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Bush A, Byrnes CA, Chan KC, Chang AB, Ferreira JC, Holden KA, Lovinsky-Desir S, Redding G, Singh V, Sinha IP, Zar HJ. Social determinants of respiratory health from birth: still of concern in the 21st century? Eur Respir Rev 2024; 33:230222. [PMID: 38599675 PMCID: PMC11004769 DOI: 10.1183/16000617.0222-2023] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/20/2024] [Indexed: 04/12/2024] Open
Abstract
Respiratory symptoms are ubiquitous in children and, even though they may be the harbinger of poor long-term outcomes, are often trivialised. Adverse exposures pre-conception, antenatally and in early childhood have lifetime impacts on respiratory health. For the most part, lung function tracks from the pre-school years at least into late middle age, and airflow obstruction is associated not merely with poor respiratory outcomes but also early all-cause morbidity and mortality. Much would be preventable if social determinants of adverse outcomes were to be addressed. This review presents the perspectives of paediatricians from many different contexts, both high and low income, including Europe, the Americas, Australasia, India, Africa and China. It should be noted that there are islands of poverty within even the highest income settings and, conversely, opulent areas in even the most deprived countries. The heaviest burden of any adverse effects falls on those of the lowest socioeconomic status. Themes include passive exposure to tobacco smoke and indoor and outdoor pollution, across the entire developmental course, and lack of access even to simple affordable medications, let alone the new biologicals. Commonly, disease outcomes are worse in resource-poor areas. Both within and between countries there are avoidable gross disparities in outcomes. Climate change is also bearing down hardest on the poorest children. This review highlights the need for vigorous advocacy for children to improve lifelong health. It also highlights that there are ongoing culturally sensitive interventions to address social determinants of disease which are already benefiting children.
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Affiliation(s)
- Andrew Bush
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, UK
| | - Catherine A Byrnes
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Starship Children's Health and Kidz First Hospital, Auckland, New Zealand
| | - Kate C Chan
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anne B Chang
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane and Menzies School of Health Research, Darwin, Australia
| | - Juliana C Ferreira
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Karl A Holden
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics and Environmental Health Sciences, Columbia University Medical Center, New York, NY, USA
| | - Gregory Redding
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Ian P Sinha
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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2
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Flores NM, Lovinsky-Desir S, Divjan A, Hoepner LA, Zou J, Miller RL, Herbstman JB, Perera FP, Perzanowski MS, Chen Q. Trajectory analysis of rhinitis in a birth cohort from lower-income New York City neighborhoods. J Allergy Clin Immunol 2023:S0091-6749(23)02415-6. [PMID: 38104949 DOI: 10.1016/j.jaci.2023.11.919] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Rhinitis is a prevalent, chronic nasal condition associated with asthma. However, its developmental trajectories remain poorly characterized. OBJECTIVE We sought to describe the course of rhinitis from infancy to adolescence and the association between identified phenotypes, asthma-related symptoms, and physician-diagnosed asthma. METHODS We collected rhinitis data from questionnaires repeated across 22 time points among 688 children from infancy to age 11 years and used latent class mixed modeling (LCMM) to identify phenotypes. Once children were between ages 5 and 12, a study physician determined asthma diagnosis. We collected information on the following asthma symptoms: any wheeze, exercise-induced wheeze, nighttime coughing, and emergency department visits. For each, we used LCMM to identify symptom phenotypes. Using logistic regression, we described the association between rhinitis phenotype and asthma diagnosis and each symptom overall and stratified by atopic predisposition and sex. RESULTS LCMM identified 5 rhinitis trajectory groups: never/infrequent; transient; late onset, infrequent; late onset, frequent; and persistent. LCMM identified 2 trajectories for each symptom, classified as frequent and never/infrequent. Participants with persistent and late onset, frequent phenotypes were more likely to be diagnosed with asthma and to have the frequent phenotype for all symptoms (P < .01). We identified interaction between seroatopy and rhinitis phenotype for physician-diagnosed asthma (P = .04) and exercise-induced wheeze (P = .08). Severe seroatopy was more common among children with late onset, frequent and persistent rhinitis, with nearly 25% of these 2 groups exhibiting sensitivity to 4 or 5 of the 5 allergens tested. CONCLUSIONS In this prospective, population-based birth cohort, persistent and late onset, frequent rhinitis phenotypes were associated with increased risk of asthma diagnosis and symptoms during adolescence.
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Affiliation(s)
- Nina M Flores
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY.
| | - Stephanie Lovinsky-Desir
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY; Division of Pulmonary Medicine, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Adnan Divjan
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Lori A Hoepner
- Data Coordinating Center, Columbia University, New York, NY
| | - Jungang Zou
- Department of Biostatistics, Mailman School of Public Health, New York, NY
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Julie B Herbstman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Qixuan Chen
- Department of Biostatistics, Mailman School of Public Health, New York, NY
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Miller RL, Rivera J, Lichtiger L, Govindarajulu US, Jung KH, Lovinsky-Desir S, Perera F, Balcer Whaley S, Newman M, Grant TL, McCormack M, Perzanowski M, Matsui EC. Associations between mitochondrial biomarkers, urban residential exposures and childhood asthma outcomes over 6 months. Environ Res 2023; 239:117342. [PMID: 37813137 PMCID: PMC10843300 DOI: 10.1016/j.envres.2023.117342] [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] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 10/11/2023]
Abstract
Determining biomarkers of responses to environmental exposures and evaluating whether they predict respiratory outcomes may help optimize environmental and medical approaches to childhood asthma. Relative mitochondrial (mt) DNA abundance and other potential mitochondrial indicators of oxidative stress may provide a sensitive metric of the child's shifting molecular responses to its changing environment. We leveraged two urban childhood cohorts (Environmental Control as Add-on Therapy in Childhood Asthma (ECATCh); Columbia Center for Children's Environmental Health (CCCEH)) to ascertain whether biomarkers in buccal mtDNA associate with airway inflammation and altered lung function over 6 months of time and capture biologic responses to multiple external stressors such as indoor allergens and fine particulate matter (PM2.5). Relative mtDNA content was amplified by qPCR and methylation of transfer RNA phenylalanine/rRNA 12S (TF/RNR1), cytochrome c oxidase (CO1), and carboxypeptidase O (CPO) was measured by pyrosequencing. Data on residential exposures and respiratory outcomes were harmonized between the two cohorts. Repeated measures and multiple regression models were utilized to assess relationships between mitochondrial biomarkers, respiratory outcomes, and residential exposures (PM2.5, allergens), adjusted for potential confounders and time-varying asthma. We found across the 6 month visits, a 0.64 fold higher level of TF/RNR1 methylation was detected among those with asthma in comparison to those without asthma ((parameter estimate (PE) 0.64, standard error 0.28, p = 0.03). In prospective analyses, CPO methylation was associated with subsequent reduced forced vital capacity (FVC; PE -0.03, standard error 0.01, p = 0.02). Bedroom dust mouse allergen, but not indoor PM2.5, was associated with higher methylation of TF/RNR1 (PE 0.015, standard error 0.006, p = 0.01). Select mtDNA measures in buccal cells may indicate children's responses to toxic environmental exposures and associate selectively with asthma and lung function.
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Affiliation(s)
- Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA; Columbia Center for Childrens Environmental Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA.
| | - Janelle Rivera
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Lydia Lichtiger
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Usha S Govindarajulu
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Kyung Hwa Jung
- Division of Pediatric Pulmonary, Columbia University Irving Medical Center, 630 W. 168th St, New York, NY, 10032, USA
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Columbia University Irving Medical Center, 630 W. 168th St, New York, NY, 10032, USA
| | - Frederica Perera
- Columbia Center for Childrens Environmental Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Susan Balcer Whaley
- Department of Population Health, Dell Medical School University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0500, Austin, TX, 78712, USA
| | - Michelle Newman
- Department of Epidemiology and Public Health, University of Maryland, 10 S. Pine St, MSTF 3-34, Baltimore, MD, 21201, USA
| | - Torie L Grant
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Meredith McCormack
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Perzanowski
- Columbia Center for Childrens Environmental Health, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0500, Austin, TX, 78712, USA
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4
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Stephenson N, Forno E, Laguna TA, Lovinsky-Desir S, Moore PE, Sheares BJ, Kazmerski TM, Udoko MN, Lypson ML, Harding LRW, Wilkes DS, Adair DJ, Afolabi F, Balasubramaniam V, Ale GJB, Castner LM, Ghera P, Heras A, Jordan K, Ly NP, Martinez-Fernandez TM, Mishra PE, Narang I, Palla JB, Rivera-Sanchez YM, Tapia IE, Toprak D, Torres-Silva CA, Cohen RT. Diversity, Equity, and Inclusion in the Pediatric Pulmonary Workforce: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:1373-1388. [PMID: 37772940 PMCID: PMC10559131 DOI: 10.1513/annalsats.202306-583st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Despite growing recognition of the need for increased diversity among students, trainees, and faculty in health care, the medical workforce still lacks adequate representation from groups historically underrepresented in medicine (URiM). The subspecialty field of pediatric pulmonology is no exception. Although there have been efforts to address issues of diversity, equity, and inclusion (DEI) in our own field, gaps persist. To address these gaps, the members of the Diversity, Equity, and Inclusion Advisory Group (DEI-AG) of the American Thoracic Society Pediatrics Assembly created and distributed a Needs Assessment Survey in the United States and Canada to better understand the racial and ethnic demographics of the pediatric pulmonary workforce and to learn more about successes, gaps, and opportunities to enhance how we recruit, train, and retain a diverse workforce. The DEI-AG leadership cochairs convened a workshop to review the findings of the DEI Needs Assessment Survey and to develop strategies to improve the recruitment and retention of URiM fellows and faculty. This Official ATS Workshop Report aims to identify barriers and opportunities for recruitment, training, and career development within the field of pediatric pulmonology. Additionally, we offer useful strategies and resources to improve the recruitment of URiM residents, the mentorship of trainees and junior faculty, and the career development of URiM faculty in academic centers. This Workshop Report is an important first deliverable by the DEI-AG. We hope that this work, originating from within the Pediatrics Assembly, will serve as a model for other Assemblies, disciplines across the ATS, and other fields in Pediatrics.
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5
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Uong SP, Zhou J, Lovinsky-Desir S, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Wilson J, Woo Baidal J, Stingone JA. The Creation of a Multidomain Neighborhood Environmental Vulnerability Index Across New York City. J Urban Health 2023; 100:1007-1023. [PMID: 37594675 PMCID: PMC10618140 DOI: 10.1007/s11524-023-00766-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/19/2023]
Abstract
Compared to previous studies commonly using a single summary score, we aimed to construct a multidomain neighborhood environmental vulnerability index (NEVI) to characterize the magnitude and variability of area-level factors with the potential to modify the association between environmental pollutants and health effects. Using the Toxicological Prioritization Index framework and data from the 2015-2019 U.S. Census American Community Survey and the 2020 CDC PLACES Project, we quantified census tract-level vulnerability overall and in 4 primary domains (demographic, economic, residential, and health status), 24 subdomains, and 54 distinct area-level features for New York City (NYC). Overall and domain-specific indices were calculated by summing standardized feature values within the subdomains and then aggregating and weighting based on the number of features within each subdomain within equally-weighted primary domains. In citywide comparisons, NEVI was correlated with multiple existing indices, including the Neighborhood Deprivation Index (r = 0.91) and Social Vulnerability Index (r = 0.87) but provided additional information on features contributing to vulnerability. Vulnerability varied spatially across NYC, and hierarchical cluster analysis using subdomain scores revealed six patterns of vulnerability across domains: 1) low in all, 2) primarily low except residential, 3) medium in all, 4) high demographic, economic, and residential 5) high economic, residential, and health status, and 6) high demographic, economic and health status. Created using methods that offer flexibility for theory-based construction, NEVI provided detailed vulnerability metrics across domains that can inform targeted research and public health interventions aimed at reducing the health impacts from environmental exposures across urban centers.
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Affiliation(s)
- Stephen P Uong
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Jiayi Zhou
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Sandra S Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA
| | - Alexander Azan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Earle C Chambers
- Department of Family and Social Medicine Bronx, Albert Einstein College of Medicine, New York, NY, USA
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health New York, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Azure Thompson
- School of Public Health Brooklyn, SUNY Downstate Health Sciences University New York, New York, NY, USA
| | - Joseph Wilson
- Department of Environmental Medicine and Public Health New York, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Woo Baidal
- Department of Pediatrics New York, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th Street, Room 1608, New York, NY, 10032, USA.
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6
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Gao C, Sanchez KM, Lovinsky-Desir S. Structural and Social Determinants of Inequitable Environmental Exposures in the United States. Clin Chest Med 2023; 44:451-467. [PMID: 37517826 DOI: 10.1016/j.ccm.2023.03.002] [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: 08/01/2023]
Abstract
American Indian (AI)/Alaskan Natives, African Americans, and Latino Americans have disproportionally high exposure to harmful environmental conditions as a consequence of unjust laws and policies, systemic racism, residential segregation, and discrimination. In this review, we draw connections between historical policies and social movements in the United States' history that have been rooted in racism and classism, leading to social isolation and marginalization of AIs, African Americans, and Latino Americans. We then discuss the structural factors that stem from the aforementioned inequities and that contribute to the inequitable distribution of environmental hazards.
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Affiliation(s)
- Courtney Gao
- Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY, USA
| | - Kimberly M Sanchez
- Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY, USA
| | - Stephanie Lovinsky-Desir
- Pulmonary Division, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHC 7-701, New York, NY 10032, USA.
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7
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Kannoth S, Chung SE, Tamakloe KD, Albrecht SS, Azan A, Chambers EC, Sheffield PE, Thompson A, Woo Baidal JA, Lovinsky-Desir S, Stingone JA. Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas. J Allergy Clin Immunol 2023; 152:378-385.e2. [PMID: 36990323 PMCID: PMC10524145 DOI: 10.1016/j.jaci.2023.03.018] [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: 12/20/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level. OBJECTIVE We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY. METHODS We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area. RESULTS Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain. CONCLUSION Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.
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Affiliation(s)
- Sneha Kannoth
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY.
| | - Sarah E Chung
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Kelvin D Tamakloe
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Sandra S Albrecht
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
| | - Alexander Azan
- Department of Population Health, New York University Langone Health, New York City, NY
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Perry E Sheffield
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Azure Thompson
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Jennifer A Woo Baidal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York City, NY
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY
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Bhakta NR, Bime C, Kaminsky DA, McCormack MC, Thakur N, Stanojevic S, Baugh AD, Braun L, Lovinsky-Desir S, Adamson R, Witonsky J, Wise RA, Levy SD, Brown R, Forno E, Cohen RT, Johnson M, Balmes J, Mageto Y, Lee CT, Masekela R, Weiner DJ, Irvin CG, Swenson ER, Rosenfeld M, Schwartzstein RM, Agrawal A, Neptune E, Wisnivesky JP, Ortega VE, Burney P. Race and Ethnicity in Pulmonary Function Test Interpretation: An Official American Thoracic Society Statement. Am J Respir Crit Care Med 2023; 207:978-995. [PMID: 36973004 PMCID: PMC10112445 DOI: 10.1164/rccm.202302-0310st] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Current American Thoracic Society (ATS) standards promote the use of racial/ethnic-specific reference equations for pulmonary function test (PFT) interpretation. There is rising concern that the use of race/ethnicity in PFT interpretation contributes to a false view of fixed differences between races and may mask the effects of differential exposures. This use of race/ethnicity may contribute to health disparities by norming differences in pulmonary function. In the United States, race serves as a social construct that is based on appearance and reflects social values, structures, and practices. Classification of people into racial/ethnic groups differs geographically and temporally. These considerations challenge the notion that racial/ethnic categories have biological meaning and question the use of race in PFT interpretation. The ATS convened a diverse group of clinicians and investigators for a workshop to evaluate the use of race/ethnicity in PFT interpretation. Review of evidence published since then that challenges current practice and continued discussion concluded with a recommendation to replace race/ethnicity-specific equations with race-neutral average reference equations, which must be accompanied with broader re-evaluation of how PFTs are used to make clinical/employment/insurance decisions. There was also a call to engage key stakeholders not represented in this workshop and a statement of caution regarding the uncertain effects and potential harms of this change. Other recommendations include continued research and education to understand the impact of the change, to improve the evidence for the use of PFTs in general, and to identify modifiable risk factors for reduced pulmonary function.
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Affiliation(s)
- Nirav R Bhakta
- University of California San Francisco, 8785, San Francisco, California, United States;
| | - Christian Bime
- University of Arizona, Medicine, Tucson, Arizona, United States
| | - David A Kaminsky
- University of Vermont College of Medicine, 12352, Pulmonary and Critical Care, Burlington, Vermont, United States
| | - Meredith C McCormack
- Johns Hopkins University, Pulmonary and Critical Care, Baltimore, Maryland, United States
| | - Neeta Thakur
- University of California, San Francisco, Medicine, San Francisco, California, United States
| | - Sanja Stanojevic
- Research Insititute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aaron D Baugh
- UCSF, Division of Pulmonary and Critical Care Medicine, Department of Medicine and CVRI, San Francisco, California, United States
| | - Lundy Braun
- Brown University, 6752, Department of African Studies, Department of Pathology and Laboratory Medicine, Science and Technology Program, Providence, Rhode Island, United States
| | | | - Rosemary Adamson
- University of Washington, Division of Pulmonary, Critical Care & Sleep Medicine, Seattle, Washington, United States
- VA Puget Sound Health Care System, Section of Pulmonary, Critical Care & Sleep Medicine, Seattle, Washington, United States
| | - Jonathan Witonsky
- University of California, San Francisco, San Francisco, California, United States
- United States
| | - Robert A Wise
- Johns Hopkins University School of Medicine, Medicine, Baltimore, Maryland, United States
| | - Sean D Levy
- Beth Israel Deaconess Medical Center, 1859, Pulmonary, Critical Care, & Sleep Medicine, Boston, Massachusetts, United States
| | - Robert Brown
- Massachusetts General Hospital and Harvard Medical School, Pulmonary and Critical Care Division, Department of Medicine, Boston, Massachusetts, United States
| | - Erick Forno
- Children's Hospital of Pittsburgh, Pediatric Pulmonary, Pittsburgh, Pennsylvania, United States
| | - Robyn T Cohen
- Boston University School of Medicine, Pediatrics, Boston, Massachusetts, United States
| | - Meshell Johnson
- UCSF, Medicine-VAMC, San Francisco, California, United States
| | - John Balmes
- University of California, Berkeley, Environmental Health Sciences, School of Public Health, Berkeley, California, United States
- University of California, San Francisco, Department of Medicine, San Francisco, California, United States
| | - Yolanda Mageto
- Baylor Scott and White North Texas, 10616, Dallas, Texas, United States
| | - Cathryn T Lee
- University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Chicago, Illinois, United States
| | - Refiloe Masekela
- University of Pretoria, Paediatrics and Child Health, Pretoria, Gauteng, South Africa
- University of Pretoria, Paediatrics and Child Health, Pretoria, Gauteng, South Africa
| | - Daniel J Weiner
- Children's Hospital of Pittsburgh, Perception of Pulmonary Function in Children with Asthma and Cystic Fibrosis, PITTSBURGH, Pennsylvania, United States
| | | | - Erik R Swenson
- University of Washington, 7284, Division of Pulmonary, Seattle, Washington, United States
- Veterans Affairs Puget Sound Healthcare System, Section of Pulmonary, Critical Care and Sleep Medicine, Seattle, Washington, United States
| | - Margaret Rosenfeld
- Seattle Children's, Pediatrics / Pulmonary, Seattle, Washington, United States
| | - Richard M Schwartzstein
- Beth Israel Deaconess Medical Center, 1859, Pulmonary, Critical Care, and Sleep Medicine, Boston, Massachusetts, United States
| | - Anurag Agrawal
- Institute of Genomics and Integrative Biology, Delhi, Delhi, India, Molecular Immunology and Immunogenetics, Delhi, India
| | - Enid Neptune
- Johns Hopkins, Medicine/Pulmonary and Critical Care, Baltimore, Maryland, United States
| | - Juan P Wisnivesky
- Icahn School of Medicine at Mount Sinai, Medicine, New York, New York, United States
| | - Victor E Ortega
- Mayo Clinic, 6915, Internal Medicine, Division of Respiratory Medicine, Scottsdale, Arizona, United States
| | - Peter Burney
- Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland
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Lovinsky-Desir S, Volerman A. Applying Lessons from the COVID-19 Pandemic to Improve Pediatric Asthma Care. Pulm Ther 2023; 9:15-24. [PMID: 36443534 PMCID: PMC9707220 DOI: 10.1007/s41030-022-00207-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
Asthma is the most common chronic childhood condition and is a risk factor for severe respiratory viral infections. Thus, early during the coronavirus disease 2019 (COVID-19) pandemic there was concern that children with asthma would be at risk for severe COVID-19 illness and that asthma control could worsen as a result of the pandemic. This article seeks to summarize what was learned in the early stages of the pandemic about the impact of COVID-19 on children with asthma. We review evidence from several studies that demonstrated a significant decline in asthma morbidity in the first year of the pandemic. Additionally, we describe several potential mechanisms that may explain the reduced frequency in childhood asthma exacerbations as well as review lessons learned for future management of childhood asthma. While the COVID-19 pandemic initially brought uncertainty, it soon became clear that the pandemic had several positive effects for children with asthma. Now we can apply the lessons that were learned during the pandemic to re-examine asthma care practices as well as advocate for best approaches for asthma management.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Department of Pediatrics and Environmental Health Sciences, Columbia University Irving Medical Center, New York, NY, USA.
| | - Anna Volerman
- Departments of Medicine and Pediatrics, University of Chicago, Chicago, IL, USA
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10
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Uong SP, Hussain H, Thanik E, Lovinsky-Desir S, Stingone JA. Urinary metabolites of polycyclic aromatic hydrocarbons and short-acting beta agonist or systemic corticosteroid asthma medication use within NHANES. Environ Res 2023; 220:115150. [PMID: 36572332 PMCID: PMC9969867 DOI: 10.1016/j.envres.2022.115150] [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] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 11/14/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Within cross-sectional studies like the U.S. National Health and Nutritional Examination Survey (NHANES), researchers have observed positive associations between polycyclic aromatic hydrocarbon (PAH) exposure and asthma diagnosis. It is unclear whether similar relationships exist for measures of acute asthma outcomes, including short-term asthma medication use to alleviate symptoms. We examined the relationship between markers of recent PAH exposure and 30-day short-acting beta agonist (SABA) or systemic corticosteroid use, an indicator for recent asthma symptoms. MATERIALS AND METHODS For 16,550 children and adults across multiple waves of NHANES (2005-2016), we fit quasi-Poisson multivariable regression models to describe the association between urinary 1-hydroxypyrene (a metabolite of PAH) and SABA or systemic corticosteroid use. We assessed for effect modification by age group and asthma controller medication use. All models were adjusted for urinary creatinine, age, female/male designation, race/ethnicity, poverty, insurance coverage, and serum cotinine. RESULTS After controlling for confounding, an increase of one standard deviation of 1-hydroxypyrene was associated with greater prevalence of recent SABA or systemic corticosteroid use (PR: 1.06, 95% CI: 1.03-1.10). The results were similar among those with ever asthma diagnosis and across urine creatinine dilution methods. We did not observe effect modification by age group (p-interaction = 0.22) or asthma controller medication use (p-interaction = 0.73). CONCLUSION Markers of recent PAH exposure was positively associated with SABA or systemic corticosteroid use, across various urine dilution adjustment methods. It is important to ensure appropriate temporality between exposures and outcomes in cross-sectional studies.
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Affiliation(s)
- Stephen P Uong
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York City, NY, USA.
| | - Haider Hussain
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, New York City, NY, USA
| | - Erin Thanik
- Icahn School of Medicine at Mount Sinai, Department of Environmental Medicine and Public Health, New York City, NY, USA
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Division of Pulmonary Medicine, Columbia University, Vagelos College of Physicians and Surgeons, New York City, NY, USA
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York City, NY, USA
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11
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Moog NK, Cummings PD, Jackson KL, Aschner JL, Barrett ES, Bastain TM, Blackwell CK, Bosquet Enlow M, Breton CV, Bush NR, Deoni SCL, Duarte CS, Ferrara A, Grant TL, Hipwell AE, Jones K, Leve LD, Lovinsky-Desir S, Miller RK, Monk C, Oken E, Posner J, Schmidt RJ, Wright RJ, Entringer S, Simhan HN, Wadhwa PD, O'Connor TG, Musci RJ, Buss C. Intergenerational transmission of the effects of maternal exposure to childhood maltreatment in the USA: a retrospective cohort study. Lancet Public Health 2023; 8:e226-e237. [PMID: 36841563 PMCID: PMC9982823 DOI: 10.1016/s2468-2667(23)00025-7] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Childhood maltreatment is associated with adverse health outcomes and this risk can be transmitted to the next generation. We aimed to investigate the association between exposure to maternal childhood maltreatment and common childhood physical and mental health problems, neurodevelopmental disorders, and related comorbidity patterns in offspring. METHODS We conducted a retrospective cohort study using data from the Environmental influences on Child Health Outcomes (ECHO) Program, which was launched to investigate the influence of early life exposures on child health and development in 69 cohorts across the USA. Eligible mother-child dyads were those with available data on maternal childhood maltreatment exposure and at least one child health outcome measure (autism spectrum disorder, attention-deficit hyperactivity disorder [ADHD], internalising problems, obesity, allergy, and asthma diagnoses). Maternal history of childhood maltreatment was obtained retrospectively from the Adverse Childhood Experiences or Life Stressor Checklist questionnaires. We derived the prevalence of the specified child health outcome measures in offspring across childhood and adolescence by harmonising caregiver reports and other relevant sources (such as medical records) across cohorts. Child internalising symptoms were assessed using the Child Behavior Checklist. Associations between maternal childhood maltreatment and childhood health outcomes were measured using a series of mixed-effects logistic regression models. Covariates included child sex (male or female), race, and ethnicity; maternal and paternal age; maternal education; combined annual household income; maternal diagnosis of depression, asthma, ADHD, allergy, or autism spectrum disorder; and maternal obesity. Two latent class analyses were conducted: to characterise patterns of comorbidity of child health outcomes; and to characterise patterns of co-occurrence of childhood maltreatment subtypes. We then investigated the association between latent class membership and maternal childhood maltreatment and child health outcomes, respectively. FINDINGS Our sample included 4337 mother-child dyads from 21 longitudinal cohorts (with data collection initiated between 1999 and 2016). Of 3954 mothers in the study, 1742 (44%) had experienced exposure to abuse or neglect during their childhood. After adjustment for confounding, mothers who experienced childhood maltreatment were more likely to have children with internalising problems in the clinical range (odds ratio [OR] 2·70 [95% CI 1·95-3·72], p<0·0001), autism spectrum disorder (1·70 [1·13-2·55], p=0·01), ADHD (2·09 [1·63-2·67], p<0·0001), and asthma (1·54 [1·34-1·77], p<0·0001). In female offspring, maternal childhood maltreatment was associated with a higher prevalence of obesity (1·69 [1·17-2·44], p=0·005). Children of mothers exposed to childhood maltreatment were more likely to exhibit a diagnostic pattern characterised by higher risk for multimorbidity. Exposure to multiple forms of maltreatment across all subtypes of maternal childhood maltreatment was associated with the highest risk increases for most offspring health outcomes, suggesting a dose-response relationship. INTERPRETATION Our findings suggest that maternal childhood maltreatment experiences can be a risk factor for disease susceptibility in offspring across a variety of outcomes and emphasise the need for policies focusing on breaking the intergenerational transmission of adversity. FUNDING Environmental influences on Child Health Outcomes Program, Office of the Director, National Institutes of Health.
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Affiliation(s)
- Nora K Moog
- Institute of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Peter D Cummings
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathryn L Jackson
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Judy L Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ, USA; Albert Einstein College of Medicine, Bronx, NY, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Environmental and Occupational Health Sciences Institute, Piscataway, NJ, USA
| | - Theresa M Bastain
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Courtney K Blackwell
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michelle Bosquet Enlow
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Carrie V Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Division of Developmental Medicine, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sean C L Deoni
- Advanced Baby Imaging Lab, School of Engineering, Brown University, Providence, RI, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Torie L Grant
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alison E Hipwell
- Department of Psychiatry and Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathryn Jones
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
| | - Leslie D Leve
- Prevention Science Institute, University of Oregon, Eugene, OR, USA
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Richard K Miller
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Catherine Monk
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca J Schmidt
- Department of Public Health Sciences and the MIND Institute, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Rosalind J Wright
- Department of Pediatrics, Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonja Entringer
- Institute of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Pediatrics, School of Medicine, University of California, Irvine, Orange, CA, USA
| | - Hyagriv N Simhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Women's Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | - Pathik D Wadhwa
- Department of Pediatrics, School of Medicine, University of California, Irvine, Orange, CA, USA; Department of Psychiatry and Human Behavior, University of California, Irvine, Orange, CA, USA; Department of Epidemiology, University of California, Irvine, Orange, CA, USA
| | - Thomas G O'Connor
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Pediatrics, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA; Department of Psychiatry, Psychology, and Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Rashelle J Musci
- Department of Mental Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Claudia Buss
- Institute of Medical Psychology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Pediatrics, School of Medicine, University of California, Irvine, Orange, CA, USA.
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12
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Jung KH, Goodwin KE, Ross JM, Cai J, Chillrud SN, Perzanowski M, Perera FP, Miller RL, Lovinsky-Desir S. Characteristics of peak exposure to black carbon pollution in school, commute and home environments among school children in an urban community. Environ Pollut 2023; 319:120991. [PMID: 36596374 PMCID: PMC9900622 DOI: 10.1016/j.envpol.2022.120991] [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] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Although real-time personal exposure monitoring devices have the ability to capture a wealth of data regarding fluctuations in pollutant levels, only a few studies have defined 'peaks' in black carbon (BC) exposure utilizing high-resolution data. Furthermore, studies to assess and characterize various features of peak exposure are very limited especially among children. A better understanding of characteristics of BC peak exposure would improve our understanding of health risks associated with BC. By capturing personal BC exposure at 5-min intervals using a real-time monitor during 24-hr monitoring periods among children in New York City (NYC), we defined 'peak characteristics' in 4 different ways across three major microenvironments (school vs. commute vs. home): 1) mean concentrations of BC across the 3 microenvironments, 2) 'peak duration' or time spent above the peak threshold (i.e., ≥1.5 μg/m3), 3) 'peak intensity' or the rate of exposure, defined as time spent above the threshold within each microenvironment divided by the total time spent in the microenvironment and 4) a novel metric of 'peak variability', defined as frequency of peaks (i.e., data points with +50% and -50% changes compared to the preceding and the subsequent data points), divided by the total time spent in the microenvironment. While peak duration was greatest at home, the intensity of peak exposure was greatest during commute hours, despite the short time spent in commute (p < 0.05). Peak variability was highest during commute, yet lowest in home environments (p < 0.05), particularly during non-sleeping hours. Children residing in a high-density urban setting spent on average, 5.4 hr per day above our peak threshold (≥1.5 μg/m3) in their everyday environments. Policies that limit children's exposure during high traffic periods and improved efforts to increase the number of vehicles using clean air technology could reduce the intensity of peaks and peak variability in children's BC exposure.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pediatric Pulmonary, Department of Pediatrics, Columbia University, Vagelos College of Physicians and Surgeons , 3959 Broadway CHC 7-750, New York, NY 10032, United States
| | - Kathleen E Goodwin
- Columbia University, Vagelos College of Physicians and Sugeons, 630 W. 168th Stree, New York, NY 10032, United States
| | - James M Ross
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9W Palisades, New York, 10964, United States
| | - Jing Cai
- School of Public Health, Fudan University, 130 Dong'An Road, Shanghai, 200032, China
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9W Palisades, New York, 10964, United States
| | - Matthew Perzanowski
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722 W. 168 St., New York, NY, 10032, United States
| | - Frederica P Perera
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722 W. 168 St., New York, NY, 10032, United States
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, United States
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, Columbia University, Vagelos College of Physicians and Surgeons , 3959 Broadway CHC 7-750, New York, NY 10032, United States.
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13
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Altman MC, Kattan M, O'Connor GT, Murphy RC, Whalen E, LeBeau P, Calatroni A, Gill MA, Gruchalla RS, Liu AH, Lovinsky-Desir S, Pongracic JA, Kercsmar CM, Khurana Hershey GK, Zoratti EM, Teach SJ, Bacharier LB, Wheatley LM, Sigelman SM, Gergen PJ, Togias A, Busse WW, Gern JE, Jackson DJ. Associations between outdoor air pollutants and non-viral asthma exacerbations and airway inflammatory responses in children and adolescents living in urban areas in the USA: a retrospective secondary analysis. Lancet Planet Health 2023; 7:e33-e44. [PMID: 36608946 PMCID: PMC9984226 DOI: 10.1016/s2542-5196(22)00302-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 10/10/2022] [Accepted: 10/27/2022] [Indexed: 05/25/2023]
Abstract
BACKGROUND Asthma prevalence and severity have markedly increased with urbanisation, and children in low-income urban centres have among the greatest asthma morbidity. Outdoor air pollution has been associated with adverse respiratory effects in children with asthma. However, the mechanisms by which air pollution exposure exacerbates asthma, and how these mechanisms compare with exacerbations induced by respiratory viruses, are poorly understood. We aimed to investigate the associations between regional air pollutant concentrations, respiratory illnesses, lung function, and upper airway transcriptional signatures in children with asthma, with particular focus on asthma exacerbations occurring in the absence of respiratory virus. METHODS We performed a retrospective analysis of data from the MUPPITS1 cohort and validated our findings in the ICATA cohort. The MUPPITS1 cohort recruited 208 children aged 6-17 years living in urban areas across nine US cities with exacerbation-prone asthma between Oct 7, 2015, and Oct 18, 2016, and monitored them during reported respiratory illnesses. The last MUPPITS1 study visit occurred on Jan 6, 2017. The ICATA cohort recruited 419 participants aged 6-20 years with persistent allergic asthma living in urban sites across eight US cities between Oct 23, 2006, and March 25, 2008, and the last study visit occurred on Dec 30, 2009. We included participants from the MUPPITS1 cohort who reported a respiratory illness at some point during the follow-up and participants from the ICATA cohort who had nasal samples collected during respiratory illness or at a scheduled visit. We used air quality index values and air pollutant concentrations for PM2·5, PM10, O3, NO2, SO2, CO, and Pb from the US Environmental Protection Agency spanning the years of both cohorts, and matched values and concentrations to each illness for each participant. We investigated the associations between regional air pollutant concentrations and respiratory illnesses and asthma exacerbations, pulmonary function, and upper airway transcriptional signatures by use of a combination of generalised additive models, case crossover analyses, and generalised linear mixed-effects models. FINDINGS Of the 208 participants from the MUPPITS1 cohort and 419 participants from the ICATA cohort, 168 participants in the MUPPITS1 cohort (98 male participants and 70 female participants) and 189 participants in the ICATA cohort (115 male participants and 74 female participants) were included in our analysis. We identified that increased air quality index values, driven predominantly by increased PM2·5 and O3 concentrations, were significantly associated with asthma exacerbations and decreases in pulmonary function that occurred in the absence of a provoking viral infection. Moreover, individual pollutants were significantly associated with altered gene expression in coordinated inflammatory pathways, including PM2·5 with increased epithelial induction of tissue kallikreins, mucus hypersecretion, and barrier functions and O3 with increased type-2 inflammation. INTERPRETATION Our findings suggest that air pollution is an important independent risk factor for asthma exacerbations in children living in urban areas and is potentially linked to exacerbations through specific inflammatory pathways in the airway. Further investigation of these potential mechanistic pathways could inform asthma prevention and management approaches. FUNDING National Institutes of Health, National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Matthew C Altman
- Department of Medicine, University of Washington, Seattle, WA, USA; Systems Immunology Division, Benaroya Research Institute, Seattle, WA, USA.
| | | | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Ryan C Murphy
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Elizabeth Whalen
- Systems Immunology Division, Benaroya Research Institute, Seattle, WA, USA
| | | | | | | | | | - Andrew H Liu
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | | | | | | | | | | | | | - Leonard B Bacharier
- Division of Allergy, Immunology, and Pulmonary Medicine, Washington University, Saint Louis, MO, USA
| | | | | | | | | | - William W Busse
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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14
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De A, Williams S, Yao Y, Jin Z, Brittenham GM, Kattan M, Lovinsky-Desir S, Lee MT. Acute chest syndrome, airway inflammation and lung function in sickle cell disease. PLoS One 2023; 18:e0283349. [PMID: 36996064 PMCID: PMC10062579 DOI: 10.1371/journal.pone.0283349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Acute chest syndrome (ACS) is an acute complication in SCD but its effects on lung function are not well understood. Inflammation is a key component of SCD pathophysiology but with an unclear association with lung function. We hypothesized that children with ACS had worse lung function than children without ACS and aimed to investigate the association of lung function deficits with inflammatory cytokines. METHODS Patients enrolled in a previous 2-year randomized clinical trial who had consented to future data use, were enrolled for the present exploratory study. Patients were categorized into ACS and non-ACS groups. Demographic and clinical information were collected. Serum samples were used for quantification of serum cytokines and leukotriene B4 levels and pulmonary function tests (PFTs) were assessed. RESULTS Children with ACS had lower total lung capacity (TLC) at baseline and at 2 years, with a significant decline in forced expiratory volume in 1 sec (FEV1) and mid-maximal expiratory flow rate (FEF25-75%) in the 2 year period (p = 0.015 and p = 0.039 respectively). For children with ACS, serum cytokines IL-5, and IL-13 were higher at baseline and at 2 years compared to children with no ACS. IP-10 and IL-6 were negatively correlated with PFT markers. In multivariable regression using generalized estimating equation approach for factors predicting lung function, age was significantly associated FEV1 (p = 0.047) and ratio of FEV1 and forced vital capacity (FVC)- FEV1/FVC ratio (p = 0.006); males had lower FEV1/FVC (p = 0.035) and higher TLC (p = 0.031). Asthma status was associated with FEV1 (p = 0.017) and FVC (p = 0.022); history of ACS was significantly associated with TLC (p = 0.027). CONCLUSION Pulmonary function abnormalities were more common and inflammatory markers were elevated in patients with ACS, compared with those without ACS. These findings suggest airway inflammation is present in children with SCD and ACS, which could be contributing to impaired pulmonary function.
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Affiliation(s)
- Aliva De
- Division of Pediatric Pulmonology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Sanford Williams
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Yujing Yao
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Gary M Brittenham
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Meyer Kattan
- Division of Pediatric Pulmonology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Margaret T Lee
- Division of Pediatric Hematology/Oncology and Stem Cell Transplantation, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, United States of America
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15
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Hwa Jung K, Pitkowsky Z, Argenio K, Quinn JW, Bruzzese JM, Miller RL, Chillrud SN, Perzanowski M, Stingone JA, Lovinsky-Desir S. The effects of the historical practice of residential redlining in the United States on recent temporal trends of air pollution near New York City schools. Environ Int 2022; 169:107551. [PMID: 36183489 PMCID: PMC9616211 DOI: 10.1016/j.envint.2022.107551] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In the 1930's the United States (US) sponsored Home Owners' Loan Corporation (HOLC) created maps that determined risk for mortgage lending based on the racial and ethnic composition of neighborhoods leading to disinvestment in "redlined" or highest risk neighborhoods. This historical practice has perpetuated racial and economic segregation, and health disparities, that persist today. Interventions near schools where children spend large portions of the day, could impact large groups of children but schools are an often-overlooked environment for exposure. Despite a declining trend of ambient pollution in New York City (NYC) between 1998 and 2012, little is known about differences in air quality improvement near schools by historical redlining neighborhood status. Our objective was to examine if recent temporal trends of air pollution near NYC public schools differed in historically redlined neighborhoods. METHODS We examined annual average street-level concentrations of combustion-related air pollutants (black carbon (BC), particulate matter (PM2.5), nitrogen dioxide (NO2), and nitric oxide (NO)), within a 250-m radius around schools using NYC Community Air Survey land-use regression models (n = 1,462). Year of monitoring, historical redlining (binary), and summer ozone were included in multivariable linear regression using generalized estimating equation models. Average annual percent change (APC) in pollutant concentration was calculated. Models were further stratified by historical redlining and a multiplicative interaction term (year of monitoring × historical redlining) was used to assess effect modification. RESULTS Overall, there was a decreasing trend of BC (APC = -4.40%), PM2.5 (-3.92%), NO2 (-2.76%), and NO (-6.20%) during the 10-year period. A smaller reduction of BC, PM2.5 and NO was observed in redlined neighborhoods (n = 722), compared to others (n = 740): BC (APC: -4.11% vs -4.69%; Pinteraction < 0.01), PM2.5 (-3.82% vs -4.11%; Pinteraction < 0.01), and NO (-5.73% vs -6.67%; Pinteraction < 0.01). Temporal trends of NO2 did not differ by historical redlining (Pinteraction = 0.60). CONCLUSIONS Despite significant reductions in annual average pollution concentrations across NYC, schools in historically redlined neighborhoods, compared to others, experienced smaller decrease in pollution, highlighting a potential ongoing ramification of the discriminatory practice.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032, United States.
| | - Zachary Pitkowsky
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY 10032, United States.
| | - Kira Argenio
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032, United States.
| | - James W Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, United States.
| | - Jean-Marie Bruzzese
- Columbia University School of Nursing, 560 W. 168 St., New York, NY 10032, United States.
| | - Rachel L Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029, United States.
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory of Columbia University, 61 Rt 9W, Palisades, NY 10964, United States.
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, United States.
| | - Jeanette A Stingone
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY 10032, United States.
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032, United States.
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Forno E, Brandenburg DD, Castro-Rodriguez JA, Celis-Preciado CA, Holguin F, Licskai C, Lovinsky-Desir S, Pizzichini M, Teper A, Yang C, Celedón JC. Asthma in the Americas: An Update: A Joint Perspective from the Brazilian Thoracic Society, Canadian Thoracic Society, Latin American Thoracic Society, and American Thoracic Society. Ann Am Thorac Soc 2022; 19:525-535. [PMID: 35030062 PMCID: PMC8996271 DOI: 10.1513/annalsats.202109-1068cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 09/20/2021] [Accepted: 01/14/2022] [Indexed: 11/20/2022] Open
Abstract
Asthma affects a large number of people living in the Americas, a vast and diverse geographic region comprising 35 nations in the Caribbean and North, Central, and South America. The marked variability in the prevalence, morbidity, and mortality from asthma across and within nations in the Americas offers a unique opportunity to improve our understanding of the risk factors and management of asthma phenotypes and endotypes in children and adults. Moreover, a better assessment of the causes and treatment of asthma in less economically developed regions in the Americas would help diagnose and treat individuals migrating from those areas to Canada and the United States. In this focused review, we first assess the epidemiology of asthma, review known and potential risk factors, and examine commonalities and differences in asthma management across the Americas. We then discuss future directions in research and health policies to improve the prevention, diagnosis, and management of pediatric and adult asthma in the Americas, including standardized and periodic assessment of asthma burden across the region; large-scale longitudinal studies including omics and comprehensive environmental data on racially and ethnically diverse populations; and dissemination and implementation of guidelines for asthma management across the spectrum of disease severity. New initiatives should recognize differences in socioeconomic development and health care systems across the region while paying particular attention to novel or more impactful risk factors for asthma in the Americas, including indoor pollutants such as biomass fuel, tobacco use, infectious agents and the microbiome, and psychosocial stressor and chronic stress.
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Affiliation(s)
- Erick Forno
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine and Pediatric Asthma Center, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Diego D. Brandenburg
- Department of Pediatrics, Pediatric Pulmonology Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos A. Celis-Preciado
- Pulmonary Unit, Internal Medicine Department, Hospital Universitario San Ignacio and Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Fernando Holguin
- Division of Pulmonary Sciences and Critical Care, University of Colorado Denver, Denver, Colorado
| | - Christopher Licskai
- Department of Medicine, Western University Canada, Schulich School of Medicine and Dentistry, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary Medicine, Columbia University Irving Medical Center, New York, New York
| | - Marcia Pizzichini
- Post-Graduate Program of Medical Sciences, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil
| | - Alejandro Teper
- Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina; and
| | - Connie Yang
- Division of Respiratory Medicine, University of British Columbia, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Juan C. Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine and Pediatric Asthma Center, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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17
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Joseph SP, Borrell LN, Lovinsky-Desir S, Moroko AR, Li S. Bullying and lifetime asthma among children and adolescents in the United States. Ann Epidemiol 2022; 69:41-47. [PMID: 35202781 DOI: 10.1016/j.annepidem.2022.02.001] [Citation(s) in RCA: 4] [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: 08/09/2021] [Revised: 01/25/2022] [Accepted: 02/13/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the association of experiencing bullying within the past year with the prevalence of lifetime childhood asthma in US children and adolescents; and whether this associations vary with sex of the child and select socioeconomic indicators. METHODS We performed secondary analysis of data from the 2018 National Survey of Children's Health participants aged 6 to 17 years (n=19,766). We used log-binomial regression to examine the association between bullying and lifetime childhood asthma before and after controlling for select covariates. We also tested interactions of bullying with sex and select socioeconomic indicators. RESULTS Children who experience bullying have a significantly increased probability of having asthma in adjusted analyses. The probability of childhood asthma increased with the frequency of bullying with PRs starting at 1.28 (95%CI:1.06, 1.55) for children bullied 1-2 times per year to 1.59 (95%:1.22, 2.09) for those being bullied at least 4 times per month. This association did not differ with sex of the child and select socioeconomic indicators. CONCLUSION We found that children who experienced bullying had a greater probability of having asthma relative to those who never experienced bullying. These finding highlight the impact of psychosocial stressors on asthma as a nontraditional trigger in children with asthma.
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Affiliation(s)
- Sharon P Joseph
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy.
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy
| | | | - Andrew R Moroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, CUNY Graduate School of Public Health & Health Policy
| | - Sheng Li
- Department of Epidemiology and Biostatistics, CUNY Graduate School of Public Health & Health Policy
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18
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Rai N, Cornett JA, Zachariah P, Quittell L, Lovinsky-Desir S. Severe respiratory viral infections in children with history of asymptomatic or mild COVID-19. Pediatr Pulmonol 2022; 57:361-366. [PMID: 34741579 PMCID: PMC8661820 DOI: 10.1002/ppul.25752] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 12/16/2022]
Abstract
IMPORTANCE The spectrum of complications of COVID-19 in children, including the effect of COVID-19 on later viral infection, is not known. OBJECTIVE To examine the features of children hospitalized for respiratory illness with history of prior COVID-19. DESIGN Retrospective observational case series at a single pediatric quaternary medical center in New York City. Data were obtained from review of medical records. PARTICIPANTS Children with prior mild or asymptomatic COVID-19 and no known risk factors for severe respiratory disease, who were hospitalized at our center for acute respiratory illness from October 2020 to May 2021, were reviewed. MAIN OUTCOMES AND MEASURES Co-morbidities, history of prior COVID-19 symptoms, respiratory viral panel findings, acuity of illness, degree of respiratory decompensation based on support and interventions required, duration of hospitalization, and overall clinical course were assessed from the medical record. RESULTS This study included 5 patients (median age, 4 years; age range: 0.8-9 years; 4 [80%] male). All had positive COVID-19 serology, 1 (20%) had mild symptoms, while the others had no symptoms of prior Sars-CoV-2 infection, 3 (60%) had asthma, and the remaining had no co-morbidities. All were admitted between April and May 2021. Two were re-admitted for respiratory symptoms in the subsequent 3 months. CONCLUSIONS AND RELEVANCE This case series describes a possible association between severe lower respiratory tract infection and prior mild COVID-19 in children. Larger cohort studies describing the respiratory effects of prior COVID-19 in children are needed.
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Affiliation(s)
- Nooralam Rai
- Division of Pediatric Pulmonary, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Joseph A Cornett
- Vagelos College of Physicians and Surgeons, Columbia University, 630 W 168th street, New York, New York, USA
| | - Philip Zachariah
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Lynne Quittell
- Division of Pediatric Pulmonary, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
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19
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Khan S, Bajwa S, Brahmbhatt D, Lovinsky-Desir S, Sheffield PE, Stingone JA, Li S. Multi-Level Socioenvironmental Contributors to Childhood Asthma in New York City: a Cluster Analysis. J Urban Health 2021; 98:700-710. [PMID: 34845655 PMCID: PMC8688591 DOI: 10.1007/s11524-021-00582-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/27/2022]
Abstract
Childhood asthma exacerbation remains the leading cause of pediatric emergency department visits and hospitalizations and disproportionately affects Latinx and Black children, compared to non-Latinx White children in NYC. Environmental exposures and socioeconomic factors may jointly contribute to childhood asthma exacerbations; however, they are often studied separately. To better investigate the multiple contributors to disparities in childhood asthma, we compiled data on various individual and neighborhood level socioeconomic and environmental factors, including education, race/ethnicity, income disparities, gentrification, housing characteristics, built environment, and structural racism, from the NYC Department of Health's KIDS 2017 survey and the US Census' American Community Survey. We applied cluster analysis and logistic regression to first identify the predominant patterns of social and environmental factors experienced by children in NYC and then estimate whether children experiencing specific patterns are more likely to experience asthma exacerbations. We found that housing and built environment characteristics, such as density and age of buildings, were the predominant features to differentiate the socio-environmental patterns observed in New York City. Children living in neighborhoods with greater proportions of rental housing, high-density buildings, and older buildings were more likely to experience asthma exacerbations than other children. These findings add to the literature about childhood asthma in urban environments, and can assist efforts to target actionable policies and practices that promote health equity related to childhood asthma.
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Affiliation(s)
- Sana Khan
- City University of New York Institute for State and Local Governance, New York, NY, USA
| | - Sarah Bajwa
- NYC Department of Health and Mental Hygiene, New York, NY, USA
| | | | | | | | | | - Sheng Li
- City University of New York School of Public Health, New York, NY, USA.
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20
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Cook Q, Argenio K, Lovinsky-Desir S. The impact of environmental injustice and social determinants of health on the role of air pollution in asthma and allergic disease in the United States. J Allergy Clin Immunol 2021; 148:1089-1101.e5. [PMID: 34743831 DOI: 10.1016/j.jaci.2021.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/12/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
There is clear evidence that exposure to environmental air pollution is associated with immune dysregulation, asthma, and other allergic diseases. However, the burden of air pollution exposure is not equally distributed across the United States. Many social and environmental factors place communities of color and people who are in poverty at increased risk of exposure to pollution and morbidity from asthma and allergies. Here, we review the evidence that supports the relationship between air pollution and asthma, while considering the social determinants of health that contribute to disparities in exposures and outcomes.
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Affiliation(s)
- Quindelyn Cook
- Division of Pediatric Pulmonary and Allergy, Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Kira Argenio
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY.
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21
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Lovinsky-Desir S, Lussier SJ, Calatroni A, Gergen PJ, Rivera-Spoljaric K, Bacharier LB, De A, O'Connor GT, Sandel MT, Wood RA, Arteaga-Solis E, Gern JE, Kattan M. Trajectories of adiposity indicators and association with asthma and lung function in urban minority children. J Allergy Clin Immunol 2021; 148:1219-1226.e7. [PMID: 34166677 PMCID: PMC8578316 DOI: 10.1016/j.jaci.2021.06.015] [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: 02/25/2021] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A relationship between adiposity and asthma has been described in some cohort studies, but little is known about trajectories of adiposity throughout early childhood among children at high risk for developing asthma in urban United States cities. Moreover, early life trajectories of adipokines that have metabolic and immunologic properties have not been comprehensively investigated. OBJECTIVE Our objective was to characterize trajectories of adiposity in a longitudinal birth cohort of predominately Black and Latinx children (n = 418) using several different repeated measures including body mass index (BMI) z score, bioimpedance analysis, leptin, and adiponectin in the first 10 years of life. METHODS In a longitudinal birth cohort of predominately Black and Latinx children, we used repeated annual measures of BMI, bioimpedance analysis (ie, percentage of body fat), leptin, and adiponectin to create trajectories across the first 10 years of life. Across those trajectories, we compared asthma diagnosis and multiple lung function outcomes, including spirometry, impulse oscillometry, and methacholine response. RESULTS Three trajectories were observed for BMI z score, bioimpedance analysis, and leptin and 2 for adiponectin. There was no association between trajectories of BMI, percentage of body fat, leptin, or adipokine and asthma diagnosis or lung function (P > .05). CONCLUSIONS Trajectories of adiposity were not associated with asthma or lung function in children at high risk for developing asthma. Risk factors related to geography as well as social and demographic factors unique to specific populations could explain the lack of association and should be considered in obesity and asthma studies.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY.
| | | | | | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | - Katherine Rivera-Spoljaric
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Aliva De
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Megan T Sandel
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University Medical Center, Baltimore, Md
| | - Emilio Arteaga-Solis
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - James E Gern
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wis
| | - Meyer Kattan
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
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22
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Jung KH, Goodwin KE, Perzanowski MS, Chillrud SN, Perera FP, Miller RL, Lovinsky-Desir S. Personal Exposure to Black Carbon at School and Levels of Fractional Exhaled Nitric Oxide in New York City. Environ Health Perspect 2021; 129:97005. [PMID: 34495741 PMCID: PMC8425518 DOI: 10.1289/ehp8985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Schools are often located near traffic sources, leading to high levels of exposure to traffic-related air pollutants, including black carbon (BC). Thus, the school environment could play in a significant role in the adverse respiratory health of children. OBJECTIVES Our objective was to determine associations between personal BC levels at school and airway inflammation [i.e., fractional exhaled nitric oxide (FeNO)] in school-age children. We hypothesized that higher school BC (SBC) would be associated with higher FeNO. METHODS Children 9-14 years of age in New York City (NYC) (n=114) wore BC monitors for two 24-h periods over a 6-d sampling period, repeated 6 months later. SBC was defined as the average personal BC concentrations measured during NYC school hours (i.e., 0830-1430 hours). FeNO was measured following each 24-h BC monitoring period. Multivariable linear regression in generalized estimating equation models were used to examine associations between SBC and FeNO. Results are presented as percentage difference (PD) in FeNO. RESULTS Personal BC at school was associated with higher FeNO (PD=7.47% higher FeNO per 1-μg/m3 BC (95% CI: 1.31, 13.9), p=0.02]. Compared with BC exposure during school, a smaller PD in FeNO was observed in association with BC exposure while commuting to and from school [PD=6.82% (95% CI: 0.70, 13.3), p=0.03]. Personal BC in non-school environments and residential BC were not associated with FeNO (p>0.05). A significant association between personal BC at school and FeNO was observed among children with seroatopy who did not have asthma [PD=21.5% (95% CI: 4.81, 40.9), p=0.01]. DISCUSSION Schools may be important sources of BC exposure that contribute to airway inflammation in school-age children. Our results provide rationale for interventions that target improved air quality in urban schools and classrooms. https://doi.org/10.1289/EHP8985.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Kathleen E. Goodwin
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Matthew S. Perzanowski
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Steven N. Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, New York, New York, USA
| | - Frederica P. Perera
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, New York, USA
| | - Rachel L. Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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23
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Thakur N, Lovinsky-Desir S, Appell D, Bime C, Castro L, Celedón JC, Ferreira J, George M, Mageto Y, Mainous III AG, Pakhale S, Riekert KA, Roman J, Ruvalcaba E, Sharma S, Shete P, Wisnivesky JP, Holguin F. Enhancing Recruitment and Retention of Minority Populations for Clinical Research in Pulmonary, Critical Care, and Sleep Medicine: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 204:e26-e50. [PMID: 34347574 PMCID: PMC8513588 DOI: 10.1164/rccm.202105-1210st] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Well-designed clinical research needs to obtain information that is applicable to the general population. However, most current studies fail to include substantial cohorts of racial/ethnic minority populations. Such underrepresentation may lead to delayed diagnosis or misdiagnosis of disease, wide application of approved interventions without appropriate knowledge of their usefulness in certain populations, and development of recommendations that are not broadly applicable.Goals: To develop best practices for recruitment and retention of racial/ethnic minorities for clinical research in pulmonary, critical care, and sleep medicine.Methods: The American Thoracic Society convened a workshop in May of 2019. This included an international interprofessional group from academia, industry, the NIH, and the U.S. Food and Drug Administration, with expertise ranging from clinical and biomedical research to community-based participatory research methods and patient advocacy. Workshop participants addressed historical and current mistrust of scientific research, systemic bias, and social and structural barriers to minority participation in clinical research. A literature search of PubMed and Google Scholar was performed to support conclusions. The search was not a systematic review of the literature.Results: Barriers at the individual, interpersonal, institutional, and federal/policy levels were identified as limiting to minority participation in clinical research. Through the use of a multilevel framework, workshop participants proposed evidence-based solutions to the identified barriers.Conclusions: To date, minority participation in clinical research is not representative of the U.S. and global populations. This American Thoracic Society research statement identifies potential evidence-based solutions by applying a multilevel framework that is anchored in community engagement methods and patient advocacy.
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24
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Jezioro JR, Gutman SA, Lovinsky-Desir S, Rauh V, Perera FP, Miller RL. A Comparison of Activity Participation between Children with and without Asthma. Open J Occup Ther 2021; 9. [PMID: 34316416 DOI: 10.15453/2168-6408.1813] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Asthma affects approximately 6 million children in the United States and can greatly impact quality of life and occupational engagement. Although occupational therapists are well-equipped to address participation limitations, insufficient evidence exists to support the role of occupational therapists in asthma treatment. Method The purpose of this study was to further understand the occupational limitations experienced by children with asthma. We also explored a dual diagnosis of asthma and obesity. The participants included children with (n = 84) and without (n = 63) asthma living in New York City. The Child Behavior Checklist, Youth Self Report, Brief Respiratory Questionnaire, and accelerometer data were used to examine occupational participation. Results Although accelerometry data demonstrated that children with asthma were equally as active as their non-asthmatic peers, the participants with asthma perceived themselves as participating more in sedentary occupations and were less likely to be members of sports teams. They also had more missed school days and nights of troubled sleep. The children with both asthma and obesity reported the highest level of activity limitations. Conclusion This study illustrates specific limitations experienced by children with asthma and supports the need for occupational therapy intervention. Future studies are needed to design and assess interventions that will support the addition of occupational therapists to multidisciplinary asthma treatment teams.
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25
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Rudman Spergel AK, Sever ML, Johnson J, Gill MA, Schulten V, Frazier A, Kercsmar CM, Lovinsky-Desir S, Searing DA, Sette A, Shao B, Teach SJ, Gern JE, Busse WW, Togias A, Wood RA, Liu AH. Development of nasal allergen challenge with cockroach in children with asthma. Pediatr Allergy Immunol 2021; 32:971-979. [PMID: 33606312 PMCID: PMC8503840 DOI: 10.1111/pai.13480] [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: 08/21/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nasal allergen challenge (NAC) could be a means to assess indication and/or an outcome of allergen-specific therapies, particularly for perennial allergens. NACs are not commonly conducted in children with asthma, and cockroach NACs are not well established. This study's objective was to identify a range of German cockroach extract doses that induce nasal symptoms and to assess the safety of cockroach NAC in children with asthma. METHODS Ten adults (18-37 years) followed by 25 children (8-14 years) with well-controlled, persistent asthma and cockroach sensitization underwent NAC with diluent followed by up to 8 escalating doses of cockroach extract (0.00381-11.9 µg/mL Bla g 1). NAC outcome was determined by Total Nasal Symptom Score (TNSS) and/or sneeze score. Cockroach allergen-induced T-cell activation and IL-5 production were measured in peripheral blood mononuclear cells. RESULTS 67% (6/9) of adults and 68% (17/25) of children had a positive NAC at a median response dose of 0.120 µg/mL [IQR 0.0380-0.379 µg/mL] of Bla g 1. Additionally, three children responded to diluent alone and did not receive any cockroach extract. Overall, 32% (11/34) were positive with sneezes alone, 15% (5/34) with TNSS alone, and 21% (7/34) with both criteria. At baseline, NAC responders had higher cockroach-specific IgE (P = .03), lower cockroach-specific IgG/IgE ratios (children, P = .002), and increased cockroach-specific IL-5-producing T lymphocytes (P = .045). The NAC was well tolerated. CONCLUSION We report the methodology of NAC development for children with persistent asthma and cockroach sensitization. This NAC could be considered a tool to confirm clinically relevant sensitization and to assess responses in therapeutic studies.
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Affiliation(s)
- Amanda K Rudman Spergel
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | | | - Michelle A Gill
- Departments of Pediatrics, Internal Medicine, and Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - April Frazier
- La Jolla Institute for Immunology, La Jolla, CA, USA
| | - Carolyn M Kercsmar
- Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephanie Lovinsky-Desir
- Department of Pediatrics, Division of Pulmonary Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Dan A Searing
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alessandro Sette
- La Jolla Institute for Immunology, La Jolla, CA, USA.,Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Baomei Shao
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - James E Gern
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - William W Busse
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew H Liu
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
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26
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McKennan C, Naughton K, Stanhope C, Kattan M, O’Connor GT, Sandel MT, Visness CM, Wood RA, Bacharier LB, Beigelman A, Lovinsky-Desir S, Togias A, Gern JE, Nicolae D, Ober C. Longitudinal data reveal strong genetic and weak non-genetic components of ethnicity-dependent blood DNA methylation levels. Epigenetics 2021; 16:662-676. [PMID: 32997571 PMCID: PMC8143220 DOI: 10.1080/15592294.2020.1817290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/02/2020] [Revised: 07/06/2020] [Accepted: 07/24/2020] [Indexed: 11/18/2022] Open
Abstract
Epigenetic architecture is influenced by genetic and environmental factors, but little is known about their relative contributions or longitudinal dynamics. Here, we studied DNA methylation (DNAm) at over 750,000 CpG sites in mononuclear blood cells collected at birth and age 7 from 196 children of primarily self-reported Black and Hispanic ethnicities to study race-associated DNAm patterns. We developed a novel Bayesian method for high-dimensional longitudinal data and showed that race-associated DNAm patterns at birth and age 7 are nearly identical. Additionally, we estimated that up to 51% of all self-reported race-associated CpGs had race-dependent DNAm levels that were mediated through local genotype and, quite surprisingly, found that genetic factors explained an overwhelming majority of the variation in DNAm levels at other, previously identified, environmentally-associated CpGs. These results indicate that race-associated blood DNAm patterns in particular, and blood DNAm levels in general, are primarily driven by genetic factors, and are not as sensitive to environmental exposures as previously suggested, at least during the first 7 years of life.
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Affiliation(s)
- Chris McKennan
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Meyer Kattan
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - George T. O’Connor
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Megan T. Sandel
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Robert A. Wood
- Department of Pediatrics, Johns Hopkins University Medical Center, Baltimore, MD, USA
| | - Leonard B. Bacharier
- Department of Pediatrics, Washington University School of Medicine and St Louis Children’s Hospital, St. Louis, MO, USA
| | - Avraham Beigelman
- Department of Pediatrics, Washington University School of Medicine and St Louis Children’s Hospital, St. Louis, MO, USA
| | | | - Alkis Togias
- National Institute of Allergy and Infectious Disease, Bethesda, MD, USA
| | - James E. Gern
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Dan Nicolae
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
- Department of Statistics, University of Chicago, Chicago, IL, USA
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
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Altman MC, Flynn K, Rosasco MG, Dapas M, Kattan M, Lovinsky-Desir S, O'Connor GT, Gill MA, Gruchalla RS, Liu AH, Pongracic JA, Khurana Hershey GK, Zoratti EM, Teach SJ, Rastrogi D, Wood RA, Bacharier LB, LeBeau P, Gergen PJ, Togias A, Busse WW, Presnell S, Gern JE, Ober C, Jackson DJ. Inducible expression quantitative trait locus analysis of the MUC5AC gene in asthma in urban populations of children. J Allergy Clin Immunol 2021; 148:1505-1514. [PMID: 34019912 PMCID: PMC8599524 DOI: 10.1016/j.jaci.2021.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mucus plugging can worsen asthma control, lead to reduced lung function and fatal exacerbations. MUC5AC is the secretory mucin implicated in mucus plugging, and MUC5AC gene expression has been associated with development of airway obstruction and asthma exacerbations in urban children with asthma. However, the genetic determinants of MUC5AC expression are not established. OBJECTIVES This study sought to assess single-nucleotide polymorphisms (SNPs) that influence MUC5AC expression and relate to pulmonary functions in childhood asthma. METHODS This study used RNA-sequencing data from upper airway samples and performed cis-expression quantitative trait loci (eQTL) and allele-specific expression analyses in 2 cohorts of predominantly Black and Hispanic urban children, a high asthma-risk birth cohort, and an exacerbation-prone asthma cohort. Inducible MUC5AC eQTLs were further investigated during incipient asthma exacerbations. Significant eQTLs SNPs were tested for associations with lung function measurements and their functional consequences were investigated in DNA regulatory databases. RESULTS Two independent groups of SNPs in the MUC5AC gene that were significantly associated with MUC5AC expression were identified. Moreover, these SNPs showed stronger eQTL associations with MUC5AC expression during asthma exacerbations, which is consistent with inducible expression. SNPs in 1 group also showed significant association with decreased pulmonary functions. These SNPs included multiple EGR1 transcription factor binding sites, suggesting a mechanism of effect. CONCLUSIONS These findings demonstrate the applicability of organ-specific RNA-sequencing data to determine genetic factors contributing to a key disease pathway. Specifically, they suggest important genetic variations that may underlie propensity to mucus plugging in asthma and could be important in targeted asthma phenotyping and disease management strategies.
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Affiliation(s)
- Matthew C Altman
- Department of Medicine, University of Washington, Seattle, Wash; Benaroya Research Institute, Seattle, Wash.
| | | | | | - Matthew Dapas
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | | | | | | | - Michelle A Gill
- University of Texas Southwestern Medical Center, Dallas, Tex
| | | | - Andrew H Liu
- Children's Hospital Colorado University of Colorado School of Medicine, Aurora, Colo
| | | | | | | | | | | | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University Medical Center, Baltimore, Md
| | | | | | - Peter J Gergen
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Alkis Togias
- National Institutes of Health/National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, Wis
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, New York, New York
| | - George T O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
- Division of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston Medical Center, Boston, Massachusetts
- Associate Editor, JAMA
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Lovinsky-Desir S, Deshpande DR, De A, Murray L, Stingone JA, Chan A, Patel N, Rai N, DiMango E, Milner J, Kattan M. Asthma among hospitalized patients with COVID-19 and related outcomes. J Allergy Clin Immunol 2020; 146:1027-1034.e4. [PMID: 32771560 PMCID: PMC7409831 DOI: 10.1016/j.jaci.2020.07.026] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [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: 06/01/2020] [Revised: 07/21/2020] [Accepted: 07/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Several underlying conditions have been associated with severe acute respiratory syndrome coronavirus 2 illness, but it remains unclear whether underlying asthma is associated with worse coronavirus disease 2019 (COVID-19) outcomes. OBJECTIVE Given the high prevalence of asthma in the New York City area, our objective was to determine whether underlying asthma was associated with poor outcomes among hospitalized patients with severe COVID-19 compared with patients without asthma. METHODS Electronic heath records were reviewed for 1298 sequential patients 65 years or younger without chronic obstructive pulmonary disease who were admitted to our hospital system with a confirmed positive severe acute respiratory syndrome coronavirus 2 test result. RESULTS The overall prevalence of asthma among all hospitalized patients with COVID-19 was 12.6%, yet a higher prevalence (23.6%) was observed in the subset of 55 patients younger than 21 years. There was no significant difference in hospital length of stay, need for intubation, length of intubation, tracheostomy tube placement, hospital readmission, or mortality between patients with and without asthma. Observations between patients with and without asthma were similar when stratified by obesity, other comorbid conditions (ie, hypertension, hyperlipidemia, and diabetes), use of controller asthma medication, and absolute eosinophil count. CONCLUSIONS Among hospitalized patients 65 years or younger with severe COVID-19, asthma diagnosis was not associated with worse outcomes, regardless of age, obesity, or other high-risk comorbidities. Future population-based studies are needed to investigate the risk of developing COVID-19 among patients with asthma once universal testing becomes readily available.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY.
| | - Deepti R Deshpande
- Division of Allergy, Immunology and Rheumatology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Aliva De
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Laurie Murray
- Department of Pediatrics, New York Presbyterian - Morgan Stanley Children's Hospital of New York, New York, NY
| | - Jeanette A Stingone
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Angela Chan
- Division of Allergy, Immunology and Rheumatology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Neha Patel
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Nooralam Rai
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Emily DiMango
- Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Joshua Milner
- Division of Allergy, Immunology and Rheumatology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - Meyer Kattan
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
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Thakur N, Lovinsky-Desir S, Bime C, Wisnivesky JP. The Structural and Social Determinants of the Racial/Ethnic Disparities in the U.S. COVID-19 Pandemic. What's Our Role? Am J Respir Crit Care Med 2020; 202:943-949. [PMID: 32677842 PMCID: PMC7528789 DOI: 10.1164/rccm.202005-1523pp] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/16/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Neeta Thakur
- Department of Medicine, University of California at San Francisco, San Francisco, California
| | | | - Christian Bime
- Department of Medicine, University of Arizona, Tucson, Arizona
| | - Juan P. Wisnivesky
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - on behalf of the Health Equality and Diversity Committee of the American Thoracic Society
- Department of Medicine, University of California at San Francisco, San Francisco, California
- Department of Pediatrics, Columbia University, New York, New York
- Department of Medicine, University of Arizona, Tucson, Arizona
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, New York; and
- Department of Pediatrics and
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Baidal JW, Wang AY, Zumwalt K, Gary D, Greenberg Y, Cormack B, Lovinsky-Desir S, Nichols K, Pasco N, Nieto A, Ancker JS, Goldsmith J, Meyer D. Social Determinants of Health and COVID-19 Among Patients in New York City. Res Sq 2020:rs.3.rs-70959. [PMID: 32995762 PMCID: PMC7523130 DOI: 10.21203/rs.3.rs-70959/v1] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Covid-19 testing and disease outcomes according to demographic and neighborhood characteristics must be understood. Methods Using aggregate administrative data from a multi-site academic healthcare system in New York from March 1 - May 14, 2020, we examined patient demographic and neighborhood characteristics according to Covid-19 testing and disease outcomes. Results Among the 23,918 patients, higher proportions of those over 65 years old, male sex, Hispanic ethnicity, Medicare, or Medicaid insurance had positive tests, were hospitalized, or died than those with younger age, non-Hispanic ethnicity, or private insurance. Patients living in census tracts with more non-White individuals, Hispanic individuals, individuals in poverty, or housing crowding had higher proportions of Covid-19 positive tests, hospitalizations, and deaths than counterparts. Discussion Variation exists in Covid-19 testing and disease outcomes according to patient and neighborhood characteristics. There is a need to monitor Covid-19 testing access and disease outcomes and resolve racist policies and practices.
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Affiliation(s)
| | - Amanda Y Wang
- Columbia University Vagelos College of Physicians & Surgeons
| | | | | | | | | | | | | | - Neil Pasco
- Columbia University Irving Medical Center
| | | | | | | | - Dodi Meyer
- Columbia University Irving Medical Center
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32
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Baidal JW, Wang AY, Zumwalt K, Gary D, Greenberg Y, Cormack B, Lovinsky-Desir S, Nichols K, Pasco N, Nieto A, Ancker JS, Goldsmith J, Meyer D. Social Determinants of Health and COVID-19 Among Patients in New York City. Res Sq 2020. [PMID: 32995762 DOI: 10.21203/rs.3.rs‐70959/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background: Covid-19 testing and disease outcomes according to demographic and neighborhood characteristics must be understood. Methods: Using aggregate administrative data from a multi-site academic healthcare system in New York from March 1 â€" May 14, 2020, we examined patient demographic and neighborhood characteristics according to Covid-19 testing and disease outcomes. Results: Among the 23,918 patients, higher proportions of those over 65 years old, male sex, Hispanic ethnicity, Medicare, or Medicaid insurance had positive tests, were hospitalized, or died than those with younger age, non-Hispanic ethnicity, or private insurance. Patients living in census tracts with more non-White individuals, Hispanic individuals, individuals in poverty, or housing crowding had higher proportions of Covid-19 positive tests, hospitalizations, and deaths than counterparts. Discussion: Variation exists in Covid-19 testing and disease outcomes according to patient and neighborhood characteristics. There is a need to monitor Covid-19 testing access and disease outcomes and resolve racist policies and practices.
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Abstract
With better understanding of the role of type 2 inflammation in allergic asthma, there has been progress made in the development of new biologic therapies targeting these specific pathways. This review will consider diagnostic criteria for using biologic therapies for pediatric asthma with special emphasis on populations that are likely to benefit the most from particular therapies. With the exception of the anti-immunoglobulin E, omalizumab, very few studies have been published on the efficacy and safety of biologic therapies in children, particularly anti-interleukin-5 (IL5) and anti-IL4/IL13 therapies. The review will highlight the scarcity of published data in pediatric-specific populations. In addition, we will consider the cost-effectiveness as well as potential long-term consequences of biologic therapies in pediatric asthma.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
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34
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Lovinsky-Desir S. Early career investigator biocommentary-pediatric research. Pediatr Res 2019; 85:6. [PMID: 30333521 DOI: 10.1038/s41390-018-0212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Stephanie Lovinsky-Desir
- New York Presbyterian Hospital-Pediatrics, Columbia University Medical Center, New York, NY, USA.
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35
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Lovinsky-Desir S, Acosta LM, Rundle AG, Miller RL, Goldstein IF, Jacobson JS, Chillrud SN, Perzanowski MS. Air pollution, urgent asthma medical visits and the modifying effect of neighborhood asthma prevalence. Pediatr Res 2019; 85:36-42. [PMID: 30337671 PMCID: PMC6353679 DOI: 10.1038/s41390-018-0189-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/14/2018] [Accepted: 08/26/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Social and environmental stressors may modify associations between environmental pollutants and asthma symptoms. We examined if neighborhood asthma prevalence (higher: HAPN vs. lower: LAPN), a surrogate for underlying risk factors for asthma, modified the relationship between pollutants and urgent asthma visits. METHODS Through zip code, home addresses were linked to New York City Community Air Survey's land use regression model for street-level, annual average nitrogen dioxide (NO2), particulate matter (PM2.5), elemental carbon (EC), summer average ozone (O3), winter average sulfur dioxide (SO2) concentrations. Poisson regression models were fit to estimate the association (prevalence ratio, PR) between pollutant exposures and seeking urgent asthma care. RESULTS All pollutants, except O3 were higher in HAPN than LAPN (P < 0.01). Neighborhood asthma prevalence modified the relationship between pollutants and urgent asthma (P-interaction < 0.01, for NO2 and SO3). Associations between pollutants and urgent asthma were observed only in LAPN (NO2: PR = 1.38, P = 0.01; SO3: PR = 1.85, P = 0.04). No association was observed between pollutants and urgent asthma among children in HAPN (P > 0.05). CONCLUSIONS Relationships between modeled street-level pollutants and urgent asthma were stronger in LAPN compared to HAPN. Social stressors that may be more prevalent in HAPN than LAPN, could play a greater role in asthma exacerbations in HAPN vs. pollutant exposure alone.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Luis M Acosta
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Inge F Goldstein
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Judith S Jacobson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, New York, NY, USA
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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36
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Lovinsky-Desir S, Lawrence J, Jung KH, Rundle AG, Hoepner LA, Yan B, Perera F, Perzanowski MS, Miller RL, Chillrud SN. Assessment of exposure to air pollution in children: Determining whether wearing a personal monitor affects physical activity. Environ Res 2018; 166:340-343. [PMID: 29913435 PMCID: PMC6330888 DOI: 10.1016/j.envres.2018.06.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/15/2018] [Accepted: 06/08/2018] [Indexed: 06/08/2023]
Abstract
Personal air pollution monitoring in research studies should not interfere with usual patterns of behavior and bias results. In an urban pediatric cohort study we tested whether wearing an air monitor impacted activity time based on continuous watch-based accelerometry. The majority (71%) reported that activity while wearing the monitor mimicked normal activity. Correspondingly, variation in activity while wearing versus not wearing the monitor did not differ greatly from baseline variation in activity (P = 0.84).
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032, United States.
| | - Jennifer Lawrence
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630W. 168th St., New York, NY 10032, United States
| | - Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630W. 168th St., New York, NY 10032, United States
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, United States
| | - Lori A Hoepner
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, United States; Department of Environmental and Occupational Health Sciences, State University of New York, Downstate School of Public Health, Box 43, 450 Clarkson Ave., Brooklyn, NY 11203, United States
| | - Beizhan Yan
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9W Palisades, NY 10964, United States
| | - Federica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, United States
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, United States
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630W. 168th St., New York, NY 10032, United States; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722W. 168th St., New York, NY 10032, United States; Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, PH8E-101, 630W 168th St., New York, NY 10032, United States
| | - Steve N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9W Palisades, NY 10964, United States
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Rudman Spergel AK, Sever ML, Johnson J, Gill MA, Kercsmar C, Searing DA, Lovinsky-Desir S, Teach SJ, Gern JE, Busse WW, Togias A, Wood RA, Liu AH. Feasibility and Safety of Cockroach Nasal Allergen Challenge (NAC) in Cockroach Sensitized Children and Adults with Asthma: A Multi-Site, Open-Label Pilot Study (Inner City Asthma Consortium). J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lovinsky-Desir S, Acosta L, Rundle A, Miller R, Goldstein I, Jacobson J, Chillrud S, Perzanowski M. Air Pollution, Urgent Asthma Care, and the Impact of Neighborhood Asthma Prevalence. Chest 2017. [DOI: 10.1016/j.chest.2017.08.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Miller RL, Zhang H, Jezioro J, De Planell Saguer M, Lovinsky-Desir S, Liu X, Perzanowski M, Divjan A, Phipatanakul W, Matsui EC. Reduced mouse allergen is associated with epigenetic changes in regulatory genes, but not mouse sensitization, in asthmatic children. Environ Res 2017; 156:619-624. [PMID: 28454014 PMCID: PMC5503684 DOI: 10.1016/j.envres.2017.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/06/2017] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
Abstract
Chronic exposure to mouse allergen may contribute greatly to the inner-city asthma burden. We hypothesized that reducing mouse allergen exposure may modulate the immunopathology underlying symptomatic pediatric allergic asthma, and that this occurs through epigenetic regulation. To test this hypothesis, we studied a cohort of mouse sensitized, persistent asthmatic inner-city children undergoing mouse allergen-targeted integrated pest management (IPM) vs education in a randomized controlled intervention trial. We found that decreasing mouse allergen exposure, but not cockroach, was associated with reduced FOXP3 buccal DNA promoter methylation, but this was unrelated to mouse specific IgE production. This finding suggests that the environmental epigenetic regulation of an immunomodulatory gene may occur following changing allergen exposures in some highly exposed cohorts. Given the clinical and public health importance of inner-city pediatric asthma and the potential impact of environmental interventions, further studies will be needed to corroborate changes in epigenetic regulation following changing exposures over time, and determine their impact on asthma morbidity in susceptible children.
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Affiliation(s)
- Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA; Department of Environmental Health Sciences, Columbia University, 722 W 168th St, 11th Floor, New York City, NY, 10032, USA.
| | - Hanjie Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA
| | - Jacqueline Jezioro
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA
| | - Mariangels De Planell Saguer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA
| | - Stephanie Lovinsky-Desir
- Division of Pulmonary, Department of Pediatrics, Columbia University Medical Center, 3959 Broadway, CHC 7-701, New York City, NY 10032, USA
| | - Xinhua Liu
- Department of Biostatistics, Columbia University Medical Center, 722 W 168 St, 6 Floor, New York City, NY, 10032, USA
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Columbia University, 722 W 168th St, 11th Floor, New York City, NY, 10032, USA
| | - Adnan Divjan
- Department of Environmental Health Sciences, Columbia University, 722 W 168th St, 11th Floor, New York City, NY, 10032, USA
| | - Wanda Phipatanakul
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Elizabeth C Matsui
- Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, CMSC 1102, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Lovinsky-Desir S, Jung KH, Jezioro JR, Torrone DZ, de Planell-Saguer M, Yan B, Perera FP, Rundle AG, Perzanowski MS, Chillrud SN, Miller RL. Physical activity, black carbon exposure, and DNA methylation in the FOXP3 promoter. Clin Epigenetics 2017. [PMID: 28630656 PMCID: PMC5470266 DOI: 10.1186/s13148-017-0364-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Physical activity is associated with improvement in lung function; however, pollution exposure during physical activity can lead to a transient reduction in lung function. This paradoxical relationship may be linked to altered T regulatory (Treg) cell activity, which increases with exercise and suppresses airway inflammation, but decreases in association with exposure to air pollution. To clarify these relationships, we investigated buccal cell DNA methylation of the forkhead box p3 (FOXP3) gene promoter, a proposed biomarker of Treg activity. We hypothesized that active urban children would have lower FOXP3 promoter methylation, associated with better lung function compared to non-active children. We also hypothesized that this relationship would be attenuated by high exposure to the air pollutant black carbon (BC). Methods We performed a cross-sectional study of 135 children ages 9–14 who live in New York City. Activity was measured across 6 days. BC exposure was assessed by personal monitors worn for two 24-h periods, followed by lung function assessment. Buccal swabs were collected for DNA methylation analysis of three regions (six CpG sites) in the FOXP3 promoter. Results In multivariable regression models, overall, there was no significant relationship between physical activity and FOXP3 promoter methylation (p > 0.05). However, in stratified analyses, among children with higher BC exposure (≥1200 ng/m3), physical activity was associated with 2.37% lower methylation in promoter 2 (CpGs −77, −65, and −58) (βestimate = −2.37%, p < 0.01) but not among those with lower BC exposure (βestimate = 0.54%, p > 0.05). Differences across strata were statistically significant (pinteraction = 0.04). Among all children, after controlling for BC concentration, promoter 2 methylation was associated with reduced FEV1/FVC (βestimate = −0.40%, p < 0.01) and reduced FEF25–75% (βestimate = −1.46%, p < 0.01). Conclusions Physical activity in urban children appeared associated with lower FOXP3 promoter methylation, a possible indicator of greater Treg function, under conditions of high BC exposure. Reduced FOXP3 promoter methylation was associated with higher lung function. These findings suggest that physical activity may induce immunologic benefits, particularly for urban children with greater risk of impaired lung function due to exposure to higher air pollution. FOXP3 promoter buccal cell methylation may function as a useful biomarker of that benefit. Electronic supplementary material The online version of this article (doi:10.1186/s13148-017-0364-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032 USA
| | - Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St, New York, NY 10032 USA
| | - Jacqueline R Jezioro
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St, New York, NY 10032 USA
| | - David Z Torrone
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St, New York, NY 10032 USA
| | | | - Beizhan Yan
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9 W Palisades, New York, 10964 NY USA
| | - Frederica P Perera
- Department of Environmental Health Sciences and Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032 USA
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032 USA
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences and Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032 USA
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9 W Palisades, New York, 10964 NY USA
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St, New York, NY 10032 USA.,Department of Environmental Health Sciences and Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, 722 W. 168 St, New York, NY 10032 USA.,Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St, New York, NY 10032 USA
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Jung KH, Lovinsky-Desir S, Yan B, Torrone D, Lawrence J, Jezioro JR, Perzanowski M, Perera FP, Chillrud SN, Miller RL. Effect of personal exposure to black carbon on changes in allergic asthma gene methylation measured 5 days later in urban children: importance of allergic sensitization. Clin Epigenetics 2017; 9:61. [PMID: 28588744 PMCID: PMC5457544 DOI: 10.1186/s13148-017-0361-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/25/2017] [Indexed: 01/02/2023] Open
Abstract
Background Asthma gene DNA methylation may underlie the effects of air pollution on airway inflammation. However, the temporality and individual susceptibility to environmental epigenetic regulation of asthma has not been fully elucidated. Our objective was to determine the timeline of black carbon (BC) exposure, measured by personal sampling, on DNA methylation of allergic asthma genes 5 days later to capture usual weather variations and differences related to changes in behavior and activities. We also sought to determine how methylation may vary by seroatopy and cockroach sensitization and by elevated fractional exhaled nitric oxide (FeNO). Methods Personal BC levels were measured during two 24-h periods over a 6-day sampling period in 163 New York City children (age 9–14 years), repeated 6 months later. During home visits, buccal cells were collected as noninvasive surrogates for lower airway epithelial cells and FeNO measured as an indicator of airway inflammation. CpG promoter loci of allergic asthma genes (e.g., interleukin 4 (IL4), interferon gamma (IFNγ), inducible nitric oxide synthase (NOS2A)), arginase 2 (ARG2)) were pyrosequenced at the start and end of each sampling period. Results Higher levels of BC were associated with lower methylation of IL4 promoter CpG−48 5 days later. The magnitude of association between BC exposure and demethylation of IL4 CpG−48 and NOS2A CpG+5099 measured 5 days later appeared to be greater among seroatopic children, especially those sensitized to cockroach allergens (RR [95% CI] 0.55 [0.37–0.82] and 0.67 [0.45–0.98] for IL4 CpG−48 and NOS2A CpG+5099, respectively), compared to non-sensitized children (RR [95% CI] 0.87 [0.65–1.17] and 0.95 [0.69–1.33] for IL4 CpG−48 and NOS2A CpG+5099, respectively); however, the difference was not statistically different. In multivariable linear regression models, lower DNA methylation of IL4 CpG−48 and NOS2A CpG+5099 were associated with increased FeNO. Conclusions Our results suggest that exposure to BC may exert asthma proinflammatory gene demethylation 5 days later that in turn may link to airway inflammation. Our results further suggest that seroatopic children, especially those sensitized to cockroach allergens, may be more susceptible to the effect of acute BC exposure on epigenetic changes. Electronic supplementary material The online version of this article (doi:10.1186/s13148-017-0361-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, PH8E-101, 630 W. 168 St., New York, NY 10032 USA
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 630 W. 168 St., New York, NY 10032 USA
| | - Beizhan Yan
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9 W Palisades, New York, 10964 USA
| | - David Torrone
- Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, PH8E-101, 630 W. 168 St., New York, NY 10032 USA
| | - Jennifer Lawrence
- Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, PH8E-101, 630 W. 168 St., New York, NY 10032 USA
| | - Jacqueline R Jezioro
- Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, PH8E-101, 630 W. 168 St., New York, NY 10032 USA
| | - Matthew Perzanowski
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722 W. 168 St., New York, NY 10032 USA
| | - Frederica P Perera
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722 W. 168 St., New York, NY 10032 USA
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9 W Palisades, New York, 10964 USA
| | - Rachel L Miller
- Division of Pulmonary, Allergy, Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, PH8E-101, 630 W. 168 St., New York, NY 10032 USA.,Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722 W. 168 St., New York, NY 10032 USA.,Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY 10032 USA
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Jung KH, Torrone D, Lovinsky-Desir S, Perzanowski M, Bautista J, Jezioro JR, Hoepner L, Ross J, Perera FP, Chillrud SN, Miller RL. Short-term exposure to PM 2.5 and vanadium and changes in asthma gene DNA methylation and lung function decrements among urban children. Respir Res 2017; 18:63. [PMID: 28424066 PMCID: PMC5397738 DOI: 10.1186/s12931-017-0550-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/11/2017] [Indexed: 12/24/2022] Open
Abstract
Background Both short and long-term exposure to traffic-related air pollutants have been associated with asthma and reduced lung function. We hypothesized that short-term indoor exposure to fine particulate matter <2.5 μm (PM2.5) and vanadium (V) would be associated with altered buccal cell DNA methylation of targeted asthma genes and decreased lung function among urban children in a nested subcohort of African American and Dominican children. Methods Six day integrated levels of air pollutants were measured from children’s homes (age 9–14; n = 163), repeated 6 months later (n = 98). Buccal samples were collected repeatedly during visits. CpG promoter loci of asthma genes (i.e., interleukin 4 (IL4), interferon gamma (IFNγ), inducible nitric oxide synthase (NOS2A), arginase 2 (ARG2)) were pyrosequenced and lung function was assessed. Results Exposure to V, but not PM2.5, was associated with lower DNA methylation of IL4 and IFNγ. In exploratory analyses, V levels were associated with lower methylation of the proinflammatory NOS2A-CpG+5099 among asthmatic overweight or obese children but not nonasthmatics. Short-term exposure to PM2.5, but not V, appeared associated with lower lung function (i.e., reduced z-scores for forced expiratory volume in one second (FEV1, FEV1/ forced vital capacity [FEV1/FVC] and forced expiratory flow at 25–75% of FVC [FEF25–75]). Conclusions Exposure to V was associated with altered DNA methylation of allergic and proinflammatory asthma genes implicated in air pollution related asthma. However, short-term exposure to PM2.5, but not V, appeared associated with decrements in lung function among urban children. Electronic supplementary material The online version of this article (doi:10.1186/s12931-017-0550-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY, 10032, USA.
| | - David Torrone
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY, 10032, USA
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 630 W. 168 St., New York, NY, 10032, USA
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY, 10032, USA
| | - Joshua Bautista
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY, 10032, USA
| | - Jacqueline R Jezioro
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY, 10032, USA
| | - Lori Hoepner
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY, 10032, USA
| | - Jamie Ross
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9 W Palisades, New York, 10964, USA
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY, 10032, USA
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9 W Palisades, New York, 10964, USA
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY, 10032, USA.,Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St., New York, NY, 10032, USA.,Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY, 10032, USA
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Lovinsky-Desir S, Jung KH, Rundle AG, Hoepner LA, Bautista JB, Perera FP, Chillrud SN, Perzanowski MS, Miller RL. Physical activity, black carbon exposure and airway inflammation in an urban adolescent cohort. Environ Res 2016; 151:756-762. [PMID: 27694044 PMCID: PMC5081133 DOI: 10.1016/j.envres.2016.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/07/2016] [Accepted: 09/08/2016] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Regular physical activity can improve cardiopulmonary health; however, increased respiratory rates and tidal volumes during activity may increase the effective internal dose of air pollution exposure. Our objective was to investigate the impact of black carbon (BC) measured by personal sampler on the relationship between physical activity and fractional exhaled nitric oxide (FeNO), a marker of airway inflammation. We hypothesized that higher personal BC would attenuate the protective effect of physical activity on airway inflammation. METHODS We performed a cross-sectional study nested in a birth cohort of African American and Dominican children living in the Bronx and Northern Manhattan, New York City. Children were recruited based on age (target 9-14 year olds) and presence (n=70) or absence (n=59) of current asthma. Children wore wrist mounted accelerometers for 6 days and were classified as 'active' if they had ≥60min of moderate-to-vigorous activity (MVA) each day and 'non-active' if they had <60min of MVA on any given day, based on CDC guidelines. Personal BC measured using a MicroAeth, was assessed during two 24-h periods, at the beginning and end of physical activity assessment. High BC was defined as the upper tertile of BC measured with personal sampler. FeNO measurements were sampled at the beginning and end of the of physical activity assessment. RESULTS In multivariable linear regression models, 'active' children had 25% higher personal BC concentrations (p=0.02) and 20% lower FeNO (p=0.04) compared to 'non-active' children. Among children with high personal BC (n=33), there was no relationship between activity and FeNO (p=1.00). The significant protective relationship between activity and airway inflammation was largely driven by children with lower personal BC (n=96, p=0.04). CONCLUSIONS Children that live in an urban environment and are physically active on a daily basis have higher personal exposure to BC. High BC offsets the protective relationship between physical activity and airway inflammation.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway CHC-745, New York, NY 10032, United States.
| | - Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168S., New York, NY 10032, United States
| | - Andrew G Rundle
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W. 168S., New York, NY 10032, United States
| | - Lori A Hoepner
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168S., New York, NY 10032, United States; Department of Environmental and Occupational Health Sciences, State University of New York, Downstate School of Public Health, Box 43, 450 Clarkson Avenue, Brooklyn, NY 11203, United States
| | - Joshua B Bautista
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168S., New York, NY 10032, United States
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168S., New York, NY 10032, United States
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9W Palisades, New York 10964, United States
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168S., New York, NY 10032, United States
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168S., New York, NY 10032, United States; Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168S., New York, NY 10032, United States; Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY 10032, United States
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Lovinsky-Desir S, Miller RL, Bautista J, Gil EN, Chillrud SN, Yan B, Camann D, Perera FP, Jung KH. Differences in Ambient Polycyclic Aromatic Hydrocarbon Concentrations between Streets and Alleys in New York City: Open Space vs. Semi-Closed Space. Int J Environ Res Public Health 2016; 13:ijerph13010127. [PMID: 26771626 PMCID: PMC4730518 DOI: 10.3390/ijerph13010127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 12/16/2015] [Accepted: 12/22/2015] [Indexed: 11/28/2022]
Abstract
Background: Outdoor ambient polycyclic aromatic hydrocarbon (PAH) concentrations are variable throughout an urban environment. However, little is known about how variation in semivolatile and nonvolatile PAHs related to the built environment (open space vs. semi-closed space) contributes to differences in concentrations. Methods: We simultaneously collected 14, two-week samples of PAHs from the outside of windows facing the front (adjacent to the street) open side of a New York City apartment building and the alley, semi-closed side of the same apartment unit between 2007 and 2012. We also analyzed samples of PAHs measured from 35 homes across Northern Manhattan and the Bronx, 17 from street facing windows with a median floor level of 4 (range 2–26) and 18 from alley-facing windows with a median floor level of 4 (range 1–15). Results: Levels of nonvolatile ambient PAHs were significantly higher when measured from a window adjacent to a street (an open space), compared to a window 30 feet away, adjacent to an alley (a semi-closed space) (street geometric mean (GM) 1.32 ng/m3, arithmetic mean ± standard deviation (AM ± SD) 1.61 ± 1.04 ng/m3; alley GM 1.10 ng/m3, AM ± SD 1.37 ± 0.94 ng/m3). In the neighborhood-wide comparison, nonvolatile PAHs were also significantly higher when measured adjacent to streets compared with adjacent to alley sides of apartment buildings (street GM 1.10 ng/m3, AM ± SD 1.46 ± 1.24 ng/m3; alley GM 0.61 ng/m3, AM ± SD 0.81 ± 0.80 ng/m3), but not semivolatile PAHs. Conclusions: Ambient PAHs, nonvolatile PAHs in particular, are significantly higher when measured from a window adjacent to a street compared to a window adjacent to an alley, despite both locations being relatively close to street traffic. This study highlights small-scale spatial variations in ambient PAH concentrations that may be related to the built environment (open space vs. semi-closed space) from which the samples are measured, as well as the relative distance from street traffic, that could impact accurate personal exposure assessments.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway, CHC 7-724, New York, NY 10032, USA.
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY 10032, USA.
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St. New York, NY 10032, USA.
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St. New York, NY 10032, USA.
| | - Joshua Bautista
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY 10032, USA.
| | - Eric N Gil
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY 10032, USA.
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt., 9W Palisades, New York, NY 10964, USA.
| | - Beizhan Yan
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt., 9W Palisades, New York, NY 10964, USA.
| | - David Camann
- Chemistry and Chemical Engineering Division, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78228, USA.
| | - Frederica P Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168 St. New York, NY 10032, USA.
| | - Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 St., New York, NY 10032, USA.
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Jung KH, Lovinsky-Desir S, Perzanowski M, Liu X, Maher C, Gil E, Torrone D, Sjodin A, Li Z, Perera FP, Miller RL. Repeatedly high polycyclic aromatic hydrocarbon exposure and cockroach sensitization among inner-city children. Environ Res 2015; 140:649-56. [PMID: 26073203 PMCID: PMC4492866 DOI: 10.1016/j.envres.2015.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/20/2015] [Accepted: 05/29/2015] [Indexed: 05/06/2023]
Abstract
BACKGROUND Exposures to traffic-related air pollutants including polycyclic aromatic hydrocarbons (PAH) have been associated with the development and exacerbation of asthma. However, there is limited evidence on whether these pollutants are associated with the development of cockroach sensitization, a strong risk factor for urban asthma. We hypothesized that repeatedly high PAH exposure during childhood would be associated with increased risk of new cockroach sensitization. METHODS As part of the research being conducted by the Columbia Center for Children's Environmental Health (CCCEH) birth cohort study in New York, a spot urine sample was collected from children at age 5 years (2003-2008) and again at age 9-10 years (2008-2012; n=248) and analyzed for 10 PAH metabolites. Repeatedly high PAH (High-High) exposure was defined as measures above median for age 5 PAH metabolites at both time points. Child blood samples at age 5 and 9 years were analyzed for total, anti-cockroach, mouse, dust mite, cat and dog IgE. Relative risks (RR) were estimated with multivariable modified Poisson regression. RESULTS Individual PAH metabolite levels, except for 1-naphthol (1-OH-NAP), increased by 10-60% from age 5 to age 9-10. The prevalence of cockroach sensitization increased from 17.6% (33/188) at age 5 to 33.0% (62/188) at 9 years (p=0.001). After controlling for potential covariates including cockroach sensitization at age 5 in regression analyses, positive associations were found between repeatedly high exposure (High-High) to 1-OH-NAP, 3-hydroxyphenanthrene (3-OH-PHEN), or 1-hydroxypyrene (1-OH-PYR) and cockroach sensitization at age 9 (p-values<0.05). Compared to Low-Low exposure, the relative risk (RR) [95% CI] with repeatedly high exposure was 1.83 [1.06-3.17] for 1-OH-NAP, 1.54 [1.06-2.23] for 3-OH-PHEN, and 1.59 [1.04-2.43] for 1-OH-PYR. CONCLUSIONS Repeatedly high levels of urinary PAH metabolites during childhood may increase likelihood of sensitization to cockroach allergen in urban inner-city children at age 9 years.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 Street, New York, NY 10032, United States.
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway, CHC 7-745, New York, NY 10032, United States.
| | - Matthew Perzanowski
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722 W. 168 Street, New York, NY 10032, United States.
| | - Xinhua Liu
- Mailman School of Public Health, Department of Biostatistics, Columbia University, 722W. 168 Street, New York, NY 10032, United States.
| | - Christina Maher
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 Street, New York, NY 10032, United States.
| | - Eric Gil
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 Street, New York, NY 10032, United States.
| | - David Torrone
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 Street, New York, NY 10032, United States.
| | - Andreas Sjodin
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Organic Analytical Toxicology Branch, Atlanta, GA, United States.
| | - Zheng Li
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Organic Analytical Toxicology Branch, Atlanta, GA, United States.
| | - Frederica P Perera
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722 W. 168 Street, New York, NY 10032, United States.
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 Street, New York, NY 10032, United States; Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722 W. 168 Street, New York, NY 10032, United States; Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, PH8E-101, 630 W. 168 Street, New York, NY 10032, United States.
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Miller EH, Zhang H, De Planell Saguer M, Lovinsky-Desir S, Perzanowski MS, Phipatanakul W, Matsui EC, Miller R. IFNγ and Foxp3 Methylation, Expression in Buccal Mucosa in Inner-City Children with Allergic Asthma. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jung KH, Liu B, Lovinsky-Desir S, Yan B, Camann D, Sjodin A, Li Z, Perera F, Kinney P, Chillrud S, Miller RL. Time trends of polycyclic aromatic hydrocarbon exposure in New York City from 2001 to 2012: assessed by repeat air and urine samples. Environ Res 2014; 131:95-103. [PMID: 24709094 PMCID: PMC4031101 DOI: 10.1016/j.envres.2014.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 05/17/2023]
Abstract
BACKGROUND Exposure to air pollutants including polycyclic aromatic hydrocarbons (PAH), and specifically pyrene from combustion of fuel oil, coal, traffic and indoor sources, has been associated with adverse respiratory health outcomes. However, time trends of airborne PAH and metabolite levels detected via repeat measures over time have not yet been characterized. We hypothesized that PAH levels, measured repeatedly from residential indoor and outdoor monitors, and children׳s urinary concentrations of PAH metabolites, would decrease following policy interventions to reduce traffic-related air pollution. METHODS Indoor PAH (particle- and gas-phase) were collected for two weeks prenatally (n=98), at age 5/6 years (n=397) and age 9/10 years (n=198) since 2001 and at all three age-points (n=27). Other traffic-related air pollutants (black carbon and PM2.5) were monitored indoors simultaneous with PAH monitoring at ages 5/6 (n=403) and 9/10 (n=257) between 2005 and 2012. One third of the homes were selected across seasons for outdoor PAH, BC and PM2.5 sampling. Using the same sampling method, ambient PAH, BC and PM2.5 also were monitored every two weeks at a central site between 2007 and 2012. PAH were analyzed as semivolatile PAH (e.g., pyrene; MW 178-206) (∑8PAH(semivolatile): Including pyrene (PYR), phenanthrene (PHEN), 1-methylphenanthrene (1-MEPH), 2-methylphenanthrene (2-MEPH), 3-methylphenanthrene (3-MEPH), 9-methylphenanthrene (9-MEPH), 1,7-dimethylphenanthrene (1,7-DMEPH), and 3,6-dimethylphenanthrene (3,6-DMEPH)) and the sum of eight nonvolatile PAH (∑8PAH(nonvolatile): Including benzo[a]anthracene (BaA), chrysene/iso-chrysene (Chry), benzo[b]fluoranthene (BbFA), benzo[k]fluoranthene (BkFA), benzo[a]pyrene (BaP), indeno[1,2,3-c,d]pyrene (IP), dibenzo[a,h]anthracene (DahA), and benzo[g,h,i]perylene (BghiP); MW 228-278). A spot urine sample was collected from children at child ages 3, 5, 7 and 9 between 2001 and 2012 and analyzed for 10 PAH metabolites. RESULTS Modest declines were detected in indoor BC and PM2.5 levels between 2005 and 2012 (Annual percent change [APC]=-2.08% [p=0.010] and -2.18% [p=0.059] for BC and PM2.5, respectively), while a trend of increasing pyrene levels was observed in indoor and outdoor samples, and at the central site during the comparable time periods (APC=4.81%, 3.77% and 7.90%, respectively; p<0.05 for all). No significant time trend was observed in indoor ∑8PAH(nonvolatile) levels between 2005 and 2012; however, significant opposite trends were detected when analyzed seasonally (APC=-8.06% [p<0.01], 3.87% [p<0.05] for nonheating and heating season, respectively). Similarly, heating season also affected the annual trends (2005-2012) of other air pollutants: the decreasing BC trend (in indoor/outdoor air) was observed only in the nonheating season, consistent with dominating traffic sources that decreased with time; the increasing pyrene trend was more apparent in the heating season. Outdoor PM2.5 levels persistently decreased over time across the seasons. With the analyses of data collected over a longer period of time (2001-2012), a decreasing trend was observed in pyrene (APC=-2.76%; p<0.01), mostly driven by measures from the nonheating season (APC=-3.54%; p<0.01). In contrast, levels of pyrene and naphthalene metabolites, 1-hydroxypyrene and 2-naphthol, increased from 2001 to 2012 (APC=6.29% and 7.90% for 1-hydroxypyrene and 2-naphthol, respectively; p<0.01 for both). CONCLUSIONS Multiple NYC legislative regulations targeting traffic-related air pollution may have led to decreases in ∑8PAH(nonvolatile) and BC, especially in the nonheating season. Despite the overall decrease in pyrene over the 2001-2012 periods, a rise in pyrene levels in recent years (2005-2012), that was particularly evident for measures collected during the heating season, and 2-naphthol, indicates the contribution of heating oil combustion and other indoor sources to airborne pyrene and urinary 2-naphthol.
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Affiliation(s)
- Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630W. 168 Street, New York, NY 10032, United States
| | - Bian Liu
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630W. 168 Street, New York, NY 10032, United States
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, 3959 Broadway, CHC 7-745, New York, NY 10032, United States
| | - Beizhan Yan
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9W Palisades, NY 10964, United States
| | - David Camann
- Chemistry and Chemical Engineering Division, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78228, United States
| | - Andreas Sjodin
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Organic Analytical Toxicology Branch, Atlanta, GA, United States
| | - Zheng Li
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Organic Analytical Toxicology Branch, Atlanta, GA, United States
| | - Frederica Perera
- Columbia Center for Children׳s Environmental Health, Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722W. 168 Street, New York, NY 10032, United States
| | - Patrick Kinney
- Columbia Center for Children׳s Environmental Health, Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722W. 168 Street, New York, NY 10032, United States
| | - Steven Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, 61 Rt, 9W Palisades, NY 10964, United States
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, PH8E-101, 630W. 168 Street, New York, NY 10032, United States; Columbia Center for Children׳s Environmental Health, Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, 722W. 168 Street, New York, NY 10032, United States; Division of Pediatric Allergy and Immunology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, PH8E-101, 630W. 168 Street, New York, NY 10032, United States.
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de Planell-Saguer M, Lovinsky-Desir S, Miller RL. Epigenetic regulation: the interface between prenatal and early-life exposure and asthma susceptibility. Environ Mol Mutagen 2014; 55:231-43. [PMID: 24323745 PMCID: PMC4148423 DOI: 10.1002/em.21836] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 11/18/2013] [Accepted: 11/20/2013] [Indexed: 05/10/2023]
Abstract
Asthma is a complex disease with genetic and environmental influences and emerging evidence suggests that epigenetic regulation is also a major contributor. Here, we focus on the developing paradigm that epigenetic dysregulation in asthma and allergy may start as early as in utero following several environmental exposures. We summarize the pathways important to the allergic immune response that are epigenetically regulated, the key environmental exposures associated with epigenetic changes in asthma genes, and newly identified epigenetic biomarkers that have been linked to clinical asthma. We conclude with a brief discussion about the potential to apply newly developing technologies in epigenetics to the diagnosis and treatment of asthma and allergy. The inherent plasticity of epigenetic regulation following environmental exposures offers opportunities for prevention using environmental remediation, measuring novel biomarkers for early identification of those at risk, and applying advances in pharmaco-epigenetics to tailor medical therapies that maximize efficacy of treatment. 'Precision Medicine' in asthma and allergy is arriving. As the field advances this may involve an individually tailored approach to the prevention, early detection, and treatment of disease based on the knowledge of an individual's epigenetic profile.
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Affiliation(s)
- Mariangels de Planell-Saguer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Rachel L. Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Columbia University, College of Physicians and Surgeons, New York, New York
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, College of Physicians and Surgeons, New York, New York
- Correspondence to: Rachel L. Miller, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, PH8E-101B; 630 West 168th Street, New York, NY 10032, USA.
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Lovinsky-Desir S, Folch C, Jung KH, Torrone D, Gil E, Perera F, Miller RL, Chillrud SN. Urban adolescents readily comply with a complicated asthma research protocol. Clin Med Insights Circ Respir Pulm Med 2014; 8:5-9. [PMID: 24683308 PMCID: PMC3966723 DOI: 10.4137/ccrpm.s13930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/29/2014] [Accepted: 02/04/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Adolescents are often cited as having poor rates of compliance with medical regimens and research protocols. We quantified compliance in a cohort of urban adolescents participating in a complex research protocol in which measures were obtained without direct supervision by research personnel. METHODS A total of 54 early adolescents ages 10–13 were asked to wear a vest containing a personal air pollutant exposure monitor for two 24-hour periods and to perform daily peak expiratory flow (PEF) for six consecutive days. Compliance with wearing the vest was measured by comparing accelerometer data from a device within the vest to one worn continuously on the child’s wrist. Daily PEF data were recorded using an electronic meter. RESULTS A priori definition of compliance was met by 85% of the adolescents by wearing the exposure monitoring vest and 72% by performing PEF. CONCLUSIONS These findings suggest that early adolescents can be compliant with complex research protocols that are needed to help bridge gaps in pediatric asthma research.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Candace Folch
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kyung Hwa Jung
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - David Torrone
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Eric Gil
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Frederica Perera
- Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, NY, USA
| | - Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care of Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University, New York, NY, USA ; Division of Pediatric Allergy and Immunology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Steven N Chillrud
- Lamont-Doherty Earth Observatory, Columbia University, Palisades, NY, USA
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Abstract
Environmental epigenetic regulation in asthma and allergic disease is an exciting area that has gained a great deal of scientific momentum in recent years. Environmental exposures, including prenatal maternal smoking, have been associated with asthma-related outcomes that may be explained by epigenetic regulation. In addition, several known allergy and asthma genes have been found to be susceptible to epigenetic regulation. We review the latest experimental and translational studies that have been published this past year in several areas, including 1) characterization of environmental asthma triggers that induce epigenetic changes, 2) characterization of allergic immune and regulatory pathways important to asthma that undergo epigenetic regulation, 3) evidence of active epigenetic regulation in asthma experimental models and the production of asthma biomarkers, 4) evidence of transmission of an asthma-related phenotype across multiple generations, and 5) "pharmaco-epigenetics." The field has certainly advanced significantly in the past year.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonary, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Rachel L. Miller
- Columbia University College of Physicians and Surgeons, PH8E-101; 630 West 168th Street, New York, NY, 10032 USA
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