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Somayaji R, Chalmers JD. Just breathe: a review of sex and gender in chronic lung disease. Eur Respir Rev 2022; 31:31/163/210111. [PMID: 35022256 DOI: 10.1183/16000617.0111-2021] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic lung diseases are the third leading cause of death worldwide and are increasing in prevalence over time. Although much of our traditional understanding of health and disease is derived from study of the male of the species - be it animal or human - there is increasing evidence that sex and gender contribute to differences in disease risk, prevalence, presentation, severity, treatment approach, response and outcomes. Chronic obstructive pulmonary disease, asthma and bronchiectasis represent the most prevalent and studied chronic lung diseases and have key sex- and gender-based differences which are critical to consider and incorporate into clinical and research approaches. Mechanistic differences present opportunities for therapeutic development whereas behavioural and clinical differences on the part of patients and providers present opportunities for greater education and understanding at multiple levels. In this review, we seek to summarise the sex- and gender-based differences in key chronic lung diseases and outline the clinical and research implications for stakeholders.
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Affiliation(s)
- Ranjani Somayaji
- Dept of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada .,Dept of Microbiology, Immunology and Infectious Disease, University of Calgary, Calgary, Canada.,Dept of Community Health Sciences, University of Calgary, Calgary, Canada
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
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Abstract
The antecedents of asthma and chronic obstructive pulmonary disease (COPD) lie before school age. Adverse effects are transgenerational, antenatal and in the preschool years. Antenatal adverse effects impair spirometry by causing low birth weight, altered lung structure and immune function, and sensitizing the foetus to later insults. The key stages of normal lung health are lung function at birth, lung growth to a plateau age 20-25 years, and the phase of decline thereafter; contrary to perceived wisdom, accelerated decline is not related to smoking. There are different trajectories of lung function. Lung function usually tracks from preschool to late middle age. Asthma is driven by antenatal and early life influences. The airflow obstruction, emphysema and multi-morbidity of COPD all start early. Failure to reach a normal plateau and accelerated decline in lung function are risk factors for COPD. Airway disease cannot be prevented in adult life; prevention must start early.
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Affiliation(s)
- Andrew Bush
- Paediatrics and Paediatric Respirology, Imperial College, UK; Imperial Centre for Paediatrics and Child Health, UK; Consultant Paediatric Chest Physician, Royal Brompton Harefield NHS Foundation Trust, UK.
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Bush A, Ferkol T, Valiulis A, Mazur A, Chkhaidze I, Maglakelidze T, Sargsyan S, Boyajyan G, Cirstea O, Doan S, Katilov O, Pokhylko V, Dubey L, Poluziorovienė E, Prokopčiuk N, Taminskienė V, Valiulis A. Unfriendly Fire: How the Tobacco Industry is Destroying the Future of Our Children. Acta Med Litu 2021; 28:6-18. [PMID: 34393624 PMCID: PMC8311841 DOI: 10.15388/amed.2020.28.1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022] Open
Abstract
Tobacco has long been known to be one of the greatest causes of morbidity and mortality in the adults, but the effects on the foetus and young children, which are lifelong, have been less well appreciated. Developing from this are electronic nicotine delivery systems or vapes, promulgated as being less harmful than tobacco. Nicotine itself is toxic to the foetus, with permanent effects on lung structure and function. Most vapes contain nicotine, but they also contain many other compounds which are inhaled and for which there are no toxicity studies. They also contain known toxic substances, whose use is banned by European Union legislation. Accelerating numbers of young people are vaping, and this does not reflect an exchange of vapes for cigarettes. The acute toxicity of e-cigarettes is greater than that of tobacco, and includes acute lung injury, pulmonary haemorrhage and eosinophilic and lipoid pneumonia. Given the worse acute toxicity, it should be impossible to be complacent about medium and long term effects of vaping. Laboratory studies have demonstrated changes in lung proteomics and the innate immune system with vaping, some but not all of which overlap with tobacco. It would be wrong to consider vapes as a weaker form of tobacco, they have their own toxicity. Children and young people are being targeted by the vaping industry (which is largely the same as the tobacco industry), including on-line, and unless an efficient legislative program is put in place, a whole new generation of nicotine addicts will result.
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Affiliation(s)
- Andrew Bush
- Imperial College Centre for Paediatrics and Child Health, London, UK
National Heart and Lung Institute, London, UK
Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - Thomas Ferkol
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Algirdas Valiulis
- Vilnius University Medical Faculty Institute of Health Sciences, Vilnius, Lithuania
| | - Artur Mazur
- Medical College of Rzeszow University, Department of Pediatrics, Pediatric Endocrinology and Diabetes, Rzeszow, Poland
| | - Ivane Chkhaidze
- Tbilisi State Medical University, Department of Paediatrics, Tbilisi, Georgia
Iashvili Central Children’s Hospital, Tbilisi, Georgia
| | - Tamaz Maglakelidze
- Ivane Javakhishvili Tbilisi State University, Department of Pulmonology, Tbilisi, Georgia
Chapidze Emergency Cardiology Center, Tbilisi, Georgia Planning Committee of Global Initiative Against Chronic Respiratory Diseases (WHO GARD), Geneva, Switzerland
| | - Sergey Sargsyan
- Arabkir Medical Centre, Instutute of Child and Adolescent Health, Yerevan, Armenia
| | - Gevorg Boyajyan
- Arabkir Medical Centre, Instutute of Child and Adolescent Health, Yerevan, Armenia
| | - Olga Cirstea
- University of Medicine and Pharmacy “Nicolae Testemitanu”, Department of Paediatrics, Chisinau, Republic of Moldova
| | - Svitlana Doan
- Kyiv Medical University, Department of Public Health and Microbiology, Kyiv, Ukraine
| | | | - Valeriy Pokhylko
- Ukrainian Medical Stomatological Academy, Department of Paediatrics, Poltava, Ukraine
| | - Leonid Dubey
- Lviv National Medical University by Danylo Galytsky, Lviv, Ukraine
| | - Edita Poluziorovienė
- Vilnius University Medical Faculty Institute of Clinical Medicine, Vilnius, Lithuania
| | - Nina Prokopčiuk
- Vilnius University Medical Faculty Institute of Clinical Medicine, Vilnius, Lithuania
| | - Vaida Taminskienė
- Vilnius University Medical Faculty Institute of Health Sciences, Vilnius, Lithuania
| | - Arūnas Valiulis
- Vilnius University Medical Faculty Institute of Health Sciences, Vilnius, Lithuania
Vilnius University Medical Faculty Institute of Clinical Medicine, Vilnius, Lithuania
Planning Committee of Global Initiative Against Chronic Respiratory Diseases (WHO GARD), Geneva, Switzerland
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Bush A, Lintowska A, Mazur A, Hadjipanayis A, Grossman Z, Del Torso S, Michaud PA, Doan S, Romankevych I, Slaats M, Utkus A, Dembiński Ł, Slobodanac M, Valiulis A. E-Cigarettes as a Growing Threat for Children and Adolescents: Position Statement From the European Academy of Paediatrics. Front Pediatr 2021; 9:698613. [PMID: 34737999 PMCID: PMC8562300 DOI: 10.3389/fped.2021.698613] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/08/2021] [Indexed: 12/02/2022] Open
Abstract
As the tobacco epidemic has waned, it has been followed by the advent of electronic nicotine delivery devices (ENDS) primarily manufactured by the tobacco industry to try to recruit replacements for deceased tobacco addicts. This document sets out the ten recommendations of the European Academy of Paediatrics (EAP) with regard to e-cigarettes and children and young people (CYP). The EAP notes that nicotine is itself a drug of addiction, with toxicity to the foetus, child and adult, and were ENDS only to contain nicotine, their use to create a new generation of addicts would be rigorously opposed. However, e-cigarettes include numerous unregulated chemicals, including known carcinogens, whose acute and long term toxicities are unknown. The EAP asserts that there is incontrovertible evidence that the acute toxicity of e-cigarettes is greater than that of "traditional" tobacco smoking, and a variety of acute pulmonary toxicities, including acute lung injuries, have been recorded due to e-cigarettes usage. The chronic toxicity of e-cigarettes is unknown, but given the greater acute toxicity compared to tobacco, the EAP cannot assume that e-cigarettes are safer in the long term. The high uptake of e-cigarettes by CYP, including under-age children, is partly fuelled by deceitful marketing and internet exposure, which is also unregulated. Although proposed as aids to smoking cessation, there is no evidence that e-cigarettes add anything to standard smoking cessation strategies. In summary, the EAP regards these devices and liquids as very dangerous, and ineluctably opposed to their use, and their direct or indirect marketing.
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Affiliation(s)
- Andrew Bush
- Imperial College Centre for Paediatrics and Child Health, National Heart and Lung Institute, Royal Brompton Harefield NHS Foundation Trust, London, United Kingdom
| | - Agnieszka Lintowska
- Department of Health Promotion, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Artur Mazur
- Institute of Medical Sciences, Medical College, University of Rzeszów, Rzeszow, Poland.,European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium
| | - Adamos Hadjipanayis
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Medical School, European University of Cyprus, Nicosia, Cyprus
| | - Zacchi Grossman
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Adelson School of Medicine, Ariel University, Ariel, Israel.,Maccabi Health Services, Tel Aviv, Israel
| | - Stefano Del Torso
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Pediatra di Famiglia ULSS 16, Padua, Italy
| | - Pierre-André Michaud
- Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland
| | - Svitlana Doan
- Department of Public Health and Microbiology, Kyiv Medical University, Kyiv, Ukraine
| | - Ivanna Romankevych
- Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Monique Slaats
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Pediatric Pulmonology, Sophia Children's Hospital, Rotterdam, Netherlands
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Łukasz Dembiński
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | | | - Arunas Valiulis
- European Academy of Paediatric (EAP/UEMS-SP), Brussels, Belgium.,Clinic of Children's Diseases, Institute of Clinical Medicine, and Department of Public Health, Institute of Health Sciences, Vilnius University Medical Faculty, Vilnius, Lithuania
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