The European Community Respiratory Health Survey: what are the main results so far? European Community Respiratory Health Survey II

The role of C-reactive protein levels on the association of physical activity with lung function in adults

Objective

Regular physical activity may be associated with improved lung function via reduced systemic inflammation, although studies exploring this mechanism are rare. We evaluated the role of C-reactive protein in blood, which is a common marker of systemic inflammation, on the association of physical activity with forced expiratory volume in one second and forced vital capacity.

Methods

Cross-sectional data on spirometry, C-reactive protein levels and self-reported physical activity (yes/no; ≥2 times and ≥1hr per week of vigorous physical activity) were available in the European Community Respiratory Health Survey (N = 2347 adults, 49.3% male, 28–56 years-old). A subsample was also assessed 10 years later using the International Physical Activity Questionnaire, and tertiles of Metabolic Equivalent of Task—minutes per week spent in vigorous, moderate and walking activities were calculated (N = 671, 49.6% male, 40–67 years-old). Adjusted cross-sectional mixed linear regression models and the “mediate” package in “R” were used to assess the presence of mediation.

Results

Despite positive significant associations between nearly all physical activity metrics with forced expiratory volume in one second and forced vital capacity, there was no evidence that C-reactive protein levels played a role. An influence of C-reactive protein levels was only apparent in the smaller subsample when comparing the medium to low tertiles of moderate activity (mean difference [95% CIs]: 21.1ml [5.2, 41.9] for forced expiratory volume in one second and 17.3ml [2.6, 38.0] for forced vital capacity).

Conclusions

In a population of adults, we found no consistent evidence that the association of physical activity with forced expiratory volume in one second or forced vital capacity is influenced by the level of C-reactive protein in blood.

Asthma, allergic rhinitis and eczema among parents of preschool children in relation to climate, and dampness and mold in dwellings in China

The main aim was to study associations between asthma, allergic rhinitis and eczema among adults across China and dampness and mold at home. Young adults (N = 40,279) in eight cities in China answered a questionnaire in 2010-2012 (response rate 75.0%). Data on asthma, allergic rhinitis, eczema and the home environment was assessed by the questionnaire. Climate data was obtained from China Meteorological Administration and the website of Weather Underground. Health associations were analyzed by two-level logistic regression models, adjusting for covariates. Totally 1.6% had asthma, 6.6% allergic rhinitis and 2.2% eczema. Mold odor was associated with asthma (OR = 1.90) and allergic rhinitis (OR = 1.25-1.44). Window pane condensation in winter was associated with asthma (OR = 1.39), allergic rhinitis (OR = 1.26-1.58) and eczema (OR = 1.36-1.77). Presence of mold spots or damp stains was related to asthma (OR = 1.58-2.49), allergic rhinitis (OR = 1.35-1.76) and eczema (OR = 1.47-1.70). Water damage was related to asthma (OR = 1.69-1.82), allergic rhinitis (OR = 1.40-1.45) and eczema (OR = 1.44-1.96). Damp bed clothing was related to asthma (OR = 1.23), allergic rhinitis (OR = 1.23) and eczema (OR = 1.35). A higher dampness score was associated with increased odds ratios for diseases. Those living in older buildings had more asthma (OR = 1.39-1.76) and allergic rhinitis (OR = 1.16-1.21). Those living in suburban or rural areas had less asthma, allergic rhinitis and eczema as compared to those living in urban areas (OR values from 0.24 to 0.66). Stronger health associations with dampness and mold were found in southern China and in newer buildings (constructed after 2005). In conclusion, dampness and mold at home can be risk factors for asthma, allergic rhinitis and eczema among adults in China. Living in older buildings can be risk factors for asthma or allergic rhinitis while living in less urbanized areas can be protective.

The Multifaceted S100A4 Protein in Cancer and Inflammation

The metastasis-promoting S100A4 protein, a member of the S100 family, has recently been discovered as a potent factor implicated in various inflammation-associated diseases. S100A4 is involved in a range of biological functions such as angiogenesis, cell differentiation, apoptosis, motility, and invasion. Moreover, S100A4 is also a potent trigger of inflammatory processes and induces the release of cytokines and growth factors under different pathological conditions.Indeed, the release of S100A4 upon stress and mainly its pro-inflammatory role emerges as the most decisive activity in disease development, such as rheumatoid arthritis (RA), systemic sclerosis (SSc) allergy, psoriasis, and cancer. In the scope of this review, we will focus on the role of S100A4 as a mediator of pro-inflammatory pathways and its associated biological processes involved in the pathogenesis of various human noncommunicable diseases (NCDs) including cancer.

FeNO level and allergy status among school children in Terengganu, Malaysia

Background: Almost one third of the world population suffers from allergic conditions. Respiratory symptoms are common in Malaysian children but there are few studies on fractional exhaled nitric oxide (FeNO), inclusive of field clinical test for asthma among children in Malaysia. The aim was to provide insight on factors related to level of FeNO among students in Terengganu, Malaysia.Methods: In total, 487 randomly selected students from eight secondary schools participated (13-14 years old). A Standardized questionnaire was used to obtained information on doctors' diagnosed asthma, current asthma and respiratory symptoms. FeNO measurement and skin prick test (SPT to common allergen) were conducted.Results: The geometric mean FeNO was 16.7 ppb. Totally, 38.4% of students had elevated FeNO level (>20 ppb) and 40.3% had had positive SPT to house dust mites allergens (HDM), Dermatophagoides pteronyssinus (Der p 1), Dermatophagoides farinae (Der f 1) or Felis domisticus (cat). Male gender, height, parental history of allergy, self-reported allergy, and atopy were associated with FeNO. In particular, a combination of sensitization to HDM or cat and elevated FeNO were associated with doctor-diagnosed asthma and self-reported allergy to food, pollen and cat.Conclusion: Asthma, respiratory symptoms and sensitization to HDM and cat are common among students and presence of elevated FeNO levels indicate ongoing airway inflammation.

Determinants of fractional exhaled nitric oxide in healthy men and women from the European Community Respiratory Health Survey III

INTRODUCTION

The fractional exhaled nitric oxide (F_E NO) is a marker for type 2 inflammation used in diagnostics and management of asthma. In order to use F_E NO as a reliable biomarker, it is important to investigate factors that influence F_E NO in healthy individuals. Men have higher levels of F_E NO than women, but it is unclear whether determinants of F_E NO differ by sex.

OBJECTIVE

To identify determinants of F_E NO in men and women without lung diseases.

METHOD

Fractional exhaled nitric oxide was validly measured in 3881 healthy subjects that had answered the main questionnaire of the European Community Respiratory Health Survey III without airways or lung disease.

RESULTS

Exhaled NO levels were 21.3% higher in men compared with women P < 0.001. Being in the upper age quartile (60.3-67.6 years), men had 19.2 ppb (95% CI: 18.3, 20.2) higher F_E NO than subjects in the lowest age quartile (39.7-48.3 years) P = 0.02. Women in the two highest age quartiles (54.6-60.2 and 60.3-67.6 years) had 15.4 ppb (14.7, 16.2), P = 0.03 and 16.4 ppb (15.6, 17.1), P = <0.001 higher F_E NO, compared with the lowest age quartile. Height was related to 8% higher F_E NO level in men (P < 0.001) and 5% higher F_E NO levels in women (P = 0.008). Men who smoked had 37% lower F_E NO levels and women had 30% lower levels compared with never-smokers (P < 0.001 for both). Men and women sensitized to both grass and perennial allergens had higher F_E NO levels compared with non-sensitized subjects 26% and 29%, P < 0.001 for both.

CONCLUSION AND CLINICAL RELEVANCE

Fractional exhaled nitric oxide levels were higher in men than women. Similar effects of current smoking, height, and IgE sensitization were found in both sexes. F_E NO started increasing at lower age in women than in men, suggesting that interpretation of F_E NO levels in adults aged over 50 years should take into account age and sex.

Changing prevalence of current asthma and inhaled corticosteroid treatment in the UK: population-based cohort 2006-2016

Asthma is the most common respiratory disorder in the UK, yet we have incomplete knowledge on the prevalence of current disease, treatment and exacerbations.We used UK electronic healthcare records, 2006-2016, to estimate the prevalence of current asthma by year, sex and age (<5, 5-11, 12-17, 18-24, 25-54 and ≥55 years), and the proportion prescribed inhaled corticosteroids (ICS) and additional asthma therapy, treated for exacerbations and other asthma care markers.Overall current asthma prevalence was 6.5% in 2016 (7.2% in 2006). Prevalence fell in those aged <45 years. The lowest prevalence and largest absolute decrease was in children aged <5 years. In 2016, 80% of current asthma patients were managed on ICS (65% in 2006); this increase occurred in all age groups, primarily due to an increase in low-dose ICS. During this time there was an increase in all age groups in the proportion prescribed additional asthma therapy, treated for an exacerbation within primary care and given an annual asthma review or management plan. Hospitalised exacerbations showed minimal change over time.Asthma remains highly prevalent and a significant healthcare burden. In those with a diagnosis, there was an increase in ICS prescriptions and treatment of exacerbations across all age groups. This may reflect a trend towards more aggressive asthma management within primary care. An apparent decline in prevalence was observed in those aged <45 years, particularly in children aged <5 years.

Onset of respiratory symptoms among Chinese students: associations with dampness and redecoration, PM10, NO2, SO2 and inadequate ventilation in the school

Objective: To study onset of respiratory symptoms among students in China in relation to the school and the home environment. Methods: A two-year prospective cohort study among 1325 students in eight schools. Air pollution was measured at baseline in the schools. Respiratory symptoms and the home environment were assessed by a questionnaire. Results: The 2-year onset was 14.3%, 23.2%, 15.4%, 4.7% and 37.3% for wheeze, daytime attacks of breathlessness, nocturnal cough, nocturnal wheeze/breathlessness and respiratory infections, respectively. The mean concentrations of PM₁₀, SO₂, NO_2, ozone and CO₂ in the classrooms were 129 µg/m³, 68.0 µg/m³, 43.2 µg/m³, 8.6 µg/m³ and 1208 ppm, respectively. Environmental tobacco smoke (ETS), dampness/mold at home and ozone in the classroom were associated with onset of wheeze. Onset of daytime breathlessness was associated with redecoration and dampness/mold at home and CO₂ and relative air humidity (RH) in the classrooms. Dampness/mold at home, PM₁₀, CO₂ and RH in the classrooms and outdoor PM₁₀, SO₂ and NO₂ were associated with onset of nocturnal cough. Onset of nocturnal wheeze/breathlessness was associated with dampness/mold at home and RH and PM₁₀ in the classrooms. Respiratory infections were more common at higher levels of outdoor PM₁₀. Conclusions: Air pollution (PM₁₀, ozone, SO₂ and NO₂) and inadequate ventilation flow in the classrooms (indicated by CO₂ > 1000 ppm) and ETS, dampness or mold and chemical emissions from redecoration at home can increase onset of respiratory symptoms.

Pharmacological treatment of asthma in a cohort of adults during a 20-year period: results from the European Community Respiratory Health Survey I, II and III

Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment.

Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries.

The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis.

Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma.

Despite increased ICS use, only 34% of subjects with persistent asthma take ICSs on a regular basis; <50% have seen a doctor in the last year. Underuse of ICSs and lack of regular healthcare contacts remains a problem in asthma.http://ow.ly/GUZ630mZkVN

Residential air pollution does not modify the positive association between physical activity and lung function in current smokers in the ECRHS study

BACKGROUND

Very few studies have examined whether a long-term beneficial effect of physical activity on lung function can be influenced by living in polluted urban areas.

OBJECTIVE

We assessed whether annual average residential concentrations of nitrogen dioxide (NO₂) and particulate matter with aerodynamic diameters < 2.5 μm (PM_2.5) and <10 μm (PM₁₀) modify the effect of physical activity on lung function among never- (N = 2801) and current (N = 1719) smokers in the multi-center European Community Respiratory Health Survey.

METHODS

Associations between repeated assessments (at 27-57 and 39-67 years) of being physically active (physical activity: ≥2 times and ≥1 h per week) and forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC) were evaluated using adjusted mixed linear regression models. Models were conducted separately for never- and current smokers and stratified by residential long-term NO₂, PM_2.5 mass and PM₁₀ mass concentrations (≤75th percentile (low/medium) versus >75th percentile (high)).

RESULTS

Among current smokers, physical activity and lung function were positively associated regardless of air pollution levels. Among never-smokers, physical activity was associated with lung function in areas with low/medium NO₂, PM_2.5 mass and PM₁₀ mass concentrations (e.g. mean difference in FVC between active and non-active subjects was 43.0 mL (13.6, 72.5), 49.5 mL (20.1, 78.8) and 49.7 mL (18.6, 80.7), respectively), but these associations were attenuated in high air pollution areas. Only the interaction term of physical activity and PM₁₀ mass for FEV₁ among never-smokers was significant (p-value = 0.03).

CONCLUSIONS

Physical activity has beneficial effects on adult lung function in current smokers, irrespective of residential air pollution levels in Western Europe. Trends among never-smokers living in high air pollution areas are less clear.

Impact of Operational Definitions on the Predictors and Prevalence of Asthma Estimates: Experience from a University Students' Survey and Implications for Interpretation of Disease Burden

BACKGROUND

Inconsistent operational definitions during asthma surveillance can lead to inaccurate estimation of disease burden and formulation of health policy. This study aimed to evaluate the impact of different definitions on the prevalence estimates and predictors of asthma among university students in Ilorin, Nigeria. The secondary aim was to compare level of agreement of the different definitions.

METHODS

This cross-sectional study was carried out from June to August 2015. The European Community Respiratory Health Survey (ECRHS) questionnaire was self-administered by 1485 students. Asthma diagnosis was based on five definitions used in previous studies in the country. These were ECRHS, International Study of Asthma, Allergies in Childhood (ISAAC), Probable, Modified ECRHS and Modified Probable asthma definitions.

RESULTS

The prevalence rates varied from 10.4 to 24.1% depending on the definition. Prevalence obtained by using ECRHS definition significantly differed from estimates by other definitions (Z score ≥ 1.96 p<0.0001) except modified probable asthma. Identified predictors of asthma varied from five to six depending on the definition, and their strength also differed by definition. Regardless of the definition, reported nasal allergy, skin allergy, family history of nasal allergy, asthma and parental smoking were the predictors of asthma. The Kappa statistics demonstrated a fair to almost perfect association between the ECRHS and other asthma definitions (Kappa = 0.334-0.841, p < 0.001).

CONCLUSION

The prevalence rates and predictors of asthma are affected by operational definitions. Researchers need to adopt a uniform definition for accurate estimation of disease burden, international comparison of result and formulation of prevention policy.

A respiratory health survey of a subsurface smoldering landfill

In late 2010, a subsurface smoldering event was detected in the Bridgeton Sanitary Landfill in St. Louis County, Missouri. This was followed by complaints from nearby residents of foul odors emanating from the landfill. In 2016 a health survey was conducted of residents near the landfill and, as a comparison, other regions of St. Louis County. The survey was a two-stage cluster sample, where the first stage was census blocks, and the second stage was households within the census blocks. The health survey, which was conducted by face-to-face interviews of residents both near the landfill and away from the landfill, focused mainly on respiratory symptoms and diseases such as asthma and chronic obstructive pulmonary disease. The differences in the prevalence of asthma (26.7%, 95% CI 19.8-34.1 landfill vs 24.7%, 95% CI 15.7-33.6 comparison) and COPD (13.7%, 95% CI 7.2-20.3 landfill vs 12.5%, 95% CI 6.4-18.7 comparison) between the two groups were not statistically significant. Landfill households reported significantly more "other respiratory conditions," (17.6%, 95% CI 11.1-24.1 landfill vs 9.5%, 95% CI 4.8-14.3 comparison) and attacks of shortness of breath (33.9%, 95% CI 25.1-42.8 landfill vs 17.9%, 95% CI 12.3-23.5). Frequency of odor perceptions and level of worry about neighborhood environmental issues was higher among landfill households (p < 0.001). We conclude that the results do not support the hypothesis that people living near the Bridgeton Landfill have elevated respiratory or related illness compared to those people who live beyond the vicinity of the landfill.

Change in the prevalence asthma, rhinitis and respiratory symptom over a 20 year period: associations to year of birth, life style and sleep related symptoms

Background

The aim of this investigation was to study change in adults over a 20 year period in the prevalence of respiratory symptoms and disorders and its association to year of birth, life style and sleep related variables.

Method

Adults 20–44 years of age, 6085 women and 5184 men, were randomly selected from seven centres in Northern Europe and followed for 20 years. The number of participants in the first survey was 21,595 and 11,269 participated in all three surveys. The participants were divided into three birth cohorts: 1944–1955, 1956–1965 and 1966–1975.

Results

During the 20 year period the prevalence of wheeze decreased (− 2%) and the prevalence of asthma (+ 4%) and allergic rhinitis (+ 5%) increased, whereas the prevalence of nocturnal respiratory symptoms was relatively unchanged. The increase in allergic rhinitis was largest in those born 1966 to 1975 except in Estonia. There was large decrease in smoking (− 20%), increase in obesity (+ 7%) and snoring (+ 6%) during the study period. Smoking, obesity, snoring and nocturnal gastroesophageal reflux (nGER) were related to a higher risk of all symptoms. Obesity, snoring and nGER were also independently related to asthma.

Conclusion

We conclude that as our participants got older there was a decrease in wheeze, no change in nocturnal symptoms and an increase in reported asthma and allergic rhinitis. These changes in prevalence are probably related to a decrease in smoking being counteracted by an increase in allergy, obesity and sleep related disorders.

Asthma prevalence among adults in Saudi Arabia

Objectives:

To investigate asthma prevalence and to measure asthma symptoms among Saudi adults in Riyadh, Kingdom of Saudi Arabia.

Methods:

A cross-sectional survey using the European Community Respiratory Health Survey (ECRHS) questionnaire carried out between April and June 2016, among male and female Saudi nationals aged 20-44 years living in Riyadh. Disproportionate cluster sampling method was used. Asthma was defined based on answering “yes” to any of the following: Have you had wheezing when you did not have a cold in the last 12 months? Have you been told by a physician to have asthma? Are you taking medicine for asthma?

Results:

A total of 2,405 participants completed the survey. The prevalence of wheezing in the last 12 months when not having a cold was 18.2% with no significant difference between males and females (p=0.107). The prevalence of physician-diagnosed asthma was 11.3% with no significant difference between males and females (p=0.239). The prevalence of taking medicine for asthma was 10.6%. There were no significant differences between asthmatic vs. non-asthmatic in terms of residency area (p=0.07), education level (p=0.11) and smoking tobacco (p=0.06). However, significant differences found between asthmatic and non-asthmatic in relation to nasal allergies (p<0.001).

Conclusion:

Asthma prevalence is high and much higher than the prevalence reported in most countries using the ECRHS questionnaire.

SERPINA1 methylation and lung function in tobacco-smoke exposed European children and adults: a meta-analysis of ALEC population-based cohorts

BACKGROUND

The pathophysiological role of SERPINA1 in respiratory health may be more strongly determined by the regulation of its expression than by common genetic variants. A family based study of predominantly smoking adults found methylation at two Cytosine-phosphate-Guanine sites (CpGs) in SERPINA1 gene to be associated with chronic obstructive pulmonary disease risk. The objective of this study was to confirm the association of lung function with SERPINA1 methylation in general population samples by testing a comprehensive set of CpGs in the SERPINA gene cluster. We considered lung function level and decline in adult smokers from three European population-based cohorts and lung function level and growth in tobacco-smoke exposed children from a birth cohort.

METHODS

DNA methylation using Illumina Infinium Human Methylation 450 k and EPIC beadchips and lung function were measured at two time points in 1076 SAPALDIA, ECRHS and NFBC adult cohort participants and 259 ALSPAC children. Associations of methylation at 119 CpG sites in the SERPINA gene cluster (PP4R4-SERPINA13P) with lung functions and circulating alpha-1-antitripsin (AAT) were assessed using multivariable cross-sectional and longitudinal regression models.

RESULTS

Methylation at cg08257009 in the SERPINA gene cluster, located 32 kb downstream of SERPINA1, not annotated to a gene, was associated with FEV1/FVC at the Bonferroni corrected level in adults, but not in children. None of the methylation signals in the SERPINA1 gene showed associations with lung function after correcting for multiple testing.

CONCLUSIONS

The results do not support a role of SERPINA1 gene methylation as determinant of lung function across the life course in the tobacco smoke exposed general population exposed.

Prevalence estimates and risk factors for early childhood wheeze across Europe: the EuroPrevall birth cohort

BACKGROUND

Preschool wheeze is an important problem worldwide. No comparative population-based studies covering different countries have previously been undertaken.

OBJECTIVE

To assess the prevalence of early childhood wheeze across Europe and evaluate risk factors focusing on food allergy, breast feeding and smoke exposure.

METHODS

Infants from nine countries were recruited into the EuroPrevall birth cohort. At 12 and 24 months, data on wheeze, allergic signs/symptoms, feeding, smoke exposure, infections and day care attendance were collected using questionnaires. Poisson regression was used to assess risk factors for wheeze.

RESULTS

12 049 infants were recruited. Data from the second year of life were available in 8805 (73.1%). The prevalence of wheeze in the second year of life ranged from <2% in Lodz (Poland) and Vilnius (Lithuania) to 13.1% (95% CI 10.7% to 15.5%) in Southampton (UK) and 17.2% (95% CI 15.0% 19.5%) in Reykjavik (Iceland). In multivariable analysis, frequent lower respiratory tract infections in the first and second years of life (incidence rate ratio (IRR) 1.9 (95% CI 1.3 to 2.6) and 2.5 (95% CI 1.9 to3.4), respectively), postnatal maternal smoking (IRR 1.6, 95% CI 1.1 to 2.4), day care attendance (IRR 1.6, 95% CI 1.1 to 2.5) and male gender (IRR 1.3, 95% CI 1.0 to 1.7) were associated with wheeze. The strength of their association with wheeze differed between countries. Food allergy and breast feeding were not independently associated with wheeze.

CONCLUSION

The prevalence of early childhood wheeze varied considerably across Europe. Lower respiratory tract infections, day care attendance, postnatal smoke exposure and male gender are important risk factors. Further research is needed to identify additional modifiable risk factors that may differ between countries.

Asthma and COPD overlap (ACO) is related to a high burden of sleep disturbance and respiratory symptoms: Results from the RHINE and Swedish GA2LEN surveys

Background

The term Asthma and COPD Overlap (ACO) describes a condition where asthma and COPD overlap. We aimed to investigate associations between ACO and insomnia and respiratory symptoms, and to investigate the prevalence of ACO and the characteristics of subjects with ACO in two Northern European population studies.

Methods

The study comprised 25 429 subjects aged ≥ 40 years who participated in one of two Northern European general population surveys. Both surveys included questions on asthma, COPD, respiratory and sleep-related symptoms, including difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and excessive daytime sleepiness. ACO was defined as having both self-reported asthma and COPD.

Results

The prevalence of ACO was 1.0%. The group with ACO had a higher prevalence of both insomnia and respiratory symptoms than subjects with only asthma or COPD. Having ACO was independently associated with a 2–3 times higher probability of having sleep-related symptoms as compared with the group without asthma or COPD, after adjustment for age, sex, BMI, smoking history and educational level (adjusted odds ratio 2.14–3.36, 95% CI).

Conclusion

Subjects with ACO have a high prevalence of insomnia and respiratory symptoms. To our knowledge, this is the first study to assess the association between sleep-related symptoms and ACO.

The association between endotoxin and beta-(1 → 3)-D-glucan in house dust with asthma severity among schoolchildren

BACKGROUND

Asthma severity can be affected by microbial exposures. However, less is known about the specific indoor agents aggravating the disease in children. We examined the associations between indoor endotoxin and beta-(1 → 3)-D-glucan exposures and asthma severity in children with asthma.

METHODS

A clinical cross-sectional study of schoolchildren (aged 7-17 years) was conducted in the province of Saskatchewan, Canada. Children with asthma (n = 116) were identified from 335 participants using a combination of survey responses and objective clinical assessments. We then ascertained asthma severity based on recommended guidelines (continuous daytime asthma symptoms, frequent nighttime asthma symptoms, and ≤ 60% predicted FEV₁). Levels of indoor endotoxin and beta-(1 → 3)-D-glucan were measured in dust samples obtained from play area floors and child's mattresses.

RESULTS

The study population of 116 children with asthma was comprised of 75.9% mild asthma and 24.1% moderate/severe asthma. Higher mattress endotoxin concentration was associated with increased odds of moderate/severe asthma [adjusted odds ratio (aOR) = 11.40, 95% confidence interval (CI): 1.45-89.43] while higher beta-(1 → 3)-D-glucan concentration (aOR = 0.16, 95% CI: 0.03-0.89) and load (aOR = 0.10, 95% CI: 0.02-0.72) in play areas were inversely associated with moderate/severe asthma. Furthermore, higher mattress endotoxin concentration was associated with lower FVC (p = 0.01) and FEV₁ (p = 0.03). These associations were not seen for beta-(1 → 3)-D-glucan.

CONCLUSION

Our results showed differential effects of microbial exposures on childhood asthma severity and further highlight domestic endotoxin exposure effects on respiratory health outcomes in children with asthma.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Leisure-time vigorous physical activity is associated with better lung function: the prospective ECRHS study

OBJECTIVE

We assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort.

METHODS

FEV₁ and FVC were measured in 3912 participants at 27-57 years and 39-67 years (mean time between examinations=11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity ≥2 times and ≥1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV₁ and FVC.

RESULTS

Physical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV₁ (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV₁ and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline.

CONCLUSION

Leisure-time vigorous physical activity was associated with higher FEV₁ and FVC over a 10-year period among current smokers, but not with FEV₁ and FVC decline.

[Evaluation of sensitization to Der p 1 and Der p 2 in a pediatric population of the North of Portugal]

INTRODUCTION

In Portugal, data on the role of Der p 1 and Der p 2 in patients with house dust mite (HDM) allergy are scarce. Allergen-specific immunotherapy (sIT) is the only treatment that improves symptoms, reduces the need for pharmacological therapy and modifies the natural history of the disease. With this study, the authors aim to understand the local epidemiology and to clarify if the molecular assay of major allergens is advantageous in deciding and/or modifying the decision to initiate sIT in children with clinical indication which are sensitized to Dermatophagoides pteronyssinus.

METHODS

Retrospective study with analysis of patients with asthma and/or rhinitis.

STUDY PERIOD

January/2013-December/2016.

INCLUSION CRITERIA

1) positive prick-test to Dermatophagoides pteronyssinus; and 2) clinically relevant disease under treatment. Assay Der p 1 and Der p 2 values ≥0.35 kUA/L were considered positive. Statistical significance was set at P<.05.

RESULTS

The clinical files of 279 patients. Mean ages 9.55 years (min.4-max.17). Asthma was present in 199 children (71.3%) and rhinitis in 245 (87.8%). Der p 1 and Der p 2 was <0.35kUA/L in 29 (10,4%) patients. The value of Der p 1/Der p 2 correlated with the size of the prick-test papule, the value of the eosinophils and the total IgE.

CONCLUSIONS

Der p 1 and Der p 2 are dominant allergens in our population and there may be benefits in determining these molecular allergen levels in patients with a positive prick-test and a clinical indication for sIT prior to a decision of initiating sIT or not.

Phenotypes of symptomatic airways disease in China and New Zealand

It is uncertain whether phenotypes of asthma and chronic obstructive pulmonary disease (COPD) vary between populations with different genetic and environmental characteristics. Here, our objective was to compare the phenotypes of airways disease in two separate populations.This was a cross-sectional observational study in adult populations from New Zealand and China. Participants aged 40-75 years who reported wheeze and breathlessness in the last 12 months were randomly selected from the general population and underwent detailed characterisation. Complete data for cluster analysis were available for 345 participants. Hierarchical cluster analysis was undertaken, based on 12 variables: forced expiratory volume in 1 s (FEV₁), FEV₁/forced vital capacity ratio, bronchodilator reversibility, peak expiratory flow variability, transfer coefficient of the lung for carbon monoxide, exhaled nitric oxide fraction, total IgE, C-reactive protein, age of symptom onset, body mass index, health status and cigarette smoke exposure.Cluster analysis of the combined dataset described five phenotypes: "severe late-onset asthma/COPD overlap group", "moderately severe early-onset asthma/COPD overlap group", "moderate to severe asthma group with type 2 predominant disease", and two groups with minimal airflow obstruction, differentiated by age of onset. Separate analyses by country showed similar patterns; however, a distinct obese/comorbid group was observed in the New Zealand population.Cluster analysis of adults with symptomatic airways disease suggests the presence of similar asthma/COPD overlap phenotypes within populations with different genetic and environmental characteristics, and an obese/comorbid phenotype in a Western population.

Prevalence and Features of Asthma in Young Adults in Urban Areas of Argentina

OBJECTIVE

To investigate the burden of asthma in a young adult population in urban areas of Argentina.

DESIGN

A nationwide telephone survey in subjects aged 20-44 years was performed in urban areas in Argentina. The European Community Respiratory Health Survey questionnaire was used. Asthma was defined as an exacerbation in the last year or use of asthma medications.

RESULTS

In total, 1,521 subjects responded (62.4% females, mean age 33 years), of whom 91 were classified as asthmatics (5.9%, 95% CI 4.7-7.1). Prevalence adjusted for age, sex and education level was 6.4% (95% CI 5.1-7.7). Wheezing was reported by 13.9% (95% CI 15.6-12.2) and a diagnosis of asthma by 9.5% (95% CI 8.0-11.0). Among individuals with a diagnosis of asthma (n=154), 71.3% had undergone spirometry. Among those treated (n=77), 51.9% used medications daily and 46.8% as a rescue measure. Of those reporting an exacerbation in the last year (n=60), 55% had attended an emergency department and 23% were admitted. Asthma was associated with rhinitis (OR 11.1, 95% CI 6.2-19.9) and family history (OR 3.6, 95% CI 2.3-5.5).

CONCLUSION

Asthma prevalence in young adults in Argentina is similar to Europe. Although attacks and admissions were common, regular use of medications was reported by half of those treated. These results may be useful for other Latin American countries.

Predictors of smoking cessation: A longitudinal study in a large cohort of smokers

BACKGROUND

There are few studies on predictors of smoking cessation in general populations. We studied the smoking cessation rate in relation to several potential predictors, with special focus on respiratory and cardiovascular disease.

METHODS

Smokers (n = 4636) from seven centres in Northern Europe, born between 1945 and 1973, who answered a questionnaire in 1999-2001 (the RHINE study) were followed up with a new questionnaire in 2010-2012. Altogether 2564 answered the questionnaire and provided complete data on smoking. Cox regression analyses were performed to calculate hazard ratios (HRs).

RESULTS

A total of 999 subjects (39%) stopped smoking during the study period. The smoking cessation rate was 44.9/1000 person-years. Smoking cessation was more common with increasing age, higher education and fewer years of smoking. Asthma, wheeze, hay fever, chronic bronchitis, diabetes and hypertension did not significantly predict smoking cessation, but smokers hospitalized for ischaemic heart disease during the study period were more prone to stopping smoking (HR 3.75 [2.62-5.37]).

CONCLUSIONS

Successful smoking cessation is common in middle-aged smokers, and is associated with few smoking years and higher education. A diagnosis of respiratory disease does not appear to motivate people to quit smoking, nor do known cardiovascular risk factors; however, an acute episode of ischaemic heart disease encouraged smoking cessation in our study population.

Prevalence of asthma-like symptoms with ageing

Background

Change in the prevalence of asthma-like symptoms in populations of ageing adults is likely to be influenced by smoking, asthma treatment and atopy.

Methods

The European Community Respiratory Health Survey collected information on prevalent asthma-like symptoms from representative samples of adults aged 20–44 years (29 centres in 13 European countries and Australia) at baseline and 10 and 20 years later (n=7844). Net changes in symptom prevalence were determined using generalised estimating equations (accounting for non-response through inverse probability weighting), followed by meta-analysis of centre level estimates.

Findings

Over 20 years the prevalence of ‘wheeze’ and ‘wheeze in the absence of a cold’ decreased (−2.4%, 95% CI −3.5 to −1.3%; −1.5%, 95% CI −2.4 to −0.6%, respectively) but the prevalence of asthma attacks, use of asthma medication and hay fever/nasal allergies increased (0.6%, 95% CI 0.1 to 1.11; 3.6%, 95% CI 3.0 to 4.2; 2.7%, 95% CI 1.7 to 3.7). Changes were similar in the first 10 years compared with the second 10 years, except for hay fever/nasal allergies (increase seen in the first 10 years only). Decreases in these wheeze-related symptoms were largely seen in the group who gave up smoking, and were seen in those who reported hay fever/nasal allergies at baseline.

Interpretation

European adults born between 1946 and 1970 have, over the last 20 years, experienced less wheeze, although they were more likely to report asthma attacks, use of asthma medication and hay fever. Decrease in wheeze is largely attributable to smoking cessation, rather than improved treatment of asthma. It may also be influenced by reductions in atopy with ageing.

Relationships between self-reported asthma and pulmonary function and various measures of obesity

OBJECTIVE

We explore the association with self-reported asthma and pulmonary function based on spirometry measurements using different measures to determine obesity because body mass index (BMI) is limited in not differentiating fat and muscle mass.

METHODS

A multi-year cross-sectional study using Korean National Health and Nutrition Examination Survey data was conducted between July 2008 and May 2011. A total of 9409 subjects were included in the final analysis.

RESULTS

Obesity was associated with self-reported asthma and pulmonary function limitations mainly in adult women aged between 40 and 65 years and elderly men aged 65 or older. The association was stronger when the measurement of obesity was based on body fat percentage or waist-to-height ratio (WHtR), compared to BMI. There was a higher self-reported asthma risk among obese women according to the WHtR [odds ratio (OR) = 1.817, 95% CI: (1.208, 2.735)]. There was an increased risk of pulmonary function limitation with abdominal obesity [OR 1.418, 95% CI (1.020, 1.972)], weight-to-height ratio [OR 1.467, 95% CI (1.058, 2.034)], and obesity with regard to body fat percentage [OR 1.753, 95% CI (1.251, 2.457)] in adult women. In elderly men, obesity based on body fat percentage was associated with an increased risk of pulmonary function limitation [OR 1.93, 95% CI (1.098, 3.388)].

CONCLUSIONS

Measures other than BMI should be examined when investigating the effect of obesity on self-reported asthma and pulmonary function limitation.

Building dampness and mold in European homes in relation to climate, building characteristics and socio-economic status: The European Community Respiratory Health Survey ECRHS II

We studied dampness and mold in homes in relation to climate, building characteristics and socio-economic status (SES) across Europe, for 7127 homes in 22 centers. A subsample of 3118 homes was inspected. Multilevel analysis was applied, including age, gender, center, SES, climate, and building factors. Self-reported water damage (10%), damp spots (21%), and mold (16%) in past year were similar as observed data (19% dampness and 14% mold). Ambient temperature was associated with self-reported water damage (OR=1.63 per 10°C; 95% CI 1.02-2.63), damp spots (OR=2.95; 95% CI 1.98-4.39), and mold (OR=2.28; 95% CI 1.04-4.67). Precipitation was associated with water damage (OR=1.12 per 100 mm; 95% CI 1.02-1.23) and damp spots (OR=1.11; 95% CI 1.02-1.20). Ambient relative air humidity was not associated with indoor dampness and mold. Older buildings had more dampness and mold (P<.001). Manual workers reported less water damage (OR=0.69; 95% CI 0.53-0.89) but more mold (OR=1.27; 95% CI 1.03-1.55) as compared to managerial/professional workers. There were correlations between reported and observed data at center level (Spearman rho 0.61 for dampness and 0.73 for mold). In conclusion, high ambient temperature and precipitation and high building age can be risk factors for dampness and mold in homes in Europe.

Respiratory symptoms are more common among short sleepers independent of obesity

INTRODUCTION

Sleep length has been associated with obesity and various adverse health outcomes. The possible association of sleep length and respiratory symptoms has not been previously described. The aim of this study was to investigate the association between sleep length and respiratory symptoms and whether such an association existed independent of obesity.

METHODS

This is a multicentre, cross-sectional, population-based study performed in 23 centres in 10 different countries. Participants (n=5079, 52.3% males) were adults in the third follow-up of the European Community Respiratory Health Survey III. The mean±SD age was 54.2±7.1 (age range 39-67 years). Information was collected on general and respiratory health and sleep characteristics.

RESULTS

The mean reported nighttime sleep duration was 6.9±1.0 hours. Short sleepers (<6 hours per night) were n=387 (7.6%) and long sleepers (≥9 hours per night) were n=271 (4.3%). Short sleepers were significantly more likely to report all respiratory symptoms (wheezing, waking up with chest tightness, shortness of breath, coughing, phlegm and bronchitis) except asthma after adjusting for age, gender, body mass index (BMI), centre, marital status, exercise and smoking. Excluding BMI from the model covariates did not affect the results. Short sleep was related to 11 out of 16 respiratory and nasal symptoms among subjects with BMI ≥30 and 9 out of 16 symptoms among subjects with BMI <30. Much fewer symptoms were related to long sleep, both for subjects with BMI <30 and ≥30.

CONCLUSIONS

Our results show that short sleep duration is associated with many common respiratory symptoms, and this relationship is independent of obesity.

Current wheeze, asthma, respiratory infections, and rhinitis among adults in relation to inspection data and indoor measurements in single-family houses in Sweden-The BETSI study

In the Swedish Building Energy, Technical Status and Indoor environment study, a total of 1160 adults from 605 single-family houses answered a questionnaire on respiratory health. Building inspectors investigated the homes and measured temperature, air humidity, air exchange rate, and wood moisture content (in attic and crawl space). Moisture load was calculated as the difference between indoor and outdoor absolute humidity. Totally, 7.3% were smokers, 8.7% had doctor' diagnosed asthma, 11.2% current wheeze, and 9.5% current asthma symptoms. Totally, 50.3% had respiratory infections and 26.0% rhinitis. The mean air exchange rate was 0.36/h, and the mean moisture load 1.70 g/m³ . Damp foundation (OR=1.79, 95% CI 1.16-2.78) was positively associated while floor constructions with crawl space (OR=0.49, 95% CI 0.29-0.84) was negatively associated with wheeze. Concrete slabs with overlying insulation (OR=2.21, 95% CI 1.24-3.92) and brick façade (OR=1.71, 95% CI 1.07-2.73) were associated with rhinitis. Moisture load was associated with respiratory infections (OR=1.21 per 1 g/m³ , 95% CI 1.04-1.40) and rhinitis (OR=1.36 per 1 g/m³ , 95% CI 1.02-1.83). Air exchange rate was associated with current asthma symptoms (OR=0.85 per 0.1/h, 95% CI 0.73-0.99). Living in homes with damp foundation, concrete slabs with overlying insulation, brick façade, low ventilation flow, and high moisture load are risk factors for asthma, rhinitis, and respiratory infections.

Association between exercise-induced asthma and parental socio-economic status among school-aged adolescents in a semiurban community in Nigeria

This study investigated the prevalence and association between exercise-induced asthma (EIA) and parental socio-economic status (PSES) among school-aged adolescents in a semiurban community in Nigeria. Three hundred and eighty-five adolescents (185 male and 200 female adolescents) whose ages ranged between 10 and 19 years participated in this cross-sectional study. Participants were recruited from four government approved secondary schools in Ido-Ekiti using a multistage sampling technique. Peak expiratory flow rate (PEFR) was assessed at baseline and after 6-min run test (6-MRT) on a level playing ground using a standard peak flow meter. PEFR measurements were repeated at 5th, 10th, 15th, and 20th min post 6-MRT. Participants who had >15.0% PEFR fall were considered to have EIA. PSES was assessed using a validated socio-economic status questionnaire. Descriptive and inferential statistics were used to analyze data. Alpha level was set at P<0.05. The mean ages of males and females were 13.9±2.0 and 13.8±1.6 years, respectively. More than half of the participants, 58.2% had EIA (>15.0% PEFR scores) while 53.5% belonged to middle PSES class. There was no significant difference between PEFR scores of male and female participants at baseline and 5th min post 6-MRT. However, male participants had significant higher PEFR than the female counterparts at 10th (t=2.090, P=0.037), 15th (t=2.162, P=0.031), and 20th min (t=2.978, P=0.003). There was significant association between EIA and PSES (χ²=152.4; P=0.001). The prevalence of EIA is very high among school-aged adolescents in Nigeria and was significantly associated with PSES.

Association of household cleaning agents and disinfectants with asthma in young German adults

OBJECTIVES

We scrutinised the association of private use of household sprays and disinfectants with asthma incidence in young adults in the transition from school to working life.

METHODS

Between 2007 and 2009,2051 young adults aged 19-24 years living in two major German cities took part in the Study on Occupational Allergy Risks II. Self-reported exposure to household sprays and disinfectants was characterised according to a composite score for frequency of use as no use (score=0), low use (score between 1 and the median), medium use (score between the median and the 90th percentile) and high use (score above the 90th percentile). Two outcome variables (current asthma and current wheezing) with four mutually exclusive categories (never, incident, persistent and remittent) were used for the risk analyses. Multinomial logistic regression models examined the association between the frequency of using household sprays and disinfectants with asthma and wheezing adjusting for potential confounders.

RESULTS

Compared with no use, high use of disinfectants was associated with a more than twofold increased odds of incident asthma (OR 2.79, 95% CI 1.14 to 6.83). In addition, low/medium use of disinfectants was associated with remittent asthma (OR 2.39, 95% CI 1.29 to 4.47). The evidence for an association between high usage of household sprays and asthma incidence was weak (OR 2.79, 95% CI 0.84 to 9.20).

CONCLUSION

Our results support the hypothesis of an association between the use of cleaning products and elevated risks for asthma and wheezing in young adults at the start of working life.

Respiratory allergies among veterinarians: two cross-sectional surveys from 2006 to 2012

PURPOSE

Animal-related allergy is known to be an occupational hazard among veterinarians; however, there is a lack of data showing to which extent these are affected. We aimed at describing the prevalence of respiratory allergies in this population.

METHODS

In two repeated cross-sectional surveys in 2006 and 2012 in Bavaria, we examined the prevalence of wheezing, asthma and allergic rhinitis by questionnaires. We additionally performed multiple regression analysis to identify associated factors.

RESULTS

Overall participation rate was above 60%, leading to sample sizes of 512 in 2006 and 596 in 2012, respectively. Prevalences of allergic symptoms ranged from 5.1 to 5.6% for asthma, 17.0 to 20.2% for rhinitis, and 11.4 to 14.3% for wheezing, as well as 7.2 to 11.3% for wheezing without having a cold. The percentage of women in this occupation grew between the first and second survey. There were gender differences in both surveys concerning age and practice type (p < 0.0001). Women had a lower mean age (42.1 vs. 53.0 years in 2012) and worked much more often exclusively with small animals (50.2 vs. 15.9% in 2012). There was a borderline significantly higher prevalence for allergic rhinitis in women than in men in 2012 (20.1 vs. 13.7, p = 0.052). Having allergic rhinitis was clearly associated with wheezing, wheezing without cold and asthma.

CONCLUSIONS

In a repeated cross-sectional survey at an interval of 6 years among veterinarians, we found a relatively stable overall prevalence of wheeze, wheeze without having a cold, asthma and allergic rhinitis.

Prevalence and determinants of asthma in adults in Kinshasa

BACKGROUND

Epidemiological data on asthma among adults in sub-Saharan Africa are sparse.

OBJECTIVE

To determine the prevalence of and factors associated with asthma among adults in Kinshasa.

METHODS

A previously validated asthma questionnaire was administered to an adult population aged ≥18 years in urban and peri-urban suburbs of Kinshasa. A random stratified multi-stage sampling plan was used to select the study participants. Logistic regression was used to identify factors associated with asthma.

RESULTS

The mean age of respondents was 36.7 (SD 15.36) years, 75% lived in an urban environment, and 57% were women. The prevalence of asthma-ever was 6.9% (95% CI: 5.4-8.4). Among asthmatic patients, intermittent asthma was estimated at 75.7% and severe asthma at 9.3%. Family atopy (OR: 3.97; 95% CI: 2.42-6.50; p<0.001), and the presence of a cat in the house (OR: 1.82; 95% CI: 1.01-3.28; p = 0.045) were associated with self-reported asthma.

CONCLUSION

Asthma is relatively frequent in adults in Kinshasa, a prevalence similar to those reported elsewhere in Africa. Family atopy and the presence of a cat in the house could be the most common determinants to be confirmed with national survey in order to design guidelines for the control of asthma.

Acupuncture in Patients with Allergic Asthma: A Randomized Pragmatic Trial

BACKGROUND

Although the available evidence is insufficient, acupuncture is used in patients suffering from chronic asthma. The aim of this pragmatic study was to investigate the effectiveness of acupuncture in addition to routine care in patients with allergic asthma compared to treatment with routine care alone.

METHODS

Patients with allergic asthma were included in a randomized controlled trial and randomized to receive up to 15 acupuncture sessions over 3 months or to a control group receiving routine care alone. Patients who did not consent to randomization received acupuncture treatment for the first 3 months and were followed as a cohort. All trial patients were allowed to receive routine care in addition to study treatment. The primary endpoint was the asthma quality of life questionnaire (AQLQ, range: 1-7) at 3 months. Secondary endpoints included general health related to quality of life (Short-Form-36, SF-36, range 0-100). Outcome parameters were assessed at baseline and at 3 and 6 months.

RESULTS

A total of 1,445 patients (mean age 43.8 [SD 13.5] years, 58.7% female) were randomized and included in the analysis (184 patients randomized to acupuncture and 173 to control, and 1,088 in the nonrandomized acupuncture group). In the randomized part, acupuncture was associated with an improvement in the AQLQ score compared to the control group (difference acupuncture vs. control group 0.7 [95% confidence interval (CI) 0.5-1.0]) as well as in the physical component scale and the mental component scale of the SF-36 (physical: 2.5 [1.0-4.0]; mental 4.0 [2.1-6.0]) after 3 months. Treatment success was maintained throughout 6 months. Patients not consenting to randomization showed similar improvements as the randomized acupuncture group.

CONCLUSIONS

In patients with allergic asthma, additional acupuncture treatment to routine care was associated with increased disease-specific and health-related quality of life compared to treatment with routine care alone.

Current asthma, respiratory symptoms and airway infections among students in relation to the school and home environment in Japan

OBJECTIVE

To study associations between the school and home environment and current asthma, respiratory symptoms and airway infections among Japanese students.

METHODS

Japanese students (12-15 y) (N = 1048) in four schools responded to a questionnaire on respiratory health, allergy and the home environment. Temperature, relative air humidity (RH) and student density (students/m² floor area) was measured in the classrooms: dust was collected from floors and in classroom air and analysed for cat (Fel d 1) and dog (Can f 1) allergens. Health associations were analysed by multi-level logistic regression.

RESULTS

Doctor's diagnosed asthma was common (13.4%), 8.8% reported cat allergy and 6.1% dog allergy. The median level in floor dust was 41 ng/g (IQR 23-92) for Fel d 1 and 101 ng/g (IQR 54-101) for Can f 1. The median level in air was 18.6 ng/ m²/ day (IQR5.9-25.1) for Fel d 1 and 18.6 ng/ m²/ day (IQR 6.0-13.3) for Can f 1. High RH, high student density and airborne cat allergen was associated with airway infections. In the home environment, recent indoor painting, new floor materials, odour, having cats as pets, window pane condensation in winter, and dampness in floor construction were associated with respiratory illness.

CONCLUSION

High relative air humidity, high student density and airborne cat allergens at school may increase the risk of airway infections. Having cats as pets, chemical emissions from paint and new floor materials, odour and dampness can constitute domestic risk factors for respiratory symptoms while having dogs as pets could be protective.

Prevalence of physical and mental non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health

Background

Previous studies examining physical and mental non-communicable diseases (NCDs) in Europe have so far largely either focused on limited numbers of countries or on fairly limited ranges of NCDs, with mental health in particular often being ignored. This article has three aims: (i) To provide a recent, comprehensive overview of a broad range of NCDs across a range of countries in all European regions; (ii) To give an overview of measures of physical and mental health in the new special rotating module in the European Social Survey (ESS); and (iii) To offer the first comprehensive comparison of estimates on physical and mental NCDs across European countries in this new promising data source. We use data from the 7th wave of the ESS. Results are presented separately for men and women. All results were age-standardized by weighting up or down the unstandardized (crude) prevalence rates for 5-year age groups in each country to a common standard. We present pooled estimates for the combined cross-national sample as well as country-specific results. Overall, 74.1% of men and 79.7% of women reported at least one physical NCD. Across the 21 countries were observed that these percentages varied between 45.2% (for men in Hungary) and 91.6% (women in Finland). Serious depressive symptoms were reported by 10.2% of men and 18.8% of women, with percentages ranging between 6.2% (men in Ireland) and 30.9% (women in Portugal). A substantial share of Europeans experience the burden of NCDs, and the extent to which people report these conditions varies across countries. However, all physical and mental NCDs in this rotating module are reported by considerable percentages in each of the 21 country samples, which emphasizes that these conditions are not marginal phenomena but public health concerns.

Respiratory symptoms and fractional exhaled nitric oxide (FeNO) among students in Penang, Malaysia in relation to signs of dampness at school and fungal DNA in school dust

Few health studies exist on dampness and mould in schools in the tropics. We studied associations between fraction of exhaled nitric oxide (FeNO), respiratory symptoms and airway infections among students and dampness and fungal DNA in schools in Malaysia. A total of 368 randomly selected students from 32 classrooms in 8 secondary schools in Penang, Malaysia, participated (58% participation rate). Information on current respiratory symptoms and the home environment was collected by a standardised questionnaire. FeNO was measured by NIOX MINO (50ml/min). The classrooms were inspected and dust was collected by vacuuming on special filters and was analysed for five fungal DNA sequences by quantitative PCR. Linear mixed models and 3-level multiple logistic regression (school, classroom, student) were applied adjusting for demographic data and the home environment. Totally 10.3% reported doctor's diagnosed asthma, 15.1% current wheeze, 12.4% current asthma, 37.3% daytime breathlessness, 10.2% nocturnal breathlessness, 38.9% airway infections and 15.5% had pollen or furry pet allergy. The geometric mean of FeNO was 19.9ppb and 45% had elevated FeNO (>20ppb). Boys had higher levels of FeNO. Chinese had less daytime breathlessness than Malay (OR=0.30: p<0.001). Indoor carbon dioxide levels were low (380-720ppm). Dampness was observed in 18% of the classrooms and was associated with respiratory infections (OR=3.70; 95% CI 1.14-12.1) and FeNO (p=0.04). Aspergillus versicolor DNA was detected in 67% of the classrooms. Higher numbers of Aspergillus versicolor DNA in classroom dust were associated with wheeze (p=0.006), current asthma (p=0.002), respiratory infections (p=0.005) and elevated FeNO levels (p=0.02). In conclusion, respiratory symptoms were common among the students and the high FeNO levels indicate ongoing airway inflammation. Building dampness and the mould Aspergillus versicolor in schools in Malaysia can be risk factors for impaired respiratory health among the students.

Evaluation of the use of Swedish integrated electronic health records and register health care data as support clinical trials in severe asthma: the PACEHR study

Background

In the development of new drugs for severe asthma, it is a challenge from an ethical point of view to randomize severe asthma patients to placebo, and to obtain long-term safety data due to discontinuations. The aim of this study was to evaluate the feasibility of using electronic health record (EHR) data to create a real-world reference population of uncontrolled asthmatic patients to supplement the concurrent control/placebo group in long-term studies of asthma.

Methods

EHR data from 36 primary care centres and a University hospital in Sweden were linked to Swedish mandatory health registers (2005–2013), creating a population covering 33 890 asthma patients, including data on co-morbidities, risk factors and laboratory/respiratory measurements. A severe asthma EHR reference cohort was established. We used logistic regression to estimate the propensity score (probability) of each RCT or EHR patient existing in the EHR cohort given their covariates.

Results

We created an EHR-derived reference cohort of 240 patients, matching the placebo group (N = 151) in an RCT of severe asthma. The exacerbation rate during follow-up in the EHR study population was 1.24 (weighted) compared to 0.9 in the RCT placebo group. Patients in the EHR cohort were of similar age as in the RCT placebo group, 50.6 years versus 50.1 years; had slightly higher body mass index 27.0 kg/m² versus 27.3 kg/m²; and consisted of 40% versus 34% males.

Conclusions

The results indicate that EHRs provide an opportunity to supplement the control group in RCTs of severe diseases.

The effects of air pollution on asthma hospital admissions in Adelaide, South Australia, 2003-2013: time-series and case-crossover analyses

BACKGROUND

Air pollution can have adverse health effects on asthma sufferers, but the effects vary with geographic, environmental and population characteristics. There has been no long time-series study in Australia to quantify the effects of environmental factors including pollen on asthma hospitalizations.

OBJECTIVES

This study aimed to assess the seasonal impact of air pollutants and aeroallergens on the risk of asthma hospital admissions for adults and children in Adelaide, South Australia.

METHODS

Data on hospital admissions, meteorological conditions, air quality and pollen counts for the period 2003-2013 were sourced. Time-series analysis and case-crossover analysis were used to assess the short-term effects of air pollution on asthma hospitalizations. For the time-series analysis, generalized log-linear quasi-Poisson and negative binomial regressions were used to assess the relationships, controlling for seasonality and long-term trends using flexible spline functions. For the case-crossover analysis, conditional logistic regression was used to compute the effect estimates with time-stratified referent selection strategies.

RESULTS

A total of 36,024 asthma admissions were considered. Findings indicated that the largest effects on asthma admissions related to PM_2.5 , NO₂ , PM₁₀ and pollen were found in the cool season for children (0-17 years), with the 5-day cumulative effects of 30.2% (95% CI: 13.4-49.6%), 12.5% (95% CI: 6.6-18.7%), 8.3% (95% CI: 2.5-14.4%) and 4.2% (95% CI: 2.2-6.1%) increases in risk of asthma hospital admissions per 10 unit increments, respectively. The largest effect for ozone was found in the warm season for children with the 5-day cumulative effect of an 11.7% (95% CI: 5.8-17.9%) increase in risk of asthma hospital admissions per 10 ppb increment in ozone level.

CONCLUSION

Findings suggest that children are more vulnerable and the associations between exposure to air pollutants and asthma hospitalizations tended to be stronger in the cool season compared to the warm season, with the exception of ozone. This study has important public health implications and provides valuable evidence for the development of policies for asthma management.

Diagnostic Utility of Total IgE in Foods, Inhalant, and Multiple Allergies in Saudi Arabia

Objective. To assess the diagnostic significance of total IgE in foods, inhalant, and multiple allergies. Methods. Retrospective review of the laboratory records of patients who presented with clinical suspicion of food or inhalant allergy between January 2013 and December 2014. Total IgE level was defined as positive for a value >195 kU/L; and diagnosis was confirmed by the detection of specific IgE (golden standard) for at least one food or inhalant allergen and at least two allergens in multiple allergies. Results. A total of 1893 (male ratio = 0.68, mean age = 39.0 ± 19.2 years) patients were included. Total IgE had comparable sensitivity (55.8% versus 59.6%) and specificity (83.9% versus 84.4%) in food versus inhalant allergy, respectively, but a superior PPV in inhalant allergy (79.1% versus 54.4%). ROC curve analysis showed a better diagnostic value in inhalant allergies (AUC = 0.817 (95% CI = 0.796-0.837) versus 0.770 (95% CI = 0.707-0.833)). In multiple allergies, total IgE had a relatively good sensitivity (78.6%), while negative IgE testing (<195 kU/L) predicted the absence of multiple allergies with 91.5% certitude. Conclusion. Total IgE assay is not efficient as a diagnostic test for foods, inhalant, or multiple allergies. The best strategy should refer to specific IgE testing guided by a comprehensive atopic history.

Cat (Fel d 1) and dog (Can f 1) allergen levels in cars, dwellings and schools

Pets are an important source of indoor allergens. The aim of the study was to compare cat and dog allergen levels in cars, schools and homes. The study was carried out in 17 cars, 14 classrooms and 19 dwellings located in the highly industrialized and urbanized region of Poland. Dust and air samples were analyzed for Fel d 1 and Can f 1 using a double monoclonal ELISA assay. The highest amounts of cat and dog allergens (Fel d 1: 1169 μg/g; Can f 1: 277 μg/g) were found in dwellings with pets. Allergen concentrations were correlated with the number of animals kept at home. Although concentrations on automobile seats were lower, Fel d 1 levels exceeded 8 μg/g in 23.5 % of cars and high levels of Can f 1 (>10 μg/g) were found in 17.6 % of cars. The study revealed that cars of pet owners may be reservoirs of cat and dog allergens even when animals are not transported in them. In schools, concentrations of pet allergens did not reach high levels, but the moderate levels of Fel d 1 (≥1-8 μg/g) and Can f 1 (≥2-10 μg/g) were detected in 42.9 and 7.1 % of the investigated classrooms. Concentrations of cat and dog allergen in schools were higher than in homes without pets. While airborne Fel d 1 and Can f 1 levels were found low, residential allergen concentrations in settled dust and air were correlated. The study results suggest that classrooms and cars of pet owners may be important sites of exposure to cat and dog allergens, though the highest concentrations of Fel d 1 and Can f 1 are found in homes of pet owners.

Epidemiology of anaphylaxis

Knowledge about the epidemiology of anaphylaxis is based on data from various sources: clinical practice, large secondary clinical and administrative databases of primary care or hospitalized patients, and recent surveys with representative samples of the general population. As several similar results are often reported in several publications and populations, such findings are highly like to be robust. One such finding is that the incidence and prevalence of anaphylaxis are higher than previously thought. Publications from the last 5 years reveal an incidence of between 50 and 112 episodes per 100 000 person-years; estimated prevalence is 0.3-5.1% depending on the rigour of the definitions used. Figures are higher in children, especially those aged 0-4 years. Publications from various geographical areas based on clinical and administrative data on hospitalized patients suggest that the frequency of admissions due to anaphylaxis has increased (5-7-fold in the last 10-15 years). Other publications point to a geographic gradient in the incidence of anaphylaxis, with higher frequencies recorded in areas with few hours of sunlight. However, these trends could be the result of factors other than a real change in the incidence of anaphylaxis, such as changes in disease coding and in the care provided. Based on data from the records of voluntary declarations of death by physicians and from large national databases, death from anaphylaxis remains very infrequent and stands at 0.35-1.06 deaths per million people per year, with no increases observed in the last 10-15 years. Although anaphylaxis can be fatal, recurrence of anaphylaxis--especially that associated with atopic diseases and hymenoptera stings--affects 26.5-54% of patients.

Asthma is a risk factor for new onset chronic migraine: Results from the American migraine prevalence and prevention study

OBJECTIVES

To test the hypothesis that in persons with episodic migraine (EM), asthma is a risk factor for the onset of chronic migraine (CM).

BACKGROUND

Migraine and asthma are comorbid chronic disorders with episodic attacks thought to involve inflammatory and neurological mechanisms. Herein, we assess the influence of asthma on the clinical course of EM.

METHODS

To be eligible for this observational cohort study, AMPP Study participants had to meet criteria for EM in 2008, complete the validated six-item asthma questionnaire from the European Community Respiratory Health Survey (ECRHS) in 2008, and provide follow-up data in 2009. Using the ECRHS, we defined asthma as a binary variable (present or absent) based on an empirical cut score and developed a Respiratory Symptom Severity Score (RSSS) based on the number of positive responses (no severity = 0 positive responses, low severity = 1-2 positive responses, moderate severity = 3-4 positive responses, high severity = 5-6 positive responses). Chronic migraine was the primary outcome measure and was defined as those with ≥15 headache days per month on the 2009 AMPP Study survey. We used logistic regression in separate models to assess the influence of asthma as a binary variable (Model 1) and RSSS score categories (Model 2 using no respiratory symptoms as the reference) on CM onset after adjusting for sociodemographic factors, headache day frequency, migraine preventive medication use, and medication overuse.

RESULTS

The eligible sample for this study included 4446 individuals with EM in 2008 of whom 17% had asthma. This group had a mean age of 50.4 and was 80.8% female. In 2009, new onset CM developed in 2.9% (131/4446) of the 2008 EM cohort, including 5.4% (40/746) of the asthma subgroup and 2.5% (91/3700) of the non-asthma subgroup. In comparison to those without asthma, the adjusted odds for individuals with asthma and EM in 2008 to develop CM in 2009 were greater than two (adjusted odds ratio [aOR] 2.1; 95% CI: 1.4-3.1). Using the RSSS, the aOR for CM onset increased with the number of asthma symptoms, but only those in the high RSSS category showed a statistically significant increase in the odds of chronic migraine onset in comparison with the no RSSS reference group (aOR 3.3; 95% CI 1.7-6.2).

CONCLUSIONS

Asthma is associated with an increased risk of new onset CM 1 year later among individuals with EM, with the highest risk being among those with the greatest number of respiratory symptoms. The exact mechanisms underlying this association are unknown, but could suggest mast cell degranulation, autonomic dysfunction, or shared genetic or environmental factors.

Risk factors for asthma: is prevention possible?

Asthma is one of the most common diseases in the world, resulting in a substantial burden of disease. Although rates of deaths due to asthma worldwide have reduced greatly over the past 25 years, no available therapeutic regimens can cure asthma, and the burden of asthma will continue to be driven by increasing prevalence. The reasons for the increase in asthma prevalence have not been defined, which limits the opportunities to develop targeted primary prevention measures. Although associations are reported between a wide range of risk factors and childhood asthma, substantiation of causality is inherently difficult from observational studies, and few risk factors have been assessed in primary prevention studies. Furthermore, none of the primary prevention intervention strategies that have undergone scrutiny in randomised controlled trials has provided sufficient evidence to lead to widespread implementation in clinical practice. A better understanding of the factors that cause asthma is urgently needed, and this knowledge could be used to develop public health and pharmacological primary prevention measures that are effective in reducing the prevalence of asthma worldwide. To achieve this it will be necessary to think outside the box, not only in terms of risk factors for the causation of asthma, but also the types of novel primary prevention strategies that are developed, and the research methods used to provide the evidence base for their implementation. In the interim, public health efforts should remain focused on measures with the potential to improve lung and general health, such as: reducing tobacco smoking and environmental tobacco smoke exposure; reducing indoor and outdoor air pollution and occupational exposures; reducing childhood obesity and encouraging a diet high in vegetables and fruit; improving feto-maternal health; encouraging breastfeeding; promoting childhood vaccinations; and reducing social inequalities.

Time trends in the incidence, prevalence and age at diagnosis of asthma in children

BACKGROUND

Current knowledge on the prevalence of asthma is mainly based on cross-sectional questionnaire data. Current population-based data on the incidence of asthma in children are scarce.

OBJECTIVE

To study the incidence, prevalence, and age at diagnosis of asthma in children in the Netherlands over the study period 2000-2012.

METHODS

A population-based cohort study was conducted in the Integrated Primary Care Information database. The cohort consisted of 176,516 children (379,536 personyears (PY) of follow-up), aged 5-18 years between 2000 and 2012. All medical records of children with physician diagnosed asthma were validated. Incidence rates, annual percent change (APC), and prevalence for asthma were calculated. Influence of age and gender on incidence rates and change in age at diagnosis were studied.

RESULTS

We identified an asthma cohort of 14,303 children with 35,118 PY. The overall incidence rate was 6.7/1000 PY (95% CI, 6.45-6.97). Until 2008, the incidence rate was significantly increasing (APC 5.79 (95% CI 1.43-10.34); from 2008 onwards, a non-significant decrease was observed (APC -12.16 (95% CI -23.07 to 0.28). Incidence for girls was lower than for boys, this difference decreased with increasing age. (p < 0.001) Overall, the age at diagnosis increased over calendar time and was lower for boys. (linear trend p < 0.001).

CONCLUSION

Our population-based cohort study observed an incidence rate of 6.7 per 1000 PY of physician-diagnosed asthma in children in the Netherlands over 2000-2012. The asthma incidence rate was increasing until 2008. Further studies are needed to confirm the decrease in asthma incidence rate from 2008 onwards.

Prevalence of asthma and allergic rhinitis among adults in Yaounde, Cameroon

BACKGROUND

Population-based estimates of asthma and allergic rhinitis in sub-Saharan African adults are lacking. We assessed the prevalence and determinants of asthma and allergic rhinitis in urban adult Cameroonians.

METHODS

A community-based survey was conducted from December 2013 to April 2014 among adults aged 19 years and above (N = 2,304, 57.3% women), selected through multilevel stratified random sampling across all districts of Yaounde (Capital city). Internationally validated questionnaires were used to investigate the presence of allergic diseases. Logistic regressions were employed to investigate the determinants of allergic conditions.

RESULTS

Prevalence rates were 2.7% (95% CI: 2.1-3.4) for asthma-ever, 6.9% (5.9-7.9) for lifetime wheezing, 2.9% (92.2-3.6) for current wheezing and 11.4% (10.1-12.7) for self-reported lifetime allergic rhinitis; while 240 (10.4%) participants reported current symptoms of allergic rhinitis, and 125 (5.4%) had allergic rhino-conjunctivitis. The prevalence of current asthma medication use and self-reported asthma attack was 0.8 (0.4-1.2) and 1 (0.6-1.4) respectively. Multivariable adjusted determinants of current wheezing were signs of atopic eczema [2.91 (1.09-7.74)] and signs of allergic rhinitis [3.24 (1.83-5.71)]. Age group 31-40 years [0.27(0.09-0.78), p = 0.016] was an independent protective factor for wheezing. Determinants of current rhinitis symptoms were active smoking [2.20 (1.37-3.54), p<0.001], signs of atopic eczema [2.84 (1.48-5.46)] and current wheezing [3.02 (1.70-5.39)].

CONCLUSION

Prevalence rates for asthma and allergic rhinitis among adults in this population were at the lower tails of those reported in other regions of the world. Beside the classical interrelation between allergic diseases found in this study, active smoking was an independent determinant of allergic rhinitis symptoms. Nationwide surveys are needed to investigate regional variations.