Risk, Mechanisms and Implications of Asthma-Associated Infectious and Inflammatory Multimorbidities (AIMs) among Individuals With Asthma: a Systematic Review and a Case Study

Metabolomic studies of respiratory infections in early life: A narrative review

Respiratory infections are a leading cause of morbidity and mortality during the early life period, and experiencing recurrent infections may increase the risk of developing chronic respiratory diseases, such as asthma. Over the last several decades, metabolomics methods have been applied to inform upon the underlying biochemistry of pediatric respiratory infection response, to discriminate between respiratory infection types, and to identify biomarkers of severity and susceptibility. While these studies have demonstrated the power of applying metabolomics to the study of pediatric respiratory infection and contributed to an understanding of respiratory infections during the unique period of immune development, key differences in study design, infection type(s) of interest, biosamples, metabolomics measurement methods, and lack of external validation have limited the translation of these findings into the clinic. The purpose of this review is to summarize overlaps across existing studies of commonly reported metabolomics findings and emphasize areas of opportunity for future study. We highlight several metabolomics pathways-such as the citric acid cycle and sphingolipid metabolism-that have been reported consistently in respiratory infection response. We then discuss putatively identified metabolomic markers to discriminate between respiratory infection types and possible markers of infection severity and proneness. Finally, we close with a summary and perspective of future directions of the field.

Disproportionately higher asthma risk and incidence with high fructose corn syrup, but not sucrose intake, among Black young adults: the CARDIA Study

OBJECTIVE

There have been unsafe levels of unpaired fructose in the high fructose corn syrup (HFCS) in US beverages, and research/case study evidence shows that their intake is associated with greater asthma prevalence/risk/incidence, a debilitating disease, likely due to fructose malabsorption, gut fructosylation and gut dysbiosis mechanisms. The 'unexplained' asthma epidemic has disproportionately affected children and Black individuals, groups with higher fructose malabsorption prevalence than others, and research to assess disproportionately higher asthma risk/incidence among Black individuals in association with HFCS-sweetened beverage intake is lacking.

DESIGN

Demographic, lifestyle and dietary data collected at enrollment (1985-86), and incident asthma through exam 5 (1995-96), were used in Cox proportional hazards models to assess HFCS intake associations (hazard ratios) with asthma risk/incidence.

SETTING

CARDIA study participants from Birmingham, AL, Chicago, IL, Minneapolis, MN and Oakland, CA.

PARTICIPANTS

1998 Black and 2104 White young adults.

RESULTS

HFCS-sweetened beverage intake > once/week was significantly associated with higher asthma risk relative to ≤ once/week (P-trend = 0·04), among Black participants only; risk was 2·8 times higher among 2-4 times/week consumers (HR = 2·8, 95 % CI 1·1, 7·3, P = 0·04) and 3·5 times higher when consumed multiple times/d, independent of sucrose intake/obesity/dietary quality/smoking/in-home smoke-exposure (HR = 3·5, 95 % CI 1·3, 9·9, P = 0·02). Intake of orange juice, with nominal unpaired fructose, was not associated with asthma in either group, nor was intake of sucrose, a disaccharide (paired) of fructose/glucose.

CONCLUSIONS

Ubiquitous HFCS in the US food supply, with HFCS that contains high/unsafe unpaired fructose, also known as excess-free-fructose, and the fructose/gut/lung/axis are overlooked risk factors in the 'unexplained' US asthma epidemic that disproportionately affects Black individuals.

Understanding the impact of adult pertussis and current approaches to vaccination: A narrative review and expert panel recommendations

Pertussis has several notable consequences, causing economic burden, increased strain on healthcare facilities, and reductions in quality of life. Recent years have seen a trend toward an increase in pertussis cases affecting older children and adults. To boost immunity, and protect vulnerable populations, an enduring approach to vaccination has been proposed, but gaps remain in the evidence surrounding adult vaccination that are needed to inform such a policy. Gaps include: the true incidence of pertussis and its complications in adults; regional variations in disease recognition and reporting; and incidence of severe disease, hospitalizations, and deaths in older adults. Better data on the efficacy/effectiveness of pertussis vaccination in adults, duration of protection, and factors leading to poor vaccine uptake are needed. Addressing the critical evidence gaps will help highlight important areas of unmet need and justify the importance of adult pertussis vaccination to healthcare professionals, policymakers, and payers.

Sex differences in sociodemographic, clinical, and laboratory variables in childhood asthma: A birth cohort study

BACKGROUND

There are marked sex differences in the prevalence and severity of asthma, both during childhood and adulthood. There is a relative lack of comprehensive studies exploring sexdifferences in pediatric asthma cohorts.

OBJECTIVE

To identify the most relevant sex differences in sociodemographic, clinical, and laboratory variables in a well-characterized large pediatric asthma cohort.

METHODS

We performed a cross-sectional analysis of the Mayo Clinic Olmsted County Birth Cohort. In the full birth cohort, we used a natural language-processing algorithm based on the Predetermined Asthma Criteria for asthma ascertainment. In a stratified random sample of 300 children, we obtained additional pulmonary function tests and laboratory data. We identified the significant sex differences among available sociodemographic, clinical, and laboratory variables.

RESULTS

Boys were more frequently diagnosed with having asthma than girls and were younger at the time of asthma diagnosis. There were no sex differences in relation to socioeconomic status. We identified a male predominance in the presence of a tympanostomy tube and a female predominance in the history of pneumonia. A higher percentage of boys had a forced expiratory volume in 1 second/forced vital capacity ratio less than 0.85. Blood eosinophilia and atopic sensitization were also more common in boys. Finally, boys had higher levels of serum periostin than girls.

CONCLUSION

This study described significant sex differences in a large pediatric asthma cohort. Overall, boys had earlier and more severe asthma than girls. Differences in blood eosinophilia and serum periostin provide insights into possible mechanisms of the sex bias in childhood asthma.

Clostridioides difficile infection across the lifespan: Estimation using life tables

Using a life tables approach with 2011-2017 claims data, we calculated lifetime risks of Clostridioides difficile infection (CDI) beginning at age 18 years. The lifetime CDI risk rates were 32% in female patients insured by Medicaid, 10% in commercially insured male patients, and almost 40% in females with end-stage renal disease.

Accumulation of long-term diseases is associated with musculoskeletal pain dimensions among middle-aged individuals with musculoskeletal pain

BACKGROUND

Long-term diseases often co-occur with musculoskeletal (MSK) pain. In middle-aged individuals with MSK pain, it remains unclear whether an accumulation (two or more) of long-term diseases is associated with MSK pain dimensions, including pain frequency, bothersomeness of pain, pain intensity and number of pain sites.

METHODS

This cross-sectional study included data from the Northern Finland Birth Cohort 1966 collected in 2012-2014 when the participants were 46 years of age. We included participants who reported having MSK pain during the previous year (collected retrospectively) and provided self-reported information related to MSK pain dimensions, long-term diseases and potential confounders (n = 4469). The association between long-term diseases and pain dimensions was modelled by general linear and logistic regression models, with beta (β) coefficients, odds ratios (ORs) and their 95% confidence intervals (CIs) being presented. Unadjusted models were followed by models adjusted for sex, educational level and smoking.

RESULTS

The presence of accumulated long-term diseases was associated with over two-fold higher odds of daily pain (adjusted OR 2.6, 95% CI 2.0-3.4) and significantly higher levels of bothersomeness of pain and pain intensity (adjusted β 1.1, 95% CI 0.9-1.4; adjusted β 1.0, 95% CI 0.8-1.1, respectively), relative to the absence of long-term diseases. Females with accumulated long-term diseases had a stronger relationship to number of pain sites than males. Associations between one long-term disease and pain dimensions were significant but smaller in magnitude.

CONCLUSION

There is a need for a better understanding of the relationships between accumulated long-term diseases and MSK pain.

SIGNIFICANCE

This study on middle-aged individuals with musculoskeletal pain showed that the presence of long-term diseases was clearly associated with pain frequency, bothersomeness of pain, pain intensity and number of pain sites. Compared with no long-term diseases, the association between accumulated (two or more) long-term diseases and pain dimensions was stronger than the association between one long-term disease and pain dimensions.

Risk factors for herpes zoster: should people with asthma or COPD be vaccinated?

Without vaccination, an estimated 1 in 3 individuals will develop herpes zoster (HZ) in their lifetime. Increased risk of HZ is attributed to impaired cell-mediated immunity, as observed in age-related immunosenescence or in individuals immunocompromised due to disease or immunosuppressive treatments. Most vaccination guidelines recommend HZ vaccination in all adults ≥ 50 years of age, although Shingrix® was recently approved by the U.S. Food and Drug Administration for use in individuals aged ≥ 18 years who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy, followed by approval by the European Medicines Agency for use in immunocompromised individuals aged ≥ 18 years. Chronic respiratory diseases are also risk factors for HZ. A new meta-analysis reported 24% and 41% increased risks of HZ in those with asthma and chronic obstructive pulmonary disorder (COPD), respectively, compared with healthy controls. Asthma and COPD increase a person's risk of HZ and associated complications at any age and may be further elevated in those receiving inhaled corticosteroids. Despite the increased risks, there is evidence that HZ vaccination uptake in those aged ≥ 50 years with COPD may be lower compared with the age-matched general population, potentially indicating a lack of awareness of HZ risk factors among clinicians and patients. The 2022 Global Initiative for Chronic Lung Disease report recognizes that Centers for Disease Control and Prevention recommended to vaccinate those aged ≥ 50 years against HZ, although health systems should consider the inclusion of all adults with asthma or COPD into their HZ vaccination programs. Further research into HZ vaccine efficacy/effectiveness and safety in younger populations is needed to inform vaccination guidelines.