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Conte M, Varraso R, Fournier A, Rothwell JA, Baglietto L, Fornili M, Sbidian E, Severi G. A prospective study of the association between living in a rural environment during childhood and risk of psoriasis. ENVIRONMENTAL RESEARCH 2023; 237:117062. [PMID: 37660877 DOI: 10.1016/j.envres.2023.117062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
Psoriasis is one of the most common immune-mediated inflammatory diseases (IMIDs). Living in a rural environment during childhood is associated with a decreased risk of certain IMIDs, like asthma, in adulthood. However, its role in other IMIDs, such as psoriasis is still unclear. To evaluate the relationships between different factors related to the environment during childhood and the risk of psoriasis in adulthood we conducted a study in E3N, a French prospective cohort composed of 98 995 women. During the 1990-2018 follow-up of 72 154 study participants, we identified 1 967 incident cases of psoriasis from self-reports in self-administered structured questionnaires. During the 2004-2018 follow-up of 67 917 study participants, 188 moderate-to-severe cases of psoriasis were identified through self-reports and from data from a drug reimbursement database. We fitted Cox proportional hazards regression models with age as the time scale from which we estimated hazard ratios adjusted for putative confounders (aHRs). We found inverse associations with risk of psoriasis for rural birthplace [aHR: 0.89 (95%CI: 0.79-0.96)] and for having farming parents [aHR: 0.84 (95%CI: 0.72-0.97)]. For moderate-to-severe psoriasis we found a nominally similar inverse association with rural birthplace but not with having farming parents. Our results suggest that an exposure to a rural environment during childhood may be associated with a reduced risk of psoriasis. These findings may help to improve our understanding of the pathogenesis of psoriasis.
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Affiliation(s)
- Marco Conte
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Exposome and Heredity team, CESP, Villejuif, 94805, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Inserm, Integrative Respiratory Epidemiology Team, CESP, Villejuif, 94807, France
| | - Agnès Fournier
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Exposome and Heredity team, CESP, Villejuif, 94805, France
| | - Joseph A Rothwell
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Exposome and Heredity team, CESP, Villejuif, 94805, France
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Italy
| | - Marco Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Italy
| | - Emilie Sbidian
- Hôpital Henri Mondor, Department of Dermatology, Créteil, 94010, France; Université Paris Est Créteil (UPEC), Epidemiology in Dermatology and Evaluation of Therapeutics (Epi-DermE), Créteil, 94010, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Exposome and Heredity team, CESP, Villejuif, 94805, France; Department of Statistics, Computer Science and Applications « G. Parenti », University of Florence, Florence, 50134, Italy.
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Ait-hadad W, Bédard A, Delvert R, Orsi L, Chanoine S, Dumas O, Laouali N, Le Moual N, Leynaert B, Siroux V, Boutron-Ruault MC, Varraso R. Plant-Based Diets and the Incidence of Asthma Symptoms among Elderly Women, and the Mediating Role of Body Mass Index. Nutrients 2022; 15:nu15010052. [PMID: 36615710 PMCID: PMC9824479 DOI: 10.3390/nu15010052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
We aimed to test the hypothesis that adherence to a healthful plant-based diet (hPDI) is associated with a subsequent decrease in the incidence of asthma symptoms, with an opposite association with adherence to an unhealthful plant-based diet (uPDI). In addition, we evaluated a potential mediating role of body mass index (BMI) and the modifying effect of smoking. Among 5700 elderly women from the French Asthma-E3N study with dietary data in 1993 and 2005, we assessed the incidence of asthma symptoms in 2018 among women with no asthma symptoms in 2011. BMI was evaluated in 2008. Mediation analyses in the counterfactual framework were used to disentangle total, direct, and indirect effects mediated by BMI. We found that both healthful and unhealthful plant-based diets were associated with a lower incidence of asthma symptoms over time, mediated by BMI (OR (95%CI) for the indirect effect: 0.94 (0.89-1.00) for hPDI and 0.92 (0.70-1.00) for uPDI)). Associations with both healthful and unhealthful PDIs were mediated by changes in BMI by 33% and 89%, respectively. Plant-based diets (healthful and unhealthful) were associated with subsequently reduced incidences of asthma symptoms over time, partly or almost totally mediated by BMI according to their nutritional quality.
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Affiliation(s)
- Wassila Ait-hadad
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Annabelle Bédard
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Rosalie Delvert
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Laurent Orsi
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Sébastien Chanoine
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Orianne Dumas
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Nasser Laouali
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, Équipe “Exposome et Hérédité”, CESP, 94805 Villejuif, France
- Correspondence:
| | - Nicole Le Moual
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Bénédicte Leynaert
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
| | - Valérie Siroux
- Team of Environmental Epidemiology Applied to the Development and Respiratory Health, Institute for Advanced Biosciences, Inserm U 1209, CNRS UMR 5309, Université Grenoble Alpes, 38000 Grenoble, France
| | - Marie-Christine Boutron-Ruault
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Gustave Roussy, Équipe “Exposome et Hérédité”, CESP, 94805 Villejuif, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe d’Épidémiologie Respiratoire Intégrative, CESP, 94805 Villejuif, France
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3
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Ait-hadad W, Bédard A, Chanoine S, Dumas O, Laouali N, Le Moual N, Leynaert B, Macdonald C, Siroux V, Boutron-Ruault MC, Varraso R. Healthy diet associated with better asthma outcomes in elderly women of the French Asthma-E3N study. Eur J Nutr 2022; 61:2555-2569. [PMID: 35220443 PMCID: PMC9279211 DOI: 10.1007/s00394-022-02815-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022]
Abstract
Purpose The impact of a healthy diet on asthma prevention and management, particularly among elderly women, remains poorly understood. We investigated whether a healthy diet would be associated with fewer asthma symptoms, and, among women with asthma, with reduced uncontrolled asthma and metabolic-related multimorbidity. Methods We included 12,991 elderly women (mean age = 63 years) from the Asthma-E3N study, a nested case–control study within the French E3N cohort. Negative binomial regressions were used to analyse associations between a healthy diet [evaluated by the Alternate Healthy Eating Index-2010 (AHEI-2010)] and a validated asthma symptom score, and logistic regressions to analyse associations between the AHEI-2010 with the asthma control test and multimorbidity profiles previously identified by clustering methods on medications used. Results After adjustment for potential confounders, a linear inverse association was found between the AHEI-2010 score and the asthma symptom score [mean score ratio (95% CI) = 0.82 (0.75–0.90) for the highest versus lowest quintile; p for trend < 0.0001]. In addition, women in the highest versus lowest AHEI-2010 tertile were at a lower risk to belong to the “Predominantly metabolic multimorbidity-related medications profile” compared to the “Few multimorbidity-related medications" profile [OR 0.80 (0.63–1.00) for tertile 3; p for trend = 0.05; n = 3474]. Conclusion Our results show that a healthy dietary intake could play an important role in the prevention and management of asthma over the life course. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-022-02815-0.
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Sigsgaard T, Basinas I, Doekes G, de Blay F, Folletti I, Heederik D, Lipinska-Ojrzanowska A, Nowak D, Olivieri M, Quirce S, Raulf M, Sastre J, Schlünssen V, Walusiak-Skorupa J, Siracusa A. Respiratory diseases and allergy in farmers working with livestock: a EAACI position paper. Clin Transl Allergy 2020; 10:29. [PMID: 32642058 PMCID: PMC7336421 DOI: 10.1186/s13601-020-00334-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022] Open
Abstract
Farmers constitute a large professional group worldwide. In developed countries farms tend to become larger, with a concentration of farm operations. Animal farming has been associated with negative respiratory effects such as work-related asthma and rhinitis. However, being born and raised or working on a farm reduces the risk of atopic asthma and rhinitis later in life. A risk of chronic bronchitis and bronchial obstruction/COPD has been reported in confinement buildings and livestock farmers. This position paper reviews the literature linking exposure information to intensive animal farming and the risk of work-related respiratory diseases and focuses on prevention. Animal farming is associated with exposure to organic dust containing allergens and microbial matter including alive microorganisms and viruses, endotoxins and other factors like irritant gases such as ammonia and disinfectants. These exposures have been identified as specific agents/risk factors of asthma, rhinitis, chronic bronchitis, COPD and reduced FEV1. Published studies on dust and endotoxin exposure in livestock farmers do not show a downward trend in exposure over the last 30 years, suggesting that the workforce in these industries is still overexposed and at risk of developing respiratory disease. In cases of occupational asthma and rhinitis, avoidance of further exposure to causal agents is recommended, but it may not be obtainable in agriculture, mainly due to socio-economic considerations. Hence, there is an urgent need for focus on farming exposure in order to protect farmers and others at work in these and related industries from developing respiratory diseases and allergy.
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Affiliation(s)
- T Sigsgaard
- Department of Environment Occupation & Health, Dept of Public Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2, Build. 1260, 8000 Aarhus C, Denmark
| | - I Basinas
- Institute of Occupational Medicine, Edinburgh, UK
| | - G Doekes
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - F de Blay
- Division of Asthma and Allergy, Department of Chest Diseases, University Hospital, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg University, Strasbourg, France
| | - I Folletti
- Occupational Medicine, Terni Hospital, University of Perugia, Perugia, Italy
| | - D Heederik
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - A Lipinska-Ojrzanowska
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - D Nowak
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig Maximilian University, Munich, Germany.,Comprehensive Pneumology Center Munich, Member DZL, German Centre for Lung Research, Munich, Germany
| | - M Olivieri
- Unit of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - S Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - M Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum, Bochum, Germany
| | - J Sastre
- Department of Allergy, Fundación Jiménez Díaz, CIBER de Enfermedades Respiratorias (Ciberes), Madrid, Spain
| | - V Schlünssen
- Department of Environment Occupation & Health, Dept of Public Health, Danish Ramazzini Centre, Aarhus University, Bartholins Allé 2, Build. 1260, 8000 Aarhus C, Denmark
| | - J Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - A Siracusa
- Formerly Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
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Bédard A, Garcia-Aymerich J, Sanchez M, Le Moual N, Clavel-Chapelon F, Boutron-Ruault MC, Maccario J, Varraso R. Confirmatory Factor Analysis Compared with Principal Component Analysis to Derive Dietary Patterns: A Longitudinal Study in Adult Women. J Nutr 2015; 145:1559-68. [PMID: 25995279 DOI: 10.3945/jn.114.204479] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/29/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Principal component analysis (PCA) has been used extensively to derive dietary patterns. We proposed to use confirmatory factor analysis (CFA) in the same context as PCA--as a one-step approach--to derive dietary patterns. OBJECTIVES The first aim of this study was methodologic and was to compare dietary patterns derived with the use of PCA and CFA, used as equivalent one-step approaches. The second aim of this study was to study these patterns in association with individual characteristics and new adult-onset asthma. METHODS We included 30,589 French women from the E3N (epidemiologic prospective cohort study of women from the MGEN national insurance plan) with 1177 reported cases of adult-onset asthma between 1993 and 2005. PCA and CFA were used in the same context, on 27 food groups, to derive dietary patterns. Associations between dietary patterns and adult-onset asthma were assessed by Cox proportional hazards models. RESULTS Whether we used PCA or CFA, 3 similar factors were found and labeled "Prudent," "Western," and "Aperitif." Correlations between patterns derived with the use of PCA and CFA were high. For the "Prudent" and "Aperitif" patterns, we observed comparable patterns in terms of associations with food groups, individual characteristics, and the onset of asthma. For the "Western" patterns, the one derived with the use of CFA was more related to an unhealthy diet than the one derived with the use of PCA, with higher correlations with the food groups "processed meat" (0.73 vs. 0.51) and "dough and pastry" (0.63 vs. 0.40), and negative associations with physical activity and with having parents who were farmers. Regarding associations with adult-onset asthma, a significant positive association was observed for the "Western" pattern derived with the use of CFA [multivariate RR for highest vs. lowest quintile: 1.30 (1.02, 1.67), P-trend: 0.03], whereas no association was reported when using PCA [RR: 1.14 (0.89, 1.47), P-trend: 0.40]. CONCLUSION Although quite similar dietary patterns were derived with the use of PCA and CFA, this study supports the alternative use of CFA to PCA for the identification of dietary patterns in epidemiologic studies.
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Affiliation(s)
- Annabelle Bédard
- INSERM U1168, Aging and chronic diseases-Epidemiological and public health approaches, Villejuif, France; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France;
| | - Judith Garcia-Aymerich
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM, Hospital del Mar Research Institute, Barcelona, Spain; CIBER en Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Margaux Sanchez
- INSERM U1168, Aging and chronic diseases-Epidemiological and public health approaches, Villejuif, France; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
| | - Nicole Le Moual
- INSERM U1168, Aging and chronic diseases-Epidemiological and public health approaches, Villejuif, France; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
| | - Françoise Clavel-Chapelon
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Gustave Roussy Institute, Villejuif, France; and University of Paris-Sud, UMRS 1018, Villejuif, France
| | - Marie-Christine Boutron-Ruault
- INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Gustave Roussy Institute, Villejuif, France; and University of Paris-Sud, UMRS 1018, Villejuif, France
| | - Jean Maccario
- INSERM U1168, Aging and chronic diseases-Epidemiological and public health approaches, Villejuif, France; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
| | - Raphaëlle Varraso
- INSERM U1168, Aging and chronic diseases-Epidemiological and public health approaches, Villejuif, France; UVSQ, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, France
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Carraro S, Scheltema N, Bont L, Baraldi E. Early-life origins of chronic respiratory diseases: understanding and promoting healthy ageing. Eur Respir J 2014; 44:1682-96. [PMID: 25323240 DOI: 10.1183/09031936.00084114] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Chronic obstructive respiratory disorders such as asthma and chronic obstructive pulmonary disease often originate early in life. In addition to a genetic predisposition, prenatal and early-life environmental exposures have a persistent impact on respiratory health. Acting during a critical phase of lung development, these factors may change lung structure and metabolism, and may induce maladaptive responses to harmful agents, which will affect the whole lifespan. Some environmental factors, such as exposure to cigarette smoke, type of childbirth and diet, may be modifiable, but it is more difficult to influence other factors, such as preterm birth and early exposure to viruses or allergens. Here, we bring together recent literature to analyse the critical aspects involved in the early stages of lung development, going back to prenatal and perinatal events, and we discuss the mechanisms by which noxious factors encountered early on may have a lifelong impact on respiratory health. We briefly comment on the need for early disease biomarkers and on the possible role of "-omic" technologies in identifying risk profiles predictive of chronic respiratory conditions. Such profiles could guide the ideation of effective preventive strategies and/or targeted early lifestyle or therapeutic interventions.
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Affiliation(s)
- Silvia Carraro
- Women's and Children's Health Dept, University of Padua, Padua, Italy
| | - Nienke Scheltema
- Dept of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Louis Bont
- Dept of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eugenio Baraldi
- Women's and Children's Health Dept, University of Padua, Padua, Italy
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Wang J, Engvall K, Smedje G, Norbäck D. Rhinitis, asthma and respiratory infections among adults in relation to the home environment in multi-family buildings in Sweden. PLoS One 2014; 9:e105125. [PMID: 25136984 PMCID: PMC4138153 DOI: 10.1371/journal.pone.0105125] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/21/2014] [Indexed: 11/18/2022] Open
Abstract
Risk factors for rhinitis, asthma and respiratory infections in the home environment were studied by a questionnaire survey. Totally 5775 occupants (≥ 18 years old) from a stratified random sample of multi-family buildings in Sweden participated (46%). 51.0% had rhinitis in the last 3 months (current rhinitis); 11.5% doctor diagnosed asthma; 46.4% respiratory infections in the last 3 months and 11.9% antibiotic medication for respiratory infections in the last 12 months. Associations between home environment and health were analyzed by multiple logistic regression, controlling for gender, age and smoking and mutual adjustment. Buildings constructed during 1960-1975 were risk factors for day time breathlessness (OR = 1.53, 95%CI 1.03-2.29). And those constructed during 1976-1985 had more current rhinitis (OR = 1.43, 95%CI 1.12-1.84) and respiratory infections (OR = 1.46, 95%CI 1.21-1.78). Cities with higher population density had more current rhinitis (p = 0.008) and respiratory infections (p<0.001). Rented apartments had more current rhinitis (OR = 1.23, 95%CI 1.07-1.40), wheeze (OR = 1.20, 95%CI 1.02-1.41), day time breathlessness (OR = 1.31, 95%CI 1.04-1.66) and respiratory infections (OR = 1.13, 95%CI 1.01-1.26). Living in colder parts of the country was a risk factor for wheeze (p = 0.03) and night time breathlessness (p = 0.002). Building dampness was a risk factor for wheeze (OR = 1.42, 95%CI 1.08-1.86) and day time breathlessness (OR = 1.57, 95%CI 1.09-2.27). Building dampness was a risk factor for health among those below 66 years old. Odor at home was a risk factor for doctor diagnosed asthma (OR = 1.49, 95%CI 1.08-2.06) and current asthma (OR = 1.52, 95%CI 1.03-2.24). Environmental tobacco smoke (ETS) was a risk factor for current asthma (OR = 1.53, 95%CI 1.09-2.16). Window panel condensation was a risk factor for antibiotic medication for respiratory infections (OR = 1.41, 95%CI 1.10-1.82). In conclusion, rhinitis, asthma and respiratory infections were related to a number of factors in the home environment. Certain building years (1961-1985), building dampness, window panel condensation and odor in the dwelling may be risk factors.
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Affiliation(s)
- Juan Wang
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
- * E-mail:
| | - Karin Engvall
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - Greta Smedje
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on childhood asthma specifically related to the underlying genetic background and pathophysiology of asthma and their interaction with environmental stimuli. We will also discuss emerging data in the field of disease phenotyping. RECENT FINDINGS The field of genetics is continuously evolving to expand our knowledge on the cause of disease. Childhood onset asthma has been related to atopy and exposure to early-life infections. More recently, phenotypes have been used to classify asthma as transient and persistent, but the association of each phenotype with the genetic origin of asthma is not clearly understood. SUMMARY This review covers the topics of genetics, epigenetics, pathophysiology, phenotypes and treatment as they relate to childhood asthma. Overall, it provides a basis for the future of asthma treatment through description of the current research.
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Chapman TJ, Georas SN. Regulatory tone and mucosal immunity in asthma. Int Immunopharmacol 2014; 23:330-6. [PMID: 24975833 DOI: 10.1016/j.intimp.2014.05.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 05/30/2014] [Accepted: 05/30/2014] [Indexed: 12/21/2022]
Abstract
The lung is constantly exposed to a variety of inhaled foreign antigens, many of which are harmless to the body. Therefore, the mucosal immune system must not only have the capacity to distinguish self from non-self, but also harmless versus dangerous non-self. To address this, mucosal immune cells establish an anti-inflammatory steady state in the lung that must be overcome by inflammatory signals in order to mount an effector immune response. In the case of inhaled allergens, the false detection of dangerous non-self results in inappropriate immune activation and eventual allergic asthma. Both basic and clinical studies suggest that the balance between tolerogenic and inflammatory immune responses is a key feature in the outcome of health or disease. This review is focused on what we term 'regulatory tone': the immunosuppressive environment in the lung that must be overcome to induce inflammatory responses. We will summarize the current literature on this topic, with a particular focus on the role of regulatory T cells in preventing allergic disease of the lung. We propose that inter-individual differences in regulatory tone have the potential to not only establish the threshold for immune activation in the lung, but also shape the quality of resulting effector responses following tolerance breakdown.
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Affiliation(s)
- Timothy J Chapman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14610, United States
| | - Steve N Georas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14610, United States.
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Abstract
The present review addresses recent advances and especially challenging aspects regarding the role of environmental risk factors in adult-onset asthma, for which the causes are poorly established. In the first part of the review, we discuss aspects regarding some environmental risk factors for adult-onset asthma: air pollution, occupational exposures with a focus on an emerging risk represented by exposure to cleaning agents (both at home and in the workplace), and lifestyle and nutrition. The second part is focused on perspectives and challenges, regarding relevant topics on which research is needed to improve the understanding of the role of environmental factors in asthma. Aspects of exposure assessment, the complexity of multiple exposures, the interrelationships of the environment with behavioral characteristics and the importance of studying biological markers and gene-environment interactions to identify the role of the environment in asthma are discussed. We conclude that environmental and lifestyle exposures play an important role in asthma or related phenotypes. The changes in lifestyle and the environment in recent decades have modified the specific risk factors in asthma even for well-recognized risks such as occupational exposures. To better understand the role of the environment in asthma, the use of objective (quantitative measurement of exposures) or modern tools (bar code, GPS) and the development of multidisciplinary collaboration would be very promising. A better understanding of the complex interrelationships between socio-economic, nutritional, lifestyle and environmental conditions might help to study their joint and independent roles in asthma.
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11
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Thorax Innovation (TORINO). Presse Med 2013; 42:e301-2. [PMID: 23972546 DOI: 10.1016/j.lpm.2013.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
BACKGROUND Because endometriosis is diagnosed predominantly in young women, exposures occurring during childhood or adolescence may have a major impact on the disease. However, potential risk factors during this time period have received little attention. Our objective was to investigate relationships between childhood and adolescent exposures and the risk of endometriosis. METHODS E3N is a prospective cohort of 98,995 French women aged 40-65 at enrollment in 1990. Follow-up questionnaires were sent every 2-3 years. Using a nested case-control design, we computed odds ratios (ORs) and 95% confidence intervals using unconditional logistic regression models. RESULTS A total of 2684 endometriosis cases were reported as surgically ascertained among the 75,918 included women. There were inverse relationships of endometriosis risk with menarcheal age (test for trend, P < 0.0001) and with menstrual cycle length before 17 years of age (test for trend, P = 0.06), whereas menstrual cycle regularity before 17 years of age was not associated with risk. There were modest associations of endometriosis risk with exposure to pet animals (OR = 1.12 [95% confidence interval =1.02-1.22]) or living in a farm for 3 or more consecutive months during childhood (1.12 [1.02-1.24]), although with no link to any specific type of farm animal. In addition, there were positive linear associations between endometriosis risk and level of indoor exposure to passive smoking during childhood (up to 1.34 [1.09-1.64] with several hours exposure a day), experiencing food deprivation during World War II (1.34 [0.94-1.91]), and walking activity at 8-15 years of age (1.17 [1.05-1.31] for 5+ hours a week). CONCLUSIONS This large study suggests that some exposures during childhood or adolescence may influence the risk of endometriosis. Further research is needed to confirm and better understand these relationships.
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Sanchez M, Bousquet J, Le Moual N, Jacquemin B, Clavel-Chapelon F, Humbert M, Kauffmann F, Tubert-Bitter P, Varraso R. Temporal asthma patterns using repeated questionnaires over 13 years in a large French cohort of women. PLoS One 2013; 8:e65090. [PMID: 23741466 PMCID: PMC3669014 DOI: 10.1371/journal.pone.0065090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 04/20/2013] [Indexed: 11/25/2022] Open
Abstract
Variable expression is one aspect of the heterogeneity of asthma. We aimed to define a variable pattern, which is relevant in general health epidemiological cohorts. Our objectives were to assess whether: 1) asthma patterns defined using simple asthma questions through repeated measurements could reflect disease variability 2) these patterns may further be classified according to asthma severity/control. Among 70,428 French women, we used seven questionnaires (1992–2005) and a comprehensive reimbursement database (2004–2009) to define three reliable asthma patterns based on repeated positive answers to the ever asthma attack question: “never asthma” (n = 64,061); “inconsistent” (“yes” followed by “no”, n = 3,514); “consistent” (fully consistent positive answers, n = 2,853). The “Inconsistent” pattern was related to both long-term (childhood-onset asthma with remission in adulthood) and short-term (reported asthma attack in the last 12 months, associated with asthma medication) asthma variability, showing that repeated questions are relevant markers of the variable expression of asthma. Furthermore, in this pattern, the number of positive responses (1992–2005) predicted asthma drug consumption in subsequent years, a marker of disease severity. The “Inconsistent” pattern is a phenotype that may capture the variable expression of asthma. Repeated answers, even to a simple question, are too often neglected.
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Affiliation(s)
- Margaux Sanchez
- Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Respiratory and environmental epidemiology Team, F-94807, Villejuif, France.
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14
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Antó JM. Recent advances in the epidemiologic investigation of risk factors for asthma: a review of the 2011 literature. Curr Allergy Asthma Rep 2013; 12:192-200. [PMID: 22422360 DOI: 10.1007/s11882-012-0254-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The present review aims to identify and summarize epidemiologic investigations published during 2011 on the environmental risk factors for asthma. Potentially eligible papers were identified by a MEDLINE search. In total, 1,130 items were retrieved. Based on a broad definition of environment, the following topics were included: obesity, diet, vitamin D, air pollution, farming environment, and social factors. Some of the more relevant contributions included evidence that 1) obesity precedes asthma, 2) fruit consumption is longitudinally associated with a lower risk of asthma and atopy, 3) a comprehensive statewide smoking ban was followed by a reduction in hospital admissions for asthma, 4) asthma is one of the diseases showing the largest burdens due to environmental tobacco smoke, 5) traffic-related urban air pollution is associated with bronchial inflammation as measured by fractional exhaled nitric oxide and uncontrolled asthma, 6) aeroallergens and desert dust may contribute to the short-term effects of air pollution and asthma, and 7) maternal exposure to air pollution before and during pregnancy may alter the immune competence in offspring.
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Affiliation(s)
- Josep M Antó
- Centre for Research in Environmental Epidemiology, Barcelona Biomedical Research Park, Spain.
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15
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Bédard A, Dumas O, Kauffmann F, Garcia-Aymerich J, Siroux V, Varraso R, Nwaru BI, Nurmatov U, Devereux G, Sheikh A. Potential confounders in the asthma-diet association: how causal approach could help? Allergy 2012; 67:1461-2; author reply 1462-3. [PMID: 23046160 DOI: 10.1111/all.12025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | - B. I. Nwaru
- School of Health Sciences; University of Tampere; Tampere; Finland
| | - U. Nurmatov
- Allergy & Respiratory Research Group; Medical School; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh; UK
| | - G. Devereux
- Department of Child Health; Royal Aberdeen Children's Hospital; University of Aberdeen; Aberdeen; UK
| | - A. Sheikh
- Allergy & Respiratory Research Group; Medical School; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh; UK
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