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Naftel J, Mistry H, Mitchell FA, Belson J, Kyyaly MA, Barber C, Haitchi HM, Dennison P, Djukanovic R, Seumois G, Vijayanand P, Arshad SH, Kurukulaaratchy RJ. How Does Mild Asthma Differ Phenotypically from Difficult-to-Treat Asthma? J Asthma Allergy 2023; 16:1333-1345. [PMID: 38144877 PMCID: PMC10748667 DOI: 10.2147/jaa.s430183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023] Open
Abstract
Background Despite most of the asthma population having mild disease, the mild asthma phenotype is poorly understood. Here, we aim to address this gap in knowledge by extensively characterising the mild asthma phenotype and comparing this with difficult-to-treat asthma. Methods We assessed two real-world adult cohorts from the South of England using an identical methodology: the Wessex AsThma CoHort of difficult asthma (WATCH) (n=498) and a mild asthma cohort from the comparator arm of the Epigenetics Of Severe Asthma (EOSA) study (n=67). Data acquisition included detailed clinical, health and disease-related questionnaires, anthropometry, allergy and lung function testing, plus biological samples (blood and sputum) in a subset. Results Mild asthma is predominantly early-onset and is associated with type-2 (T2) inflammation (atopy, raised fractional exhaled nitric oxide (FeNO), blood/sputum eosinophilia) plus preserved lung function. A high prevalence of comorbidities and multimorbidity was observed in mild asthma, particularly depression (58.2%) and anxiety (56.7%). In comparison to difficult asthma, mild disease showed similar female predominance (>60%), T2-high inflammation and atopy prevalence, but lower peripheral blood/airway neutrophil counts and preserved lung function. Mild asthma was also associated with a greater prevalence of current smokers (20.9%). A multi-component T2-high inflammatory measure was comparable between the cohorts; T2-high status 88.1% in mild asthma and 93.5% in difficult asthma. Conclusion Phenotypic characterisation of mild asthma identified early-onset disease with high prevalence of current smokers, T2-high inflammation and significant multimorbidity burden. Early comprehensive assessment of mild asthma patients could help prevent potential later progression to more complex severe disease.
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Affiliation(s)
- Jennifer Naftel
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Heena Mistry
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
- Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, UK
- Vijayanand Laboratory, La Jolla Institute of Immunology, San Diego, CA, 92037, USA
| | - Frances Ann Mitchell
- The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, UK
| | - Jane Belson
- The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, UK
| | - Mohammed Aref Kyyaly
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
- The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, UK
| | - Clair Barber
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hans Michael Haitchi
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
- Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Paddy Dennison
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
- Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ratko Djukanovic
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
- Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Gregory Seumois
- Vijayanand Laboratory, La Jolla Institute of Immunology, San Diego, CA, 92037, USA
| | - Pandurangan Vijayanand
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
- Vijayanand Laboratory, La Jolla Institute of Immunology, San Diego, CA, 92037, USA
| | - Syed Hasan Arshad
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
- Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, UK
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Ramesh J Kurukulaaratchy
- National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, UK
- Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, UK
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Manoochehri Z, Faradmal J, Moghimbeigi A. Modeling of smoking intensity by age at smoking onset among Iranian adult male using generalized additive model. Sci Rep 2022; 12:16700. [PMID: 36202896 PMCID: PMC9537518 DOI: 10.1038/s41598-022-21194-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 09/23/2022] [Indexed: 11/24/2022] Open
Abstract
Because the age at which a person first starts smoking has such a strong correlation with future smoking behaviours, it's crucial to examine its relationship with smoking intensity. However, it is still challenging to accurately prove this relationship due to limitations in the methodology of the performed studies. Therefore the main purpose of this study is to evaluate the potential risk factors affecting the intensity of smoking, especially the age of smoking onset among Iranian adult male smokers over 18 years of age using a generalized additive model (GAM). In GAM a latent variable with logistic distribution and identity link function was considered. Data from 913 Iranian male current smokers over the age of 18 was evaluated from a national cross-sectional survey of non-communicable disease (NCD) risk factors in 2016. Individuals were classified into: light, moderate, and heavy smokers. A GAM was used to assess the relationship. The results showed that 246 (26.9%) subjects were light smokers, 190 (20.8%) subjects were moderate smokers and 477 (52.2%) subjects were heavy smokers. According to the GAM results, the relationship was nonlinear and smokers who started smoking at a younger age were more likely to become heavy smokers. The factors of unemployment (OR = 1.364, 95% CI 0.725–2.563), retirement (OR = 1.217, 95% CI 0.667–2.223), and exposure to secondhand smoke at home (OR = 1.364, 95% CI 1.055–1.763) increased the risk of heavy smoking. but, smokers with high-income (OR = 0.742, 95% CI 0.552–0.998) had a low tendency to heavy smoking. GAM identified the nonlinear relationship between the age of onset of smoking and smoking intensity. Tobacco control programs should be focused on young and adolescent groups and poorer socio-economic communities.
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Affiliation(s)
- Zohreh Manoochehri
- Department of Biostatistics, Student Research Committee, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Javad Faradmal
- Modeling of Noncommunicable Diseases Research Center, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moghimbeigi
- Department of Biostatistics and Epidemiology, Faculty of Health & Health, Safety and Environment Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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3
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Feltmann K, Gripenberg J, Elgán TH. Sales of cigarettes to pseudo-underage mystery shoppers: Experiences from Stockholm County. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:573-585. [PMID: 35309850 PMCID: PMC8900174 DOI: 10.1177/14550725211003423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022] Open
Abstract
Aims There is an 18 years age limit for cigarette purchase in Sweden and in order to implement this law outlets need to perform ID checks. This study investigates the rate of cigarette sales and ID checks when pseudo-underage mystery shoppers attempted to purchase cigarettes. It explores possible factors associated with sales outcomes. Design Nine mystery shoppers (6 females and 3 males) attempted to purchase cigarettes without providing ID. The mystery shoppers were 18 years old but had a younger appearance as judged by an expert panel. During each attempt, the adolescents worked in pairs (shopper and observer). A total of 320 outlets in 13 municipalities in Stockholm County were randomly selected based on an outlet type stratum (i.e., gas station, convenience store, kiosk, grocery store). Effects of variables on sales outcomes were analysed using Pearson's chi-square and binominal regression analysis. Results In 25.4% of the purchase attempts (total n = 287), cigarettes were sold although the pseudo-underage mystery shopper did not provide a valid ID. In 82.6% of the attempts, the shopper was asked to provide ID, and cigarettes were sold in 9.7% of these cases. The rate of sales was significantly higher among female mystery shoppers (29.5%) compared to male (15.0%). Age limit signs were observed in 89.5% of the outlets but they were not significantly associated with the success rate in a regression analysis. Conclusions The results of the present study indicate that cigarettes could potentially and frequently be sold to underage adolescents by outlets within Stockholm County. Therefore, routines established for checking IDs clearly need to be improved. For example, strategies to improve adherence to the legal age limit on the purchase of cigarettes, such as compliance checks using mystery shopping with feedback to retailers, are needed.
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Affiliation(s)
- Kristin Feltmann
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Johanna Gripenberg
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Tobias H Elgán
- STAD, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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Underner M, Peiffer G, Perriot J, Jaafari N. [Smoking cessation in asthmatic patients and its impact]. Rev Mal Respir 2021; 38:87-107. [PMID: 33414027 DOI: 10.1016/j.rmr.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/18/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The prevalence of smoking in asthmatic patients is similar to, or even higher than in the general population. OBJECTIVES This systematic review addresses (1) the effects of smoking on asthma, (2) smoking cessation strategies in asthmatic patients, and (3) the consequences of smoking cessation for people with asthma. RESULTS Active or passive smoking can promote the development of asthma. The few studies on smoking cessation in asthma confirm the efficacy of validated smoking cessation strategies in these patients (nicotine replacement therapy, varenicline, bupropion, cognitive and behavioural therapies). Smoking cessation in parents with asthmatic children is essential and is based on the same strategies. Electronic cigarettes may be a useful help to quit smoking in some patients. Smoking cessation is beneficial in asthmatic smokers and associated with (1) a reduction of asthma symptoms, acute exacerbations, bronchial hyperresponsiveness, and bronchial inflammation, (2) decreased use of rescue medications and in doses of inhaled corticosteroids, (3) improved asthma control, quality of life, and lung function. CONCLUSION In asthmatic patients, it is essential to assess smoking status and health professionals must assist them to quit smoking.
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Affiliation(s)
- M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France.
| | - G Peiffer
- Service de pneumologie, hôpital de Mercy, CHR Metz-Thionville, 57085 Metz cedex 3, France
| | - J Perriot
- Dispensaire Émile-Roux, CLAT 63, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - N Jaafari
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
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Li L, Borland R, Cummings KM, McNeill A, Heckman BW, Fong GT, O'Connor RJ, Driezen P. Are health conditions and concerns about health effects of smoking predictive of quitting? Findings from the ITC 4CV Survey ( 2016-2018 ). Tob Prev Cessat 2020; 6:60. [PMID: 33163706 PMCID: PMC7643583 DOI: 10.18332/tpc/127471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Limited research has investigated the relationship between multiple health conditions and subsequent quitting activities at the population level. This study examines whether nine health conditions and concerns related to smoking are predictive of quit attempts and success among those who tried. METHODS Data came from the International Tobacco Control Four Country Smoking and Vaping Survey conducted in Australia, Canada, England and the US. A total of 3998 daily smokers were surveyed in 2016 and recontacted in 2018. Respondents were asked in 2016 whether they had a medical diagnosis for depression, anxiety, alcohol problems, obesity, chronic pain, diabetes, heart disease, cancer, and chronic lung disease, and whether they had concerns about past/future health effects of smoking. Outcomes were quit attempts and success (having been abstinent for at least one month between surveys). RESULTS Across all four countries, 44.4% of smokers tried to quit between the two survey years, and of these 36.8% were successful. Concerns about past (adjusted odds ratio, AOR=1.66, 95% CI: 1.32–2.08, p<0.001) and future effects of smoking (AOR=2.17, 95% CI: 1.62–2.91, p<0.001) and most health conditions predicted quit attempts, but were mostly unrelated to quit success, with concerns about future effects (AOR=0.59, 95% CI: 0.35–0.99, p<0.05), chronic lung conditions (AOR=0.56, 95% CI: 0.37–0.86, p<0.01) and chronic pain (with a trend) being associated with lower success. CONCLUSIONS Having a major chronic health condition does, generally, motivate making quit attempts, but in some cases it is associated with failure among those who try. More effective cessation support is required for these high priority groups.
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Affiliation(s)
- Lin Li
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Cancer Council Victoria, Melbourne, Australia
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Cancer Council Victoria, Melbourne, Australia
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States.,Hollings Cancer Center, Medical University of South Carolina, Charleston, United States
| | - Ann McNeill
- Addiction Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Shaping Public Health Policies To Reduce Inequalities And Harm (SPECTRUM), the University of Edinburgh, Edinburgh, United Kingdom
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.,Ontario Institute for Cancer Research, Toronto, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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Almaaitah S, Ciemins EL, Joshi V, Arora A, Meskow C, Rothberg MB. Variation in Patient Smoking Cessation Rates Among Health-Care Providers: An Observational Study. Chest 2020; 158:2038-2046. [PMID: 32561440 DOI: 10.1016/j.chest.2020.05.599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 04/22/2020] [Accepted: 05/24/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Physicians play a crucial role in providing smoking cessation counseling and medications. However, it is unknown whether individual physicians' approaches affect whether patients quit. RESEARCH QUESTION This study assessed patient quit rates within a national quality-improvement learning collaborative to document variation in quit rates at the physician, practice, and health system levels. STUDY DESIGN AND METHODS A retrospective cohort study was conducted of primary care patients identified from the Optum analytics database containing longitudinal ambulatory data for patients from 22 health-care organizations between January 2012 and December 2018. The study included smokers aged ≥ 18 years who attended at least three ambulatory visits, with two visits at least 1 year apart. The primary study outcome was abstinence for ≥ 1 year. A mixed effects logistic regression model was used to predict the probability of quitting as a function of patient variables. Quit rates were then adjusted by patient factors and calculated at the level of clinician, clinic/practice, and health system. RESULTS Across all systems, 56% of patients had a documented smoking status in 2017. Among nearly 1 million smokers, 24% quit smoking. In the regression model, patient characteristics associated with quitting included older age, Hispanic ethnicity, being married, urban residence, commercial insurance, pregnancy, and a diagnosis of pneumonia, myocardial infarction, ischemic heart disease, cataract, or asthma. Medicaid insurance, low income, high BMI, peripheral vascular disease, alcohol-related diagnosis, and COPD were negatively associated with smoking cessation. Adjusted quit rates ranged from 14.3% to 34.5% across 20 health systems, 5% to 66% among 1,399 practice sites, and 4% to 87% among 3,803 health-care providers. Of smokers, 10.2% were prescribed smoking deterrents, and 3.9% were referred for counseling. INTERPRETATION Smoking cessation rates varied substantially at the practitioner, practice site, and health system levels. It is likely that individual physician approaches to smoking cessation influence patients' likelihood of quitting.
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Affiliation(s)
| | | | | | | | | | - Michael B Rothberg
- Medicine Institute, Cleveland Clinic, Cleveland, OH; Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH.
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Liang HJ, Wu MJ, Jerng JS, Yang CH. Reinforcement of Tobacco Control and Reduction in Medical Utilization for Asthma in Taiwan: A Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3950. [PMID: 31627282 PMCID: PMC6844081 DOI: 10.3390/ijerph16203950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/26/2019] [Accepted: 10/15/2019] [Indexed: 11/21/2022]
Abstract
Environmental air quality can affect asthma control and the development of overt asthmatic manifestations. In this population-based study, we investigated the effect of reinforcing a smoking ban in Taiwan through the enactment of the Tobacco Hazards and Prevention Act (THPA) on healthcare utilization rate by asthmatics. Analysis was performed based on data relevant to non-hospitalized asthmatic patients with insurance claims between 2005 and 2013 from the National Health Insurance Research Database of Taiwan, reported data on Asian dust storms, and penalty rates for violations of the tobacco ban. Poisson regression showed that the risk for outpatient visits for asthma was lower after enactment of the THPA (RR = 0.98, 95% CI = 0.98-0.99), with a yearly trend of a reduced risk (RR = 0.99, 95% CI = 0.99-1.00), also lower in geographic regions with medium (RR = 0.79, 95% CI = 0.79-0.80) and high (RR = 0.91, 95% CI = 0.91-0.92) penalty rates. Subgroup analysis showed that asthma visit rates were reduced in both male and female groups after the enactment of the THPA. The risk of an asthma ER visit was increased after the enactment of the amended THPA (RR = 1.07, 95% CI = 1.05-1.09), although the yearly trend was not significant (RR = 1.00, 95% CI = 1.00-1.00). The risk of emergency room visits for asthma was significantly reduced in regions with medium (RR = 0.68, 95% CI = 0.68-0.69) and high (RR = 0.75, 95% CI = 0.74-0.76) penalty rates. Subgroup analysis showed that the visit rates were similar in both male and female groups. The effectiveness of reinforcing the smoking ban warrants further policies aimed at further reducing passive smoking.
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Affiliation(s)
- Huang-Ju Liang
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 108, Taiwan.
- Center for Quality Management, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Ming-Jiuan Wu
- Department of Business and Management, Ming Chi University of Technology, New Taipei City 243, Taiwan.
| | - Jih-Shuin Jerng
- Center for Quality Management, National Taiwan University Hospital, Taipei 100, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100, Taiwan.
| | - Chiang-Hsing Yang
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei 108, Taiwan.
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Watai K, Sekiya K, Hayashi H, Fukutomi Y, Taniguchi M. Effects of short-term smoking on lung function and airway hyper-responsiveness in young patients with untreated intermittent adult-onset asthma: retrospective cross-sectional study at a primary-tertiary care hospital in Japan. BMJ Open 2019; 9:e023450. [PMID: 31167855 PMCID: PMC6561610 DOI: 10.1136/bmjopen-2018-023450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In daily clinical practice, smokers with asthma and with intermittent disease severity are frequently encountered. The effects of short-term smoking on lung function or disease presentation in younger patients with intermittent adult-onset asthma remain unclear. We sought to clarify the effects of short-term smoking (<10 pack-years) on lung function and airway hyper-responsiveness (AHR) in young patients with untreated intermittent adult-onset asthma. DESIGN Retrospective, cross-sectional study. SETTING A single primary-tertiary medical centre in Japan. PARTICIPANTS From patients who underwent bronchodilator reversibility tests between January 2004 and March 2011 (n=7291), 262 consecutive patients (age, 20-34 years) with untreated intermittent adult-onset asthma, including 157 never smokers and 105 current smokers within 10 pack-years, were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the association of the daily smoking frequency (number of cigarettes per day), smoking duration (years) and cumulative smoking history (pack-years) with postbronchodilator lung function. The secondary outcome was the association of the former three smoking parameters with AHR. RESULTS The daily smoking frequency, smoking duration and cumulative smoking history were significantly associated with decreased postbronchodilator lung function. Daily smoking of ≥11 cigarettes per day was also associated with marked AHR (OR 2.23; 95% CI 1.03 to 4.80), even after adjustment for age, sex, disease duration and body mass index. CONCLUSION Short-term active smoking in early adulthood may be associated with decreased lung function and AHR, even in patients with intermittent adult-onset asthma. Our findings suggest a benefit of never smoking, even for young patients with intermittent adult-onset asthma.
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Affiliation(s)
- Kentaro Watai
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kiyoshi Sekiya
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Hiroaki Hayashi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yuma Fukutomi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masami Taniguchi
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Course of Allergy and Clinical Immunology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Abstract
Because the pathophysiology of asthma has diverse characteristics, to manage the disease effectively, it is important for clinicians to distinguish among the clinical phenotypes. Among them, adult-onset asthma, that is, late-onset asthma (LOA), is increasing because of the aging of the population. The phenotype of LOA is largely divided into two types according to the presence or absence of eosinophilic inflammation, T-helper (Th)2- and non-Th2-associated LOA. Especially in Th2 LOA related to rhinosinusitis, as pulmonary function at onset is poor and asthma exacerbations occur frequently, it is important to detect this phenotype in the early phase by using a biomarker of Th2-type inflammation such as fractional exhaled nitric oxide (FENO). As non-Th2-LOA is often resistant to corticosteroids, this phenotype often requires another treatment strategy such as macrolide, diet, or smoking cessation. We often struggle with the management of LOA patients due to a lack of evidence; therefore, the elucidation of the mechanism of LOA contributes to increased efficiency of diagnosis and treatment of LOA. Age-related immune system and structural changes are thought to be associated with the pathophysiology of LOA. In the former case, changes in inflammatory cell function such as variations in the innate immune response and acquisition of autoimmunity or upregulation of oxidative stress are thought to be involved in the mechanism. Meanwhile, the latter can also become triggers or exacerbating factors of LOA via enhancement of airway hyperresponsiveness, decline in lung function, increased air trapping, and reduction in chest wall compliance. Therefore, appropriate individualized management in LOA may be possible through precisely assessing the pathophysiology based on age-related functional changes, including the immune and structural system.
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Affiliation(s)
- Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
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10
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Thomson NC. Asthma and smoking-induced airway disease without spirometric COPD. Eur Respir J 2017; 49:49/5/1602061. [PMID: 28461294 DOI: 10.1183/13993003.02061-2016] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022]
Abstract
Due to the high prevalence rates of cigarette smoking and asthma, current and ex-smokers frequently develop chronic airway disease without spirometric evidence of chronic obstructive pulmonary disease (COPD), either alone or associated with asthma. This review considers the classification, clinical outcomes, inflammatory and imaging variables, phenotypes, and management of current and ex-smokers with airway disease without COPD, focusing on overlaps in those with and without asthma. These individuals have more respiratory symptoms, worse quality of life, increased exacerbation rates, reduced lung function and more comorbidities than never-smokers with asthma or healthy never-smokers. As well as clinical features, airway inflammatory and structural changes in smoking-induced airway disease without COPD overlap with those found in smokers with asthma. Cigarette smoking is associated with worse clinical outcomes in some phenotypes of asthma. Management involves public health measures to control exposure to tobacco smoke, personal advice on smoking cessation and the use of appropriate targeted therapies, although evidence is limited on their effectiveness. Understanding the mechanisms, natural history and management of current and ex-smokers with asthma and smoking-induced airway disease without COPD is a priority for future research.
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Affiliation(s)
- Neil C Thomson
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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11
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Swedin L, Saarne T, Rehnberg M, Glader P, Niedzielska M, Johansson G, Hazon P, Catley MC. Patient stratification and the unmet need in asthma. Pharmacol Ther 2016; 169:13-34. [PMID: 27373855 DOI: 10.1016/j.pharmthera.2016.06.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/14/2016] [Indexed: 02/07/2023]
Abstract
Asthma is often described as an inflammatory disease of the lungs and in most patients symptomatic treatment with bronchodilators or inhaled corticosteroids is sufficient to control disease. Unfortunately there are a proportion of patients who fail to achieve control despite treatment with the best current treatment. These severe asthma patients have been considered a homogeneous group of patients that represent the unmet therapeutic need in asthma. Many novel therapies have been tested in unselected asthma patients and the effects have often been disappointing, particularly for the highly specific monoclonal antibody-based drugs such as anti-IL-13 and anti-IL-5. More recently, it has become clear that asthma is a syndrome with many different disease drivers. Clinical trials of anti-IL-13 and anti-IL-5 have focused on biomarker-defined patient groups and these trials have driven the clinical progression of these drugs. Work on asthma phenotyping indicates that there is a group of asthma patients where T helper cell type 2 (Th2) cytokines and inflammation predominate and these type 2 high (T2-high) patients can be defined by biomarkers and response to therapies targeting this type of immunity, including anti-IL-5 and anti-IL-13. However, there is still a subset of T2-low patients that do not respond to these new therapies. This T2-low group will represent the new unmet medical need now that the T2-high-targeting therapies have made it to the market. This review will examine the current thinking on patient stratification in asthma and the identification of the T2-high subset. It will also look at the T2-low patients and examine what may be the drivers of disease in these patients.
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Affiliation(s)
- Linda Swedin
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Tiiu Saarne
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Maria Rehnberg
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Pernilla Glader
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Magdalena Niedzielska
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Gustav Johansson
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Petra Hazon
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden
| | - Matthew C Catley
- Respiratory, Inflammation and Autoimmunity iMED, Translational Biology, AstraZeneca R&D Gothenburg, Sweden.
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12
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Thomson NC, Shepherd M, Spears M, Chaudhuri R. Corticosteroid insensitivity in smokers with asthma : clinical evidence, mechanisms, and management. ACTA ACUST UNITED AC 2016; 5:467-81. [PMID: 17154674 DOI: 10.2165/00151829-200605060-00010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Corticosteroids are the most effective treatment for asthma, but the therapeutic response varies considerably between individuals. Several clinical studies have found that smokers with asthma are insensitive to the beneficial effects of short- to medium-term inhaled corticosteroid treatment compared with non-smokers with asthma. It is estimated that 25% of adults in most industrialized countries smoke cigarettes, and similar surveys amongst asthmatic individuals suggest that the prevalence of smoking in this grouping mirrors that found in the general population. Therefore, cigarette smoking is probably the most common cause of corticosteroid insensitivity in asthma. Cigarette smoking and asthma are also associated with poor symptom control and an accelerated rate of decline in lung function. The mechanism of corticosteroid insensitivity in smokers with asthma is currently unexplained but could be due to alterations in airway inflammatory cell phenotypes, changes in glucocorticoid receptor alpha/beta ratio, and/or reduced histone deacetylase activity. Smoking cessation should be encouraged in all smokers with asthma. Short-term benefits include improvements in lung function and asthma control. However, the numbers of sustained quitters is disappointingly small. Additional or alternative drugs need to be identified to treat those individuals who are unable to stop smoking or who have persistent symptoms following smoking cessation.
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Affiliation(s)
- Neil C Thomson
- Department of Respiratory Medicine, Division of Immunology, Infection and Inflammation, University of Glasgow, Glasgow, Scotland
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13
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Jiménez-Ruiz CA, Andreas S, Lewis KE, Tonnesen P, van Schayck CP, Hajek P, Tonstad S, Dautzenberg B, Fletcher M, Masefield S, Powell P, Hering T, Nardini S, Tonia T, Gratziou C. Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit. Eur Respir J 2015; 46:61-79. [PMID: 25882805 DOI: 10.1183/09031936.00092614] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/24/2014] [Indexed: 12/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD), lung cancer, asthma and pulmonary tuberculosis are common pulmonary diseases that are caused or worsened by tobacco smoking. Growing observational evidence suggests that symptoms and prognosis of these conditions improve upon smoking cessation. Despite increasing numbers of (small) randomised controlled trials suggesting intensive smoking cessation treatments work in people with pulmonary diseases many patients are not given specific advice on the benefits or referred for intensive cessation treatments and, therefore, continue smoking.This is a qualitative review regarding smoking cessation in patients with COPD and other pulmonary disorders, written by a group of European Respiratory Society experts. We describe the epidemiological links between smoking and pulmonary disorders, the evidence for benefits of stopping smoking, how best to assess tobacco dependence and what interventions currently work best to help pulmonary patients quit. Finally, we describe characteristics and management of any "hardcore" smoker who finds it difficult to quit with standard approaches.
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Affiliation(s)
| | - Stefan Andreas
- Lungenfachklinik Immenhausen and Pneumology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Keir E Lewis
- Dept of Respiratory Medicine, Prince Philip Hospital and Swansea College of Medicine, Swansea, UK
| | - Philip Tonnesen
- Dept of Sleep Medicine, Glostrup Hospital, Glostrup, Denmark
| | - C P van Schayck
- Care and Public Health Research Institute (Caphri), Maastricht University, Maastricht, The Netherlands
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Serena Tonstad
- Section for Preventive Cardiology, Oslo University Hospital, Oslo, Norway
| | | | | | | | | | | | - Stefano Nardini
- Pulmonary and TB Unit, Ospedale Civile, Vittorio Veneto, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Christina Gratziou
- University Centre for Research and Smoking Cessation, Evgenidio Hospital, Medical School, Athens University, Athens, Greece
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14
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Bae J. Influence of asthma on the longitudinal trajectories of cigarette use behaviors from adolescence to adulthood using latent growth curve models. J Prev Med Public Health 2015; 48:111-7. [PMID: 25857649 PMCID: PMC4398155 DOI: 10.3961/jpmph.14.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/17/2015] [Indexed: 11/13/2022] Open
Abstract
Objectives: While epidemiologic research indicates that the prevalence of risk-taking behaviors including cigarette smoking among young people with asthma is substantial, the longitudinal patterns of cigarette smoking in this vulnerable population have received little attention. The aim of this study was to evaluate differences in the longitudinal trajectories of cigarette use behaviors from adolescence to adulthood between young people with and without asthma. Methods: Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) during the years 1994 to 1995 (Wave I, adolescence), 2001 to 2002 (Wave III, young adulthood), and 2007 to 2008 (Wave IV, adulthood) were analyzed (n=12 244). Latent growth curve models were used to examine the longitudinal trajectories of cigarette use behaviors during the transition to adulthood according to asthma status. Results: Regardless of asthma status, the trajectory means of cigarette use behaviors were found to increase, and then slightly decrease from adolescence to adulthood. In total participants, there were no statistically significant differences in initial levels and changes in cigarette use behaviors according to asthma status. However, in select sex and race subgroups (i.e., females and non-whites), former asthmatics showed greater escalation in cigarette use behaviors than did non-asthmatics or current asthmatics. Conclusions: This study indicated that the changing patterns of cigarette use behaviors during the transition to adulthood among young people with asthma are comparable to or even more drastic than those among young people without asthma.
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Affiliation(s)
- Jisuk Bae
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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15
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Teo SSH, Tan NC, Ngoh ASH, Swah TS, Chen Z, Tai BC. Smoking Behaviour of Asthmatic Patients in Primary Care: A Cross-Sectional Study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2014. [DOI: 10.1177/201010581402300204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: One-third of adult asthma patients smoke cigarettes despite smoking being a known trigger of asthma exacerbation. This study aims to describe the behaviour of asthmatic patients who smoke and explore the reasons why they continue to smoke cigarettes even when unwell. Methods: A cross-sectional questionnaire survey was conducted on adult asthma patients at primary care clinics in Singapore. One hundred and seventy-four asthmatic smokers (AS) of four ethnic groups, both genders, aged 21–50 years were recruited. Demographic data and smoking characteristics, reasons for smoking, and experiences during their attempts to quit were collected and analysed using the statistical software STATA version 12. Results: The median age of AS was 30 years. Seventy-five percent were males and mostly Malays (58%). Seventy-one percent had at least secondary education. Eighty-six percent started smoking before 20 years old. Ninety-eight percent smoked less than 10 sticks per day and 51% smoked ≤5 pack-years. Thirty-eight percent smoked within 5 minutes of awakening. AS cited reasons such as stress relief (79%), peer pressure (36%), influence from family members who smoke (40%), think better (35%), staying alert (57%), and relaxed (53%). Although 77% believed smoking worsened their asthma, they continued to smoke. Restlessness (43%), mood swings (27%), difficulties in concentration (25%) and irritability (24%) were common symptoms encountered in those who attempted to quit. About 44% did not refrain from smoking even when they were ill. Conclusion: Adult asthmatic smokers continued cigarette smoking to relieve stress, maintain mental alertness and avoid withdrawal symptoms. Implementing a programme to address smoking behaviour and withdrawal symptoms is paramount towards successful smoking cessation.
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Affiliation(s)
| | | | | | - Teck Sin Swah
- Department of Clinical Services, SingHealth Polyclinics, Singapore
| | - Zhaojin Chen
- Investigational Medicine Unit, National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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16
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Polosa R, Morjaria J, Caponnetto P, Caruso M, Strano S, Battaglia E, Russo C. Effect of smoking abstinence and reduction in asthmatic smokers switching to electronic cigarettes: evidence for harm reversal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:4965-77. [PMID: 24814944 PMCID: PMC4053879 DOI: 10.3390/ijerph110504965] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/24/2014] [Accepted: 04/30/2014] [Indexed: 11/16/2022]
Abstract
Electronic cigarettes (e-cigs) are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who quit or reduced their tobacco consumption by switching to these products. We retrospectively reviewed changes in spirometry data, airway hyper-responsiveness (AHR), asthma exacerbations and subjective asthma control in smoking asthmatics who switched to regular e-cig use. Measurements were taken prior to switching (baseline) and at two consecutive visits (Follow-up/1 at 6 (±1) and Follow-up/2 at 12 (±2) months). Eighteen smoking asthmatics (10 single users, eight dual users) were identified. Overall there were significant improvements in spirometry data, asthma control and AHR. These positive outcomes were noted in single and dual users. Reduction in exacerbation rates was reported, but was not significant. No severe adverse events were noted. This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods.
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Affiliation(s)
- Riccardo Polosa
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania 95125, Italy.
| | - Jaymin Morjaria
- Department of Academic Respiratory Medicine, University of Hull, Castle Hill Hospital, Castle Road, Cottingham HU16 5JQ, UK.
| | - Pasquale Caponnetto
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania 95125, Italy.
| | - Massimo Caruso
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania 95125, Italy.
| | - Simona Strano
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania 95125, Italy.
| | - Eliana Battaglia
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania 95125, Italy.
| | - Cristina Russo
- Department of Clinical and Molecular Biomedicine, University of Catania, Catania 95125, Italy.
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17
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Stephens SH, Hartz SM, Hoft NR, Saccone NL, Corley RC, Hewitt JK, Hopfer CJ, Breslau N, Coon H, Chen X, Ducci F, Dueker N, Franceschini N, Frank J, Han Y, Hansel NN, Jiang C, Korhonen T, Lind PA, Liu J, Lyytikäinen LP, Michel M, Shaffer JR, Short SE, Sun J, Teumer A, Thompson JR, Vogelzangs N, Vink JM, Wenzlaff A, Wheeler W, Yang BZ, Aggen SH, Balmforth AJ, Baumeister SE, Beaty TH, Benjamin DJ, Bergen AW, Broms U, Cesarini D, Chatterjee N, Chen J, Cheng YC, Cichon S, Couper D, Cucca F, Dick D, Foroud T, Furberg H, Giegling I, Gillespie NA, Gu F, Hall AS, Hällfors J, Han S, Hartmann AM, Heikkilä K, Hickie IB, Hottenga JJ, Jousilahti P, Kaakinen M, Kähönen M, Koellinger PD, Kittner S, Konte B, Landi MT, Laatikainen T, Leppert M, Levy SM, Mathias RA, McNeil DW, Medland SE, Montgomery GW, Murray T, Nauck M, North KE, Paré PD, Pergadia M, Ruczinski I, Salomaa V, Viikari J, Willemsen G, Barnes KC, Boerwinkle E, Boomsma DI, Caporaso N, Edenberg HJ, Francks C, Gelernter J, Grabe HJ, Hops H, Jarvelin MR, Johannesson M, Kendler KS, Lehtimäki T, Magnusson PK, Marazita ML, Marchini J, Mitchell BD, Nöthen MM, Penninx BW, Raitakari O, Rietschel M, Rujescu D, Samani NJ, Schwartz AG, Shete S, Spitz M, Swan GE, Völzke H, Veijola J, Wei Q, Amos C, Cannon DS, Grucza R, Hatsukami D, Heath A, Johnson EO, Kaprio J, Madden P, Martin NG, Stevens VL, Weiss RB, Kraft P, Bierut LJ, Ehringer MA. Distinct loci in the CHRNA5/CHRNA3/CHRNB4 gene cluster are associated with onset of regular smoking. Genet Epidemiol 2013; 37:846-59. [PMID: 24186853 PMCID: PMC3947535 DOI: 10.1002/gepi.21760] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/21/2013] [Accepted: 08/14/2013] [Indexed: 12/21/2022]
Abstract
Neuronal nicotinic acetylcholine receptor (nAChR) genes (CHRNA5/CHRNA3/CHRNB4) have been reproducibly associated with nicotine dependence, smoking behaviors, and lung cancer risk. Of the few reports that have focused on early smoking behaviors, association results have been mixed. This meta-analysis examines early smoking phenotypes and SNPs in the gene cluster to determine: (1) whether the most robust association signal in this region (rs16969968) for other smoking behaviors is also associated with early behaviors, and/or (2) if additional statistically independent signals are important in early smoking. We focused on two phenotypes: age of tobacco initiation (AOI) and age of first regular tobacco use (AOS). This study included 56,034 subjects (41 groups) spanning nine countries and evaluated five SNPs including rs1948, rs16969968, rs578776, rs588765, and rs684513. Each dataset was analyzed using a centrally generated script. Meta-analyses were conducted from summary statistics. AOS yielded significant associations with SNPs rs578776 (beta = 0.02, P = 0.004), rs1948 (beta = 0.023, P = 0.018), and rs684513 (beta = 0.032, P = 0.017), indicating protective effects. There were no significant associations for the AOI phenotype. Importantly, rs16969968, the most replicated signal in this region for nicotine dependence, cigarettes per day, and cotinine levels, was not associated with AOI (P = 0.59) or AOS (P = 0.92). These results provide important insight into the complexity of smoking behavior phenotypes, and suggest that association signals in the CHRNA5/A3/B4 gene cluster affecting early smoking behaviors may be different from those affecting the mature nicotine dependence phenotype.
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Affiliation(s)
- Sarah H. Stephens
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
| | - Sarah M. Hartz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Nicole R. Hoft
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, United States of America
| | - Nancy L. Saccone
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Robin C. Corley
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, United States of America
| | - John K. Hewitt
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, United States of America
| | - Christian J. Hopfer
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, United States of America
| | - Naomi Breslau
- Department of Epidemiology, Michigan State University, East Lansing, Michigan, United States of America
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Xiangning Chen
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Francesca Ducci
- Institute of Psychiatry, King’s College London and Department of Mental Health, St George’s University, London, United Kingdom
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Pisa, Italy
| | - Nicole Dueker
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Clinical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Younghun Han
- Department of Epidemiology, MD Anderson, Houston, Texas, United States of America
| | - Nadia N. Hansel
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Chenhui Jiang
- Departments of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Tellervo Korhonen
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Penelope A. Lind
- Department of Epidemiology, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Jason Liu
- Department of Statistics, University of Oxford, Oxford, United Kingdom
| | - Leo-Pekka Lyytikäinen
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere University Hospital and University of Tampere School of Medicine, Tampere, Finland
| | - Martha Michel
- Center for Health Sciences, SRI International, Menlo Park, California, United States of America
| | - John R. Shaffer
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Susan E. Short
- Department of Sociology, Brown University, Providence, Rhode Island, United States of America
| | - Juzhong Sun
- Department of Epidemiology Research, American Cancer Society, Atlanta, Georgia, United States of America
| | - Alexander Teumer
- University Medicine Greifswald, University of Greifswald, Greifswald, Germany
| | - John R. Thompson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Nicole Vogelzangs
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Jacqueline M. Vink
- Department of Biological Psychology, VU University, Amsterdam, Amsterdam, The Netherlands
| | - Angela Wenzlaff
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, United States of America
| | - William Wheeler
- Division of Cancer Epidemiology and Genetics, National Institute of Health, Bethesda, Maryland, United States of America
| | - Bao-Zhu Yang
- Departments of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Steven H. Aggen
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Anthony J. Balmforth
- LIGHT Research Institute, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | | | - Terri H. Beaty
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Daniel J. Benjamin
- Department of Economics, Cornell University, Ithaca, New York, United States of America
| | - Andrew W. Bergen
- Center for Health Sciences, SRI International, Menlo Park, California, United States of America
| | - Ulla Broms
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - David Cesarini
- Department of Economics, New York University, New York, New York, United States of America
| | - Nilanjan Chatterjee
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Jingchun Chen
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Yu-Ching Cheng
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
| | - Sven Cichon
- Institute of Neuroscience and Medicine (INM-1); Structural and Functional Organization of the Brain Genomic Imaging; Department of Genomics, Life and Brain Center; Research Center Juelich, Juelich, Germany; Life and Brain Center and Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - David Couper
- Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnology, University of Pisa, Pisa, Italy
| | - Francesco Cucca
- Istituto di Ricerca Genetica e Biomedica, CNR, Cittadella Universitaria di Monserrato, Monserrato, Cagliari, Italy
| | - Danielle Dick
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Helena Furberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Ina Giegling
- Department of Psychiatry, University of Munich (LMU), Munich, Germany
| | - Nathan A. Gillespie
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Fangyi Gu
- Division of Cancer Epidemiology and Genetics, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Alistair S. Hall
- LIGHT Research Institute, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Jenni Hällfors
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Shizhong Han
- Departments of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | | | - Kauko Heikkilä
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Ian B. Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Jouke Jan Hottenga
- Department of Biological Psychology, VU University, Amsterdam, Amsterdam, The Netherlands
| | - Pekka Jousilahti
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Marika Kaakinen
- Institute of Health Sciences and Biocenter Oulu, University of Oulu, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and University of Tampere School of Medicine, Tampere, Finland
| | - Philipp D. Koellinger
- Department of Applied Economics, Erasmus Universiteit Rotterdam, Rotterdam, Netherlands
| | - Stephen Kittner
- Department of Neurology, Baltimore Veterans Affairs Medical Center, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Bettina Konte
- Department of Psychiatry, University of Munich (LMU), Munich, Germany
| | - Maria-Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Tiina Laatikainen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Mark Leppert
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Steven M. Levy
- Department of Preventive and Community Dentistry and Department of Epidemiology, University of Iowa, Iowa City, Iowa, United States of America
| | - Rasika A. Mathias
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Daniel W. McNeil
- Department of Psychology and Dental Practice and Rural Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Sarah E. Medland
- Department of Epidemiology, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Grant W. Montgomery
- Department of Epidemiology, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Tanda Murray
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Matthias Nauck
- University Medicine Greifswald, University of Greifswald, Greifswald, Germany
| | - Kari E. North
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Peter D. Paré
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Michele Pergadia
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Ingo Ruczinski
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Veikko Salomaa
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Jorma Viikari
- Department of Medicine, Turku University Hospital, Turku, Finland
| | - Gonneke Willemsen
- Department of Biological Psychology, VU University, Amsterdam, Amsterdam, The Netherlands
| | - Kathleen C. Barnes
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Eric Boerwinkle
- Human Genetics Center, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Dorret I. Boomsma
- Department of Biological Psychology, VU University, Amsterdam, Amsterdam, The Netherlands
| | - Neil Caporaso
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Howard J. Edenberg
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Clyde Francks
- Department of the MPI Psycholinguistics, Max Planck Institute for Psycholinguistics, Nijmegen, The Netherlands
| | - Joel Gelernter
- Departments of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Hans Jörgen Grabe
- University Medicine Greifswald, University of Greifswald, Greifswald, Germany
| | - Hyman Hops
- Oregon Research Institute, Eugene, Oregon, United States of America
| | - Marjo-Riitta Jarvelin
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health School of Public Health, Imperial College London, United Kingdom; Institute of Health Sciences and Biocenter Oulu, University of Oulu, Finland; Unit of Primary Care, Oulu University Hospital, Oulu, Finland; Department of Children and Young People and Families, National Institute for Health and Welfare, Oulu, Finland
| | - Magnus Johannesson
- Department of Economics, Stockholm School of Economics, Stockholm, Sweden
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere University Hospital and University of Tampere School of Medicine, Tampere, Finland
| | - Patrik K.E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mary L. Marazita
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jonathan Marchini
- Department of Statistics, University of Oxford, Oxford, United Kingdom
| | - Braxton D. Mitchell
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland, United States of America
| | - Markus M. Nöthen
- Department of Genomics, Life and Brain Center, Life and Brain Center, Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - Brenda W. Penninx
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Olli Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Clinical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Dan Rujescu
- Department of Psychiatry, University of Munich (LMU), Munich, Germany
| | - Nilesh J. Samani
- Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Ann G. Schwartz
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, United States of America
| | - Sanjay Shete
- Department of Epidemiology, MD Anderson, Houston, Texas, United States of America
| | - Margaret Spitz
- Department of Epidemiology, MD Anderson, Houston, Texas, United States of America
| | - Gary E. Swan
- Center for Health Sciences, SRI International, Menlo Park, California, United States of America
| | - Henry Völzke
- University Medicine Greifswald, University of Greifswald, Greifswald, Germany
| | - Juha Veijola
- Institute of Health Sciences and Biocenter Oulu, University of Oulu, Finland
| | - Qingyi Wei
- Department of Epidemiology, MD Anderson, Houston, Texas, United States of America
| | - Chris Amos
- Department of Epidemiology, MD Anderson, Houston, Texas, United States of America
| | - Dale S. Cannon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Richard Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Dorothy Hatsukami
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Andrew Heath
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Eric O. Johnson
- Department of Behavioral Health Epidemiology, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Jaakko Kaprio
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Pamela Madden
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Nicholas G. Martin
- Department of Epidemiology, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Victoria L. Stevens
- Department of Epidemiology Research, American Cancer Society, Atlanta, Georgia, United States of America
| | - Robert B. Weiss
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Peter Kraft
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Marissa A. Ehringer
- Institute for Behavioral Genetics, University of Colorado, Boulder, Colorado, United States of America
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Polosa R, Caponnetto P, Sands MF. Caring for the smoking asthmatic patient. J Allergy Clin Immunol 2012; 130:1221-4. [PMID: 22608574 DOI: 10.1016/j.jaci.2012.04.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 03/16/2012] [Accepted: 04/11/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Riccardo Polosa
- Institute of Internal Medicine and Clinical Immunology, AOU Policlinico-Vittorio Emanuele, Università di Catania, Catania, Italy.
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Tamimi A, Serdarevic D, Hanania NA. The effects of cigarette smoke on airway inflammation in asthma and COPD: therapeutic implications. Respir Med 2011; 106:319-28. [PMID: 22196881 DOI: 10.1016/j.rmed.2011.11.003] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 12/29/2022]
Abstract
Asthma and COPD are two chronic inflammatory disorders of the airway characterized by airflow limitation. While many similarities exist between these two diseases, they are pathologically distinct due to the involvement of different inflammatory cells; predominantly neutrophils, CD8 lymphocytes in COPD and eosinophils and CD4 lymphocytes in asthma. Cigarette smoking is associated with accelerated decline of lung function, increased mortality, and worsening of symptoms in both asthma and COPD. Furthermore, exposure to cigarette smoke can alter the inflammatory mechanisms in asthma to become similar to that seen in COPD with increasing CD8 cells and neutrophils and may therefore alter the response to therapy. Cigarette smoke exposure has been associated with a poor response to inhaled corticosteroids which are recommended as first line anti-inflammatory medications in asthma and as an add-on therapy in patients with severe COPD with history of exacerbations. While the main proposed mechanism for this altered response is the reduction of the histone deacetylase 2 (HDAC2) enzyme system, other possible mechanisms include the overexpression of GR-β, activation of p38 MAPK pathway and increased production of inflammatory cytokines such as IL-2, 4, 8, TNF-α and NF-Kß. Few clinical trials suggest that leukotriene modifiers may be an alternative to corticosteroids in smokers with asthma but there are currently no drugs which effectively reduce the progression of inflammation in smokers with COPD. However, several HDAC2 enhancers including low dose theophylline and other potential anti-inflammatory therapies including PDE4 inhibitors and p38 MAPK inhibitors are being evaluated.
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Affiliation(s)
- Asad Tamimi
- Clinical Sciences, Primary Care Business Unit, Pfizer Inc, Ramsgate Road, Sandwich CT13 9NJ, UK
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Morrell HER, Song AV, Halpern-Felsher BL. Earlier age of smoking initiation may not predict heavier cigarette consumption in later adolescence. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2011; 12:247-54. [PMID: 21384136 PMCID: PMC3152718 DOI: 10.1007/s11121-011-0209-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Previous studies suggest that earlier cigarette smoking initiation in adolescence predicts greater cigarette consumption later in adolescence or adulthood. Results from these studies have been used to inform interventions for adolescent smoking. However, previous studies suffer from several important methodological limitations. The objective of the present study was to address these limitations by longitudinally and prospectively examining whether and how age of initiation of smoking among adolescents predicts cigarette consumption by age 16 or 17. Participants completed an in-class survey every 6 months for 2-3 school years. Participants included 395 adolescents (Mean age=14 years at baseline; 53.2% female) from two public high schools in Northern California (Schools A and B) who completed self-report measures of smoking initiation, number of friends who smoke, and number of whole cigarettes smoked by the final survey time point. Adolescents who were older when they first smoked one whole cigarette were 5.3 to 14.6 times more likely in School A and 2.9 to 4.3 times more likely in School B to have smoked a greater number of cigarettes by age 16 or 17. Results suggested that earlier smoking initiation may not lead to heavier cigarette consumption later in time, as has been previously shown. There may be a period of heightened vulnerability in mid- or late adolescence where smoking experimentation is more likely to lead to greater cigarette consumption. Targeting prevention efforts to adolescents aged 14 to 17 years may further reduce smoking initiation among youth, thus limiting subsequent smoking-related morbidity and mortality in adulthood.
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Affiliation(s)
- Holly E R Morrell
- University of California, San Francisco, 3333 California St., Suite 245, San Francisco, CA 94118, USA.
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Fattahi F, Hylkema MN, Melgert BN, Timens W, Postma DS, ten Hacken NHT. Smoking and nonsmoking asthma: differences in clinical outcome and pathogenesis. Expert Rev Respir Med 2011; 5:93-105. [PMID: 21348590 DOI: 10.1586/ers.10.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cigarette smoking in asthma is frequently present and is associated with worsening of symptoms, accelerated lung-function decline, a higher frequency of hospital admissions, a higher degree of asthma severity, poorer asthma control and reduced responsiveness to corticosteroids. Furthermore, it is associated with reduced numbers of eosinophils and higher numbers of mast cells in the submucosa of the airway wall. Airway remodeling is increased as evidenced by increased epithelial thickness and goblet cell hyperplasia in smoking asthmatics. The pathogenesis responsible for smoking-induced changes in airway inflammation and remodeling in asthma is complex and largely unknown. The underlying mechanism of reduced corticosteroid responsiveness is also unknown. This article discusses differences between smoking and nonsmoking asthmatics regarding the clinical expression of asthma, lung function, response to corticosteroids, airway inflammation and remodeling processes. Possible pathogenetic mechanisms that may explain the links between cigarette smoking and changes in the clinical expression of asthma will be discussed, as well as the beneficial effects of smoking cessation.
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Affiliation(s)
- Fatemeh Fattahi
- Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Vozoris NT, Stanbrook MB. Smoking prevalence, behaviours, and cessation among individuals with COPD or asthma. Respir Med 2010; 105:477-84. [PMID: 20850288 DOI: 10.1016/j.rmed.2010.08.011] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 07/08/2010] [Accepted: 08/23/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Smoking prevalence, behaviours, physician counselling regarding smoking cessation, and smoking cessation medications were evaluated among male and female smokers with COPD and asthma compared to the general smoking population. METHODS Data from the large, nationally representative Canadian Community Health Survey (CCHS) was used (for 2003 CCHS, n = 134,072). All data were based on self-report, including the presence of COPD and asthma which were defined by health-professional diagnosis. Nicotine addiction was assessed by the Fagerstrom Test for Nicotine Dependence. RESULTS In 2003, 32.8% of individuals with COPD, 21.0% with asthma, and 22.1% without COPD or asthma were current smokers. After adjusting for sociodemographic and smoking behaviour confounders, among current smokers, greater odds of high or very high nicotine addiction were observed among women with versus without COPD (OR = 2.49, 95% CI = 1.41-4.39), and among women with versus without asthma (OR = 1.74, 95% CI = 1.01-2.99), but no associations were seen among men. Smokers with COPD and asthma were no more likely to have received physician counselling regarding smoking cessation, nor smoking cessation pharmacotherapy compared to the general smoking population. CONCLUSIONS Gender differences were observed in the association between COPD and asthma and higher nicotine addition levels in current smokers. These findings could in part explain population trends showing that COPD and asthma are increasing more rapidly in women. Physician counselling and pharmacotherapy for smoking cessation do not appear to be received more frequently among individuals with COPD or asthma compared to the general smoking population, despite the greater vulnerability of such patients to smoking effects.
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Affiliation(s)
- Nicholas T Vozoris
- Division of Respirology, St Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada.
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Association between tobacco use and lifestyle in a sample of lower income urban African-Americans in the American south. J Ethn Subst Abuse 2009; 6:155-66. [PMID: 19842311 DOI: 10.1300/j233v06n03_07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There has been little research evaluating links between low-income populations' lifestyles and their tobacco use status. We surveyed 398 low-income individuals living in Housing Authority complexes in Columbus, Georgia. Current, former, and never tobacco users were compared for their health-related behaviors and lifestyles. Study findings suggest that current tobacco users were less healthy than comparisons, but had less unfavorable obesity measurements. In lifestyle choices, tobacco users were more likely than comparisons to be interested in sports (football, basketball, etc.), shopping, and participate in church activities.
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Patel SN, Tsai CL, Boudreaux ED, Kilgannon JH, Sullivan AF, Blumenthal D, Camargo CA. Multicenter study of cigarette smoking among patients presenting to the emergency department with acute asthma. Ann Allergy Asthma Immunol 2009; 103:121-7. [PMID: 19739424 DOI: 10.1016/s1081-1206(10)60164-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Many studies have focused on smoking and chronic asthma severity. However, research on the relationship between smoking and acute asthma severity in an acute care setting is sparse. OBJECTIVES To determine the smoking prevalence among emergency department (ED) patients with acute asthma and to investigate the relationships between smoking and acute asthma severity. METHODS A 63-site medical record review study of ED patients, ages 14 to 54 years, with a principal diagnosis of acute asthma was performed. Patients with chronic obstructive pulmonary disease were excluded. Measurements for acute asthma severity included sociodemographic factors, asthma medical history, ED presentation, clinical course, medications administered, and return visit within 48 hours. RESULTS A total of 4,052 patient medical records were reviewed. A total of 1,332 patients (33%; 95% confidence interval, 31%-34%) were documented as smokers. No statistically significant differences were found between smokers and nonsmokers in vital signs, oxygen saturation, peak expiratory flow, and administration of asthma medications. By contrast, smokers were more likely than nonsmokers to receive antibiotics in the ED (12% vs 9%, P < .001) or at discharge (23% vs 14%, P < .001). A multivariate analysis confirmed that smoking status was independently associated with antibiotic administration (odds ratio, 1.6; 95% confidence interval, 1.3-1.8). CONCLUSIONS One-third of ED patients with acute asthma smoked cigarettes. Smokers and nonsmokers did not differ in their acute asthma severity. Asthmatic smokers, however, were more likely to receive antibiotics, even when adjusting for other possible confounders.
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Affiliation(s)
- Sundip N Patel
- Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Cooper University Hospital, Camden 08103, USA.
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Patel K, Schlundt D, Larson C, Wang H, Brown A, Hargreaves M. Chronic illness and smoking cessation. Nicotine Tob Res 2009; 11:933-9. [PMID: 19516050 DOI: 10.1093/ntr/ntp088] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoking is among the leading causes of premature mortality and preventable death in the United States. Although smoking contributes to the probability of developing chronic illness, little is known about the relationship between quitting smoking and the presence of chronic illness. The present study investigated the association between diagnoses of one or more chronic diseases (diabetes, hypertension, or high cholesterol) and smoking status (former or current smoker). METHODS The data analyzed were a subset of questions from a 155-item telephone-administered community survey that assessed smoking status, demographic characteristics, and presence of chronic disease. The study sample consisted of 3,802 randomly selected participants. RESULTS Participants with diabetes were more likely to report being former smokers, after adjusting for sociodemographic characteristics, whereas having hypertension or high cholesterol was not associated significantly with smoking status. The likelihood of being a former smoker did not increase as number of diagnosed chronic diseases increased. Participants who were women, older (aged 65+), or single were significantly less likely to be former smokers. Participants with at least a college degree, those with incomes of 50,000+ US dollars, and those who were underweight or obese were more likely to be former smokers. DISCUSSION These findings were inconsistent with research that has suggested that having a chronic illness or experiencing a serious medical event increases the odds of smoking cessation. Supporting prior research, we found that being male, having a higher income, and being obese were associated with greater likelihood of being a former smoker.
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Affiliation(s)
- Kushal Patel
- Department of Internal Medicine, Meharry Medical College, 1005 D.B. Todd Blvd., Nashville, TN 37208, USA.
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Abstract
PURPOSE OF REVIEW Cigarette smoking in asthma is associated with poor symptom control and reduced sensitivity to corticosteroids. We summarize recent evidence supporting the adverse effects of smoking in asthma and consider strategies to manage these patients. RECENT FINDINGS Smokers have more severe symptoms and are more likely to be admitted to hospital due to poorly controlled asthma compared with nonsmokers with asthma. Possible causes of reduced sensitivity to inhaled corticosteroids in smokers with asthma are noneosinophilic airway inflammation, impaired glucocorticoid receptor function, and/or reduced histone deacetylase activity. Smoking cessation improves asthma control, but quit rates are low. The optimal drug therapy for smokers with asthma is not established due, in part, to the small number of clinical trials performed in these patients. Preliminary data, however, suggest that leukotriene-receptor antagonists may have a beneficial effect in smokers with mild asthma. SUMMARY Cigarette smoking in asthma is a risk factor for poor asthma control and reduced sensitivity to corticosteroids. Every effort should be made to encourage individuals with asthma who smoke to quit. Clinical trials are required to identify therapies that restore corticosteroid sensitivity or directly improve symptom control in individuals with asthma who are unable to stop smoking.
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King G, Polednak AP, Gilreath T, Bendel RB. Disparities in smoking cessation among U.S. adults with a history of asthma. Ann Behav Med 2007; 33:312-7. [PMID: 17600458 DOI: 10.1007/bf02879913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Socioeconomic status (SES) and racial-ethnic disparities in smoking cessation among U.S. adults with a history of asthma have received limited attention. PURPOSE This study examined sociodemographic characteristics associated with smoking cessation in national samples of adults with a self-reported history of asthma. METHODS Data from the National Health Interview Survey (years 2000 and 2001 combined) was used to assess the quit ratio (i.e., former smokers as a proportion of ever-smokers) by sociodemographic characteristics, and predictors of former versus current smoking status were examined with multiple logistic regression. RESULTS Quit ratios were 53% in Hispanics, 52% in non-Hispanic Whites, and 42% in African American ever-smokers. The quit ratio reached 70% in college graduates versus 45% in those with less than 12 years of education. In multivariate analyses, education and marital status but not racially classified social groups/ethnicity were independently associated with former versus current smoking. CONCLUSIONS Expanded smoking cessation efforts are needed among persons with a history of asthma, especially those of lower SES.
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Affiliation(s)
- Gary King
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA 16802, USA.
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Yun S, Chanetsa F, Kelsey A, Zhu BP. Active and passive smoking among asthmatic Missourians: implications for health education. Prev Med 2006; 42:286-90. [PMID: 16488000 DOI: 10.1016/j.ypmed.2006.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2005] [Revised: 01/04/2006] [Accepted: 01/07/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the prevalence of smoking and exposure to secondhand smoke among asthmatic Missourians and to describe associated predisposing factors. METHOD The Missouri County-level Behavioral Risk Factor Survey, conducted among 15,059 non-institutionalized Missourians aged 18 years or older using random-digit-dialed telephone interviews during 2002-2003, was used in this study. RESULTS Current smoking (28.4%) and regular exposure to secondhand smoke (19.9%-36.4%, depending on the setting) were prevalent among asthmatic Missourians. Among asthmatics, those with college or technical school education were less likely to be current smokers compared to those with less than a high school education [odds ratio (OR)=0.25, 95% confidence interval (CI): 0.11, 0.57]; African Americans were less likely to be current smokers than white (OR=0.24, 95% CI: 0.07, 0.83); however, among asthmatic non-current smokers, African Americans were more likely to expose to secondhand smoke one or more days per week inside home than whites. Of the asthmatic current smokers who had visited a physician in the past 12 months, 30.0% were not advised by health care professionals to quit smoking. CONCLUSIONS Asthma intervention programs should strengthen smoking cessation components and should educate health care professionals about the importance of advising asthmatic patients to quit smoking.
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Affiliation(s)
- Shumei Yun
- Missouri Department of Health and Senior Services, Division of Community and Public Health, Jefferson City, MO 65102-0570, USA.
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Affiliation(s)
- J Perriot
- Dispensaire Emile Roux, Clermont-Ferrand, France.
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Paasche-Orlow MK, Riekert KA, Bilderback A, Chanmugam A, Hill P, Rand CS, Brancati FL, Krishnan JA. Tailored education may reduce health literacy disparities in asthma self-management. Am J Respir Crit Care Med 2005; 172:980-6. [PMID: 16081544 PMCID: PMC2718412 DOI: 10.1164/rccm.200409-1291oc] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Although inadequate health literacy has been associated with lower asthma medication knowledge and worse metered-dose inhaler (MDI) technique, the relationship between health literacy and the capacity to learn asthma self-management skills is unknown. OBJECTIVES In this prospective cohort study of adults hospitalized for severe asthma exacerbations at two inner-city hospitals, we examined the relationship between inadequate health literacy and difficulties learning and retaining instructions about discharge medications and appropriate MDI technique. METHODS At hospital discharge, participants received one-on-one, 30-min, guideline-based, written and oral instruction about their asthma discharge regimen as well as appropriate MDI technique. MEASUREMENTS AND MAIN RESULTS Seventy-three patients were enrolled. Inadequate health literacy was identified in 16 (22%) participants. Before instruction, inadequate health literacy was associated with lower asthma medication knowledge (5.2/10 vs. 7.2/10, p < 0.001) and worse MDI technique (3.2/6 vs. 3.9/6, p = 0.03). However, inadequate health literacy was not associated with difficulty learning (p = 0.33) or retaining (p = 0.35) instructions about the discharge regimen. Similarly, inadequate health literacy was not associated with difficulty learning (p = 0.26) or retaining (p = 0.97) appropriate MDI technique. Results were similar in multivariable models adjusted for demographic characteristics and asthma severity indicators. CONCLUSIONS These findings suggest that inadequate health literacy is a surmountable barrier to learning and remembering key asthma self-management skills.
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Affiliation(s)
- Michael K Paasche-Orlow
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
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Chaix B, Guilbert P, Chauvin P. A multilevel analysis of tobacco use and tobacco consumption levels in France: are there any combination risk groups? Eur J Public Health 2004; 14:186-90. [PMID: 15230507 PMCID: PMC5374221 DOI: 10.1093/eurpub/14.2.186] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both the predictors for tobacco use and the determinants of the amounts of tobacco consumed by smokers should be taken into account when designing prevention programmes. METHODS Using a sample of 12,948 individuals representative of the French population in 1999, multilevel models were used to carry out a comparative investigation for the predictors of tobacco use and the determinants of the amount of tobacco consumed by smokers. RESULTS At the individual level, a combination of risks (higher risk of smoking and larger amounts of tobacco consumed by smokers) was found for males, for individuals with a low level of education and for divorcees. At the level of the area of residence, both the risk of smoking (odds ratio 1.07, 95% confidence interval: 1.01-1.12 for an increase by one standard deviation) and the amount of tobacco consumed among smokers (percentage variation +4%, 95% confidence interval: 0% - +8%) increased with the gross domestic product per capita. CONCLUSION This study justifies the combined use, in such analyses, of consumption levels for smokers in addition to the risk of smoking, in order to identify the profiles with the highest risk. It was possible to identify various groups with both a high risk of tobacco use and a high level of consumption among smokers, on the basis of individual (male, divorced or less educated) and environmental (living in a high GDP area) factors. The prevention efforts should thus be focused on such groups.
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Affiliation(s)
- Basile Chaix
- Research Unit in Epidemiology and Information Sciences, National Institute of Health and Medical Research (INSERM U444), Paris, France.
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Martinez-Donate AP, Hovell MF, Wahlgren DR, Meltzer SB, Meltzer EO, Hofstetter CR, Matt GE. Association between Residential Tobacco Smoking Bans, Smoke Exposure, and Pulmonary Function: A Survey of Latino Children with Asthma. ACTA ACUST UNITED AC 2003. [DOI: 10.1089/088318703322751354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Silverman RA, Boudreaux ED, Woodruff PG, Clark S, Camargo CA. Cigarette smoking among asthmatic adults presenting to 64 emergency departments. Chest 2003; 123:1472-9. [PMID: 12740263 DOI: 10.1378/chest.123.5.1472] [Citation(s) in RCA: 134] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES The emergency department (ED) is an important focal point for asthmatic individuals with uncontrolled illness. Anecdotally, many adults presenting to the ED with acute asthma are active cigarette smokers. The present study determined the prevalence of cigarette smoking among adults presenting to the ED with acute asthma and identified the factors associated with current smoking status. DESIGN A prospective cohort study conducted as part of the Multicenter Airway Research Collaboration. PATIENTS A structured interview was performed in 1,847 patients, ages 18 to 54 years, who presented to the ED with acute asthma. SETTING Sixty-four EDs in 21 US states and 4 Canadian provinces. RESULTS Thirty-five percent of the enrolled asthmatic patients were current smokers with a median of 10 pack-years (interquartile range, 4 to 20 pack-years), while 23% were former smokers, and 42% were never-smokers. Current smokers comprised 33% of asthmatic patients aged 18 to 29 years, 40% for ages 30 to 39 years, and 33% for ages 40 to 54 (p < 0.001). In a multivariate analysis, the factors independently associated with current smoking status (p < 0.05) were as follows: age 30 to 39 years; white race/ethnicity; non-high school graduate; lower household income; lack of private insurance; no recent inhaled steroid usage; and no history of systemic steroid usage. Although 50% of current smokers admitted that smoking worsens their asthma symptoms, only 4% stated that smoking was responsible for their current exacerbation. CONCLUSIONS Although cigarette smoke is generally recognized as a respiratory irritant, cigarette smoking is common among adults presenting to the ED with acute asthma. The ED visit may provide an opportunity for patients to be targeted for smoking cessation efforts.
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Affiliation(s)
- Robert A Silverman
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.
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Eisner MD, Katz PP, Yelin EH, Shiboski SC, Blanc PD. Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity. Respir Res 2002; 2:53-60. [PMID: 11686864 PMCID: PMC56211 DOI: 10.1186/rr37] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2000] [Revised: 11/09/2000] [Accepted: 12/04/2000] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The morbidity and mortality from asthma have markedly increased since the late 1970s. The hospitalization rate, an important marker of asthma severity, remains substantial. METHODS In adults with health care access, we prospectively studied 242 with asthma, aged 18-50 years, recruited from a random sample of allergy and pulmonary physician practices in Northern California to identify risk factors for subsequent hospitalization. RESULTS Thirty-nine subjects (16%) reported hospitalization for asthma during the 18-month follow-up period. On controlling for asthma severity in multiple logistic regression analysis, non-white race (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.1-8.8) and lower income (OR, 1.1 per $10,000 decrement; 95% CI, 0.9-1.3) were associated with a higher risk of asthma hospitalization. The severity-of-asthma score (OR, 3.4 per 5 points; 95%, CI 1.7-6.8) and recent asthma hospitalization (OR, 8.3; 95%, CI, 2.1-33.4) were also related to higher risk, after adjusting for demographic characteristics. Reliance on emergency department services for urgent asthma care was also associated with a greater likelihood of hospitalization (OR, 3.2; 95% CI, 1.0-9.8). In multivariate analysis not controlling for asthma severity, low income was even more strongly related to hospitalization (OR, 1.2 per $10,000 decrement; 95% CI, 1.02-1.4). CONCLUSION In adult asthmatics with access to health care, non-white race, low income, and greater asthma severity were associated with a higher risk of hospitalization. Targeted interventions applied to high-risk asthma patients may reduce asthma morbidity and mortality.
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Affiliation(s)
- M D Eisner
- Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, California, USA.
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