spirometry grades 1-4. Quality of life was assessed with Short Form 12 (SF-12) Health Survey Questionnaire. Health burden was assessed as lost time off work or social activities, and healthcare utilization. Results Of the study sample, 2969 participants did not have airflow limitation, 294 (8.4%) were classified as GOLD Grade 1, 212 (6.0%) as GOLD 2 and 43 (1.2%) as GOLD 3-4. Participants with higher GOLD grades had more respiratory symptoms, more comorbidities and greater burden than those with lower GOLD grades. The scores of mental and physical subscales of SF-12 were lower, indicating worse quality of life, from the no airflow limitation group to the GOLD 3-4 group (P = 0.03 and P < 0.001, respectively). Conclusion Greater airflow limitation is associated with greater burden and poor quality of life. Interventions to prevent, or reduce the level of, airflow limitation will reduce the symptom burden and improve quality of life for patients.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Maria R Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alan L James
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Helen K Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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17
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McDonald VM, Archbold G, Beyene T, Brew BK, Franklin P, Gibson PG, Harrington J, Hansbro PM, Johnston FH, Robinson PD, Sutherland M, Yates D, Zosky GR, Abramson MJ. Asthma and landscape fire smoke: A Thoracic Society of Australia and New Zealand position statement. Respirology 2023; 28:1023-1035. [PMID: 37712340 PMCID: PMC10946536 DOI: 10.1111/resp.14593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/14/2023] [Indexed: 09/16/2023]
Abstract
Landscape fires are increasing in frequency and severity globally. In Australia, extreme bushfires cause a large and increasing health and socioeconomic burden for communities and governments. People with asthma are particularly vulnerable to the effects of landscape fire smoke (LFS) exposure. Here, we present a position statement from the Thoracic Society of Australia and New Zealand. Within this statement we provide a review of the impact of LFS on adults and children with asthma, highlighting the greater impact of LFS on vulnerable groups, particularly older people, pregnant women and Aboriginal and Torres Strait Islander peoples. We also highlight the development of asthma on the background of risk factors (smoking, occupation and atopy). Within this document we present advice for asthma management, smoke mitigation strategies and access to air quality information, that should be implemented during periods of LFS. We promote clinician awareness, and the implementation of public health messaging and preparation, especially for people with asthma.
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Affiliation(s)
- Vanessa M. McDonald
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
- Department of Sleep and Respiratory MedicineHunter New England Local Health DistrictNewcastleNew South WalesAustralia
| | - Gregory Archbold
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
| | - Tesfalidet Beyene
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
| | - Bronwyn K. Brew
- National Perinatal Epidemiology and Biostatistics Unit, Centre for Big Data Research in Health, Discipline of Women's Health, Faculty of MedicineUNSWSydneyNew South WalesAustralia
| | - Peter Franklin
- School of Population and Global HealthThe University of Western AustraliaPerthWestern AustraliaAustralia
| | - Peter G. Gibson
- College of Health, Medicine and WellbeingUniversity of NewcastleCallaghanNew South WalesAustralia
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
- Department of Sleep and Respiratory MedicineHunter New England Local Health DistrictNewcastleNew South WalesAustralia
| | - John Harrington
- Asthma and Breathing Research ProgramThe Hunter Medical Research Institute (HMRI)New LambtonNew South WalesAustralia
- Department of Sleep and Respiratory MedicineHunter New England Local Health DistrictNewcastleNew South WalesAustralia
| | - Philip M. Hansbro
- Centre for InflammationCentenary Institute and University of Technology Sydney, School of Life Sciences, Faculty of ScienceSydneyNew South WalesAustralia
- Immune HealthHunter Medical Research Institute and The University of NewcastleCallaghanNew South WalesAustralia
| | - Fay H. Johnston
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Paul D. Robinson
- Department of Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia
- Children's Health and Environment Program, Child Health Research CentreUniversity of QueenslandBrisbaneQueenslandAustralia
| | | | - Deborah Yates
- Department of Thoracic MedicineSt Vincent's HospitalDarlinghurstNew South WalesAustralia
- School of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Graeme R. Zosky
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
- Tasmanian School of MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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18
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Areal AT, Singh N, Zhao Q, Berdel D, Koletzko S, von Berg A, Gappa M, Heinrich J, Standl M, Abramson MJ, Schikowski T. The Influence of Short-Term Weather Parameters and Air Pollution on Adolescent Airway Inflammation. Int J Environ Res Public Health 2023; 20:6827. [PMID: 37835097 PMCID: PMC10572171 DOI: 10.3390/ijerph20196827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 10/15/2023]
Abstract
Fraction of exhaled Nitric Oxide (FeNO) is a marker of airway inflammation. We examined the main effects and interactions of relative humidity (RH) and air pollution on adolescents' FeNO. Two thousand and forty-two participants from the 15-year follow-up of the German GINIplus and LISA birth cohorts were included. Daily meteorological (maximum [Tmax], minimum [Tmin] and mean [Tmean] temperatures and RH) and air pollution [Ozone (O3), nitrogen dioxide (NO2) and particulate matter < 2.5 µm (PM2.5)] were assessed. Linear models were fitted with Ln(FeNO) as the outcome. Increases in FeNO indicate an increase in lung inflammation. Increased FeNO was associated with an increase in temperature, PM2.5, O3 and NO2. A 5% increase in RH was associated with a decrease in FeNO. Interactions between RH and high (p = 0.007) and medium (p = 0.050) NO2 were associated with increases in FeNO; while interactions between RH and high (p = 0.042) and medium (p = 0.040) O3 were associated with decreases in FeNO. Adverse effects were present for male participants, participants with low SES, participants with chronic respiratory disease, and participants from Wesel. Short-term weather and air pollution have an effect on lung inflammation in German adolescents. Future research should focus on further assessing the short-term effect of multiple exposures on lung inflammation in adolescents.
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Affiliation(s)
- Ashtyn Tracey Areal
- IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany; (A.T.A.); (N.S.); (Q.Z.)
- Department of Epidemiology, Medical Research School, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Nidhi Singh
- IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany; (A.T.A.); (N.S.); (Q.Z.)
| | - Qi Zhao
- IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany; (A.T.A.); (N.S.); (Q.Z.)
- School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250100, China
| | - Dietrich Berdel
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany; (D.B.); (A.v.B.)
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children’s Hospital Munich, University Hospital, LMU Munich, 80539 Munich, Germany;
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum, University of Warmia and Mazury, 10-082 Olsztyn, Poland
| | - Andrea von Berg
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, 46483 Wesel, Germany; (D.B.); (A.v.B.)
| | - Monika Gappa
- Department of Paediatrics, Evangelisches Krankenhaus, 40217 Düsseldorf, Germany;
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, 80539 Munich, Germany;
- German Center for Lung Research (DZL), 35392 Gießen, Germany;
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Marie Standl
- German Center for Lung Research (DZL), 35392 Gießen, Germany;
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Michael J. Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Tamara Schikowski
- IUF—Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany; (A.T.A.); (N.S.); (Q.Z.)
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19
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Suresh S, Perret JL, Walters EH, Abramson MJ, Bowatte G, Lodge C, Lowe A, Erbas B, Thomas P, Hamilton GS, Chang AB, Dharmage SC, Bui DS. Disease burden, comorbidities and antecedents of chronic cough phenotypes in Australian adults. Pulmonology 2023:S2531-0437(23)00154-X. [PMID: 37743172 DOI: 10.1016/j.pulmoe.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES While adult chronic cough has high burden, its phenotypes, particularly those without aetiologically related underlying conditions, are understudied. We investigated the prevalence, lung function and comorbidities of adult chronic cough phenotypes. METHODS Data from 3608 participants aged 53 years from the Tasmanian Longitudinal Health Study (TAHS) were included. Chronic cough was defined as cough on most days for >3 months in a year. Chronic cough was classified into "explained cough" if there were any one of four major cough-associated conditions (asthma, COPD, gastroesophageal reflux disease or rhinosinusitis) or "unexplained cough" if none were present. Adjusted regression analyses investigated associations between these chronic cough phenotypes, lung function and non-respiratory comorbidities at 53 years. RESULTS The prevalence of chronic cough was 10% (95%CI 9.1,11.0%) with 46.4% being "unexplained". Participants with unexplained chronic cough had lower FEV1/FVC (coefficient: -1.2% [95%CI:-2,3, -0.1]) and increased odds of comorbidities including obesity (OR=1.6 [95%CI: 1.2, 2.3]), depression (OR=1.4 [95%CI: 1.0, 2.1]), hypertension (OR=1.7 [95%CI: 1.2, 2.4]) and angina, heart attack or myocardial infarction to a lesser extent, compared to those without chronic cough. Participants with explained chronic cough also had lower lung function than both those with unexplained chronic cough and those without chronic cough. CONCLUSIONS Chronic cough is prevalent in middle-age and a high proportion is unexplained. Unexplained cough contributes to poor lung function and increased comorbidities. Given unexplained chronic cough is not a symptom of major underlying respiratory conditions it should be targeted for better understanding in both clinical settings and research.
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Affiliation(s)
- S Suresh
- University of Melbourne Medical School, Parkville, Victoria, Australia; Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - J L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - E H Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - M J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - C Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - A Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - B Erbas
- School of Psychology & Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - P Thomas
- Prince of Wales' Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - G S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Australia; School of Clinical Sciences, Monash University, Clayton, Australia
| | - A B Chang
- Dept of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - S C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia; NHMRC-CRE Centre for Air pollution, Energy and Health Research, Australia
| | - D S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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20
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Perret JL, Zwar NA, Haydn Walters E, Patsamanis H, Abramson MJ, Dharmage SC, Hancock K. A chronic obstructive pulmonary disease risk assessment tool in preventive lung healthcare: An unmet need? Aust J Gen Pract 2023; 52:595-598. [PMID: 37666779 DOI: 10.31128/ajgp-12-22-6653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Jennifer L Perret
- MBBS, FRACP, PhD, NHMRC, Research Fellow, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic; Affiliate, Institute for Breathing and Sleep (IBAS), Melbourne, Vic; Honorary Respiratory Physician, Austin Health, Melbourne, Vic
| | - Nicholas A Zwar
- MBBS, MPH, PhD, FRACGP, FACTM, Executive Dean, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Qld; Chair, RACGP Travel Medicine Specific Interest Group
| | - E Haydn Walters
- MA, DM, DSc, FRCP, FRACP, FCCP, FThorSoc, Honorary Professorial Fellow in Epidemiology, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic; Emeritus Professor of Medicine, School of Medicine, University of Tasmania, Hobart, Tas
| | - Harry Patsamanis
- BAppSc, GradCertDiabEd, General Manager Clinical Programs Research and Innovation, Lung Foundation Australia, Milton, Qld
| | - Michael J Abramson
- MB, BS, BMedSc, PhD, FRACP, FAFPHM, FThorSoc, FERS, Professor of Clinical Epidemiology, School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic; Honorary Respiratory Physician, The Alfred, Melbourne, Vic
| | - Shyamali C Dharmage
- MBBS, MSc, MD, PhD, FCCPSL, FThorSoc, FERS, NHMRC, Leadership Fellow, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic
| | - Kerry Hancock
- BMBS, FRACGP (Hon), Chair, Primary Care Clinical Council, Lung Foundation Australia, Milton, Qld; Chair, Respiratory Medicine Network, Specific Interests Faculty, The Royal Australian College of General Practitioners, East Melbourne, Vic; Honorary Fellow, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic; General Practitioner, Chandlers Hill Surgery, Adelaide, SA
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21
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Xu R, Ye T, Yue X, Yang Z, Yu W, Zhang Y, Bell ML, Morawska L, Yu P, Zhang Y, Wu Y, Liu Y, Johnston F, Lei Y, Abramson MJ, Guo Y, Li S. Global population exposure to landscape fire air pollution from 2000 to 2019. Nature 2023; 621:521-529. [PMID: 37730866 PMCID: PMC10511322 DOI: 10.1038/s41586-023-06398-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/03/2023] [Indexed: 09/22/2023]
Abstract
Wildfires are thought to be increasing in severity and frequency as a result of climate change1-5. Air pollution from landscape fires can negatively affect human health4-6, but human exposure to landscape fire-sourced (LFS) air pollution has not been well characterized at the global scale7-23. Here, we estimate global daily LFS outdoor fine particulate matter (PM2.5) and surface ozone concentrations at 0.25° × 0.25° resolution during the period 2000-2019 with the help of machine learning and chemical transport models. We found that overall population-weighted average LFS PM2.5 and ozone concentrations were 2.5 µg m-3 (6.1% of all-source PM2.5) and 3.2 µg m-3 (3.6% of all-source ozone), respectively, in 2010-2019, with a slight increase for PM2.5, but not for ozone, compared with 2000-2009. Central Africa, Southeast Asia, South America and Siberia experienced the highest LFS PM2.5 and ozone concentrations. The concentrations of LFS PM2.5 and ozone were about four times higher in low-income countries than in high-income countries. During the period 2010-2019, 2.18 billion people were exposed to at least 1 day of substantial LFS air pollution per year, with each person in the world having, on average, 9.9 days of exposure per year. These two metrics increased by 6.8% and 2.1%, respectively, compared with 2000-2009. Overall, we find that the global population is increasingly exposed to LFS air pollution, with socioeconomic disparities.
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Affiliation(s)
- Rongbin Xu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xu Yue
- Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, Joint International Research Laboratory of Climate and Environment Change, School of Environmental Science and Engineering, Nanjing University of Information Science and Technology, Nanjing, China.
| | - Zhengyu Yang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wenhua Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yiwen Zhang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, USA
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Pei Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuxi Zhang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yao Wu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yanming Liu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Fay Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Yadong Lei
- State Key Laboratory of Severe Weather and Key Laboratory of Atmospheric Chemistry of CMA, Chinese Academy of Meteorological Sciences, Beijing, China
| | - Michael J Abramson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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22
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Gao CX, Menssink J, Campbell TCH, Smith CL, Ikin JF, Lane T, Abramson MJ, Carroll M. Somatic symptoms, psychological distress and trauma after disasters: lessons from the 2014 Hazelwood mine fire and 2019-20 Black Summer bushfires. BMC Public Health 2023; 23:1573. [PMID: 37596570 PMCID: PMC10436633 DOI: 10.1186/s12889-023-16501-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 08/10/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Wildfires cause significant physical and mental ill-health. How physical and mental symptoms interact following wildfire smoke exposure is unclear, particularly in the context of repeated exposures. In this cross-sectional study we investigated how posttraumatic stress and general psychological distress associated with somatic symptoms in a community exposed to multiple smoke events. METHODS A random weighted sample of 709 adults exposed to smoke during the 2014 Hazelwood coal mine fire in south-eastern Australia completed a survey in 2020. The survey coincided with the Black Summer wildfires that caused a similar period of smoke haze in the region. Participants self-reported somatic symptoms (PHQ-15) and mine fire-related posttraumatic stress (IES-R) experienced over the previous week, general psychological distress (K10) experienced over the previous four weeks, lifetime health diagnoses and demographic information. Associations between posttraumatic stress, general psychological distress, and each PHQ-15 somatic symptom were analysed using ordinal logistic regression models. RESULTS Overall, 36.2% of participants reported moderate- or high-level somatic symptomology. The most frequent somatic symptoms were fatigue, limb pain, trouble sleeping, back pain, headaches, and shortness of breath. After controlling for confounding factors, general psychological distress and posttraumatic stress were independently associated with all somatic symptoms (except menstrual problems in females for posttraumatic stress). CONCLUSIONS Results highlight the high prevalence of somatic symptoms and their association with general psychological distress and posttraumatic stress within a community in the midst of a second large-scale smoke event. It is essential that healthcare providers and public health authorities consider the interconnections of these conditions when supporting communities affected by climate-related disasters.
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Affiliation(s)
- Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Jana Menssink
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, VIC, 3052, Australia
- Orygen, 35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Timothy C H Campbell
- Monash Rural Health, Monash University, Northways Road, Churchill, VIC, 3842, Australia
| | - Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tyler Lane
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Matthew Carroll
- Monash Rural Health, Monash University, Northways Road, Churchill, VIC, 3842, Australia.
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23
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Markevych I, Zhao T, Fuertes E, Marcon A, Dadvand P, Vienneau D, Garcia Aymerich J, Nowak D, de Hoogh K, Jarvis D, Abramson MJ, Accordini S, Amaral AF, Bentouhami H, Jacobsen Bertelsen R, Boudier A, Bono R, Bowatte G, Casas L, Dharmage SC, Forsberg B, Gislason T, Gnesi M, Holm M, Jacquemin B, Janson C, Jogi R, Johannessen A, Keidel D, Leynaert B, Maldonado Perez JA, Marchetti P, Migliore E, Martínez-Moratalla J, Orru H, Pin I, Potts J, Probst-Hensch N, Ranzi A, Sánchez-Ramos JL, Siroux V, Soussan D, Sunyer J, Urrutia Landa I, Villani S, Heinrich J. Residential greenspace and lung function decline over 20 years in a prospective cohort: The ECRHS study. Environ Int 2023; 178:108036. [PMID: 37336027 DOI: 10.1016/j.envint.2023.108036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/14/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND The few studies that have examined associations between greenspace and lung function in adulthood have yielded conflicting results and none have examined whether the rate of lung function decline is affected. OBJECTIVE We explored the association between residential greenspace and change in lung function over 20 years in 5559 adults from 22 centers in 11 countries participating in the population-based, international European Community Respiratory Health Survey. METHODS Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were measured by spirometry when participants were approximately 35 (1990-1994), 44 (1999-2003), and 55 (2010-2014) years old. Greenness was assessed as the mean Normalized Difference Vegetation Index (NDVI) in 500 m, 300 m, and 100 m circular buffers around the residential addresses at the time of lung function measurement. Green spaces were defined as the presence of agricultural, natural, or urban green spaces in a circular 300 m buffer. Associations of these greenspace parameters with the rate of lung function change were assessed using adjusted linear mixed effects regression models with random intercepts for subjects nested within centers. Sensitivity analyses considered air pollution exposures. RESULTS A 0.2-increase (average interquartile range) in NDVI in the 500 m buffer was consistently associated with a faster decline in FVC (-1.25 mL/year [95% confidence interval: -2.18 to -0.33]). These associations were especially pronounced in females and those living in areas with low PM10 levels. We found no consistent associations with FEV1 and the FEV1/FVC ratio. Residing near forests or urban green spaces was associated with a faster decline in FEV1, while agricultural land and forests were related to a greater decline in FVC. CONCLUSIONS More residential greenspace was not associated with better lung function in middle-aged European adults. Instead, we observed slight but consistent declines in lung function parameters. The potentially detrimental association requires verification in future studies.
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Affiliation(s)
- Iana Markevych
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Tianyu Zhao
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Payam Dadvand
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Judith Garcia Aymerich
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Dennis Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Deborah Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK; MRC Centre for Environment & Health, London, UK
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Andre Fs Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Hayat Bentouhami
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Randi Jacobsen Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anne Boudier
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France; Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Gayan Bowatte
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia; Faculty of Allied Health, University of Peradeniya, Kandy, Sri Lanka; National Institute of Fundamental Studies, Kandy, Sri Lanka
| | - Lidia Casas
- Social Epidemiology and Health Policy, Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Institute for Environment and Sustainable Development (IMDO), University of Antwerp, Belgium
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Marco Gnesi
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Mathias Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Benedicte Jacquemin
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dirk Keidel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Benedicte Leynaert
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Center for Epidemiology and Population Health (CESP) - Integrative Respiratory Epidemiology Team, 94807 Villejuif, France
| | | | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy
| | | | - Hans Orru
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Isabelle Pin
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France; CHU de Grenoble Alpes, Department of Pédiatrie, Inserm, Grenoble, France
| | - James Potts
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Andrea Ranzi
- Centre for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena, Italy
| | | | - Valerie Siroux
- Pediatric Department, CHU Grenoble Alpes, Grenoble, France
| | - David Soussan
- Paris Diderot University, Faculty of Medicine, Paris, France; Laboratory of Excellence, INFLAMEX, Université Sorbonne Paris Cité and DHU FIRE, Paris, France
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Simona Villani
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany; Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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24
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Alotaibi N, Borg BM, Abramson MJ, Paul E, Zwar N, Russell G, Wilson S, Holland AE, Bonevski B, Mahal A, George J. Different Case Finding Approaches to Optimise COPD Diagnosis: Evidence from the RADICALS Trial. Int J Chron Obstruct Pulmon Dis 2023; 18:1543-1554. [PMID: 37492489 PMCID: PMC10364814 DOI: 10.2147/copd.s371371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/28/2023] [Indexed: 07/27/2023] Open
Abstract
Aim Diagnosis of COPD in primary care is hindered by underuse of spirometry. Case finding using validated symptom and health status questionnaires, and simple handheld devices in high-risk populations may improve diagnosis. This study aimed to determine the best combination of measures to optimise COPD diagnosis in the primary care setting. Methods We recruited 335 current or ex-smokers, including those with an established diagnosis of COPD from general practices. Participants' FEV1 and FEV6 were measured using a handheld spirometry device (COPD-6®). Each completed the COPD assessment test (CAT), a modified Medical Research Council (mMRC) dyspnoea scale, St George's Respiratory Questionnaire (SGRQ) and smoking history questionnaire. From these data we calculated the predictive validity for spirometry-confirmed diagnosis of COPD. Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (PPV, NPV) were calculated for each. Kappa coefficient was used to measure the agreement between the Fixed-Ratio (FR) and Lower Limit of Normal (LLN) spirometric criteria in diagnosing COPD. Results FEV1/FEV6 <0.70 alone showed significant association (p<0.0001) with COPD diagnosis and good predictive accuracy (AUROC=0.725). However, no further improvement was found after combining SGRQ, CAT and mMRC with FEV1/FEV6. FEV1/FEV6 <0.70 using the COPD-6® handheld device had moderate sensitivity (65.7%) and high PPV (90.1%), high specificity (79.3%) and NPV (44.8%). There was good agreement between FR and LLN definitions (κ=0.70). Conclusion Handheld micro-spirometers can facilitate case finding of COPD in smokers and ex-smokers attending general practice. The fixed ratio criterion currently recommended by COPD-X guidelines offers the simplest method for diagnosing COPD in Australian primary care.
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Affiliation(s)
- Nawar Alotaibi
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | - Brigitte M Borg
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Eldho Paul
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD, Australia
| | - Grant Russell
- Department of General Practice, Monash University, Melbourne, VIC, Australia
| | - Sally Wilson
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- Department of Infrastructure Engineering, The University of Melbourne, Melbourne, VIC, Australia
| | - Anne E Holland
- Respiratory Medicine, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Ajay Mahal
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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25
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Tan DJ, Lodge CJ, Walters EH, Lowe AJ, Bui DS, Bowatte G, Pham J, Erbas B, Hui J, Hamilton GS, Thomas PS, Hew M, Washko G, Wood-Baker R, Abramson MJ, Perret JL, Dharmage SC. Longitudinal Asthma Phenotypes from Childhood to Middle-Age: A Population-based Cohort Study. Am J Respir Crit Care Med 2023; 208:132-141. [PMID: 37209134 DOI: 10.1164/rccm.202208-1569oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/17/2023] [Indexed: 05/22/2023] Open
Abstract
Rationale: Asthma is a heterogeneous condition, and longitudinal phenotyping may provide new insights into the origins and outcomes of the disease. Objectives: We aimed to characterize the longitudinal phenotypes of asthma between the first and sixth decades of life in a population-based cohort study. Methods: Respiratory questionnaires were collected at seven time points in the TAHS (Tasmanian Longitudinal Health Study) when participants were aged 7, 13, 18, 32, 43, 50, and 53 years. Current-asthma and ever-asthma status was determined at each time point, and group-based trajectory modeling was used to characterize distinct longitudinal phenotypes. Linear and logistic regression models were fitted to investigate associations of the longitudinal phenotypes with childhood factors and adult outcomes. Measurements and Main Results: Of 8,583 original participants, 1,506 had reported ever asthma. Five longitudinal asthma phenotypes were identified: early-onset adolescent-remitting (40%), early-onset adult-remitting (11%), early-onset persistent (9%), late-onset remitting (13%), and late-onset persistent (27%). All phenotypes were associated with chronic obstructive pulmonary disease at age 53 years, except for late-onset remitting asthma (odds ratios: early-onset adolescent-remitting, 2.00 [95% confidence interval (CI), 1.13-3.56]; early-onset adult-remitting, 3.61 [95% CI, 1.30-10.02]; early-onset persistent, 8.73 [95% CI, 4.10-18.55]; and late-onset persistent, 6.69 [95% CI, 3.81-11.73]). Late-onset persistent asthma was associated with the greatest comorbidity at age 53 years, with increased risk of mental health disorders and cardiovascular risk factors. Conclusions: Five longitudinal asthma phenotypes were identified between the first and sixth decades of life, including two novel remitting phenotypes. We found differential effects of these phenotypes on risk of chronic obstructive pulmonary disease and nonrespiratory comorbidities in middle age.
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Affiliation(s)
- Daniel J Tan
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh S Bui
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jonathan Pham
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jennie Hui
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, Victoria, Australia
- School of Clinical Sciences and
| | - Paul S Thomas
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Hew
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - George Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and
| | | | - Michael J Abramson
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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26
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study. ERJ Open Res 2023; 9:00098-2023. [PMID: 37609600 PMCID: PMC10440648 DOI: 10.1183/23120541.00098-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 08/24/2023] Open
Abstract
Background Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (asthma+COPD) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both. Method We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics and lung function were compared between groups. Results Of the study sample (n=3522), 336 reported asthma only, 172 reported COPD only, 77 reported asthma+COPD and 2937 reported neither. Fewer than half of participants with a COPD diagnosis (with or without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (modified Medical Research Council score ≥2) than asthma only (adjusted OR 3.44, 95% CI 1.86-6.33) or COPD only (adjusted OR 3.28, 95% CI 1.69-6.39). Airflow limitation (Global Initiative for Chronic Obstructive Lung Disease 2 or higher, using post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio <0.7) was similar between asthma only and COPD only, but twice as prevalent in asthma+COPD (adjusted OR 2.18 and 2.58, respectively). Conclusions Adults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma only or COPD only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Maria R. Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David P. Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Guy B. Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Helen K. Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Brett G. Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
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Ye T, Zhang Y, Chen G, Yang Z, Guo Y, Abramson MJ, Li S. Associations between neighborhood greenspace and multiple birth outcomes across two metropolitan areas in Australia. Sci Total Environ 2023:164647. [PMID: 37290659 DOI: 10.1016/j.scitotenv.2023.164647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Beneficial effects of greenspace on birth outcomes have been reported. However, insights on key windows of exposure and underlying mechanisms are needed. METHOD Births in Sydney (2016-2019) were retrieved from NSW Midwives Data Collection. Births in Brisbane (2000-2014) were retrieved from Queensland Health Perinatal Data Collection. Satellite image-derived normalized difference vegetation index (NDVI) and night time light (NTL) index were used. For each city, linear regression models were used to assess associations between greenspace and birth weight, and logistic models to estimate the risks of preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) per 0.1 increase in NDVI. We examined the trimester-specific associations, and heterogeneities by night time light. RESULTS The study included 193,264 singleton births in Sydney and 155,606 singleton births in Brisbane. An 0.1 increase in greenspace during whole pregnancy was associated with 17.4 g (95%CI: 14.5 to 20.2) increase in birth weight in Sydney, and 15.1 g (95%CI: 12.0 to 18.5) in Brisbane. The odds ratios were 0.98 (95%CI: 0.97 to 0.99) for LBW, 0.99 (95%CI: 0.98 to 1.00) for PTB, and 0.98 (95%CI: 0.96 to 0.99) for SGA per 0.1 increase in NDVI during whole pregnancy for participants in Sydney. Similarly, reduced odds of adverse birth outcomes were observed in Brisbane. Trimester specific models demonstrated a consistent pattern of associations in the same direction across all outcomes. We found that effects of greenspace exposure on birth outcomes attenuated after adjusting for NTL, but stronger effects among babies of mothers from areas with more NTL. CONCLUSIONS AND RELEVANCE These findings suggest a beneficial association between neighborhood greenspace and healthier pregnancies in urban areas. We provide novel evidence of interactions between greenspace and NTL.
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Affiliation(s)
- Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yiwen Zhang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Gongbo Chen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Zhengyu Yang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Michael J Abramson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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Pham J, Bui DS, Lodge CJ, Abramson MJ, Lowe AJ, Li S, Win AK, Hew M, Dharmage SC. Genetic ancestry is associated with asthma, and this could be modified by environmental factors. A systematic review. Clin Exp Allergy 2023; 53:668-671. [PMID: 37051940 PMCID: PMC10947234 DOI: 10.1111/cea.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Jonathan Pham
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global HealthThe University of MelbourneMelbourneVictoriaAustralia
- Asthma, Allergy and Clinical Immunology Service, Department of Respiratory MedicineAlfred HospitalMelbourneVictoriaAustralia
| | - Dinh S. Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Shuai Li
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneParkvilleVictoriaAustralia
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- Precision Medicine, School of Clinical Sciences at Monash HealthMonash UniversityClaytonVictoriaAustralia
| | - Aung K. Win
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Mark Hew
- Asthma, Allergy and Clinical Immunology Service, Department of Respiratory MedicineAlfred HospitalMelbourneVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global HealthThe University of MelbourneMelbourneVictoriaAustralia
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Gallagher C, Pirkis J, Lambert KA, Perret JL, Ali GB, Lodge CJ, Bowatte G, Hamilton GS, Matheson MC, Bui DS, Abramson MJ, Walters EH, Dharmage SC, Erbas B. Life course BMI trajectories from childhood to mid-adulthood are differentially associated with anxiety and depression outcomes in middle age. Int J Obes (Lond) 2023:10.1038/s41366-023-01312-6. [PMID: 37161067 PMCID: PMC10359183 DOI: 10.1038/s41366-023-01312-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 04/12/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND/OBJECTIVE Obesity is a risk factor for multimorbidity, including depression and possibly anxiety. However, it is currently unclear how patterns of change in BMI over the life course differentially influence the magnitude in risk of depression and anxiety in mid-adulthood. We aimed to examine associations between BMI trajectories from childhood to adulthood and the risk of depression and anxiety in middle age. METHODS In the Tasmanian Longitudinal Health Study (n = 2416), five distinct BMI trajectories were previously defined from age 5 to 45 years using group-based modelling. At age 53, current depression and anxiety were assessed using the Patient Health Questionnaire and the Generalized Anxiety Disorder scale, respectively. Logistic regression models adjusted for potential confounders estimated associations between BMI trajectories and these outcomes. RESULTS Those belonging to the child average-increasing (OR = 2.24; 95%CI: 1.24, 4.06) and persistently high (OR = 2.64; 1.26, 5.52) trajectories were more likely to have depression in middle age, compared to the persistently average trajectory. However, the odds of experiencing greater severity of depressive symptoms was highest in the child average-increasing group (OR = 2.36; 1.59, 3.49). Despite finding no evidence of association between BMI trajectories and current anxiety, we observed less severe symptoms in the child high-decreasing trajectory (OR = 0.68; 0.51, 0.91). CONCLUSION We found an increased risk of depression in middle age among individuals with a persistently high BMI from childhood to mid-adulthood and individuals with an average BMI in childhood which then increased consistently throughout adulthood. Encouragingly, resolving childhood adiposity by adulthood was associated with lesser anxiety symptoms. Taken together, these findings highlight the need to target mental health screening and treatment towards high-risk BMI trajectory groups and the importance of early interventions to prevent and resolve excess weight.
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Affiliation(s)
- Claire Gallagher
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Katrina A Lambert
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gulshan B Ali
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Caroline J Lodge
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gayan Bowatte
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy & Immunology, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Melanie C Matheson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- Population Health Solutions, Telstra Health, Melbourne, VIC, Australia
| | - Dinh S Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - E Haydn Walters
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
- School of Medicine, University of Tasmania, Hobart, VIC, Australia
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Smith CL, Gao CX, Xu R, Ikin JF, Dimitriadis C, Carroll MT, Sim MR, Stub D, Lane TJ, Abramson MJ, Guo Y. Long-term impact of the 2014 Hazelwood coal mine fire on emergency department presentations in Australia. Environ Res 2023; 223:115440. [PMID: 36758918 DOI: 10.1016/j.envres.2023.115440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/09/2022] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND In 2014, wildfires ignited a coal mine in Australia, burning for 6 weeks, releasing large amounts of fine particulate matter ≤2.5 μm in diameter (PM2.5). We investigated the association between individual PM2.5 exposure and emergency department presentations (EDPs) within 5 years post-fire. METHODS Survey and exposure data for 2725 residents from an exposed and unexposed town were linked with ED administrative data from 2009 to 2019. The association between individual PM2.5 and EDPs was assessed using recurrent survival analysis. RESULTS A 10 μg/m3 increase in PM2.5 was associated with a 10% increase in respiratory EDPs (HR = 1.10; 95%CI:1.00-1.22) over 5 years post-fire. Increased risks of EDPs for ischaemic heart disease (HR = 1.39; 95%CI:1.12-1.73), atherothrombotic disease (HR = 1.27; 95%CI:1.08-1.50), and cardiovascular disease (HR = 1.10, 95%CI:0.99-1.22) were evident within 2.5 years. CONCLUSION PM2.5 exposure from a 6-week mine fire increased the 5-year risk of respiratory conditions. An increased risk of CVD within 2.5 years post-fire subsided after this time.
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Affiliation(s)
- Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, 3052, Australia; Orygen, Parkville, VIC, 3052, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Christina Dimitriadis
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Matthew Tc Carroll
- Monash Rural Health Churchill, Monash University, Northways Road, Churchill, Victoria, 3842, Australia
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia; Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, 3004, Australia; The Baker Institute, Melbourne, Victoria, 3004, Australia
| | - Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.
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Hemstock EJ, Foong RE, Hall GL, Wheeler AJ, Dharmage SC, Dalton M, Williamson GJ, Gao C, Abramson MJ, Johnston FH, Zosky GR. No association between in utero exposure to emissions from a coalmine fire and post-natal lung function. BMC Pulm Med 2023; 23:120. [PMID: 37059986 PMCID: PMC10103534 DOI: 10.1186/s12890-023-02414-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Studies linking early life exposure to air pollution and subsequent impaired lung health have focused on chronic, low-level exposures in urban settings. We aimed to determine whether in utero exposure to an acute, high-intensity air pollution episode impaired lung function 7-years later. METHOD We conducted a prospective cohort study of children who lived in the vicinity of a coalmine fire. Respiratory function was measured using the forced oscillation technique (FOT). Z-scores for resistance at 5 Hz (R5), reactance at 5 Hz (X5) and area under the reactance curve (AX) were calculated. Two sets of analyses were conducted to address two separate questions: (1) whether mine fire exposure (a binary indicator; conceived after the mine fire vs in utero exposed) was associated with the respiratory Z-scores; (2) whether there was any dose-response relationship between fire-related PM2.5 exposure and respiratory outcomes among those exposed. RESULTS Acceptable lung function measurements were obtained from 79 children; 25 unexposed and 54 exposed in utero. Median (interquartile range) for daily average and peak PM2.5 for the exposed children were 4.2 (2.6 - 14.2) and 88 (52-225) µg/m3 respectively. There were no detectable differences in Z-scores between unexposed and exposed children. There were no associations between respiratory Z-scores and in utero exposure to PM2.5 (daily average or peak). CONCLUSION There was no detectable effect of in utero exposure to PM2.5 from a local coalmine fire on post-natal lung function 7-years later. However, statistical power was limited.
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Affiliation(s)
- Emily J Hemstock
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Centre for Air Pollution, Energy and Health Research, NHMRC CRE, Glebe, NSW, Australia
| | - Rachel E Foong
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
- School of Allied Health, Curtin University, Bentley, WA, Australia
| | - Graham L Hall
- Children's Lung Health, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA, Australia
- School of Allied Health, Curtin University, Bentley, WA, Australia
| | - Amanda J Wheeler
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Commonwealth Scientific and Industrial Research Organization, Aspendale, VIC, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marita Dalton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Grant J Williamson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Caroline Gao
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Orygen Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Graeme R Zosky
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
- Tasmanian School of Medicine, University of Tasmania, Hobart, TAS, Australia.
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Smith CL, Campbell TCH, Gao CX, Lane TJ, Maybery D, Berger E, Brown D, Ikin JF, McFarlane A, Abramson MJ, Carroll M. Sociodemographic circumstances, health, and life experience shape posttraumatic distress trajectories among individuals exposed to smoke during a large-scale coal mine fire. J Trauma Stress 2023; 36:465-473. [PMID: 37005219 DOI: 10.1002/jts.22923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/29/2022] [Accepted: 12/29/2022] [Indexed: 04/04/2023]
Abstract
The 2014 Hazelwood coal mine fire in the Latrobe Valley, Australia, distributed toxic smoke into surrounding communities over 45 days. This study investigated risk and protective factors associated with four trajectories of posttraumatic distress (resilient, recovery, delayed-onset, chronic) among exposed adults. Participants (N = 709) completed surveys in 2016-2017 and 2019-2020 assessing mine fire-related particulate matter (PM2.5 ) exposure; sociodemographic, physical, and mental health variables; and exposure to other traumatic and recent stressful events. Mine fire-related posttraumatic distress was measured using the IES-R; trajectories were determined according to established clinical significance thresholds. Relative risk ratios (RRRs) were generated from multivariate multinomial regressions. The resilient trajectory was most common (77.0%). The chronic trajectory (8.5%) was associated with loneliness, RRR = 2.59, 95% CI [1.30, 5.16], and physical health diagnoses, RRR = 2.31, 95% CI [1.32, 4.02]. The delayed-onset trajectory (9.1%) was associated with multiple recent stressful events, RRR = 2.51, 95% CI [1.37, 4.59]; mental health diagnoses, RRR = 2.30, 95% CI [1.25, 4.24]; loneliness, RRR = 2.05, 95% CI [1.09, 3.88]; and male gender, RRR = 2.01, 95% CI [1.18, 3.44]. Socioeconomic advantage protected against chronic, RRR = 0.68, 95% CI [0.53, 0.86], and delayed-onset trajectory membership, RRR = 0.68, 95% CI [0.50, 0.94]; social support protected against chronic trajectory membership, RRR = 0.67, 95% CI [0.49, 0.92]. PM2.5 exposure did not determine trajectory. These findings enhance understanding of longer-term posttraumatic responses to large-scale smoke events and can inform mental health initiatives within at-risk communities.
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Affiliation(s)
- Catherine L Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Orygen, Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darryl Maybery
- Monash Rural Health, Monash University, Warragul, Australia
| | - Emily Berger
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Australia
| | - David Brown
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jillian F Ikin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew Carroll
- Monash Rural Health Churchill, Monash University, Churchill, Australia
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Tan DJ, Lodge CJ, Walters EH, Lowe AJ, Bui DS, Bowatte G, Kandane‐Rathnayake R, Aldakheel FM, Erbas B, Hamilton GS, Thomas PS, Hew M, Tang MLK, Abramson MJ, Perret JL, Dharmage SC. Biomarkers of asthma relapse and lung function decline in adults with spontaneous asthma remission: A population-based cohort study. Allergy 2023; 78:957-967. [PMID: 36301194 PMCID: PMC10953440 DOI: 10.1111/all.15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The extent to which biomarkers of asthma activity persist in spontaneous asthma remission and whether such markers are associated with future respiratory outcomes remained unclear. We investigated the association between sub-clinical inflammation in adults with spontaneous asthma remission and future asthma relapse and lung function decline. METHODS The Tasmanian Longitudinal Health Study is a population-based cohort (n = 8583). Biomarkers of systemic inflammation were measured on participants at age 45, and latent profile analysis was used to identify cytokine profiles. Bronchial hyperresponsiveness (BHR) and nitric oxide products in exhaled breath condensate (EBC NOx) were measured at age 50. Participants with spontaneous asthma remission at ages 45 (n = 466) and 50 (n = 318) were re-evaluated at age 53, and associations between baseline inflammatory biomarkers and subsequent asthma relapse and lung function decline were assessed. RESULTS We identified three cytokine profiles in adults with spontaneous asthma remission: average (34%), Th2-high (42%) and Th2-low (24%). Compared to the average profile, a Th2-high profile was associated with accelerated decline in post-BD FEV1 /FVC (MD -0.18% predicted per-year; 95% CI -0.33, -0.02), while a Th2-low profile was associated with accelerated decline in both post-BD FEV1 (-0.41%; -0.75, -0.06) and post-BD FVC (-0.31%; -0.62, 0.01). BHR and high TNF-α during spontaneous remission were associated with an increased risk of asthma relapse. In contrast, we found no evidence of association between EBC NOx and either asthma relapse or lung function decline. CONCLUSION BHR and serum inflammatory cytokines have prognostic value in adults with spontaneous asthma remission. At-risk individuals with BHR, Th2-high or Th2-low cytokine profiles may benefit from closer monitoring and on-going follow-up.
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Affiliation(s)
- Daniel J. Tan
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Eugene Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- School of Medicine, University of TasmaniaHobartTasmaniaAustralia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Dinh S. Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- Department of Basic Sciences, Faculty of Allied Health SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | | | - Fahad M. Aldakheel
- Department of Clinical Laboratory Sciences, College of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Bircan Erbas
- School of Psychology and Public HealthLa Trobe UniversityMelbourneVictoriaAustralia
- Violet Vines Marshman Centre for Rural Health ResearchLa Trobe UniversityBendigoVictoriaAustralia
| | - Garun S. Hamilton
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
- Monash Lung, Sleep, Allergy and ImmunologyMonash HealthMelbourneVictoriaAustralia
| | - Paul S. Thomas
- Prince of Wales' Clinical School, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mark Hew
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- The Alfred HospitalMelbourneVictoriaAustralia
| | - Mimi L. K. Tang
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Jennifer L. Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsSchool of Population and Global Health, University of MelbourneMelbourneVictoriaAustralia
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Perret J, Yip SWS, Idrose NS, Hancock K, Abramson MJ, Dharmage SC, Walters EH, Waidyatillake N. Undiagnosed and 'overdiagnosed' COPD using postbronchodilator spirometry in primary healthcare settings: a systematic review and meta-analysis. BMJ Open Respir Res 2023; 10:10/1/e001478. [PMID: 37130651 DOI: 10.1136/bmjresp-2022-001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/24/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Despite chronic obstructive pulmonary disease (COPD) being a major global cause of mortality and hospitalisation, it is often undiagnosed or inaccurately diagnosed in clinical settings. OBJECTIVE To systematically synthesise all peer-reviewed papers from primary healthcare settings that have reported data on: (1) undiagnosed COPD, that is, patients with respiratory symptoms and postbronchodilator airflow obstruction consistent with COPD, without a formal clinician's diagnosis of COPD either documented in health records or reported by patients and (2) 'overdiagnosed COPD', that is, clinician's diagnosis without postbronchodilator airflow obstruction. METHODS Studies investigating these diagnostic metrics in patients from primary healthcare clinics (according to predefined inclusion/exclusion criteria) were sourced from Medline and Embase and assessed for bias (Johanna Briggs Institute tools for prevalence studies and case series). Meta-analyses of studies of adequate sample size used random effect modelling stratified by risk factor categories. RESULTS Of 26 eligible articles, 21 cross-sectional studies investigated 3959 cases of spirometry-defined COPD (with or without symptoms), and 5 peer-reviewed COPD case series investigated 7381 patients. The prevalence of spirometry-confirmed COPD without a diagnosis documented in their health records was 14%-26% in studies of symptomatic smokers (N=3). 1 in 4 patients taking inhaled therapies (25% (95% CI 22% to 28%), N=2) and 1 in 6 smokers irrespective of symptoms (16% (95% CI 14% to 18%), N=6) fulfilled diagnostic spirometry criteria but did not report receiving a COPD-related diagnosis. In an adequately powered series of COPD cases documented in primary healthcare records (N=4), only between 50% and 75% of subjects had any airflow obstruction on postbronchodilator spirometry performed by study researchers, therefore, COPD was clinically 'overdiagnosed' in 25%-50% of subjects. DISCUSSION Although data were heterogeneous and of modest quality, undiagnosed COPD was common in primary healthcare, especially for symptomatic smokers and patients treated with inhaled therapies. In contrast, frequent COPD 'overdiagnosis' may represent treatment of asthma/reversible component or another medical diagnosis. PROSPERO REGISTRATION NUMBER CRD42022295832.
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Affiliation(s)
- Jennifer Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep (IBAS), Melbourne, Victoria, Australia
| | - Sui Wah Sean Yip
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nur Sabrina Idrose
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Food and Allergy Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kerry Hancock
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Chandlers Hill Surgery, Happy Valley, South Australia, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - E Haydn Walters
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
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35
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Abramson MJ, Glass DC. Trajectories of lung function in urban firefighters. Respirology 2023; 28:208-209. [PMID: 36437525 DOI: 10.1111/resp.14418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J Abramson
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Deborah C Glass
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Dharmage SC, Bui DS, Walters EH, Lowe AJ, Thompson B, Bowatte G, Thomas P, Garcia-Aymerich J, Jarvis D, Hamilton GS, Johns DP, Frith P, Senaratna CV, Idrose NS, Wood-Baker RR, Hopper J, Gurrin L, Erbas B, Washko GR, Faner R, Agusti A, Abramson MJ, Lodge CJ, Perret JL. Lifetime spirometry patterns of obstruction and restriction, and their risk factors and outcomes: a prospective cohort study. Lancet Respir Med 2023; 11:273-282. [PMID: 36244396 DOI: 10.1016/s2213-2600(22)00364-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Interest in lifetime lung function trajectories has increased in the context of emerging evidence that chronic obstructive pulmonary disease (COPD) can arise from multiple disadvantaged lung function pathways, including those that stem from poor lung function in childhood. To our knowledge, no previous study has investigated both obstructive and restrictive lifetime patterns concurrently, while accounting for potential overlaps between them. We aimed to investigate lifetime trajectories of the FEV1/forced vital capacity (FVC) ratio, FVC, and their combinations, relate these combined trajectory groups to static lung volume and gas transfer measurements, and investigate both risk factors for and consequences of these combined trajectory groups. METHODS Using z scores from spirometry measured at ages 7, 13, 18, 45, 50, and 53 years in the Tasmanian Longitudinal Health Study (n=2422), we identified six FEV1/FVC ratio trajectories and five FVC trajectories via group-based trajectory modelling. Based on whether trajectories of the FEV1/FVC ratio and FVC were low (ie, low from childhood or adulthood) or normal, four patterns of lifetime spirometry obstruction or restriction were identified and compared against static lung volumes and gas transfer. Childhood and adulthood characteristics and morbidities of these patterns were investigated. FINDINGS The prevalence of the four lifetime spirometry patterns was as follows: low FEV1/FVC ratio only, labelled as obstructive-only, 25·8%; low FVC only, labelled as restrictive-only, 10·5%; both low FEV1/FVC ratio and low FVC, labelled as mixed, 3·5%; and neither low FEV1/FVC ratio nor low FVC, labelled as reference, 60·2%. The prevalence of COPD at age 53 years was highest in the mixed pattern (31 [37%] of 84 individuals) followed by the obstructive-only pattern (135 [22%] of 626 individuals). Individuals with the mixed pattern also had the highest prevalence of parental asthma, childhood respiratory illnesses, adult asthma, and depression. Individuals with the restrictive-only pattern had lower total lung capacity and residual volume, and had the highest prevalence of childhood underweight, adult obesity, diabetes, cardiovascular conditions, hypertension, and obstructive sleep apnoea. INTERPRETATION To our knowledge, this is the first study to characterise lifetime phenotypes of obstruction and restriction simultaneously using objective data-driven techniques and unique life course spirometry measures of FEV1/FVC ratio and FVC from childhood to middle age. Mixed and obstructive-only patterns indicate those who might benefit from early COPD interventions. Those with the restrictive-only pattern had evidence of true lung restriction and were at increased risk of multimorbidity by middle age. FUNDING National Health and Medical Research Council of Australia, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, The Victorian, Queensland & Tasmanian Asthma Foundations, The Royal Hobart Hospital, Helen MacPherson Smith Trust, and GlaxoSmithKline.
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Affiliation(s)
- Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Dinh S Bui
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eugene H Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bruce Thompson
- School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Paul Thomas
- Inflammation and Infection Research, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Judith Garcia-Aymerich
- ISGlobal, Barcelona, Spain; Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Garun S Hamilton
- School of Clinical Sciences, Monash University, Melbourne, VIC, Australia; Lung, Sleep, Allergy and Immunology Department at Monash Health, Melbourne, VIC, Australia
| | - David P Johns
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter Frith
- College of Medicine and Public Health, Flinders University, Adelaide, SA Australia
| | - Chamara V Senaratna
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nur S Idrose
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - John Hopper
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Lyle Gurrin
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Bircan Erbas
- School of Psychology and Public Heath, La Trobe University, Bundoora, VIC, Australia
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | - Rosa Faner
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
| | - Alvar Agusti
- Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain; Respiratory Institute, Hospital Clinic, Barcelona, Spain; Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer L Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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James AL, Donovan GM, Green FHY, Mauad T, Abramson MJ, Cairncross A, Noble PB, Elliot JG. Heterogeneity of Airway Smooth Muscle Remodeling in Asthma. Am J Respir Crit Care Med 2023; 207:452-460. [PMID: 36399661 DOI: 10.1164/rccm.202111-2634oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Rationale: Ventilatory defects in asthma are heterogeneous and may represent the distribution of airway smooth muscle (ASM) remodeling. Objectives: To determine the distribution of ASM remodeling in mild-severe asthma. Methods: The ASM area was measured in nine airway levels in three bronchial pathways in cases of nonfatal (n = 30) and fatal asthma (n = 20) and compared with control cases without asthma (n = 30). Correlations of ASM area within and between bronchial pathways were calculated. Asthma cases with 12 large and 12 small airways available (n = 42) were classified on the basis of the presence or absence of ASM remodeling (more than two SD of mean ASM area of control cases, n = 86) in the large or small airway or both. Measurements and Main Results: ASM remodeling varied widely within and between cases of nonfatal asthma and was more widespread and confluent and more marked in fatal cases. There were weak correlations of ASM between levels within the same or separate bronchial pathways; however, predictable patterns of remodeling were not observed. Using mean data, 44% of all asthma cases were classified as having no ASM remodeling in either the large or small airway despite a three- to 10-fold increase in the number of airways with ASM remodeling and 81% of asthma cases having ASM remodeling in at least one large and small airway. Conclusions: ASM remodeling is related to asthma severity but is heterogeneous within and between individuals and may contribute to the heterogeneous functional defects observed in asthma. These findings support the need for patient-specific targeting of ASM remodeling.
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Affiliation(s)
- Alan L James
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,School of Medicine and Pharmacology and
| | - Graham M Donovan
- Department of Mathematics, University of Auckland, Auckland, New Zealand
| | - Francis H Y Green
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Thais Mauad
- Department of Pathology, Sao Paulo University Medical School, Sao Paulo, Brazil; and
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alvenia Cairncross
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Peter B Noble
- School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - John G Elliot
- West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,School of Human Sciences, The University of Western Australia, Crawley, Western Australia, Australia
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38
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Moitra S, Carsin AE, Abramson MJ, Accordini S, Amaral AFS, Anto J, Bono R, Casas Ruiz L, Cerveri I, Chatzi L, Demoly P, Dorado-Arenas S, Forsberg B, Gilliland F, Gislason T, Gullón JA, Heinrich J, Holm M, Janson C, Jogi R, Gómez Real F, Jarvis D, Leynaert B, Nowak D, Probst-Hensch N, Sánchez-Ramos JL, Raherison-Semjen C, Siroux V, Guerra S, Kogevinas M, Garcia-Aymerich J. Long-term effect of asthma on the development of obesity among adults: an international cohort study, ECRHS. Thorax 2023; 78:128-135. [PMID: 35477559 DOI: 10.1136/thoraxjnl-2021-217867] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 03/16/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Obesity is a known risk factor for asthma. Although some evidence showed asthma causing obesity in children, the link between asthma and obesity has not been investigated in adults. METHODS We used data from the European Community Respiratory Health Survey (ECRHS), a cohort study in 11 European countries and Australia in 3 waves between 1990 and 2014, at intervals of approximately 10 years. We considered two study periods: from ECRHS I (t) to ECRHS II (t+1), and from ECRHS II (t) to ECRHS III (t+1). We excluded obese (body mass index≥30 kg/m2) individuals at visit t. The relative risk (RR) of obesity at t+1 associated with asthma at t was estimated by multivariable modified Poisson regression (lag) with repeated measurements. Additionally, we examined the association of atopy and asthma medication on the development of obesity. RESULTS We included 7576 participants in the period ECRHS I-II (51.5% female, mean (SD) age of 34 (7) years) and 4976 in ECRHS II-III (51.3% female, 42 (8) years). 9% of participants became obese in ECRHS I-II and 15% in ECRHS II-III. The risk of developing obesity was higher among asthmatics than non-asthmatics (RR 1.22, 95% CI 1.07 to 1.38), and particularly higher among non-atopic than atopic (1.47; 1.17 to 1.86 vs 1.04; 0.86 to 1.27), those with longer disease duration (1.32; 1.10 to 1.59 in >20 years vs 1.12; 0.87 to 1.43 in ≤20 years) and those on oral corticosteroids (1.99; 1.26 to 3.15 vs 1.15; 1.03 to 1.28). Physical activity was not a mediator of this association. CONCLUSION This is the first study showing that adult asthmatics have a higher risk of developing obesity than non-asthmatics, particularly those non-atopic, of longer disease duration or on oral corticosteroids.
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Affiliation(s)
- Subhabrata Moitra
- Division of Pulmonary Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada .,Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Anne-Elie Carsin
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Andre F S Amaral
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Josep Anto
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Roberto Bono
- Department of Public Health and Pediatrics, University of Turin, Torino, Italy
| | - Lidia Casas Ruiz
- Epidemiology and Social Medicine, University of Antwerp, Antwerpen, Belgium.,Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isa Cerveri
- Unit of Respiratory Diseases, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Leda Chatzi
- Department of Social Medicine, University of Crete, Rethimno, Greece.,Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California, USA.,Department of Genetics & Cell Biology, Maastricht University, Maastricht, The Netherlands
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, University Hospital of Montpellier, Montpellier, France.,Inserm, Sorbonne Université, Equipe, EPAR - IPLESP, Paris, France
| | - Sandra Dorado-Arenas
- Osakidetza Basque Health Service, Department of Respiratory Medicine, Galdakao University Hospital, Galdakao, Spain
| | - Bertil Forsberg
- Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Frank Gilliland
- Department of Preventive Medicine, USC Keck School of Medicine, Los Angeles, California, USA
| | - Thorarinn Gislason
- Department of Sleep, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jose A Gullón
- Department of Pneumology, Universitary Hospital San Agustín, Avilés, Spain
| | - Joachim Heinrich
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University Munich, University Hospital Munich, Munich, Germany.,Institut of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Oberschleissheim, Germany
| | - Mathias Holm
- Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Rain Jogi
- Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Francisco Gómez Real
- Department of Gynaecology and Obstetrics, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Debbie Jarvis
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Bénédicte Leynaert
- Inserm - U1168, VIMA (Aging and Chronic Diseases. Epidemiological and Public Health Approaches), INSERM, Villejuif, France.,UMR-S 1168, Université de Versailles Saint-Quentin-en-Yvelines - UVSQ, Saint-Quentin-en-Yvelines, France
| | - Dennis Nowak
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University Munich, University Hospital Munich, Munich, Germany
| | - Nicole Probst-Hensch
- Department Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | | | | | - Valerie Siroux
- Team of Environemental Epidemiology, Inserm U1209, Univ Grenoble Alpes, La Tronche, France
| | - Stefano Guerra
- Arizona Respiratory Center, University of Arizona Medical Center - University Campus, Tucson, Arizona, USA
| | - Manolis Kogevinas
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Judith Garcia-Aymerich
- Non-Communicable Diseases and Environment Programme, ISGlobal, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Tandra M, Walters EH, Perret J, Lowe AJ, Lodge CJ, Johns DP, Thomas PS, Bowatte G, Davis PG, Abramson MJ, Dharmage SC, Bui DS. Small for gestational age is associated with reduced lung function in middle age: A prospective study from first to fifth decade of life. Respirology 2023; 28:159-165. [PMID: 36197802 PMCID: PMC10947040 DOI: 10.1111/resp.14379] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE The association between birth weight, particularly relative to gestational age, and adult lung function is uncertain. We investigated the associations between birth weight relative to gestational age and measures of lung function in middle age, and mediation of these associations by adult height. METHODS Participants in the Tasmanian Longitudinal Health Study who had both known birth weight and lung function assessment at age 45 years were included (n = 849). Linear regression models were fitted to investigate the association between small for gestational age and birth weight with post-bronchodilator lung function measures (forced expiratory volume in 1 second [FEV1 ], forced vital capacity [FVC], FEV1 /FVC, diffusing capacity for carbon monoxide [DL co], residual volume [RV] and total lung capacity [TLC]), adjusting for potential confounders. The contribution of adult height as a mediator of these associations was investigated. RESULTS Compared with infants born with normal weight for gestational age, those born small for gestational age had reduced FEV1 (coefficient: -191 ml [95%CI: -296, -87]), FVC (-205 ml [-330, -81]), TLC (-292 ml [-492, -92]), RV (-126 ml [-253, 0]) and DL co (-0.42 mmol/min/kPa [-0.79, -0.041]) at age 45 years. However, they had comparable FEV1 /FVC. For every 1 kg increase in birth weight, lung function indices increased by an average of 117 ml (95%CI: 40, 196) for FEV1 , 124 ml (30, 218) for FVC, 215 ml (66, 365) for TLC and 0.36 mmol/min/kPa (0.11, 0.62) for DL co, independent of gestational age, but again not for FEV1 /FVC. These associations were significantly mediated by adult height (56%-90%). CONCLUSION Small for gestational age was associated with reduced lung function that is likely due to smaller lungs with little evidence of any specific parenchymal impairment.
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Affiliation(s)
- Melvin Tandra
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
| | - E. Haydn Walters
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
- School of Medicine and Menzies InstituteUniversity of TasmaniaHobartTasmaniaAustralia
| | - Jennifer Perret
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
| | - David P. Johns
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
- School of Medicine and Menzies InstituteUniversity of TasmaniaHobartTasmaniaAustralia
| | - Paul S. Thomas
- Inflammation and Infection Research, Faculty of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Gayan Bowatte
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
- Department of Basic Sciences, Faculty of Allied Health SciencesUniversity of PeradeniyaPeradeniyaSri Lanka
| | - Peter G. Davis
- Department of Obstetrics and GynaecologyUniversity of MelbourneMelbourneVictoriaAustralia
- Department of Newborn ResearchThe Royal Women's HospitalMelbourneVictoriaAustralia
| | - Michael J. Abramson
- School of Public Health & Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
| | - Dinh S. Bui
- Allergy and Lung Health Unit, School of Population and Global healthThe University of MelbourneMelbourneVictoriaAustralia
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40
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Ye T, Guo Y, Abramson MJ, Li T, Li S. Greenspace and children's lung function in China: A cross-sectional study between 2013 and 2015. Sci Total Environ 2023; 858:159952. [PMID: 36336037 DOI: 10.1016/j.scitotenv.2022.159952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
This study aims to investigate how surrounding greenspace density and proximity were associated with children's lung function. Between 2013 and 2015, spirometry and a parental survey were performed with children from four primary schools in two Chinese cities. Forced expiratory volume in 1 s (FEV1, L), forced vital capacity (FVC, L), peak expiratory flow rate (PEF, L/s), and forced expiratory flow at 25 % (FEF25, L/s) and 75 % (FEF75, L/s) of FVC were measured. Outdoor surrounding greenspace index incorporated residential, school and commuting greenness and was weighted using assumed daytime hours spent at home and school. Residential proximity to greenspace index was defined as walking distance to nearest park. A total of 913 children (48.7 % female) were included. Overall, an interquartile range (IQR) increase in outdoor surrounding greenspace was associated with decreased FVC (0.06 L, 95%CI 0.01-0.11), but increased FEV1/FVC (2.03, 1.13-3.04), PEF (0.26 L/s, 0.13-0.39), and FEF25 (0.30 L/s, 0.17-0.42). Residential proximity to greenspace was associated with increased FEV1 (0.05 L, 0.02-0.08) and FVC (0.04 L, 0.01-0.07) per IQR decrease in distance. Protective effect was significant for children whose parents were less educated and those living in higher road density areas, though interactions were not significant. Structural equation modeling showed that higher level of surrounding greenspace was associated with lower ambient air pollution and in turn with better lung function. Greenspace density and proximity could influence children's lung function differently.
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Affiliation(s)
- Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Michael J Abramson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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41
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Zeleke BM, Lowe AJ, Dharmage SC, Lopez DJ, Koplin JJ, Peters RL, Soriano VX, Tang MLK, Walters EH, Varigos GA, Lodge CJ, Perret JL, Abramson MJ. Epidemiology of eczema in South-Eastern Australia. Australas J Dermatol 2023; 64:e41-e50. [PMID: 36533890 PMCID: PMC10952653 DOI: 10.1111/ajd.13966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Eczema is a common chronic debilitating skin condition in childhood. Data on the epidemiology and natural history of eczema across the life course are lacking. This analysis aimed to describe these epidemiological features in Australian children and adults. METHODS Data collected on eczema from four Australian cohort studies were analysed: namely HealthNuts, Melbourne Atopic Cohort Study (MACS), Tasmanian Longitudinal Health Study (TAHS) and the Australian arm of the European Community Respiratory Health Survey (ECRHS). RESULTS Among children aged under 6 years, 28.8%-35.6% have ever-had eczema, and 16.7%-26.6% had 'current eczema'. Among those aged 6-12 years, 14.6%-24.7% had 'current eczema' with 12.0%-18.5% of those at ages of 6 and 10 years classified as having moderate-to-severe eczema according to the Scoring of Atopic Dermatitis (SCORAD) index. In adults, the prevalence of 'eczema ever' ranged between 13.8% and 48.4%. The 12-month period prevalence of eczema was 15.1% at age 18, while current eczema was 8.5% at an average age of 51, and 8.8% at an average age 53 years. Eczema was more common among young boys, but this difference became non-significant for older children and early adolescents. In contrast, eczema was more common for adult women than men. CONCLUSIONS Eczema is common both in children and adults. The proportion of severe eczema in children was substantial.
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Affiliation(s)
- Berihun M. Zeleke
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
| | - Adrian J. Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
| | - Shyamali C. Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
| | - Diego J. Lopez
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
| | - Jennifer J. Koplin
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Rachel L. Peters
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - Victoria X. Soriano
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
| | - Mimi L. K. Tang
- Murdoch Children's Research Institute, Royal Children's HospitalParkvilleVictoriaAustralia
- Department of PaediatricsUniversity of MelbourneParkvilleVictoriaAustralia
| | - E. Haydn Walters
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
- School of Medicine, University of TasmaniaHobartAustralia
| | - George A. Varigos
- Department of DermatologyThe Royal Melbourne HospitalMelbourne, ParkvilleVictoriaAustralia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
| | - Jennifer L. Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, University of MelbourneCarltonVictoriaAustralia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneVictoriaAustralia
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Wu Y, Xu R, Li S, Ming Wong E, Southey MC, Hopper JL, Abramson MJ, Li S, Guo Y. Epigenome-wide association study of short-term temperature fluctuations based on within-sibship analyses in Australian females. Environ Int 2023; 171:107655. [PMID: 36476687 DOI: 10.1016/j.envint.2022.107655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/26/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Temperature fluctuations can affect human health independent of the effect of mean temperature. However, no study has evaluated whether short-term temperature fluctuations could affect DNA methylation. METHODS Peripheral blood DNA methylation for 479 female siblings of 130 families were analysed. Gridded daily temperatures data were obtained, linked to each participant's home address, and used to calculate nine different metrics of short-term temperature fluctuations: temperature variabilities (TVs) within the day of blood draw and preceding one to seven days (TV 0-1 to TV 0-7), diurnal temperature range (DTR), and temperature change between neighbouring days (TCN). Within-sibship design was used to perform epigenome-wide association analyses, adjusting for daily mean temperatures, and other important covariates (e.g., smoking, alcohol use, cell-type proportions). Differentially methylated regions (DMRs) were further identified. Multiple-testing comparisons with a significant threshold of 0.01 for cytosine-guanine dinucleotides (CpGs) and 0.05 for DMRs were applied. RESULTS Among 479 participants (mean age ± SD, 56.4 ± 7.9 years), we identified significant changes in methylation levels in 14 CpGs and 70 DMRs associated with temperature fluctuations. Almost all identified CpGs were associated with exposure to temperature fluctuations within three days. Differentially methylated signals were mapped to 68 genes that were linked to human diseases such as cancer (e.g., colorectal carcinoma, breast carcinoma, and metastatic neoplasms) and mental disorder (e.g., schizophrenia, mental depression, and bipolar disorder). The top three most significantly enriched gene ontology terms were Response to bacterium (TV 0-3), followed by Hydrolase activity, acting on ester bonds (TCN), and Oxidoreductase activity (TV 0-3). CONCLUSIONS Short-term temperature fluctuations were associated with differentially methylated signals across the human genome, which provides evidence on the potential biological mechanisms underlying the health impact of temperature fluctuations. Future studies are needed to further clarify the roles of DNA methylation in diseases associated with temperature fluctuations.
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Affiliation(s)
- Yao Wu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Ee Ming Wong
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia; Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Melissa C Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia; Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, Australia; Cancer Epidemiology Division, Cancer Council Victoria, VIC 3004, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Shuai Li
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study. Chron Respir Dis 2023; 20:14799731231221820. [PMID: 38126966 DOI: 10.1177/14799731231221820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults. METHOD The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40 years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2). RESULTS Among all respondents (n = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV1 below 80% predicted, or FEV1/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively). CONCLUSIONS Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Maria R Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- South Western Sydney Clinical School, Sydney, NSW, Australia
| | - Helen K Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
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Rabbani G, Nimmi N, Benke GP, Dharmage SC, Bui D, Sim MR, Abramson MJ, Alif SM. Ever and cumulative occupational exposure and lung function decline in longitudinal population-based studies: a systematic review and meta-analysis. Occup Environ Med 2023; 80:51-60. [PMID: 36280382 DOI: 10.1136/oemed-2022-108237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/23/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Adverse occupational exposures can accelerate age-related lung function decline. Some longitudinal population-based studies have investigated this association. This study aims to examine this association using findings reported by longitudinal population-based studies. METHODS Ovid Medline, PubMed, Embase, and Web of Science were searched using keywords and text words related to occupational exposures and lung function and 12 longitudinal population-based studies were identified using predefined inclusion criteria. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Lung function decline was defined as annual loss of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) or the ratio (FEV1/FVC). Fixed and random-effects meta-analyses were conducted to calculate pooled estimates for ever and cumulative exposures. Heterogeneity was assessed using the I2 test, and publication bias was evaluated using funnel plots. RESULTS Ever exposures to gases/fumes, vapours, gases, dusts, fumes (VGDF) and aromatic solvents were significantly associated with FEV1 decline in meta-analyses. Cumulative exposures for these three occupational agents observed a similar trend of FEV1 decline. Ever exposures to fungicides and cumulative exposures to biological dust, fungicides and insecticides were associated with FEV1 decline in fixed-effect models only. No statistically significant association was observed between mineral dust, herbicides and metals and FEV1 decline in meta-analyses. CONCLUSION Pooled estimates from the longitudinal population-based studies have provided evidence that occupational exposures are associated with FEV1 decline. Specific exposure control and respiratory health surveillance are required to protect the lung health of the workers.
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Affiliation(s)
| | - Naima Nimmi
- Institute of Health and Wellbeing, Federation University Australia, Berwick, Victoria, Australia
| | - Geza P Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Dinh Bui
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm R Sim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sheikh M Alif
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia .,Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Xu R, Li S, Wu Y, Yue X, Wong EM, Southey MC, Hopper JL, Abramson MJ, Li S, Guo Y. Wildfire-related PM 2.5 and DNA methylation: An Australian twin and family study. Environ Int 2023; 171:107704. [PMID: 36542997 DOI: 10.1016/j.envint.2022.107704] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/24/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Wildfire-related fine particulate matter (PM2.5) has many adverse health impacts, but its impacts on human epigenome are unknown. We aimed to evaluate the associations between long-term exposure to wildfire-related PM2.5 and blood DNA methylation, and whether the associations differ from those with non-wildfire-related PM2.5. METHODS We studied 479 Australian women comprising 132 twin pairs and 215 of their sisters. Blood-derived DNA methylation was measured using the HumanMethylation450 BeadChip array. Data on 3-year (year of blood collection and previous two years) average wildfire-related and non-wildfire-related PM2.5 at 0.01°×0.01° spatial resolution were created by combining information from satellite observations, chemical transport models, and ground-based observations. Exposure data were linked to each participant's home address, assuming the address did not change during the exposure window. For DNA methylation of each cytosine-guanine dinucleotide (CpG), and for global DNA methylation represented by the average of all measured CpGs or CpGs in repetitive elements, we evaluated their associations with wildfire- or non-wildfire-related PM2.5 using a within-sibship analysis controlling for factors shared between siblings and other important covariates. Differentially methylated regions (DMRs) were defined by comb-p and DMRcate. RESULTS The 3-year average wildfire-related PM2.5 (range: 0.3 to 7.6 µg/m3, mean: 1.6 µg/m3) was negatively, but not significantly (p-values greater than 0.05) associated with all seven global DNA methylation measures. There were 26 CpGs and 33 DMRs associated with wildfire-related PM2.5 (Bonferroni adjusted p-value < 0.05) mapped to 47 genes enriched for pathways related to inflammatory regulation and platelet activation. These genes have been related to many human diseases or phenotypes e.g., cancer, mental disorders, diabetes, obesity, asthma, blood pressure. These CpGs, DMRs and enriched pathways did not overlap with the 1 CpG and 7 DMRs associated with non-wildfire-related PM2.5. CONCLUSIONS Long-term exposure to wildfire-related PM2.5 was associated with various blood DNA methylation signatures in Australian women, and these were distinct from those associated with non-wildfire-related PM2.5.
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Affiliation(s)
- Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Yao Wu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Xu Yue
- Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, School of Environmental Science and Engineering, Nanjing University of Information Science and Technology, Nanjing, China
| | - Ee Ming Wong
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia; Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Melissa C Southey
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia; Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3010, Australia; Cancer Epidemiology Division, Cancer Council Victoria, VIC 3004, Australia
| | - John L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Shuai Li
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3800, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia; Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
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Ye T, Xu R, Yue X, Chen G, Yu P, Coêlho MSZS, Saldiva PHN, Abramson MJ, Guo Y, Li S. Short-term exposure to wildfire-related PM 2.5 increases mortality risks and burdens in Brazil. Nat Commun 2022; 13:7651. [PMID: 36496479 PMCID: PMC9741581 DOI: 10.1038/s41467-022-35326-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
To assess mortality risks and burdens associated with short-term exposure to wildfire-related fine particulate matter with diameter ≤ 2.5 μm (PM2.5), we collect daily mortality data from 2000 to 2016 for 510 immediate regions in Brazil, the most wildfire-prone area. We integrate data from multiple sources with a chemical transport model at the global scale to isolate daily concentrations of wildfire-related PM2.5 at a 0.25 × 0.25 resolution. With a two-stage time-series approach, we estimate (i) an increase of 3.1% (95% confidence interval [CI]: 2.4, 3.9%) in all-cause mortality, 2.6% (95%CI: 1.5, 3.8%) in cardiovascular mortality, and 7.7% (95%CI: 5.9, 9.5) in respiratory mortality over 0-14 days with each 10 μg/m3 increase in daily wildfire-related PM2.5; (ii) 0.65% of all-cause, 0.56% of cardiovascular, and 1.60% of respiratory mortality attributable to acute exposure to wildfire-related PM2.5, corresponding to 121,351 all-cause deaths, 29,510 cardiovascular deaths, and 31,287 respiratory deaths during the study period. In this study, we find stronger associations in females and adults aged ≥ 60 years, and geographic difference in the mortality risks and burdens.
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Affiliation(s)
- Tingting Ye
- grid.1002.30000 0004 1936 7857Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Rongbin Xu
- grid.1002.30000 0004 1936 7857Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Xu Yue
- grid.260478.f0000 0000 9249 2313Jiangsu Key Laboratory of Atmospheric Environment Monitoring and Pollution Control, Collaborative Innovation Center of Atmospheric Environment and Equipment Technology, School of Environmental Science and Engineering, Nanjing University of Information Science & Technology (NUIST), Nanjing, 210044 China
| | - Gongbo Chen
- grid.1002.30000 0004 1936 7857Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Pei Yu
- grid.1002.30000 0004 1936 7857Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Micheline S. Z. S. Coêlho
- grid.11899.380000 0004 1937 0722Urban Health Laboratory University of São Paulo, Faculty of Medicine/INSPER, São Paulo, 01246-903 Brazil
| | - Paulo H. N. Saldiva
- grid.11899.380000 0004 1937 0722Urban Health Laboratory University of São Paulo, Faculty of Medicine/INSPER, São Paulo, 01246-903 Brazil
| | - Michael J. Abramson
- grid.1002.30000 0004 1936 7857Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Yuming Guo
- grid.1002.30000 0004 1936 7857Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
| | - Shanshan Li
- grid.1002.30000 0004 1936 7857Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004 Australia
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Ye T, Yu P, Wen B, Yang Z, Huang W, Guo Y, Abramson MJ, Li S. Greenspace and health outcomes in children and adolescents: A systematic review. Environ Pollut 2022; 314:120193. [PMID: 36122655 DOI: 10.1016/j.envpol.2022.120193] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 06/15/2023]
Abstract
An increasing body of evidence has linked greenspace and various health outcomes in children and adolescents, but the conclusions were inconsistent. For this review, we comprehensively summarized the measurement methods of greenspace, resultant health outcomes, and potential mechanisms from epidemiological studies in children and adolescents (aged ≤19 years). We searched for studies published and indexed in MEDLINE and EMBASE (via Ovid) up to April 11, 2022. There were a total of 9,291 studies identified with 140 articles from 28 countries finally assessed and included in this systematic review. Over 70% of the studies were conducted in highly urbanised countries/regions, but very limited research has been done in low-and middle-income countries and none in Africa. Measures of greenspace varied. Various health outcomes were reported, including protective effects of greenspace exposure on aspects of obesity/overweight, myopia, lung health, circulatory health, cognitive function, and general health in children and adolescents. The associations between greenspace exposure and other health outcomes were inconsistent, especially for respiratory health studies. We pooled odds ratios (OR) using random-effects meta-analysis for health outcomes of asthma (OR = 0.94, 95%CI: 0.84 to 1.06), allergic rhinitis (OR = 0.95; 95% CI: 0.73 to 1.25), and obesity/overweight (OR = 0.91, 95%CI: 0.84 to 0.98) with per 0.1 unit increase in normalized difference in vegetation index (NDVI). These associations have important implications for the assessment and management of urban environment and health in children and adolescents.
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Affiliation(s)
- Tingting Ye
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Pei Yu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Bo Wen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Zhengyu Yang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Michael J Abramson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
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Boudier A, Markevych I, Jacquemin B, Abramson MJ, Accordini S, Forsberg B, Fuertes E, Garcia-Aymerich J, Heinrich J, Johannessen A, Leynaert B, Pin I, Siroux V. Long-term air pollution exposure, greenspace and health-related quality of life in the ECRHS study. Sci Total Environ 2022; 849:157693. [PMID: 35907524 DOI: 10.1016/j.scitotenv.2022.157693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Associations of long-term exposure to air pollution and greenspace with health-related quality of life (HRQOL) are poorly studied and few studies have accounted for asthma-rhinitis status. OBJECTIVE To assess the associations of air pollution and greenspace with HRQOL and whether asthma and/or rhinitis modify these associations. METHODS The study was based on the participants in the second (2000-2002, n = 6542) and third (2011-2013, n = 3686) waves of the European Community Respiratory Health Survey (ECRHS) including 19 centres. The mean follow-up time was 11.3 years. HRQOL was assessed by the SF-36 Physical and Mental Component Summary scores (PCS and MCS). NO2, PM2.5 and PM10 annual concentrations were estimated at the residential address from existing land-use regression models. Greenspace around the residential address was estimated by the (i) mean of the Normalized Difference Vegetation Index (NDVI) and by the (ii) presence of green spaces within a 300 m buffer. Associations of each exposure variable with PCS and MCS were assessed by mixed linear regression models, accounting for the multicentre design and repeated data, and adjusting for potential confounders. Analyses were stratified by asthma-rhinitis status. RESULTS The mean (SD) age of the ECRHS-II and III participants was 43 (7.1) and 54 (7.2) years, respectively, and 48 % were men. Higher NO2, PM2.5 and PM10 concentrations were associated with lower MCS (regression coefficients [95%CI] for one unit increase in the inter-quartile range of exposures were -0.69 [-1.23; -0.15], -1.79 [-2.88; -0.70], -1.80 [-2.98; -0.62] respectively). Higher NDVI and presence of forests were associated with higher MCS. No consistent associations were observed for PCS. Similar association patterns were observed regardless of asthma-rhinitis status. CONCLUSION European adults who resided at places with higher air pollution and lower greenspace were more likely to have lower mental component of HRQOL. Asthma or rhinitis status did not modify these associations.
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Affiliation(s)
- Anne Boudier
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France; Pediatrics, CHU Grenoble-Alpes, Grenoble, France
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Bénédicte Jacquemin
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, F-35000 Rennes, France
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Elaine Fuertes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Judith Garcia-Aymerich
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Germany
| | - Ane Johannessen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Isabelle Pin
- Pediatrics, CHU Grenoble-Alpes, Grenoble, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France.
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Batra M, Dharmage SC, Newbigin E, Tang M, Abramson MJ, Erbas B, Vicendese D. Grass pollen exposure is associated with higher readmission rates for pediatric asthma. Pediatr Allergy Immunol 2022; 33:e13880. [PMID: 36433858 DOI: 10.1111/pai.13880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pediatric asthma hospital readmission is a burden on the individual and costly for Australian hospitals. Grass pollen's role, a known trigger for asthma admissions, is unexamined in readmissions. We examined the association between grass pollen and pediatric asthma readmission. METHODS The Victorian Admitted Episodes Dataset was used to identify all primary admissions with a principal diagnosis of asthma in children aged 2-18 years between 1997 and 2009. Readmissions were defined as subsequent admissions within 28 days of index admission discharge. Generalized additive models were used to assess associations between readmission, grass pollen season, and daily grass pollen counts, lagged and cumulative. Models were further stratified by sex and age group. RESULTS Mean daily readmission was higher during grass pollen season than other times of the year, incidence rate ratio (IRR) 1.44 (95% CI, 1.03, 2.02) and for children aged 2-5 years, IRR 1.99 (1.26, 3.14). Same day grass pollen was nonlinearly associated with daily readmission for the 13-18 age group between 110 and 256 grains/m3 , p < .01. Lag 2 grass pollen was nonlinearly associated with daily readmissions overall (p = .03), boys (p = .01), and younger age groups 2-5 (p = .02) and 6-12 (p < .001). CONCLUSIONS Grass pollen exposure was associated with higher readmission rates for pediatric asthma. Treatment plans prior to discharge could be implemented to reduce the likelihood of readmission by younger children during the pollen season.
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Affiliation(s)
- Mehak Batra
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Edward Newbigin
- School of BioSciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mimi Tang
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, The Royal Children's Hospital Victoria, Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Bendigo, Victoria, Australia
| | - Don Vicendese
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.,School of Engineering & Mathematical Science, La Trobe University, Bundoora, Victoria, Australia
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Idrose NS, Lodge CJ, Peters RL, Douglass JA, Koplin JJ, Lowe AJ, Perrett KP, Tang MLK, Newbigin EJ, Abramson MJ, Erbas B, Vicendese D, Dharmage SC. The role of short-term grass pollen exposure in food skin-prick test reactivity, food allergy, and eczema flares in children. Pediatr Allergy Immunol 2022; 33:e13862. [PMID: 36282135 PMCID: PMC9828461 DOI: 10.1111/pai.13862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/13/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND While the relationship between pollen and respiratory allergies is well-documented, the role of short-term pollen exposure in food allergy and eczema flares has not previously been explored. We aimed to investigate these associations in a population-based sample of children. METHODS We investigated 1- (n = 1108) and 6-year-old (n = 675) children in the grass pollen season from the HealthNuts cohort. Grass pollen concentrations were considered on the day of testing (lag 0), up to three days before (lag 1-lag 3) and cumulatively (lag 0-3). Associations between grass pollen and food skin-prick test reactivity (SPT ≥ 2 mm at age 1 year and ≥ 3 mm at age 6 years), eczema flares, challenge-confirmed food allergy, reaction threshold to oral food challenges (OFC), and serum food-specific IgE levels were analyzed using either logistic or quantile regression models. Atopy and family history of allergic disease were considered as potent effect modifiers. RESULTS Grass pollen at lag 0-3 (every 20 grains/m3 increase) was associated with an up to 1.2-fold increased odds of food SPT reactivity and eczema flares in 6-year-olds. In 1-year-olds, the associations were only observed for peanut in those with a family history of food allergy. Increasing grass pollen concentrations were associated with a lower reaction threshold to OFC and higher serum IgE levels in peanut-allergic 1-year-olds only. CONCLUSION Increasing grass pollen concentration was associated with increased risk of food SPT reactivity and eczema flares in children. The associations in peanut-allergic infants may be related to immune activation and/or peanut and grass pollen cross-reactivity leading to a lower reaction threshold.
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Affiliation(s)
- Nur Sabrina Idrose
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia
| | - Rachel L Peters
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia
| | - Jo A Douglass
- Department of Clinical Immunology and Allergy, Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine, University of Melbourne, Victoria, Australia
| | - Jennifer J Koplin
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mimi L K Tang
- Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Pediatrics, The University of Melbourne, Victoria, Australia.,Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ed J Newbigin
- School of Biosciences, The University of Melbourne, Victoria, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Don Vicendese
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, Carlton, Victoria, Australia.,Centre for Food and Allergy Research (CFAR), Murdoch Children's Research Institute, Parkville, Victoria, Australia
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