Extreme weather and asthma: a systematic review and meta-analysis

Evaluation of the Arabic version of the Asthma Trigger Inventory among asthmatic pediatric patients in Saudi Arabia

BACKGROUND

Asthma Trigger Inventory (ATI) is available in English, German, and Spanish languages; however, a version in Arabic language specifically tailored for identifying asthma triggers within Saudi Arabia has been missing.

OBJECTIVES

To assess the reliability and validity of the adapted Arabic ATI among parents of asthmatic children in Saudi Arabia.

METHODS

A cross-cultural adaptation of the ATI was conducted, adding seven region-specific triggers to reflect cultural and environmental factors. The Pediatric Asthma Quality of Life Questionnaire (PACQLQ) was used to assess quality of life. Construct validity of the Arabic ATI was evaluated via exploratory factor analysis (EFA), and reliability was measured with Cronbach's alpha.

RESULTS

EFA yielded a KMO of 0.634 and a significant Bartlett's Test (χ2 = 10,005.076, p < 0.001). Six trigger subscales showed high reliability (α > 0.90), though Middle Eastern triggers had lower internal consistency (α = -0.11). Physical and psychological triggers correlated significantly with poorer quality of life (exercise: r = -0.662, p < 0.001; psychological: r = -0.307, p < 0.001). Air pollution and Middle Eastern triggers correlated positively with quality of life (r = 0.222, p < 0.001 and r = 0.245, p < 0.001).

CONCLUSION

The Arabic version of the ATI exhibited robust reliability and validity when administered to parents of asthmatic children in Saudi Arabia. Additional research is warranted to further validate its applicability across various Arabic-speaking populations.

Global, regional, and national burden of asthma and atopic dermatitis, 1990-2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050.

METHODS

Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010-19) and during (2019-21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs).

FINDINGS

In 2021, there were an estimated 260 million (95% UI 227-298) individuals with asthma and 129 million (124-134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250-331) in 1990 to 238 million (209-272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103-112) in 1990 to 129 million (124-134) in 2021. However, age-standardised prevalence rates decreased-by 40·0% (from 5568·3 per 100 000 to 3340·1 per 100 000) for asthma and 8·3% (from 1885·4 per 100 000 to 1728·5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465·0 [357·2-648·9] per 100 000) and the high-income super-region for atopic dermatitis (3552·5 [3407·2-3706·1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic -1·39% [-2·07 to -0·71] and during the pandemic 0·47% [-1·86 to 2·79]; p=0·020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic -0·28% [-0·33 to -0·22] and during the pandemic -0·35% [-0·78 to 0·08]; p=0·20). Modifiable risk factors were responsible for 29·9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39·4 [19·6-60·2] per 100 000), followed by occupational asthmagens (20·8 [16·7-26·5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224-330) asthma cases and 148 million (140-158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (-23·2% [-44·4 to 5·3] for asthma and -1·4% [-9·1 to 7·0] for atopic dermatitis) from 2021 to 2050.

INTERPRETATION

Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable.

FUNDING

Gates Foundation.

Strengthening the WHO Emergency Care Systems Framework: insights from an integrated, patient-centered approach in the Copenhagen Emergency Medical Services system-a qualitative system analysis

BACKGROUND

The World Health Organization Emergency Care Systems Framework (WHO ECSF) was designed to offer guidance in establishing and developing effective Emergency Medical Services (EMS) systems. However, evolving disease patterns, changing community needs, and a rising demand for emergency care services, highlight the need for more integrated and patient-centered EMS systems. This evolution should be mirrored in the WHO ECSF. Hence, this study explores system components of the Copenhagen (CPH) EMS that may enhance the WHO ECSF´s emphasis on integrated and patient-centered care.

METHODS

A qualitative case study was conducted from April through June 2021, including (i) semi-structured interviews with researchers and professionals at the CPH EMS and (ii) a scoping literature review using PubMed, Google Scholar, expert recommendations and snowballing.

RESULTS

Thirteen expert interviews and 35 records were analyzed, revealing key integrated care components within the CPH EMS. These include education and citizen participation programs, early triaging, differentiated care pathways coordinated with primary care and out-of-hours services, and specialized mobile care units complementing "traditional" ambulance services. Technology supports integrated and patient-centered care by facilitating early differentiation of care, efficient dispatching, and communication. Data-driven approaches were fostered through technology-aided data collection, supporting research, quality improvement, and patient safety. The identified components were mapped within the WHO ECSF´s four domains: scene, transport, facility, and cross-cutting elements. Due to the prehospital focus of the CPH EMS, limited data was available for the "facility" site.

CONCLUSIONS

The CPH EMS demonstrates an integrated, patient-centered systems approach that emphasizes seamless coordination along the patient care pathway, bridging EMS with broader health and social systems. Research-informed initiatives and intelligent technology solutions underscore the potential for enhancing the WHO ECSF. These findings highlight the importance of continued system integration and a holistic health perspective, including in emergency settings. Further research is needed to assess the transferability of these components across diverse global contexts.

TRIAL REGISTRATION

Not applicable.

Chinese Expert Consensus on the Impact of Ambient Air Pollution on Allergic Rhinitis and Recommendations for Mitigation Strategies

Ambient air pollution poses a significant yet manageable threat to human health. The growing consensus on the impact of ambient air pollutants on allergic rhinitis (AR) emphasizes the importance of prevention, control, and treatment strategies. A multidisciplinary consensus development group was established to further standardize management strategies for AR in the presence of exposure to ambient air pollutants. The quality of the evidence and the strength of the recommendations were evaluated using the grading of recommendations, assessment, development, and evaluation (GRADE) system based on domestic and international relevant medical evidence. This consensus evaluates the effects of key air pollutants on public health in relation to AR, including the synergistic effects of air pollutants with meteorological conditions and aeroallergens. At the same time, the consensus provides recommendations for targeted therapeutic and preventive measures for AR under conditions of ambient air pollution, aiming to improve AR-related health outcomes. These recommendations aim to increase public and clinical awareness of the contribution of environmental factors to AR, and offer evidence-based insights for policymakers and regulators to establish informed ambient air quality standards.

Modeling the latent impacts of extreme floods on indoor mold spores in residential buildings: Application of machine learning algorithms

Floods can severely impact the economy, environment and society. These impacts can be direct and indirect. Past research has focused more on the former impacts. Of the indirect impacts, those on mold growth in indoor environments that affect human respiratory health (e.g. asthma) have received limited attention. Models can be used to predict these impacts and support development of mitigation and preventive actions. Despite the presence of models for some other impacts of flooding, quantitative models for estimating the impacts of flooding on indoor mold spores are lacking. In this article, we studied the aftermath of two recent hurricanes-Ida and Ian-in the United States and applied machine learning algorithms to develop the first quantitative model for predicting mold spores in buildings. A comprehensive fine-scale database (building level), consisting of flood characteristics, building properties, human indoor activities and existing mold spores, prepared through survey questionnaires, home inspections, laboratory analyses and flood hindcasting, from 60 homes was utilized. The modeling results suggested satisfactory performance for regression-based predictions of indoor mold spores (coefficient of determination or R2 of 0.83 and 0.38). This is the first quantitative model for predicting the impacts of flooding on mold spores. Our study provides a foundation for quantitative assessments of flood impacts on indoor mold spores in residential buildings. This supports insurance companies, public health officials and emergency managers to better assess the impacts of hurricanes and extreme flooding on human respiratory health.

Exposure to climate change-related extreme events in the first year of life and occurrence of infant wheezing

INTRODUCTION

Climate change increases the intensity and frequency of extreme events, which will most impact younger generations. Within the NINFEA birth cohort, we investigated the relationship between exposure to such events during the first year of life and infant respiratory health.

METHODS

The NINFEA cohort study recruited pregnant women across 11 years in Italy, allowing for climatic variability exploitation by birth place and time. We combined geocoded addresses with climate data, to derive children's cumulative exposure to the following extreme events during their first year: (i) heatwaves (i.e. 3 + consecutive days, with maximum temperature > 35 °C); (ii) days with wildfire PM2.5 >15 μg/m3 and (iii) daily precipitation > 100 mm; (iv) months with exceptional drought. Logistic regression models estimated the relationship between each exposure and wheezing at 6-18 months, adjusting for individual and contextual factors.

RESULTS

Wheezing prevalence in the cohort was 17.6%. The exposure to each additional heatwave in the first year of life increased wheezing risk by 16%, with an odds ratio (OR) of 1.16 and a 95% Confidence Interval (CI) of 1.00;1.35. The OR for each month of extreme drought exposure was 1.10, 95%CI 0.95; 1.26. Results for wildfire PM2.5 were unclear with wider confidence intervals (OR for each high exposure day:1.36, 95% CI 0.85; 2.16). Wheezing was not associated with extreme precipitation.

CONCLUSIONS

Exposure to multiple extreme events, especially heatwaves, in the first year of life is associated with later infant respiratory health suggesting the need to implement climate change mitigation policies to protect long-term health.

Decreased childhood asthma hospitalizations linked to hotter, drier climate with lower wind speed in drylands

Climate change poses a significant threat to human health. Long-term climate effects on childhood asthma hospitalizations depend on the population's geographic region. These effects in tropical drylands are not well understood. The objective of this study is to examine the long-term association between childhood asthma hospitalizations and the climate of a tropical dryland. The study covered 14 municipalities in the Brazilian semiarid. Monthly trends in hospitalizations and climatic variables were calculated. A generalized additive model analyzed the association between these trends, and the Mann-Kendall test determined if trends were increasing, decreasing, or not significant. Thirteen municipalities showed a significant link between hospitalizations and climate variables, especially wind speed, maximum temperature, and humidity. Overall, hospitalizations decreased, correlating with decreasing wind speed and humidity, and increasing temperature. However, no discernable pattern was found between hospitalizations and precipitation. The study emphasizes the need for climate-health analysis to manage childhood asthma amid climate change.

Impact of seasonal biometeorological conditions and particulate matter on asthma and COPD hospital admissions

Climate change and air pollution are pressing public health concerns, necessitating monitoring of their impact, particularly on respiratory diseases like obstructive lung diseases. This retrospective study analyzed medical records of patients hospitalized at the Warmia and Mazury Centre for Pulmonary Diseases in Olsztyn, Poland (2012-2021) for asthma and chronic obstructive pulmonary disease (COPD) exacerbations. Data included meteorological factors such as temperature, humidity, wind speed, precipitation, and levels of PM2.5 and PM10. The Humidex was utilized to assess thermal discomfort, considering various meteorological and thermal seasons. Findings indicated seasonal variability in asthma and COPD exacerbations. During winter, poorer air quality due to higher PM2.5 and PM10 levels correlated with increased exacerbations (r = 0.283, p < 0.05; r = 0.491, p < 0.001). In summer, discomfort from meteorological conditions led to more hospital admissions. Humidex values strongly correlated with admissions for obstructive diseases (R2 = 0.956 for asthma; R2 = 0.659 for COPD), with July and August showing statistically higher admission rates (p < 0.05). The study highlights the significant impact of air pollution and meteorological conditions on exacerbations of asthma and COPD, with Humidex serving as a valuable predictor during summer months.

Climate change, air pollution and chronic respiratory diseases: understanding risk factors and the need for adaptive strategies

Under the background of climate change, the escalating air pollution and extreme weather events have been identified as risk factors for chronic respiratory diseases (CRD), causing serious public health burden worldwide. This review aims to summarize the effects of changed atmospheric environment caused by climate change on CRD. Results indicated an increased risk of CRD (mainly COPD, asthma) associated with environmental factors, such as air pollutants, adverse meteorological conditions, extreme temperatures, sandstorms, wildfire, and atmospheric allergens. Furthermore, this association can be modified by factors such as socioeconomic status, adaptability, individual behavior, medical services. Potential pathophysiological mechanisms linking climate change and increased risk of CRD involved pulmonary inflammation, immune disorders, oxidative stress. Notably, the elderly, children, impoverished groups and people in regions with limited adaptability are more sensitive to respiratory health risks caused by climate change. This review provides a reference for understanding risk factors of CRD in the context of climate change, and calls for the necessity of adaptive strategies. Further interdisciplinary research and global collaboration are needed in the future to enhance adaptability and address climate health inequality.

Effects of climate and environmental factors on childhood and adolescent asthma: A systematic review based on spatial and temporal analysis evidence

BACKGROUND

Asthma is a prevalent chronic respiratory disease among children, influenced by various climate and environmental factors. Despite its prevalence, the specific effects of these factors on asthma remain unclear. This study aims to systematically assess the epidemiological evidence using spatial and temporal methods on the impact of climate and environmental factors on childhood asthma.

METHODS

A systematic review was conducted to analyse the impact of climate and environmental factors on childhood asthma and wheezing, focusing on spatial and temporal trends. Searches were carried out in PubMed, Embase, and CINAHL databases for studies published from January 2000 to April 2024, using key search terms 'asthma/wheezing', 'extreme weather, 'green space', 'air pollution' and 'spatial or temporal analyses".

RESULTS

The systematic review analysed 28 studies, with six employing spatial and 22 using temporal analysis methods; however, none incorporated spatio-temporal analysis in their models. The findings reveal that extreme weather events, including heatwaves and heavy rainfall, elevate childhood asthma risks across various climates, with significant effects observed during summer and winter months. Dust storms in arid and subtropical regions are linked to immediate spikes in hospital admissions due to asthma exacerbations. The effects of green spaces on childhood asthma are mixed, with some studies indicating protective effects while others suggest increased risks, influenced by local environmental factors. Air pollutants such as PM2.5, NO2, and ozone can exacerbate asthma symptoms and along with other environmental factors, contribute to seasonal effects. High temperatures generally correlate with increased asthma risks, though the effects vary by age, sex, and climate.

CONCLUSION

Future research should integrate spatial and temporal methods to better understand the effects of environmental and climate changes on childhood asthma.

Prescribing sustainability: should UN sustainable development goals be part of the medical, pharmacy, and biomedical education?

Introduction

How to adapt the curriculum of medicine, pharmacy, and biomedical sciences to prepare future health professionals to meet the challenge of maintaining quality care in a period of socio-ecological crisis? Addressing connections between humanity and sustainable environment should include an analysis of the reciprocal influence of various ecosystems, since it is now clear that healthcare systems have an impact on ecosystems and vice versa. Here, we propose that integrating the United Nations Sustainable Development Goals (SDGs) into the curriculum could be a first step in such a transversal education.

Methods

Members of the faculty of medicine at the University of Namur, Belgium, including teaching staff of the department of medicine, pharmacy, biomedical sciences and psychology, were invited to respond anonymously to a questionnaire about their views on the feasibility of integrating the SDGs into their teaching. A subsequent survey on students' perceptions of such teaching was conducted by student representatives.

Results

Seventy-nine percent of surveyed members of the medical faculty believe that it is possible to integrate SDGs into their lectures. However, 44-86% of them did not know how to integrate each individual goal. 94.4% of students would like SDGs to play a greater role in their education; 64.4% of them would integrate them into existing modules; 23.9% would create an optional module, and 11.9% would create a mandatory module.

Conclusion

Sustainable Development Goals integration into the curriculum of medicine, pharmacy, and biomedical sciences is perceived as challenging in a dense teaching program. To clarify how SDGs can translate into traditional lectures, we provide for each SDG targeted applications for bachelor's, master's and continuing education.

Highlights from the 11th Bronchitis International Symposium: "Heterogeneity of Lung Disease in a Changing Environment," Groningen, The Netherlands, 2024

This meeting report provides an overview of the highlights of the Bronchitis XI international symposium, held in June 2024 in Groningen, The Netherlands. The theme of this year's symposium was "heterogeneity of lung disease in a changing environment," and the symposium contained five different sessions focused on (i) heterogeneity of chronic lung disease, (ii) environmental changes with impact on lung disease, (iii) the aging lung, (iv) bronchitis, and (v) innovative therapy. The highlights from each of these sessions will be discussed separately, providing an overview of latest studies, new data, and enthralling discussions.

Asthma Inception: Epidemiologic Risk Factors and Natural History Across the Life Course

Asthma is a descriptive label for an obstructive inflammatory disease in the lower airways manifesting with symptoms including breathlessness, cough, difficulty in breathing, and wheezing. From a clinician's point of view, asthma symptoms can commence at any age, although most patients with asthma-regardless of their age of onset-seem to have had some form of airway problems during childhood. Asthma inception and related pathophysiologic processes are therefore very likely to occur early in life, further evidenced by recent lung physiologic and mechanistic research. Herein, we present state-of-the-art updates on the role of genetics and epigenetics, early viral and bacterial infections, immune response, and pathophysiology, as well as lifestyle and environmental exposures, in asthma across the life course. We conclude that early environmental insults in genetically vulnerable individuals inducing abnormal, pre-asthmatic airway responses are key events in asthma inception, and we highlight disease heterogeneity across ages and the potential shortsightedness of treating all patients with asthma using the same treatments. Although there are no interventions that, at present, can modify long-term outcomes, a precision-medicine approach should be implemented to optimize treatment and tailor follow-up for all patients with asthma.

Rate of Asthma Prescriptions for Children and Adolescents During the 2018 Floods in Japan

BACKGROUND AND OBJECTIVES

Victims of natural disasters are exposed to air pollution, changes in living conditions, and physical/emotional stress, which leads to exacerbation of asthma. The study aimed to examine the association between being victims of a natural disaster and asthma medication prescriptions among children and adolescents by comparing those affected and unaffected by the 2018 Japan floods.

METHODS

Within the most severely impacted regions, a 1-year postdisaster retrospective cohort study was conducted on the basis of the National Health Insurance Claims Database. Participants aged 0 to 19 years with no record of asthma treatment in the year preceding the disaster were included in the analysis. The cumulative incidence of newly prescribed asthma inhalers in the 12 months after the disasters was compared between victims and nonvictims using survival analysis. To test the robustness, a difference-in-differences analysis was performed, including participants with a history of asthma prescriptions.

RESULTS

Of the 1 073 170 participants included in the study, 4425 (0.40%) were assigned to the victim group. Of these, 287 individuals (6.5%) from the victim group and 59 469 individuals (5.6%) from the nonvictim group were newly prescribed asthma inhalers within the year after the floods. Survival analysis revealed that victims were more prone to receiving inhaler prescriptions compared with nonvictims (adjusted hazard ratio 1.30; 95% confidence interval 1.16-1.46). Consistent results were obtained from the difference-in-differences analysis.

CONCLUSIONS

The 2018 Japan floods increased the demand for asthma inhalers among flood victims, underscoring the general implication that natural disasters can increase the incidence of asthma.

The impact of outdoor pollution and extreme temperatures on asthma-related outcomes: A systematic review for the EAACI guidelines on environmental science for allergic diseases and asthma

Air pollution is one of the biggest environmental threats for asthma. Its impact is augmented by climate change. To inform the recommendations of the EAACI Guidelines on the environmental science for allergic diseases and asthma, a systematic review (SR) evaluated the impact on asthma-related outcomes of short-term exposure to outdoor air pollutants (PM2.5, PM10, NO2, SO2, O3, and CO), heavy traffic, outdoor pesticides, and extreme temperatures. Additionally, the SR evaluated the impact of the efficacy of interventions reducing outdoor pollutants. The risk of bias was assessed using ROBINS-E tools and the certainty of the evidence by using GRADE. Short-term exposure to PM2.5, PM10, and NO2 probably increases the risk of asthma-related hospital admissions (HA) and emergency department (ED) visits (moderate certainty evidence). Exposure to heavy traffic may increase HA and deteriorate asthma control (low certainty evidence). Interventions reducing outdoor pollutants may reduce asthma exacerbations (low to very low certainty evidence). Exposure to fumigants may increase the risk of new-onset asthma in agricultural workers, while exposure to 1,3-dichloropropene may increase the risk of asthma-related ED visits (low certainty evidence). Heatwaves and cold spells may increase the risk of asthma-related ED visits and HA and asthma mortality (low certainty evidence).

Climate change and its impact on asthma

ABSTRACT

Earth's climate is changing at an unprecedented pace, primarily due to anthropogenic causes including greenhouse gas emissions. Evidence shows a strong link between climate change and its effects on asthma. Healthcare professionals must be educated to advocate for and lead effective strategies to reduce the health risks of climate change.

Impact of Climate Change on Dietary Nutritional Quality and Implications for Asthma and Allergy

Asthma and allergic disorders are common in childhood with genetic and environmental determinants of disease that include prenatal nutritional exposures such as long-chain polyunsaturated fatty acids and antioxidants. Global climate change is implicated in asthma and allergic disorder morbidity with potential mechanisms including perturbations of ecosystems. There is support that environmental and climatic changes such as increasing global temperate and carbon dioxide levels affect aquatic and agricultural ecosystems with subsequent alterations in long-chain polyunsaturated fatty acid availability and nutrient quality and antioxidant capacity of certain crops, respectively. This article discusses asthma epidemiology and the influence of global climate change.

Climate and environmental changes exacerbate health disparities in pregnant people and their offspring. How can we protect women and their babies?

BACKGROUND

The effects of climate and environmental changes (CEC) are being felt globally and will worsen over the next decade unless significant changes are made on a global level. Climate change is having serious consequences for health, particularly for vulnerable women and their offspring and less resilient individuals in communities with socioeconomic inequalities. To protect human health from CEC effects, efforts need to be directed toward building resilience strategies. Building political and economic power, as well as directly addressing CEC-related challenges, are critical components of climate resilience. Effective communication and tailored methods to engage women in preventive strategies are also necessary to ameliorate the deleterious effects of CEC on women's health. Furthermore, women from marginalized communities face more CEC-associated challenges.

CONCLUSIONS

Therefore, effective policies and programs targeting these at-risk populations-are crucial to improve the overall state of global health. In closing, it is time to increase awareness of the effects of CECs on women's health and their transgenerational effects in order to ensure that all people, regardless of race, ethnicity, education and income are protected from the detrimental effects of CECs.

Long term respiratory morbidity of cesarean-delivered second twin compared to their vaginally-delivered sibling: A retrospective population-based cohort study

BACKGROUND

Offspring born via cesarean delivery (CD) may be more prone to develope long-term respiratory diseases, compared to those delivered vaginally (VD). In this study, we compared the rates of respiratory diseases between first twins VD and second twins delivered via CD.

METHODS

This was a retrospective database study. All twin deliveries encompassed at the Soroka University Medical Center, a large tertiary hospital in southern Israel, between 1991 and 2020, in which the first twin was VD and the second via CD were included. Respiratory diseases included respiratory tract diseases such as bronchiolitis and bronchial asthma. The cumulative incidence of respiratory diseases was compared between the twins using Kaplan-Meier survival analysis and multivariable Cox models to adjust for confounding variables.

RESULTS

A total of 395,408 deliveries occurred during the study period, with 13,402 (3.4%) of all deliveries being twins. Of these, 184 (1.4%) were first twins VD and second twins delivered via CD. The second CD twin was more likely to have a non-reassuring fetal heart rate pattern and an Apgar score less than 7 at 5 min. No other differences were found between the siblings. The incidence of long-term respiratory diseases was not statistically different between the CD and VD siblings (7.6% vs. 9.4%, respectively; OR = 0.54; 95% CI: 0.23-1.26). Similarly, the cumulative incidence of respiratory diseases was not statistically different (Kaplan-Meier, log-rank, p = .59), and in the multivariable analysis which adjusted for birthweight and fetal distress during delivery (adjusted hazard ratio = 1.06; 95% CI: 0.43-26.25).

CONCLUSIONS

While the immediate outcomes for the CD twin were slightly worse compared to the VD twin, there was no difference in long-term respiratory diseases between the siblings.