Influence of underweight on asthma control

Unraveling the hidden link between asthma and depression among University students in Bangladesh

BACKGROUND

Asthma is a severe long-term respiratory and multidimensional disease. It affects a large proportion of people worldwide. Knowledge regarding asthma and its impact on depression among university students in Bangladesh is very limited. The objective of this study was to investigate asthma, as well as to explore the relationship between asthma and depressive symptoms among university students in Bangladesh.

METHODS

This study employed a cross-sectional design. Data was collected from Rajshahi University, Bangladesh. A total of 400 university students were recruited for this study. A semi-structured questionnaire was utilized to gather information from the participants. The primary outcome variable was asthma, which was assessed with the question: "Are you suffering from asthma (diagnosed by a doctor within the past year)?" Depressive symptoms were measured using the nine-item Patient Health Questionnaire (PHQ-9). Factors influencing asthma and its association were examined using a binary logistic regression model.

RESULTS

The study revealed that 53 (13.3%, 95% CI: 10.1% - 17.0%) of the students were suffering from asthma. Three significant predictors of asthma among university students were found: (i) having a family history of asthma (p < 0.01), (ii) being underweight (p < 0.01), and (iii) being born as a second or later child (p < 0.01). Findings also revealed that 48.8% of students exhibited symptoms of depression, with a significantly higher prevalence among female students compared to males (65.3% vs. 38.8%). Having asthma was found to be significantly associated with increased odds of depression (OR = 2.65, p < 0.002). Students with a history of asthma had 165% of more likelihood to depressive symptoms compared to their non-asthmatic peers suggesting a significant association between depressive symptoms and asthma in this population.

CONCLUSION

A considerable number of university students in Bangladesh suffer from asthma, with several modifiable factors such as depressive symptoms associated with the condition. The findings of this research will assist health professionals, policymakers, and university authorities in addressing the health challenges faced by students.

Association Between Asthma and Gout: A Longitudinal Follow-Up Study Using a National Health Screening Cohort

Background: Previous reports suggest a connection between gout and asthma; however, additional research is required to clarify this link. This study explores the relationship between gout and asthma using data from the Korean National Health Insurance Service-Health Screening Cohort. Methods: Participants were selected according to medical claim codes, and individuals diagnosed with gout were paired with control subjects at a 1:4 ratio. Variables, including demographic characteristics, health-related information, and medical history, were incorporated into the analysis. The incidence rates and hazard ratios of asthma were examined. Additionally, a comprehensive analysis was conducted to investigate the relationship between gout and asthma exacerbation. Results: Among the 514,866 participants, 19,830 patients with gout and 79,320 matched controls were analyzed. After adjusting for variables, the gout group demonstrated a significantly higher risk of asthma compared with the control group (adjusted hazard ratio [HR], 1.11, p < 0.001). Compared with the control group, the Kaplan-Meier method and log-rank test revealed a statistically significant increase in the cumulative incidence of asthma in the gout group over a 17-year period. However, the gout group did not show a significantly higher hazard ratio for asthma exacerbation. Conclusions: This study demonstrated that gout was associated with an increased risk of asthma. Additional analysis showed that gout was not correlated with asthma exacerbation. Further research is needed to fully elucidate the association between gout and asthma.

Food for thought: optimal diet in patients with asthma and chronic obstructive pulmonary disease

PURPOSE OF REVIEW

Nutritional intake plays a major role in the management of lung health. This review provides the latest perspective on how dietary choices can modulate lung function in patients with chronic obstructive pulmonary disease (COPD) and asthma.

RECENT FINDINGS

The pathophysiology of COPD and asthma is driven by oxidative stress and inflammation of the airways, which is exacerbated by modifiable risk factors such as cigarette smoking and diet. Various foods can influence patient symptoms; highly processed foods increase the production of reactive oxygen species that augment airway inflammation, whereas foods rich in antioxidants, fiber and protein combat oxidative stress and muscle wastage. Patients with COPD or asthma are at increased risk of developing metabolic comorbidities, including cachexia and obesity that complicate disease phenotypes, leading to greater symptom severity. While clinical findings suggest a role for antioxidant and macronutrient support of lung function, comprehensive translational and clinical studies are necessary to better understand the mechanisms underlying nutrient interaction and lung structure-function.

SUMMARY

Understanding the nutritional requirements that protect lung health and support weight management in COPD and asthma is imperative to providing personalized dietary recommendations and reducing patient morbidity.

Asthma Increases Long-Term Risk of Death by Suicide: A Nationwide Population-Based Cohort Study

BACKGROUND

Previous studies have identified an increased risk of suicidal behaviors among individuals with asthma.

OBJECTIVE

To evaluate the long-term risk and factors related to suicide in the adult population with asthma.

METHODS

This study used the Korean National Health Insurance Service data. We investigated the risk of suicide concerning the presence or absence of asthma and potential risk factors for suicide among 3,914,041 adults aged 20 years or more.

RESULTS

During a median follow-up of 12.3 years (interquartile range, 12.1-12.6 years), 1383 (0.48%) individuals with asthma died by suicide. Individuals with asthma had an increased risk of suicide compared with controls (adjusted hazard ratio [aHR], 1.26; 95% CI, 1.19-1.33). Suicide risk was especially high in individuals with asthma phenotypes: hospitalization-prone (aHR, 1.61; 95% CI, 1.40-1.84), nonobese (aHR, 1.37; 95% CI, 1.27-1.64), and asthma-chronic obstructive pulmonary disease overlap (aHR, 1.47; 95% CI, 1.22-1.76). Coexisting underweight status (aHR, 2.54; 95% CI, 2.05-3.16), mental health disorders (schizophrenia [aHR, 3.38; 95% CI, 2.28-5.02], depression [aHR, 3.24; 95% CI, 2.85-3.68], and anxiety disorder [aHR, 2.47; 95% CI, 2.00-3.05]), and cancers (aHR, 2.22; 95% CI, 1.73-2.84) further increased the suicide risk.

CONCLUSIONS

Asthma was associated with an increased risk of suicide, particularly in hospitalization-prone, nonobese, and asthma-chronic obstructive pulmonary disease overlap phenotypes. The risk was further increased when asthma coexisted with underweight status, mental health disorders, or cancers.

Relationship between prognostic nutritional index and asthma: a cross-sectional analysis

Background and objective

Asthma is a chronic disease characterized by inflammation of the airways. The association between nutritional status, inflammation, and asthma has been well-documented, yet the relationship between the Prognostic Nutritional Index (PNI) and asthma remains unclear. This is a study to see whether there is a relationship between PNI and asthma prevalence.

Methods

The present study employed data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2020, including a total of 7,869 adult participants were included in the analysis. Participants were categorized into four quartiles based on PNI levels. A multivariable regression model was employed for the purpose of evaluating the correlation between PNI and asthma. In order to ascertain the stability of the association across different populations, subgroup analyses were performed.

Results

Higher PNI levels were significantly associated with lower asthma prevalence. In the complete adjusted model, each additional unit of PNI was associated with a 3% reduction in the prevalence of asthma [0.97 (0.95, 0.99)]. Trend analysis indicated a significant negative correlation between PNI and asthma (p for trend = 0.0041). Subgroup analyses showed a consistent negative association across different populations.

Conclusion

The findings of our study indicated that lower PNI values were linked to an elevated odds prevalence of asthma. Early nutritional intervention and inflammation management in high-risk populations with low PNI may reduce the incidence and severity of asthma. Future prospective studies are needed to confirm this relationship.

Association of endometriosis with asthma: a study of the NHANES database in 1999-2006

OBJECTIVE

Asthma is a chronic inflammatory disease of the airways with a gender differences in the prevalence after puberty. Recent studies have reported a relationship between asthma and endometriosis, possibly related to the immune response mechanisms, but the evidences are limited and inconsistent. Herein, this research aimed to investigate the association of endometriosis with asthma based on the representative population in the United States (U.S.) to provide some reference for further exploration on mechanism of gender difference in asthma.

METHODS

In this cross-sectional study, data of women aged ≥ 20 years old were extracted from the National Health and Nutrition Examination Survey (NHANES) database in 1999-2006. Weighted univariate and multivariate logistic regression analyses were utilized to explore the association of endometriosis with asthma. The multivariate models adjusted for covariates including age, race, education level, marital status, poverty income ratio (PIR), body mass index (BMI), waist circumference, smoking, estrogen and progesterone hormones use, uterine fibroids, at least one ovary removed, and birth control pills intake. The evaluation indexes were odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses of age, race, BMI, and pregnancy history were also performed.

RESULTS

Among 5,556 eligible women, 782 had asthma, and 380 had endometriosis. The average age of participants was 37.19 years old, and more than half of them were non-Hispanic White (68.44%). After adjusting for covariates, endometriosis was associated with higher odds of asthma compared with non-endometriosis [OR = 1.48, 95%CI: (1.10-1.99)]. This relationship was also found in 40-49 years old [OR = 2.26, 95%CI: (1.21-4.23)], BMI of 25-29.9 kg/m2 [OR = 2.87, 95%CI: (1.52-5.44)], and pregnancy history [OR = 1.44, 95%CI: (1.01-2.06)] subgroups.

CONCLUSION

Endometriosis had a positive association with asthma in adult women. Females aged 40-49 years old, with BMI of 25-29.9 kg/m2 and had a history of pregnancy should take care about monitoring endometriosis to reduce the potential risk of asthma. Further studies are still needed to clarify the causal association between endometriosis and asthma.

Self-reported prevalence of asthma and its associated factors among adult rural population in Bangladesh: a cross-sectional study using WHO PEN protocol

OBJECTIVE

For over a decade, the prevalence of asthma remained unchanged at around 7% in Bangladesh. Although asthma causes significant morbidity among both children and adults, updates on epidemiological data are limited on the prevalence in Bangladesh. This study attempted to determine the prevalence of asthma, and its modifiable and non-modifiable lifestyle predictors in a rural population of Bangladesh.

METHOD

This study was part of a cross-sectional study that applied the WHO Package of Essential Noncommunicable Disease Interventions via census in a rural area of Bangladesh, where self-reported data on asthma were recorded. Data on anthropometric measurement, sociodemographic characteristics and behavioural risk factors were collected following the standard protocol described in the WHO STEP-wise approach to surveillance (STEPS) questionnaire. Analysis included descriptive statistics to assess the prevalence of asthma and its risk factors, and binary logistic regression to determine contributing factors.

RESULT

The overall prevalence of asthma was 4.2%. Asthma was predominant among people above 60 years (8.4%). Higher asthma was noted among males (4.6%), self-employed (5.1%), with a family history of asthma (9.1%), with comorbidities besides asthma (7.8%) and underweight (6.0%) compared with their counterparts. The OR of having asthma was 1.89, 1.93, 1.32, 1.50, 2.60, 0.67, 0.67 and 0.78 if a respondent was 45 years old or more, married, underweight, ever smoker, with a family history of asthma, housewife, employed and consumed red meat, respectively, while considering all other variables constant, compared with their counterparts.

CONCLUSION

The study emphasised asthma to be a public health concern in Bangladesh, although it seems to have decreased over the last decade. Among others, red meat intake and nutritional status were strongly associated with asthma, and the linkage among these is still a grey area that needs further exploration.

Thinness negatively affects lung function among Sri Lankan children

Background

There have been conflicting findings on the effect of body mass index (BMI) on lung functions in children. Therefore, we studied the relationship between spirometry parameters and BMI among healthy Sri Lankan school children aged 5–7 years.

Methods

A cross-sectional study was conducted among 296 school children (5–7-year-old) without apparent lung disease. Recruitment was done with stratified random sampling. Spirometry parameters, FEV₁, FVC, PEFR, and FEV₁/FVC ratio were determined. The acceptable and reproducible spirometry recordings were included in the analysis. Simple and multivariate linear regression analysis examined possible associations of lung function parameters with BMI, socio‐demographic variables and indoor risk factors. Also, the mediator effect of gender on lung function through BMI was explored.

Results

The participants’ mean age (SD) was 6.4 (0.65) years. One-third were thin/severely thin (37%). A statistically significant difference in FVC (p = 0.001) and FEV₁ (p = 0.001) was observed between BMI groups (obesity/overweight, normal, and thinness). Yet, PEFR or FEV₁/FVC did not significantly differ among BMI groups (p = 0.23 and p = 0.84). Multivariate regression analysis showed that FEV₁ and FVC were significantly associated with BMI, child’s age, gender, family income, father’s education, having a pet, and exposure to mosquito coil smoke. Interaction between gender and BMI for lung functions was not significant. The thin children had significantly lower FVC (OR: -0.04, 95%CI: -0.077, -0.012, p = 0.008) and FEV₁ (OR: -0.04, 95%CI: -0.075, -0.014, p = 0.004) than normal/overweight/obese children. Family income demonstrated the greatest effect on lung functions; FVC and FEV₁ were 0.25L and 0.23L smaller in low-income than the high-income families.

Conclusion

Lower lung function parameters (FVC and FEV₁) are associated with thinness than normal/overweight/obese dimensions among children without apparent lung disease. It informs that appropriate nutritional intervention may play a role in improving respiratory health.

Factors associated with resolution of childhood asthma by the age of 17: Large cohort analysis

BACKGROUND

Many children with asthma will become asymptomatic during adolescence. In this study, we evaluated factors associated with recovery from asthma by the age of 17.

METHODS

The medical records of 17-year-old conscripts to the Israeli army with asthma were compared with the records of conscripts with rigorously diagnosed resolved asthma. We assessed the association between the following parameters and asthma resolution: body mass index (BMI), recurrent rhinitis, birth season, socioeconomic level, and cognition.

RESULTS

Sixty-eight thousand and ninety conscripts with active asthma were compared to 14,695 with resolved asthma. In univariate analysis, rhinitis, overweight, underweight, higher socioeconomic level, and lower cognitive score were associated with active asthma (p < 0.001 for both sexes), but not the season of birth. In multivariate analysis, only overweight, underweight, rhinitis, and lower cognitive score (p < 0.001 for both sexes) remained significantly associated with persistence of asthma.

CONCLUSIONS

Although association does not prove causation, our finding is another reason to encourage adolescents with asthma to maintain a normal body weight. Prospective interventional studies are needed in order to decide whether changing weight to ensure BMI is within the ideal range and controlling rhinitis increases the odds of resolution of asthma in adolescence.

Nutrition and respiratory health--feature review

Diet and nutrition may be important modifiable risk factors for the development, progression and management of obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). This review examines the relationship between dietary patterns, nutrient intake and weight status in obstructive lung diseases, at different life stages, from in-utero influences through childhood and into adulthood. In vitro and animal studies suggest important roles for various nutrients, some of which are supported by epidemiological studies. However, few well-designed human intervention trials are available to definitively assess the efficacy of different approaches to nutritional management of respiratory diseases. Evidence for the impact of higher intakes of fruit and vegetables is amongst the strongest, yet other dietary nutrients and dietary patterns require evidence from human clinical studies before conclusions can be made about their effectiveness.

Analysis of the influenza A (H1N1) 2009 pandemic infection in Japanese asthmatic patients: using a questionnaire-based survey

BACKGROUND

Influenza infection is known to be an exacerbating factor in the control of asthma, therfore its prevention is critical in managing asthma. The aim of this study was to investigate the influenza A H1N1 2009 pandemic virus (H1N1 pdm09) infection in adult asthmatic patients.

METHODS

Data were obtained from a questionnaire-based survey of asthmatic patients conducted from September to October 2010 in Niigata Prefecture. Patient background, H1N1 pdm09 infection, vaccination status, and asthma exacerbation due to influenza infection were analyzed.

RESULTS

In total, 2,555 cases were analyzed. The incidence of the infection was 6.7% (95% confidence interval [CI]: 5.7-7.6), and the rate of vaccination was 63.9% (95% CI: 62.1-65.8). The odds ratio (OR) for vaccination against the infection among adult patients and younger patients (≤ the median age) were 0.61 (95% CI: 0.45-0.84) and 0.62 (95% CI: 0.42-0.90), respectively. However, OR among the older patient (> median age) were 1.38 (95%CI: 0.66-2.89). The rate of infection-induced asthma exacerbation was 23.2% (95% CI: 18.6-29.6), and the OR for vaccination against the infection-induced asthma exacerbation was 1.42 (95% CI: 0.69-2.92).

CONCLUSIONS

The effectiveness of the vaccination against the H1N1 pdm09 virus was confirmed during the first pandemic season, but it was limited. Further investigation on H1N1 pdm09 virus infection in asthmatics will be required.

The Asthma Control Test, Japanese version (ACT-J) as a predictor of Global Initiative for Asthma (GINA) guideline-defined asthma control: analysis of a questionnaire-based survey

BACKGROUND

The 2006 Global Initiative for Asthma (GINA 2006) guidelines emphasize the importance of evaluating the control rather than the severity of asthma. The Asthma Control Test (ACT) is well known to be an excellent tool for evaluating asthma control in the clinical setting. This study aimed to evaluate the ACT, Japanese version (ACT-J) as a predictor of asthma control as defined by the GINA 2006 guidelines in actual clinical practice.

METHODS

A cross-sectional analysis comparing the ACT-J score and GINA classification of asthma control among 419 patients of primary care physicians and specialists was performed using the data from a 2010 questionnaire-based survey conducted by the Niigata Asthma Treatment Study Group.

RESULTS

The optimal cut-off point of the ACT-J score for predicting GINA-defined asthma control was 23, with ACT-J scores of ≥23 and ≤22 predicting controlled and uncontrolled asthma with area under the receiver operating characteristics curve values of 0.76 [95% confidence interval (CI): 0.72-0.81] and 0.93 [95% CI: 0.90-0.97], respectively.

CONCLUSIONS

ACT scores of ≥23 and ≤22 are useful for identifying patients with controlled and uncontrolled asthma, respectively, as defined by GINA 2006, and the latter is more strongly predictive than the former. The reason for the higher cut-off point of the ACT-J relative to other versions of the ACT is unclear and warrants further investigation.