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Sun BZ, Gaffin JM. Recent Insights into the Environmental Determinants of Childhood Asthma. Curr Allergy Asthma Rep 2024; 24:253-260. [PMID: 38498229 DOI: 10.1007/s11882-024-01140-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE OF REVIEW Ubiquitous environmental exposures, including ambient air pollutants, are linked to the development and severity of childhood asthma. Advances in our understanding of these links have increasingly led to clinical interventions to reduce asthma morbidity. RECENT FINDINGS We review recent work untangling the complex relationship between air pollutants, including particulate matter, nitrogen dioxide, and ozone and asthma, such as vulnerable windows of pediatric exposure and their interaction with other factors influencing asthma development and severity. These have led to interventions to reduce air pollutant levels in children's homes and schools. We also highlight emerging environmental exposures increasingly associated with childhood asthma. Growing evidence supports the present threat of climate change to children with asthma. Environmental factors play a large role in the pathogenesis and persistence of pediatric asthma; in turn, this poses an opportunity to intervene to change the course of disease early in life.
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Affiliation(s)
- Bob Z Sun
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave, BCH 3121, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Ave, BCH 3121, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
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2
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Guillien A, Slama R, Andrusaityte S, Casas M, Chatzi L, de Castro M, de Lauzon-Guillain B, Granum B, Grazuleviciene R, Julvez J, Krog NH, Lepeule J, Maitre L, McEachan R, Nieuwenhuijsen M, Oftedal B, Urquiza J, Vafeiadi M, Wright J, Vrijheid M, Basagaña X, Siroux V. Associations between combined urban and lifestyle factors and respiratory health in European children. Environ Res 2024; 242:117774. [PMID: 38036203 DOI: 10.1016/j.envres.2023.117774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/22/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Previous studies identified some environmental and lifestyle factors independently associated with children respiratory health, but few focused on exposure mixture effects. This study aimed at identifying, in pregnancy and in childhood, combined urban and lifestyle environment profiles associated with respiratory health in children. METHODS This study is based on the European Human Early-Life Exposome (HELIX) project, combining six birth cohorts. Associations between profiles of pregnancy (38 exposures) and childhood (84 exposures) urban and lifestyle factors, identified by clustering analysis, and respiratory health were estimated by regression models adjusted for confounders. RESULTS Among the 1033 included children (mean ± standard-deviation (SD) age: 8.2 ± 1.6 years old, 47% girls) the mean ± SD forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) were 99 ± 13% and 101 ± 14%, respectively, and 12%, 12% and 24% reported ever-asthma, wheezing and rhinitis, respectively. Four profiles of pregnancy exposures and four profiles of childhood exposures were identified. Compared to the reference childhood exposure profile (low exposures), two exposure profiles were associated with lower levels of FEV1. One profile was characterized by few natural spaces in the surroundings and high exposure to the built environment and road traffic. The second profile was characterized by high exposure to meteorological factors and low levels of all other exposures and was also associated with an increased risk of ever-asthma and wheezing. A pregnancy exposure profile characterized by high exposure levels to all risk factors, but a healthy maternal lifestyle, was associated with a lower risk of wheezing and rhinitis in children, compared to the reference pregnancy profile (low exposures). CONCLUSION This comprehensive approach revealed pregnancy and childhood profiles of urban and lifestyle exposures associated with lung function and/or respiratory conditions in children. Our findings highlight the need to pursue the study of combined exposures to improve prevention strategies for multifactorial diseases such as asthma.
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Affiliation(s)
- Alicia Guillien
- University of Grenoble Alpes, French National Institute of Health and Medical Research, French National Center for Scientific Research, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France.
| | - Rémy Slama
- University of Grenoble Alpes, French National Institute of Health and Medical Research, French National Center for Scientific Research, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
| | - Sandra Andrusaityte
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, 53361, Academia, Lithuania
| | - Maribel Casas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Leda Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, USA
| | - Montserrat de Castro
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Blandine de Lauzon-Guillain
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
| | - Berit Granum
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Regina Grazuleviciene
- Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, 53361, Academia, Lithuania
| | - Jordi Julvez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Clinical and Epidemiological Neuroscience Group (NeuroÈpia), Institut d'Investigatió Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Norun Hjertager Krog
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Johanna Lepeule
- University of Grenoble Alpes, French National Institute of Health and Medical Research, French National Center for Scientific Research, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
| | - Léa Maitre
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Rosemary McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Mark Nieuwenhuijsen
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Bente Oftedal
- Division of Climate and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jose Urquiza
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Martine Vrijheid
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Xavier Basagaña
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Valérie Siroux
- University of Grenoble Alpes, French National Institute of Health and Medical Research, French National Center for Scientific Research, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, Grenoble, France
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Huang W, Schinasi LH, Kenyon CC, Auchincloss AH, Moore K, Melly S, Robinson LF, Forrest CB, De Roos AJ. Do respiratory virus infections modify associations of asthma exacerbation with aeroallergens or fine particulate matter? A time series study in Philadelphia PA. Int J Environ Health Res 2024:1-12. [PMID: 38164931 DOI: 10.1080/09603123.2023.2299249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Respiratory virus infections are related to over 80% of childhood asthma exacerbations. They enhance pro-inflammatory mediator release, especially for sensitized individuals exposed to pollens/molds. Using a time-series study design, we investigated possible effect modification by respiratory virus infections of the associations between aeroallergens/PM2.5 and asthma exacerbation rates. Outpatient, emergency department (ED), and inpatient visits for asthma exacerbation among children with asthma (28,540/24,444 [warm/cold season]), as well as viral infection counts were obtained from electronic health records of the Children's Hospital of Philadelphia from 2011 to 2016. Rate ratios (RRs, 90th percentile vs. 0) for late-season grass pollen were 1.00 (0.85-1.17), 1.04 (0.95-1.15), and 1.12 (0.96-1.32), respectively, for respiratory syncytial virus (RSV) counts within each tertile. However, similar trends were not observed for weed pollens/molds or PM2.5. Overall, our study provides little evidence supporting effect modification by respiratory viral infections.
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Affiliation(s)
- Wanyu Huang
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Leah H Schinasi
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Chén C Kenyon
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amy H Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Steven Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lucy F Robinson
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Christopher B Forrest
- The Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Hui-Beckman JW, Goleva E, Leung DYM, Kim BE. The impact of temperature on the skin barrier and atopic dermatitis. Ann Allergy Asthma Immunol 2023; 131:713-719. [PMID: 37595740 DOI: 10.1016/j.anai.2023.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023]
Abstract
Climate change is a global threat to public health and causes or worsens various diseases including atopic dermatitis (AD), allergic, infectious, cardiovascular diseases, physical injuries, and mental disorders. The incidence of allergy, such as AD, has increased over the past several decades, and environmental factors such as climate change have been implicated as a potential mechanism. A substantial amount of literature has been published on the impact of climate factors, including cold and hot temperatures, on the skin barrier and AD. Studies in several countries have found a greater incidence of AD in children born in the colder seasons of fall and winter. The effect of cold and warm temperatures on itch, skin flares, increased outpatient visits, skin barrier dysfunction, development of AD, and asthma exacerbations have been reported. Understanding mechanisms by which changes in temperature influence allergies is critical to the development of measures for the prevention and treatment of allergic disorders, such as AD and asthma. Low and high temperatures induce the production of proinflammatory cytokines and lipid mediators such as interleukin-1β, thymic stromal lymphopoietin, and prostaglandin E2, and cause itch and flares by activation of TRPVs such as TRPV1, TRPV3, and TRPV4. TRPV antagonists may attenuate temperature-mediated itch, skin barrier dysfunction, and exacerbation of AD.
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Affiliation(s)
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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Guan H, Yang G, Gao J, Lin X, Liu C, Ren H, Chen D, Zhou L, Hu Q, Huang Y, Zhao Y, Tong S, Lu Z, Liu S, Wang D. Sanya climatic-treatment cohort profile: objectives, design, and baseline characteristics. Front Public Health 2023; 11:1290303. [PMID: 37927865 PMCID: PMC10625485 DOI: 10.3389/fpubh.2023.1290303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
Background The prevalence of allergic diseases has increased globally, climate and environment also have important effects on respiratory or allergic diseases. However, population-based studies investigating the impact of tropical climates and environments on migratory-bird old people (MBOP) are lacking. Methods/Design For this prospective cohort study, we recruited 756 participants from the community in Sanya City, Hainan Province, China. In addition to the completed baseline survey, a follow-up survey will be conducted during the periods of October-December and March-April for the next 3 years of MBEPs from northern China who spend the winter in Sanya. We will continue to record the height, weight, and blood pressure of all participants, as well as lung function for those with asthma and chronic obstructive pulmonary disease (COPD). Venous blood at baseline and urine samples will be collected during follow-up. Results A total of 756 volunteers were recruited. Their average age is 66.1 years; 32.1% of them have high-school educations, while 37.3% have graduated from college or done undergraduate studies. The top five diseases in this cohort are allergic rhinitis (57.9%); eczema, urticaria, or dermatitis (35.6%); bronchitis and bronchiectasis (35.6%); asthma (14.7%); and emphysema (11.7%). Compared with their symptoms while at their summer places of residence, rates of remission reported by participants while living in Sanya were 80.4% for allergic rhinitis, 82.3% for bronchitis and emphysema, 85.2% for asthma, 96.0% for COPD (P < 0.001). Conclusions The baseline survey has been completed. The preliminary findings support that a tropical climate may relieve the symptoms of allergic diseases in migratory-bird old people.
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Affiliation(s)
- Haidao Guan
- Department of Science and Education, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Guiyan Yang
- Department of Hospital Management, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Jiashi Gao
- Department of Science and Education, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Xiaoya Lin
- Department of Science and Education, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Chao Liu
- Department of Science and Education, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Han Ren
- Department of Hospital Management, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Duyue Chen
- Department of Hospital Management, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Lingyao Zhou
- Department of Hospital Management, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Qian Hu
- Department of Hospital Infection, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Yongzhen Huang
- Department of Hospital Infection, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Yumei Zhao
- Department of Nursing, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Children Health Advocacy Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Zhaohui Lu
- Department of Pediatric Surgery, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Shijian Liu
- Department of Science and Education, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
- Department of Clinical Epidemiology and Biostatistics, Children Health Advocacy Institute, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Big Center, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
| | - Dan Wang
- Department of Science and Education, Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China
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Vicedo-Cabrera AM, Melén E, Forastiere F, Gehring U, Katsouyanni K, Yorgancioglu A, Ulrik CS, Hansen K, Powell P, Ward B, Hoffmann B, Andersen ZJ. Climate change and respiratory health: a European Respiratory Society position statement. Eur Respir J 2023; 62:2201960. [PMID: 37661094 DOI: 10.1183/13993003.01960-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/05/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Erik Melén
- Department of Clinical Sciences and Education, Karolinska Institutet, Stockholm, Sweden
| | - Francesco Forastiere
- Department of Epidemiology, Lazio Regional Health Service/ASL Roma 1, Rome, Italy
- Science Policy and Epidemiology Environmental Research Group King's College London, London UK
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, The Netherlands
| | - Klea Katsouyanni
- National and Kapodistrian University of Athens, Medical School, Athens, Greece
- Environmental Research Group, School of Public Health, Imperial College London, London, UK
| | - Arzu Yorgancioglu
- Celal Bayar University Medical Faculty Department of Pulmonology, Manisa, Turkey
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kjeld Hansen
- European Lung Foundation, Sheffield, UK
- Kristiania University College, Technology, Oslo, Norway
| | | | - Brian Ward
- European Respiratory Society, Brussels, Belgium
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University of Düsseldorf, Düsseldorf, Germany
| | - Zorana Jovanovic Andersen
- Section of Environment and Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Deng S, Han A, Jin S, Wang S, Zheng J, Jalaludin BB, Hajat S, Liang W, Huang C. Effect of extreme temperatures on asthma hospital visits: Modification by event characteristics and healthy behaviors. Environ Res 2023; 226:115679. [PMID: 36913996 DOI: 10.1016/j.envres.2023.115679] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/16/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Although ambient temperature has been linked to asthma exacerbation, impacts associated with extreme temperature events remain unclear. This study aims to identify the events characteristics that elevate risk of asthma hospital visits, and to assess whether healthy behavior changes due to the COVID-19 prevention and control policy may modify the relationships. Data of asthma hospital visits from all medical facilities in Shenzhen, China during 2016-2020 were assessed in relation to extreme temperature events using a distributed lag model. Stratified analysis was conducted by gender, age and hospital department to identify susceptible populations. Through events defined by various duration days and temperature thresholds, we explored the modification by events intensity, length, occurrence time and healthy behaviors. The cumulative relative risk of asthma during heat waves compared to other days was 1.06 (95%CI: 1.00-1.13) and for cold spells was 1.17 (95%CI: 1.05-1.30), and that of males and school-aged children were generally higher than other sub-groups. There were significant effects of heat waves and cold spells on asthma hospital visits when the mean temperature was above 90th percentile (30 °C) and below 10th percentile (14 °C) respectively, and the relative risks were higher when events lasted longer, became stronger, occurred in daytime and in early summer or winter. During the healthy behaviors maintaining period, the risk of heat waves increased whilst the risk of cold spells reduced. Extreme temperatures may pose considerable impact on asthma and the health effect can be modified by the event characteristics and anti-epidemic healthy behaviors. Strategies of asthma control should consider the heightened threats of the intense and frequent extreme temperature events in the context of climate change.
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Affiliation(s)
- Shizhou Deng
- School of Public Health, Sun Yat-sen University, Guangzhou, China; Shanghai Typhoon Institute, China Meteorological Administration & Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Service, Shanghai, China
| | - Azhu Han
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shuyan Jin
- Department of Prevention and Health Care, Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, China
| | - Shuang Wang
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Jing Zheng
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Bin B Jalaludin
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Shakoor Hajat
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China.
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China.
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Abstract
PURPOSE OF REVIEW The current review provides an assessment of the recent pediatric literature evaluating socioeconomic drivers of asthma incidence and morbidity. The review addresses the specific social determinants of health related to housing, indoor and outdoor environmental exposures, healthcare access and quality, and the impact of systematic racism. RECENT FINDINGS Many social risk factors are associated with adverse asthma outcomes. Children living in low-income, urban neighborhoods have greater exposure to both indoor and outdoor hazards, including molds, mice, second-hand smoke, chemicals, and air pollutants, all of which are associated with adverse asthma outcomes. Providing asthma education in the community - via telehealth, school-based health centers, or peer mentors - are all effective methods for improving medication adherence and asthma outcomes. The racially segregated neighborhoods created by the racist 'redlining' policies implemented decades ago, persist today as hotspots of poverty, poor housing conditions, and adverse asthma outcomes. SUMMARY Routine screening for social determinants of health in clinical settings is important to identify the social risk factors of pediatric patients with asthma. Interventions targeting social risk factors can improve pediatric asthma outcomes, but more studies are needed related to social risk interventions.
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Affiliation(s)
- Tregony Simoneau
- Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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9
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Andersen ZJ, Vicedo-Cabrera AM, Hoffmann B, Melén E. Climate change and respiratory disease: clinical guidance for healthcare professionals. Breathe (Sheff) 2023; 19:220222. [PMID: 37492343 PMCID: PMC10365076 DOI: 10.1183/20734735.0222-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/28/2023] [Indexed: 07/27/2023] Open
Abstract
Climate change is one of the major public health emergencies with already unprecedented impacts on our planet, environment and health. Climate change has already resulted in substantial increases in temperatures globally and more frequent and extreme weather in terms of heatwaves, droughts, dust storms, wildfires, rainstorms and flooding, with prolonged and altered allergen and microbial exposure as well as the introduction of new allergens to certain areas. All these exposures may have a major burden on patients with respiratory conditions, which will pose increasing challenges for respiratory clinicians and other healthcare providers. In addition, complex interactions between these different factors, along with other major environmental risk factors (e.g. air pollution), will exacerbate adverse health effects on the lung. For example, an increase in heat and sunlight in urban areas will lead to increases in ozone exposure among urban populations; effects of very high exposure to smoke and pollution from wildfires will be exacerbated by the accompanying heat and drought; and extreme precipitation events and flooding will increase exposure to humidity and mould indoors. This review aims to bring respiratory healthcare providers up to date with the newest research on the impacts of climate change on respiratory health. Respiratory clinicians and other healthcare providers need to be continually educated about the challenges of this emerging and growing public health problem and be equipped to be the key players in solutions to mitigate the impacts of climate change on patients with respiratory conditions. Educational aims To define climate change and describe major related environmental factors that pose a threat to patients with respiratory conditions.To provide an overview of the epidemiological evidence on climate change and respiratory diseases.To explain how climate change interacts with air pollution and other related environmental hazards to pose additional challenges for patients.To outline recommendations to protect the health of patients with respiratory conditions from climate-related environmental hazards in clinical practice.To outline recommendations to clinicians and patients with respiratory conditions on how to contribute to mitigating climate change.
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Affiliation(s)
- Zorana Jovanovic Andersen
- Section of Environment and Health, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Erik Melén
- Department of Clinical Sciences and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Lee JX, Phipatanakul W, Gaffin JM. Environment and the development of severe asthma in inner city population. Curr Opin Allergy Clin Immunol 2023; 23:179-184. [PMID: 36728241 PMCID: PMC9974609 DOI: 10.1097/aci.0000000000000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Higher asthma prevalence and morbidity are seen in inner-city areas, disproportionately affecting low-income families living in substandard housing. Children within these families experience more frequent asthma exacerbations, acute care and emergency department visits, and hospitalizations, thus characterizing severe asthma. In this review, we assess recent published literature focused on indoor and outdoor exposures that contribute to the development and morbidity of asthma. RECENT FINDINGS Many urban environmental exposures contribute to asthma burden, including tobacco/e-cigarette smoke, pest allergens, molds, and possibly synthetic chemicals such as phthalates and bisphenol A, radon, and volatile organic compounds. Individuals living in inner-city areas also experience higher levels of air pollutants and ambient heat, further perpetuating asthma incidence and severity. SUMMARY This article summarizes the latest advances and provides direction for future research on risk factors, interventions, and public policy to help alleviate the burden of asthma due to urban environment exposures.
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Affiliation(s)
- Julia X Lee
- Division of Pulmonary Medicine, Boston Children's Hospital
| | - Wanda Phipatanakul
- Division of allergy and immunology, Boston Children's Hospital
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital
- Harvard Medical School, Boston, Massachusetts, USA
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Guo S, Chen D, Chen J, Zhu C, Huang L, Chen Z. Relationship between meteorological and environmental factors and acute exacerbation for pediatric bronchial asthma: Comparative study before and after COVID-19 in Suzhou. Front Public Health 2023; 11:1090474. [PMID: 36778545 PMCID: PMC9911831 DOI: 10.3389/fpubh.2023.1090474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective Climate and environmental change is a well-known factor causing bronchial asthma in children. After the outbreak of coronavirus disease (COVID-19), climate and environmental changes have occurred. The present study investigated the relationship between climate changes (meteorological and environmental factors) and the number of hospitalizations for pediatric bronchial asthma in Suzhou before and after the COVID-19 pandemic. Methods From 2017 to 2021, data on daily inpatients diagnosed with bronchial asthma at Children's Hospital of Soochow University were collected. Suzhou Meteorological and Environmental Protection Bureau provided daily meteorological and environmental data. To assess the relationship between bronchial asthma-related hospitalizations and meteorological and environmental factors, partial correlation and multiple stepwise regression analyses were used. To estimate the effects of meteorological and environmental variables on the development of bronchial asthma in children, the autoregressive integrated moving average (ARIMA) model was used. Results After the COVID-19 outbreak, both the rate of acute exacerbation of bronchial asthma and the infection rate of pathogenic respiratory syncytial virus decreased, whereas the proportion of school-aged children and the infection rate of human rhinovirus increased. After the pandemic, the incidence of an acute asthma attack was negatively correlated with monthly mean temperature and positively correlated with PM2.5. Stepwise regression analysis showed that monthly mean temperature and O3 were independent covariates (risk factors) for the rate of acute asthma exacerbations. The ARIMA (1, 0, 0) (0, 0, 0) 12 model can be used to predict temperature changes associated with bronchial asthma. Conclusion Meteorological and environmental factors are related to bronchial asthma development in children. The influence of meteorological and environmental factors on bronchial asthma may be helpful in predicting the incidence and attack rates.
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Cheng CG, Yen SY, Hsiao CC, Lin YY, Chang YH, Chen YH, Cheng CA. Short-Term Exposure Effect of Ambient Fine Particulate Matter, Ozone and Cold Temperature on Emergency Room Visits for Asthma Patients. Toxics 2023; 11:94. [PMID: 36850970 PMCID: PMC9964231 DOI: 10.3390/toxics11020094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: The acute effects of ozone, cold temperature and particulate matter less than 2.5 μm (PM2.5) in size related to asthma attacks are well known worldwide. The adverse effects of ozone and cold temperature on asthma morbidity in Taiwan are still inconclusive. (2) Methods: This retrospective study included patients who had asthma emergency room visits (ERVs) from 1 January 2016 to 31 December 2019 in a regional hospital in Taiwan. The short-term negative effects were estimated using Distributed Lag Non-Linear Models (DLNMs) for the relative risks (RRs) of asthma ERVs associated with PM2.5, ozone and cold temperature exposures within 5 days. (3) Results: There was a significant association between a 10 ppm increase in PM2.5 exposure and asthma ERVs at a 2-day lag (RR 1.166, 95% confidence interval (C.I.): 1.051-1.294). There was a significant association between ozone and asthma ERVs at a 1-day lag (RR 1.179, 95% C.I.: 1.034-1.345). The ambient temperature in cold weather compared with the temperature of minimum asthma ERV showed an RR of 1.214, 95% C.I.: 1.009-1.252 at a 1-day lag. (4) Conclusions: This study provides evidence that short-term exposure to fine suspended particulates, ozone and inverse temperature is associated with asthma exacerbation.
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Affiliation(s)
- Chun-Gu Cheng
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Shang-Yih Yen
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Chih-Chun Hsiao
- Department of Nursing, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
| | - Yen-Yue Lin
- Department of Emergency Medicine, Taoyuan Armed Forces General Hospital, Taoyuan 32549, Taiwan
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yin-Han Chang
- Department of Psychology, National Taiwan University, Taipei 10621, Taiwan
| | - Yu-Hsuan Chen
- Division of Chest Medicine, Department of Internal Medicine, Cheng Hsin General Hospital, Taipei 11220, Taiwan
| | - Chun-An Cheng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
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