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Davis SR, Ampon RD, Poulos LM, Lee T, Marks GB, Toelle BG, Reddel HK. Prevalence and burden of difficult-to-treat and severe asthma in Australia: A national population survey. Respirology 2024. [PMID: 38709664 DOI: 10.1111/resp.14722] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 04/02/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND OBJECTIVE Most evidence about difficult-to-treat and severe asthma (DTTA) comes from clinical trials and registries. We aimed to identify people with DTTA from a large nationally representative asthma population and describe their characteristics and healthcare utilization compared with people whose asthma was not 'difficult-to-treat'. METHODS We conducted a cross-sectional survey of Australians aged ≥18 years with current asthma from large web-based survey panels. Enrolment was stratified by gender, age-group and state/territory based on national population data for people with asthma. Difficult-to-treat or severe asthma was defined by poor symptom control, exacerbations and/or oral corticosteroid/biologic use despite medium/high-dose inhaled therapy. Outcomes included exacerbations, healthcare utilization, multimorbidity, quality of life and coronavirus disease of 2019 (COVID-19)-related behaviour. Weighted data were analysed using SAS version 9.4. RESULTS The survey was conducted in February-March 2021. The weighted sample comprised 6048 adults with current asthma (average age 47.3 ± SD 18.1 years, 59.9% female), with 1313 (21.7%) satisfying ≥1 DTTA criteria. Of these, 50.4% had very poorly controlled symptoms (Asthma Control Test ≤15), 36.2% were current smokers, and 85.4% had ≥1 additional chronic condition, most commonly anxiety/depression. More than twice as many participants with DTTA versus non-DTTA had ≥1 urgent general practitioner (GP) visit (61.4% vs. 27.5%, OR 4.8 [4.2-5.5, p < 0.0001]), or ≥1 emergency room visit (41.9% vs. 17.9%, OR 3.8 [3.3-4.4, p < 0.0001]) in the previous 12 months. CONCLUSION Our findings emphasize the burden of uncontrolled symptoms, current smoking, multimorbidity and healthcare utilization in people with DTTA in the community, who may be under-represented in registries or clinical trials.
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Affiliation(s)
- Sharon R Davis
- Australian Centre for Airways disease Monitoring, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
| | - Rosario D Ampon
- Australian Centre for Airways disease Monitoring, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
| | - Leanne M Poulos
- Australian Centre for Airways disease Monitoring, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
| | - Taehoon Lee
- Australian Centre for Airways disease Monitoring, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Ulsan University Hospital, Ulsan, Korea
| | - Guy B Marks
- Australian Centre for Airways disease Monitoring, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- School of Clinical Medicine, University of NSW, Sydney, New South Wales, Australia
| | - Brett G Toelle
- Australian Centre for Airways disease Monitoring, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Helen K Reddel
- Australian Centre for Airways disease Monitoring, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Ivey MA, Smith SM, Benke G, Toelle BG, Hunter ML, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Abramson MJ. COPD in Never-Smokers: BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2024; 19:161-174. [PMID: 38249822 PMCID: PMC10800088 DOI: 10.2147/copd.s439307] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose Tobacco smoking is the major risk factor for COPD, and it is common for other risk factors in never-smokers to be overlooked. We examined the prevalence of COPD among never-smokers in Australia and identified associated risk factors. Methods We used data from the Australia Burden of Obstructive Lung Disease (BOLD) study, a cross-section of people aged ≥40 years from six sites. Participants completed interviews and post-bronchodilator spirometry. COPD was primarily defined as an FEV1/FVC ratio <0.70 and secondarily as the ratio less than the lower limit of normal (LLN). Results The prevalence of COPD in the 1656 never-smokers who completed the study was 10.5% (95% CI: 9.1-12.1%) [ratio Conclusion COPD was prevalent in this population of never-smokers aged 40 years and over. This finding highlights the significance of risk factors other than smoking in the development of COPD.
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Affiliation(s)
- Marsha A Ivey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
- School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Sheree M Smith
- School of Nursing and Midwifery, Campbelltown Campus, Western Sydney University, Penrith, NSW, 2751, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Geza Benke
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Brett G Toelle
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- Sydney Local Health District, Sydney, NSW, 2050, Australia
| | - Michael L Hunter
- School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Alan L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital and Medical School, University of Western Australia, Perth, WA, 6009, Australia
| | - Graeme P Maguire
- Curtin Medical School, Curtin University, Perth, WA, 6102, Australia
| | - Richard Wood-Baker
- School of Medicine, University of Tasmania, Hobart, TAS, 7000, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Guy B Marks
- Respiratory and Environmental Epidemiology Group, Woolcock Institute of Medical Research, Sydney, NSW, 2037, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Respiratory Symptoms, Disease Burden, and Quality of Life in Australian Adults According to GOLD Spirometry Grades: Data from the BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2023; 18:2839-2847. [PMID: 38053919 PMCID: PMC10695119 DOI: 10.2147/copd.s425202] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose Population data on the burden of chronic obstructive pulmonary disease (COPD) are often based on patient-reported diagnoses of COPD, emphysema or chronic bronchitis, without spirometry. We aimed to investigate the relationship between health burden, quality of life and severity of airway obstruction in Australian adults aged ≥40 years. Methods We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites to reflect the sociodemographic and geographic diversity of the Australian population (n = 3522). Participants with post-bronchodilator airflow limitation (ratio of forced expiratory volume in 1 second FEV1 to forced vital capacity <0.7) were grouped by GOLD spirometry grades 1-4. Quality of life was assessed with Short Form 12 (SF-12) Health Survey Questionnaire. Health burden was assessed as lost time off work or social activities, and healthcare utilization. Results Of the study sample, 2969 participants did not have airflow limitation, 294 (8.4%) were classified as GOLD Grade 1, 212 (6.0%) as GOLD 2 and 43 (1.2%) as GOLD 3-4. Participants with higher GOLD grades had more respiratory symptoms, more comorbidities and greater burden than those with lower GOLD grades. The scores of mental and physical subscales of SF-12 were lower, indicating worse quality of life, from the no airflow limitation group to the GOLD 3-4 group (P = 0.03 and P < 0.001, respectively). Conclusion Greater airflow limitation is associated with greater burden and poor quality of life. Interventions to prevent, or reduce the level of, airflow limitation will reduce the symptom burden and improve quality of life for patients.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Maria R Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alan L James
- Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Helen K Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Clinical characteristics of adults with self-reported diagnosed asthma and/or COPD: data from the BOLD Australia Study. ERJ Open Res 2023; 9:00098-2023. [PMID: 37609600 PMCID: PMC10440648 DOI: 10.1183/23120541.00098-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 08/24/2023] Open
Abstract
Background Diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the community is variable, often without spirometry. Some studies report that adults with both diagnostic labels (asthma+COPD) have worse health outcomes than those with asthma or COPD only, but data for Australian adults are limited. We investigated the relationship between clinical characteristics and self-reported diagnoses of asthma, COPD and both. Method We used data from the BOLD Australia study, which included randomly selected adults aged ≥40 years from six study sites. The BOLD questionnaires and spirometry test were used in all sites. Participants were grouped by self-reported diagnosis. Demographic and clinical characteristics and lung function were compared between groups. Results Of the study sample (n=3522), 336 reported asthma only, 172 reported COPD only, 77 reported asthma+COPD and 2937 reported neither. Fewer than half of participants with a COPD diagnosis (with or without asthma) had airflow limitation. Participants with asthma+COPD had more respiratory symptoms and greater airflow limitation than those with either diagnosis alone. Having asthma+COPD was independently associated with a higher probability of having clinically important breathlessness (modified Medical Research Council score ≥2) than asthma only (adjusted OR 3.44, 95% CI 1.86-6.33) or COPD only (adjusted OR 3.28, 95% CI 1.69-6.39). Airflow limitation (Global Initiative for Chronic Obstructive Lung Disease 2 or higher, using post-bronchodilator forced expiratory volume in 1 s/forced vital capacity ratio <0.7) was similar between asthma only and COPD only, but twice as prevalent in asthma+COPD (adjusted OR 2.18 and 2.58, respectively). Conclusions Adults with diagnoses of asthma+COPD have a higher symptom and disease burden than those with diagnoses of asthma only or COPD only. These patients should receive regular comprehensive reviews because of the substantially increased burden of having both diagnoses.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Maria R. Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Michael J. Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - David P. Johns
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Guy B. Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Helen K. Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
| | - Brett G. Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia
- Sydney Local Health District, Sydney, Australia
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5
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Marshall NS, Cho G, Toelle BG, Tonin R, Bartlett DJ, D’Rozario AL, Evans CA, Cowie CT, Janev O, Whitfeld CR, Glozier N, Walker BE, Killick R, Welgampola MS, Phillips CL, Marks GB, Grunstein RR. The Health Effects of 72 Hours of Simulated Wind Turbine Infrasound: A Double-Blind Randomized Crossover Study in Noise-Sensitive, Healthy Adults. Environ Health Perspect 2023; 131:37012. [PMID: 36946580 PMCID: PMC10032045 DOI: 10.1289/ehp10757] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/09/2023] [Accepted: 02/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Large electricity-generating wind turbines emit both audible sound and inaudible infrasound at very low frequencies that are outside of the normal human range of hearing. Sufferers of wind turbine syndrome (WTS) have attributed their ill-health and particularly their sleep disturbance to the signature pattern of infrasound. Critics have argued that these symptoms are psychological in origin and are attributable to nocebo effects. OBJECTIVES We aimed to test the effects of 72 h of infrasound (1.6-20 Hz at a sound level of ∼90 dB pk re 20μPa, simulating a wind turbine infrasound signature) exposure on human physiology, particularly sleep. METHODS We conducted a randomized double-blind triple-arm crossover laboratory-based study of 72 h exposure with a >10-d washout conducted in a noise-insulated sleep laboratory in the style of a studio apartment. The exposures were infrasound (∼90 dB pk), sham infrasound (same speakers not generating infrasound), and traffic noise exposure [active control; at a sound pressure level of 40-50 dB LAeq,night and 70 dB LAFmax transient maxima, night (2200 to 0700 hours)]. The following physiological and psychological measures and systems were tested for their sensitivity to infrasound: wake after sleep onset (WASO; primary outcome) and other measures of sleep physiology, wake electroencephalography, WTS symptoms, cardiovascular physiology, and neurobehavioral performance. RESULTS We randomized 37 noise-sensitive but otherwise healthy adults (18-72 years of age; 51% female) into the study before a COVID19-related public health order forced the study to close. WASO was not affected by infrasound compared with sham infrasound (-1.36 min; 95% CI: -6.60, 3.88, p=0.60) but was worsened by the active control traffic exposure compared with sham by 6.07 min (95% CI: 0.75, 11.39, p=0.02). Infrasound did not worsen any subjective or objective measures used. DISCUSSION Our findings did not support the idea that infrasound causes WTS. High level, but inaudible, infrasound did not appear to perturb any physiological or psychological measure tested in these study participants. https://doi.org/10.1289/EHP10757.
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Affiliation(s)
- Nathaniel S. Marshall
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Garry Cho
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
| | - Brett G. Toelle
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Renzo Tonin
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- Renzo Tonin Associates, Sydney, Australia (Retired)
| | - Delwyn J. Bartlett
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Angela L. D’Rozario
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Carla A. Evans
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
| | - Christine T. Cowie
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Oliver Janev
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
| | | | - Nick Glozier
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| | - Bruce E. Walker
- Channel Islands Acoustics, Santa Barbara, California, USA (Retired)
| | - Roo Killick
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
| | - Miriam S. Welgampola
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| | - Craig L. Phillips
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- School of Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Guy B. Marks
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Ronald R. Grunstein
- Woolcock Institute for Medical Research, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
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Zhou Y, Ampon MR, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB, Reddel HK, Toelle BG. Risk factors and clinical characteristics of breathlessness in Australian adults: Data from the BOLD Australia study. Chron Respir Dis 2023; 20:14799731231221820. [PMID: 38126966 DOI: 10.1177/14799731231221820] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Breathlessness is a common symptom related to a significant health burden. However, the association of breathlessness with clinical characteristics, especially objective pulmonary test results is scarce. We aimed to identify the characteristics independently associated with breathlessness in Australian adults. METHOD The analysis used data from BOLD Australia, a cross-sectional study that included randomly selected adults aged ≥40 years from six sites in Australia. Clinical characteristics and spirometry results were compared for breathlessness (modified Medical Research Council [mMRC] grade ≥2). RESULTS Among all respondents (n = 3321), 252 participants (7.6%) reported breathlessness. The main univariate associations were obesity, chronic respiratory diseases, heart diseases and being Indigenous Australians (odds ratios [ORs] = 2.78, 5.20, 3.77 and 4.38, respectively). Participants with breathlessness had lower pre-and post-bronchodilator lung function than those without. Impaired spirometry results including FVC or FEV1 below 80% predicted, or FEV1/FVC < LLN were independently associated with breathlessness (adjusted ORs = 2.66, 2.94 and 2.34, respectively). CONCLUSIONS Breathlessness is common among Australian adults and is independently associated with obesity, chronic respiratory diseases, heart diseases, being Indigenous Australians, and impaired spirometry. Multi-disciplinary assessment and comprehensive investigation is needed in clinical practice to address the many factors associated with breathlessness in the population.
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Affiliation(s)
- Yijun Zhou
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Maria R Ampon
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Richard Wood-Baker
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - David P Johns
- Melbourne School of Population and Global Health, University of Melbourne, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- South Western Sydney Clinical School, Sydney, NSW, Australia
| | - Helen K Reddel
- Australian Centre for Airways Disease Monitoring, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, Australia
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Guo YL, Ampon MR, Poulos LM, Davis SR, Toelle BG, Marks GB, Reddel HK. Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults. Respirology 2022; 28:350-356. [PMID: 36336647 DOI: 10.1111/resp.14400] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults. METHODS A cross-sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self-reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant-reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. RESULTS Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co-morbid conditions, the aRR was slightly attenuated to around 1.85-1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1-29.1) and after further adjustment for co-morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. CONCLUSION Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity.
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Affiliation(s)
- Yue Leon Guo
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Department of Environmental and Occupational Medicine National Taiwan University (NTU) College of Medicine and NTU Hospital Taipei Taiwan
- Institute of Environmental and Occupational Health Sciences National Taiwan University College of Public Health Taipei Taiwan
| | - Maria R. Ampon
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Leanne M. Poulos
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Sharon R. Davis
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Brett G. Toelle
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Sydney Local Health District Sydney New South Wales Australia
| | - Guy B. Marks
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- School of Clinical Medicine UNSW Medicine & Health, University of New South Wales Sydney New South Wales Australia
| | - Helen K. Reddel
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
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Robinson PD, Salimi F, Cowie CT, Clifford S, King GG, Thamrin C, Hardaker K, Mazaheri M, Morawska L, Toelle BG, Marks GB. Ultrafine particle exposure and biomarkers of effect on small airways in children. Environ Res 2022; 214:113860. [PMID: 35820650 DOI: 10.1016/j.envres.2022.113860] [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: 01/24/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
The small size and large surface area of ultrafine particles (UFP) enhance their ability to deposit in the lung periphery and their reactivity. The Ultrafine Particles from Traffic Emissions and Children's Health (UPTECH) cross-sectional study was conducted in 8-11-year-old schoolchildren attending 25 primary (elementary) schools, randomly selected from the Brisbane Metropolitan Area, Queensland, Australia. Main study findings outlined indirect evidence of distal airway deposition (raised C reactive protein) but as yet, there is no direct evidence in the literature of effects of UFP exposure on peripheral airway function. We present further UPTECH study data from two sensitive peripheral airway function tests, Oscillometry and Multiple Breath Nitrogen Washout (MBNW), performed in 577 and 627 children (88% and 96% of UPTECH study cohort) respectively: mean(SD) age 10.1(0.9) years, 46% male, with 50% atopy and 14% current asthma. Bayesian generalised linear mixed effects regression models were used to estimate the effect of UFP particle number count (PNC) exposure on key oscillometry (airway resistance, (Rrs), and reactance, (Xrs)) and MBNW (lung clearance index, (LCI) and functional residual capacity, (FRC)) indices. We adjusted for age, sex, and height, and potential confounders including socio-economic disadvantage, PM2.5 and NO2 exposure. All models contained an interaction term between UFP PNC exposure and atopy, allowing estimation of the effect of exposure on non-atopic and atopic students. Increasing UFP PNC was associated with greater lung stiffness as evidenced by a decrease in Xrs [mean (95% credible interval) -1.63 (-3.36 to -0.05)%] per 1000#.cm-3]. It was also associated with greater lung stiffness (decrease in Xrs) in atopic subjects across all models [mean change ranging from -2.06 to -2.40% per 1000#.cm-3]. A paradoxical positive effect was observed for Rrs across all models [mean change ranging from -1.55 to -1.70% per 1000#.cm-3] (decreases in Rrs indicating an increase in airway calibre), which was present for both atopic and non-atopic subjects. No effects on MBNW indices were observed. In conclusion, a modest detrimental effect of UFP on peripheral airway function among atopic subjects, as assessed by respiratory system reactance, was observed extending the main UPTECH study findings which reported a positive association with a biomarker for systemic inflammation, C-reactive protein (CRP). Further studies are warranted to explore the pathophysiological mechanisms underlying increased respiratory stiffness, and whether it persists through to adolescence and adulthood.
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Affiliation(s)
- Paul D Robinson
- The Children's Hospital at Westmead, Sydney, Australia; Airway Physiology and Imaging, Woolcock Institute of Medical Research, University of Sydney, Australia; University of Sydney, Sydney, Australia
| | - Farhad Salimi
- University of Sydney, Sydney, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre for Air Pollution, Energy and Health Research (CAR), Australia
| | - Christine T Cowie
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, University of Sydney, Australia; South Western Sydney Clinical Campus, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Samuel Clifford
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; London School of Hygiene and Tropical Medicine, London, UK; International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Gregory G King
- Airway Physiology and Imaging, Woolcock Institute of Medical Research, University of Sydney, Australia; University of Sydney, Sydney, Australia
| | - Cindy Thamrin
- Airway Physiology and Imaging, Woolcock Institute of Medical Research, University of Sydney, Australia; University of Sydney, Sydney, Australia
| | - Kate Hardaker
- Airway Physiology and Imaging, Woolcock Institute of Medical Research, University of Sydney, Australia; University of Sydney, Sydney, Australia
| | - Mandana Mazaheri
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; Department of Planning, Industry and the Environment, Sydney, Australia
| | - Lidia Morawska
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Brett G Toelle
- University of Sydney, Sydney, Australia; Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, University of Sydney, Australia; Sydney Local Health District, Sydney, Australia.
| | - Guy B Marks
- Centre for Air Pollution, Energy and Health Research (CAR), Australia; Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, University of Sydney, Australia; South Western Sydney Clinical Campus, University of New South Wales, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia
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9
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Hasan T, Thach PN, Anh NT, Hien LTT, An NTM, Thuy DT, Van Duyet L, Dung NT, Diep TT, Van Huynh H, Toelle BG, Marks GB, Fox GJ. The prevalence of SARS-CoV-2 antibodies in quarantine workers and high-risk communities in Vietnam. IJID Regions 2022; 2:137-140. [PMID: 35721423 PMCID: PMC8665841 DOI: 10.1016/j.ijregi.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/04/2022]
Abstract
A low prevalence (2%) of SARS-CoV-2 antibodies was found among quarantine workers. A low prevalence of SARS-CoV-2 antibodies was found in communities with COVID-19. Vietnam had controlled the COVID-19 pandemic until mid-2021. This study preceded the widespread outbreak in Vietnam in mid-2021.
Objective The aim of this study was to determine the seroprevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) antibodies in high-risk communities and quarantine workers in Vietnam. Methods The prevalence of SARS-CoV-2 antibodies was measured in household contacts, close contacts, community members, and migrant workers from two sub-communes in which COVID-19 outbreaks occurred in early 2021: Bac Ma 1 and Tien. The prevalence of SARS-CoV-2 antibodies was also evaluated among quarantine workers at two facilities responsible for quarantining of contacts of COVID-19 cases. Results Among 2069 participants from the two sub-communes, six individuals (0.3%) had detectable SARS-CoV-2 antibodies despite no history of COVID-19. This included one Vietnamese migrant worker, two community members, two household contacts, and one close contact of known COVID-19 cases. Among 50 workers at two COVID-19 quarantine facilities, including 15 health care workers (HCWs), one of the HCWs tested positive for SARS-CoV-2 antibodies (1/50, 2.0%) despite no known disease. Conclusion The prevalence of SARS-CoV-2 antibodies was low in Vietnamese ‘hotspots’, suggesting limited community transmission.
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10
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Veivers D, Williams GM, Toelle BG, de Waterman AMC, Guo Y, Denison L, Yang BY, Dong GH, Jalaludin B, Marks GB, Knibbs LD. The Indoor Environment and Otitis Media among Australian Children: A National Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:ijerph19031551. [PMID: 35162576 PMCID: PMC8835613 DOI: 10.3390/ijerph19031551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/01/2023]
Abstract
The association between the indoor environment and lifetime prevalence of otitis media (OM) in Australian children was assessed. We analysed data from a cross-sectional study of children, aged 7–11 years, performed in twelve Australian cities during 2007–2008. The main outcome was a parental report of their child’s diagnosis with OM by a doctor. Information on the indoor environment (energy sources used for heating, cooling, and cooking, pets, and second-hand smoke exposure), in the first year of life and at present, was collected from parents by a questionnaire. Multi-level logistic regression models were used to adjust for individual- and area-level confounders. Our analysis comprised 2872 children (51% female, mean age: 10.0 (SD 1.2)). Of those, 1097 (39%) were reported to have OM. Exposure to gas heating in the first year of life was significantly associated with higher odds of OM in adjusted models (OR:1.22; 95% CI: 1.00,1.47), as was current exposure to reverse-cycle air conditioning (OR: 1.52, 95% CI: 1.27,1.82). Ownership of a cat or dog at any time was also associated with high odds of OM (OR: 1.50; 95% CI: 1.17,1.92). No other significant associations were observed. In this national study of Australian children, indoor environmental exposures associated with the lifetime prevalence of OM were gas heating, reverse-cycle air conditioning and pet ownership. Exposures in both early life and later childhood may both play a role in OM.
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Affiliation(s)
- David Veivers
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
- Northern Clinical School, The University of Sydney, St. Leonards, Sydney, NSW 2065, Australia
- Correspondence: ; Tel.: +61-2-94360012
| | - Gail M. Williams
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD 4006, Australia;
| | - Brett G. Toelle
- Sydney Local Health District, Sydney, NSW 2050, Australia;
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia; (A.M.C.d.W.); (B.J.); (G.B.M.)
| | - Adriana M. Cortés de Waterman
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia; (A.M.C.d.W.); (B.J.); (G.B.M.)
| | - Yuming Guo
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; (Y.G.); (L.D.K.)
- Department of Epidemiology and Biostatistics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Lyn Denison
- ERM Services Australia, Melbourne, VIC 3000, Australia;
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China;
| | - Guang-Hui Dong
- Population Health, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia;
| | - Bin Jalaludin
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia; (A.M.C.d.W.); (B.J.); (G.B.M.)
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; (Y.G.); (L.D.K.)
- Population Health, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia;
- Ingham Institute, Liverpool, NSW 2170, Australia
| | - Guy B. Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW 2006, Australia; (A.M.C.d.W.); (B.J.); (G.B.M.)
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; (Y.G.); (L.D.K.)
- South Western Sydney Clinical School, The University of New South Wales, Liverpool, NSW 2170, Australia
| | - Luke D. Knibbs
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; (Y.G.); (L.D.K.)
- School of Public Health, The University of Sydney, Camperdown, NSW 2006, Australia
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11
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Jetmalani K, Brown NJ, Boustany C, Toelle BG, Marks GB, Abramson MJ, Johns DP, James AL, Hunter M, Musk AW, Berend N, Farah CS, Chapman DG, Thamrin C, King GG. Normal limits for oscillometric bronchodilator responses and relationships with clinical factors. ERJ Open Res 2021; 7:00439-2021. [PMID: 34761000 PMCID: PMC8573235 DOI: 10.1183/23120541.00439-2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction We aimed to determine normal thresholds for positive bronchodilator responses for oscillometry in an Australian general population sample aged ≥40 years, to guide clinical interpretation. We also examined relationships between bronchodilator responses and respiratory symptoms, asthma diagnosis, smoking and baseline lung function. Methods Subjects recruited from Sydney, Melbourne and Busselton, Australia, underwent measurements of spirometry, resistance (Rrs6) and reactance (Xrs6) at 6 Hz, before and after inhalation of salbutamol 200 μg. Respiratory symptoms and/or medication use, asthma diagnosis, and smoking were recorded. Threshold bronchodilator responses were defined as the fifth percentile of decrease in Rrs6 and 95th percentile increase in Xrs6 in a healthy subgroup. Results Of 1318 participants, 1145 (570 female) were analysed. The lower threshold for ΔRrs6 was −1.38 cmH2O·s·L−1 (−30.0% or −1.42 Z-scores) and upper threshold for ΔXrs6 was 0.57 cmH2O·s·L−1 (1.36 Z-scores). Respiratory symptoms and/or medication use, asthma diagnosis, and smoking all predicted bronchodilator response, as did baseline oscillometry and spirometry. When categorised into clinically relevant groups according to those predictors, ΔXrs6 was more sensitive than spirometry in smokers without current asthma or chronic obstructive pulmonary disease (COPD), ∼20% having a positive response. Using absolute or Z-score change provided similar prevalences of responsiveness, except in COPD, in which responsiveness measured by absolute change was twice that for Z-score. Discussion This study describes normative thresholds for bronchodilator responses in oscillometry parameters, including intra-breath parameters, as determined by absolute, relative and Z-score changes. Positive bronchodilator response by oscillometry correlated with clinical factors and baseline function, which may inform the clinical interpretation of oscillometry. Normative values for bronchodilator responses measured by oscillometry were derived. Responsiveness related to clinical factors and baseline function. Reactance was more sensitive in detecting bronchodilator response than spirometry mild airways disease.https://bit.ly/3wtWVeV
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Affiliation(s)
- Kanika Jetmalani
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nathan J Brown
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Brisbane and Women's Hospital, Emergency and Trauma Centre, Herston, QLD, Australia
| | - Chantale Boustany
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Nursing, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Brett G Toelle
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Guy B Marks
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Michael J Abramson
- School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David P Johns
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Alan L James
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Arthur W Musk
- Busselton Population Medical Research Institute, Busselton, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Norbert Berend
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Claude S Farah
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Dept of Thoracic Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - David G Chapman
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Dept of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Cindy Thamrin
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gregory G King
- The Woolcock Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
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12
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Toelle BG, Ampon RD, Abramson MJ, James AL, Maguire GP, Wood-Baker R, Johns DP, Marks GB. Prevalence of chronic obstructive pulmonary disease with breathlessness in Australia: weighted using the 2016 Australian census. Intern Med J 2021; 51:784-787. [PMID: 34047039 DOI: 10.1111/imj.15325] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
Access to up-to-date Australian disease prevalence estimates assists health services and consumer organisations to plan and allocate resources. The Burden of Obstructive Lung Disease study was conducted between 2006 and 2012 and provided chronic obstructive pulmonary disease (COPD) (post-bronchodilator airflow limitation) prevalence estimates weighted to the 2006 Australian census. Using the 2016 Australian census, an updated prevalence estimate of all COPD is 8.30% (95% confidence interval = 6.59%-10.01%) for adults aged 40 or more years in Australia and includes 2.52% with mild breathlessness, 0.99% with moderate breathlessness and 0.91% with severe breathlessness.
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Affiliation(s)
- Brett G Toelle
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,Sydney Local Health District, Sydney, New South Wales, Australia
| | - Rosario D Ampon
- Australian Centre for Airways Disease Monitoring, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alan L James
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Graeme P Maguire
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Richard Wood-Baker
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - David P Johns
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Guy B Marks
- Australian Centre for Airways Disease Monitoring, Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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13
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Poulos LM, Ampon RD, Currow DC, Marks GB, Toelle BG, Reddel HK. Prevalence and burden of breathlessness in Australian adults: The National Breathlessness Survey-a cross-sectional web-based population survey. Respirology 2021; 26:768-775. [PMID: 33971059 DOI: 10.1111/resp.14070] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Chronic respiratory symptoms (in particular, breathlessness and cough) can cause physical, social and emotional distress, and may indicate the presence of an underlying disease that presages future poor health outcomes. Our aim was to investigate the burden of breathlessness in Australian adults, including breathlessness that may be undiagnosed, unlabelled or untreated. METHODS The National Breathlessness Survey was a cross-sectional, web-based survey conducted in October 2019. Australian adults were randomly selected from a large web-based survey panel with recruitment stratified by age-group, gender and state of residence according to national population data. The main outcome measures were modified Medical Research Council (mMRC) dyspnoea scale, EuroQol visual analog scale, Dyspnoea-12 score and 4-item Patient Health Questionnaire (PHQ-4). RESULTS Among all respondents (n = 10,072; 51.1% female; median age group 40-49 years), 9.5% reported clinically important breathlessness (mMRC dyspnoea grade ≥ 2, 2 = 'I walk slower than people of the same age on the level because of breathlessness or have to stop for breath when walking at my own pace on the level'). Among those with clinically important breathlessness, 49.1% rated their general health as fair or poor and 44.2% had at least moderate depression or anxiety symptoms (PHQ ≥ 6) but over half (50.8%) did not report a current respiratory or heart condition diagnosis. CONCLUSION Breathlessness is common among Australian adults, and is associated with a substantial burden of ill health, including among people without a diagnosed respiratory or heart condition. The extent of underdiagnosis of these conditions or alternative causes of breathlessness requires further investigation.
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Affiliation(s)
- Leanne M Poulos
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Rosario D Ampon
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Guy B Marks
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Brett G Toelle
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Local Health District, Sydney, New South Wales, Australia
| | - Helen K Reddel
- Australian Centre for Airways disease Monitoring (ACAM), the Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
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14
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Petrie K, Toelle BG, Wood-Baker R, Maguire GP, James AL, Hunter M, Johns DP, Marks GB, George J, Abramson MJ. Undiagnosed and Misdiagnosed Chronic Obstructive Pulmonary Disease: Data from the BOLD Australia Study. Int J Chron Obstruct Pulmon Dis 2021; 16:467-475. [PMID: 33658776 PMCID: PMC7920499 DOI: 10.2147/copd.s287172] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose Spirometry is necessary to confirm COPD, but many patients are diagnosed based on clinical presentation and/or chest x-ray. There are also those who do not present to primary care for case finding and remain undiagnosed. We aimed to identify: (a) factors that are associated with undiagnosed COPD; and (b) factors that are associated with a potential misdiagnosis of COPD. Patients and Methods This analysis used data from the Burden of Obstructive Lung Disease (BOLD), a cross-sectional study of community dwelling adults randomly selected from six study sites, chosen to provide a representative sample of the Australian population (n= 3357). Participants were grouped by COPD diagnostic criteria based on spirometry and self-reported diagnosis. Odds ratios for predictors of undiagnosed and misdiagnosed were estimated using logistic regression. Results Of the BOLD Australia sample, 1.8% had confirmed COPD, of whom only half self-reported a diagnosis of COPD. A further 6.9% probably had COPD, but were undiagnosed. The priority target population for case finding of undiagnosed COPD was aged ≥60 years (particularly those ≥75 years), with wheezing, shortness of breath and a body mass index (BMI) <25kg/m2. The priority target population for identifying and reviewing misdiagnosed COPD was aged <60 years, female, with no wheezing and a BMI ≥25kg/m2. Conclusion Challenges continue in accurately diagnosing COPD and greater efforts are needed to identify undiagnosed and misdiagnosed individuals to ensure an accurate diagnosis and the initiation of appropriate management in order to reduce the burden of COPD.
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Affiliation(s)
- Kate Petrie
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Richard Wood-Baker
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Graeme P Maguire
- Western Clinical School, University of Melbourne, Melbourne, Australia and General Internal Medicine, Western Health, Melbourne, VIC, Australia
| | - Alan L James
- Sir Charles Gairdner Hospital, West Australian Sleep Disorders Research Institute, Department of Pulmonary Physiology and Sleep Medicine, Perth, WA, Australia.,University of Western Australia, Medical School, Perth, WA, Australia
| | - Michael Hunter
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia.,Busselton Population Medical Research Institute, Busselton, WA, Australia
| | - David P Johns
- College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael J Abramson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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15
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Tu Y, Williams GM, Cortés de Waterman AM, Toelle BG, Guo Y, Denison L, Babu GR, Yang BY, Dong GH, Jalaludin B, Marks GB, Knibbs LD. A national cross-sectional study of exposure to outdoor nitrogen dioxide and aeroallergen sensitization in Australian children aged 7-11 years. Environ Pollut 2021; 271:116330. [PMID: 33383426 DOI: 10.1016/j.envpol.2020.116330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/20/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
The prevalence of allergic diseases in Australian children is high, but few studies have assessed the potential role of outdoor air pollution in allergic sensitization. We investigated the association between outdoor air pollution and the prevalence of aeroallergen sensitization in a national cross-sectional study of Australian children aged 7-11 years. Children were recruited from 55 participating schools in 12 Australian cities during 2007-2008. Parents completed a detailed (70-item) questionnaire. Outdoor nitrogen dioxide (NO2), as a proxy for exposure to traffic-related emissions, was estimated using measurements from regulatory monitors near each school and a national land-use regression (LUR) model. Three averaging periods were assessed, using information on duration of residence at the address, including lifetime, previous (lifetime, excluding the last year), and recent (the last year only). The LUR model was used as an additional source of recent exposure estimates at school and home addresses. Skin prick tests (SPTs) were performed to measure sensitization to eight common aeroallergens. Multilevel logistic regression estimated the association between NO2 and sensitization (by individual allergens, indoor and outdoor allergens, and all allergens combined), after adjustment for individual- and area-level covariates. In total, 2226 children had a completed questionnaire and SPT. The prevalence of sensitization to any allergen was 44.4%. Sensitization to house dust mites (HDMs) was the most common (36.1%), while sensitization to Aspergillus was the least common (3.4%). Measured mean (±s.d.) NO2 exposure was between 9 (±2.9) ppb and 9.5 (±3.2) ppb, depending on the averaging period. An IQR (4 ppb) increase in measured previous NO2 exposure was associated with greater odds of sensitization to HDMs (OR: 1.21, 95% CI: 1.01-1.43, P = 0.035). We found evidence of an association between relatively low outdoor NO2 concentrations and sensitization to HDMs, but not other aeroallergens, in Australian children aged 7-11 years.
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Affiliation(s)
- Yanhui Tu
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Gail M Williams
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | | | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, NSW, 2006, Australia; Sydney Local Health District, Sydney, NSW, 2050, Australia
| | - Yuming Guo
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW, 2037, Australia; Department of Epidemiology and Biostatistics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Lyn Denison
- ERM Services Australia, Melbourne, VIC, 3000, Australia
| | - Giridhara R Babu
- Indian Institute of Public Health-Bangalore, Public Health Foundation of India, Bangalore, 560023, India
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Bin Jalaludin
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW, 2037, Australia; Population Health, South Western Sydney Local Health District, Liverpool, NSW, 2170, Australia; Ingham Institute, Liverpool, NSW, 2170, Australia
| | - Guy B Marks
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW, 2037, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW, 2006, Australia; South Western Sydney Clinical School, The University of New South Wales, Liverpool, NSW, 2170, Australia
| | - Luke D Knibbs
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia; Centre for Air Pollution, Energy and Health Research, Glebe, NSW, 2037, Australia.
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16
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Guo L, Salimi F, Wang H, Hofmann W, Johnson GR, Toelle BG, Marks GB, Morawska L. Experimentally determined deposition of ambient urban ultrafine particles in the respiratory tract of children. Environ Int 2020; 145:106094. [PMID: 32932065 DOI: 10.1016/j.envint.2020.106094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/26/2020] [Revised: 07/30/2020] [Accepted: 08/25/2020] [Indexed: 05/06/2023]
Abstract
A critical element of the risk assessment of exposure to airborne ambient ultrafine particles (UFP) is the quantification of respiratory tract deposition (RTD) of the particles, which is intrinsically challenging, particularly at the population scale. In this study, we used a recently proposed method to experimentally determine the RTD of urban UFP in a large group of children exposed to these particles in a school setting in Brisbane, Australia. Children are one of the most susceptible population groups; However, little is known about the deposition of UFP from urban traffic in their airways. In order to advance the knowledge in this field, the objectives of this study were: to determine the deposition of ambient urbane UFP in large number children, to catergorize the source of inhaled UFPs and hence to assess the contribution of air pollution sources to the deposition. RTD was measured in children aged 8-11 at primary schools using a flow-through chamber bag system. First, the inhaled and exhaled air was separated; then the particle number size distribution and particle number concentration were measured. The sources of inhaled UFP were categorized according to their particle number size distribution by a K means cluster technique. A total of 128 children from five schools performed the RTD measurement. The mean total deposition fraction of urban UFP in all children was 0.59 ± 0.10. Inhaled UFP were categorized into two groups: traffic and urban background, with the GMD of corresponding particle number size distribution of 20 nm and 40 nm, respectively. The total deposition fraction (mean ± SD) of UFP from these two groups was 0.68 ± 0.09 for traffic and 0.55 ± 0.08 for urban background respectively. This is the first study in which RTD was measured in a large group of children inhaling real urban UFP. First, we proved that this novel method can indeed be applied easily and quickly to a large group of people. Second, we quantified the RTD of children, thus providing an important input to the risk assessment for exposure to UFP.
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Affiliation(s)
- Lingli Guo
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Fahard Salimi
- University Centre for Rural Health-North Coast, The University of Sydney, Australia
| | - Hao Wang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China
| | - Werner Hofmann
- Department of Chemistry and Physics of Materials, University of Salzburg, A-5020 Salzburg, Austria
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Brett G Toelle
- Respiratory & Environmental Epidemiology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Guy B Marks
- Respiratory & Environmental Epidemiology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; South Western Sydney Clinical School, University of New South Wale, Randwick, NSW 2052s, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD 4001, Australia; JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China.
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17
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Guo L, Salimi F, Wang H, Hofmann W, Johnson GR, Toelle BG, Marks GB, Morawska L. Experimentally determined deposition of ambient urban ultrafine particles in the respiratory tract of children. Environ Int 2020. [PMID: 32932065 DOI: 10.1016/j.jaerosci.2019.105465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A critical element of the risk assessment of exposure to airborne ambient ultrafine particles (UFP) is the quantification of respiratory tract deposition (RTD) of the particles, which is intrinsically challenging, particularly at the population scale. In this study, we used a recently proposed method to experimentally determine the RTD of urban UFP in a large group of children exposed to these particles in a school setting in Brisbane, Australia. Children are one of the most susceptible population groups; However, little is known about the deposition of UFP from urban traffic in their airways. In order to advance the knowledge in this field, the objectives of this study were: to determine the deposition of ambient urbane UFP in large number children, to catergorize the source of inhaled UFPs and hence to assess the contribution of air pollution sources to the deposition. RTD was measured in children aged 8-11 at primary schools using a flow-through chamber bag system. First, the inhaled and exhaled air was separated; then the particle number size distribution and particle number concentration were measured. The sources of inhaled UFP were categorized according to their particle number size distribution by a K means cluster technique. A total of 128 children from five schools performed the RTD measurement. The mean total deposition fraction of urban UFP in all children was 0.59 ± 0.10. Inhaled UFP were categorized into two groups: traffic and urban background, with the GMD of corresponding particle number size distribution of 20 nm and 40 nm, respectively. The total deposition fraction (mean ± SD) of UFP from these two groups was 0.68 ± 0.09 for traffic and 0.55 ± 0.08 for urban background respectively. This is the first study in which RTD was measured in a large group of children inhaling real urban UFP. First, we proved that this novel method can indeed be applied easily and quickly to a large group of people. Second, we quantified the RTD of children, thus providing an important input to the risk assessment for exposure to UFP.
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Affiliation(s)
- Lingli Guo
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Fahard Salimi
- University Centre for Rural Health-North Coast, The University of Sydney, Australia
| | - Hao Wang
- Institute for Environmental and Climate Research, Jinan University, Guangzhou 511443, China; JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China
| | - Werner Hofmann
- Department of Chemistry and Physics of Materials, University of Salzburg, A-5020 Salzburg, Austria
| | - Graham R Johnson
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD 4001, Australia
| | - Brett G Toelle
- Respiratory & Environmental Epidemiology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Guy B Marks
- Respiratory & Environmental Epidemiology, Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; South Western Sydney Clinical School, University of New South Wale, Randwick, NSW 2052s, Australia; Ingham Institute of Applied Medical Research, Liverpool, NSW 2170, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD 4001, Australia; JNU-QUT Joint Laboratory for Air Quality Science and Management, Jinan University, Guangzhou 511443, China.
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18
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Toelle BG, Garden FL, McIntyre PB, Wood N, Marks GB. Pertussis vaccination and allergic illness in Australian children. Pediatr Allergy Immunol 2020; 31:857-861. [PMID: 32459867 DOI: 10.1111/pai.13300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Frances L Garden
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, NSW, Australia.,The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Nicholas Wood
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, NSW, Australia.,The Children's Hospital at Westmead, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
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19
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Toelle BG, Marks GB, Dunn SM. Psychological and Medical Characteristics Associated with Non-Adherence to Prescribed Daily Inhaled Corticosteroid. J Pers Med 2020; 10:jpm10030126. [PMID: 32937794 PMCID: PMC7565720 DOI: 10.3390/jpm10030126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 12/28/2022] Open
Abstract
Medication non-adherence is associated with sub-optimal asthma control. Identification of medical and psychological characteristics associated with non-adherence is important to enable a targeted and personalized approach when working with patients and for the development of interventions to improve patient outcomes by improving medication adherence. We enrolled adults who had diagnosed asthma and who were prescribed daily inhaled corticosteroid medication. We used published and validated instruments to measure medical characteristics including asthma features, practical asthma knowledge and perceived involvement in care and psychological characteristics including anxiety, depression, optimism, and personality traits, to assess the relationship with medication non-adherence. A total of 126 participants provided data, with 64 (50.8%) of the participants identified as non-adherent. Multivariate analyses showed that younger age, high neuroticism scores and a previous asthma hospital admission were associated with non-adherence. Interestingly, depression was associated with a lower risk of non-adherence. This study showed that a personalized medicine approach would include interventions targeting those who are younger, who have been in hospital for asthma and who rate high on the neuroticism personality trait. Given the availability of effective medications for asthma, better understanding of the characteristics associated with non-adherence is important to enhance optimal self-management.
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Affiliation(s)
- Brett G. Toelle
- Woolcock Institute of Medical Research, The University of Sydney, Sydney 2006, Australia;
- Sydney Local Health District, Sydney 2050, Australia
- Correspondence: ; Tel.: +61-2-9114-0462; Fax: +61-2-9114-0011
| | - Guy B. Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney 2006, Australia;
- South Western Sydney Clinical School, University of New South Wales, Sydney 2170, Australia
- Ingham Institute of Applied Medical Research, Sydney 2170, Australia
| | - Stewart M. Dunn
- Department of Psychological Medicine, The University of Sydney, Sydney 2006, Australia;
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20
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Bastos ML, Campbell JR, Oxlade O, Adjobimey M, Trajman A, Ruslami R, Kim HJ, Baah JO, Toelle BG, Long R, Hoeppner V, Elwood K, Al-Jahdali H, Apriani L, Benedetti A, Schwartzman K, Menzies D. Health System Costs of Treating Latent Tuberculosis Infection With Four Months of Rifampin Versus Nine Months of Isoniazid in Different Settings. Ann Intern Med 2020; 173:169-178. [PMID: 32539440 DOI: 10.7326/m19-3741] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Four months of rifampin treatment for latent tuberculosis infection is safer, has superior treatment completion rates, and is as effective as 9 months of isoniazid. However, daily medication costs are higher for a 4-month rifampin regimen than a 9-month isoniazid regimen. OBJECTIVE To compare health care use and associated costs of 4 months of rifampin and 9 months of isoniazid. DESIGN Health system cost comparison using all health care activities recorded during 2 randomized clinical trials. (ClinicalTrials.gov: NCT00931736 and NCT00170209). SETTING High-income countries (Australia, Canada, Saudi Arabia, and South Korea), middle-income countries (Brazil and Indonesia), and African countries (Benin, Ghana, and Guinea). PARTICIPANTS Adults and children with clinical or epidemiologic factors associated with increased risk for developing tuberculosis that warranted treatment for latent tuberculosis infection. MEASUREMENTS Health system costs per participant. RESULTS A total of 6012 adults and 829 children were included. In both adults and children, greater health system use and higher costs were observed with 9 months of isoniazid than with 4 months of rifampin. In adults, the ratios of costs of 4 months of rifampin versus 9 months of isoniazid were 0.76 (95% CI, 0.70 to 0.82) in high-income countries, 0.90 (CI, 0.85 to 0.96) in middle-income countries, and 0.80 (CI, 0.78 to 0.81) in African countries. Similar findings were observed in the pediatric population. LIMITATION Costs may have been overestimated because the trial protocol required a minimum number of follow-up visits, although fewer than recommended by many authoritative guidelines. CONCLUSION A 4-month rifampin regimen was safer and less expensive than 9 months of isoniazid in all settings. This regimen could be adopted by tuberculosis programs in many countries as first-line therapy for latent tuberculosis infection. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Mayara Lisboa Bastos
- State University of Rio de Janeiro, Rio de Janeiro, Brazil, and McGill University, Montreal, Quebec, Canada (M.L.B.)
| | | | - Olivia Oxlade
- McGill International TB Center, Montreal, Quebec, Canada (O.O.)
| | - Menonli Adjobimey
- Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A.)
| | - Anete Trajman
- McGill University, Montreal, Quebec, Canada, and Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (A.T.)
| | | | - Hee Jin Kim
- Korean National Tuberculosis Association, Seoul, South Korea (H.J.K.)
| | | | - Brett G Toelle
- The University of Sydney, Woolcock Institute of Medical Research, and Sydney Local Health District, Sydney, Australia (B.G.T.)
| | - Richard Long
- University of Alberta, Edmonton, Alberta, Canada (R.L.)
| | - Vernon Hoeppner
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.H.)
| | - Kevin Elwood
- BC Centre for Disease Control and University of British Columbia, Vancouver, British Columbia, Canada (K.E.)
| | - Hamdan Al-Jahdali
- King Saud University, King Abdulaziz Medical City, Riyadh, Saudi Arabia (H.A.)
| | - Lika Apriani
- Universitas Padjadjaran, Bandung, Indonesia (L.A.)
| | - Andrea Benedetti
- McGill University, Montreal, Quebec, Canada (J.R.C., A.B., K.S., D.M.)
| | - Kevin Schwartzman
- McGill University, Montreal, Quebec, Canada (J.R.C., A.B., K.S., D.M.)
| | - Dick Menzies
- McGill University, Montreal, Quebec, Canada (J.R.C., A.B., K.S., D.M.)
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21
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Lambert KA, Katelaris C, Burton P, Cowie C, Lodge C, Garden FL, Prendergast LA, Toelle BG, Erbas B. Tree pollen exposure is associated with reduced lung function in children. Clin Exp Allergy 2020; 50:1176-1183. [PMID: 32662228 DOI: 10.1111/cea.13711] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 05/03/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Allergic disease is a recognized global epidemic and a significant cause of ill health and poor quality of life. The prevalence of pollen allergy is high throughout the world, and pollen exposure itself plays a role in emergency department presentations and hospitalizations for asthma. Lung function and airway inflammation are important measures of asthma activity and control. OBJECTIVE To examine associations between exposure to multiple pollen types and lung function and markers of airway inflammation at 8 and 14 years of age, and to explore potential modification by residential greenness. METHODS A cohort of high-risk children living in Sydney, Australia had spirometry and fractional exhaled nitric oxide (FeNO) measured at 8 and 14 years of age. Ambient pollen concentration on the day of lung function measurement and up to three days prior was used as the exposure measure. Residential greenness was derived from satellite imagery. We modelled the association between six pollen types and lung function and FeNO. We also assessed modifying effects of residential greenness. RESULTS Casuarina, cypress and Pinus pollen in the air the day before measurement and 3 days prior respectively, were associated with reduced lung function in 8-year-olds. The pollen exposures were associated with decreases in FEV1 and FVC; however, the FEV1 /FVC ratio was not affected. Effect modification by greenness was not observed due to loss of power. CONCLUSIONS & CLINICAL RELEVANCE Airborne tree pollen of cypress, Casuarina and Pinus and not grass in some regions may be detrimental to childhood lung function.
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Affiliation(s)
- Katrina A Lambert
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Constance Katelaris
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia.,Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Pamela Burton
- Immunology and Allergy Unit, Campbelltown Hospital, Campbelltown, NSW, Australia
| | - Christine Cowie
- South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
| | - Frances L Garden
- South West Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Luke A Prendergast
- Department of Mathematics and Statistics, School of Engineering and Mathematical Sciences, La Trobe University, Melbourne, Vic., Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Bircan Erbas
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
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22
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Garden FL, Toelle BG, Mihrshahi S, Webb KL, Almqvist C, Tovey ER, Brew BK, Ayer JG, Skilton MR, Jones G, Ferreira MAR, Cowie CT, Weber-Chrysochoou C, Britton WJ, Celermajer DS, Leeder SR, Peat JK, Marks GB. Cohort profile: The Childhood Asthma Prevention Study (CAPS). Int J Epidemiol 2019; 47:1736-1736k. [PMID: 29800224 DOI: 10.1093/ije/dyy078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Frances L Garden
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Sydney Local Health District, Sydney, NSW, Australia
| | - Seema Mihrshahi
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Karen L Webb
- Nutrition Policy Institute, University of California, Berkeley, CA, USA
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Euan R Tovey
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Julian G Ayer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Heart Centre for Children, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Michael R Skilton
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, NSW, Australia
| | - Graham Jones
- School of Science and Health, Western Sydney University, Sydney, NSW, Australia
| | | | - Christine T Cowie
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - Warwick J Britton
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Mycobacterial Research Program, Centenary Institute, Sydney, NSW, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Stephen R Leeder
- Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Jennifer K Peat
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
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23
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Barraclough JY, Garden FL, Toelle BG, Marks GB, Baur LA, Ayer JG, Celermajer DS. Weight Gain Trajectories from Birth to Adolescence and Cardiometabolic Status in Adolescence. J Pediatr 2019; 208:89-95.e4. [PMID: 30738659 DOI: 10.1016/j.jpeds.2018.12.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the influence of the trajectory of weight gain from birth to adolescence on cardiovascular and metabolic risk. We studied childhood body mass index (BMI) trajectories from birth to age 14 years and cardiometabolic risk factors at age 14 years. STUDY DESIGN In total, 410 children with weight and height measurements were assessed from birth throughout childhood, from the Childhood Asthma Prevention Study, a prospective community-based cohort. BMI trajectory groups were determined by latent basis growth mixture models. Of these subjects, 190 had detailed cardiometabolic risk factors assessed at age 14 years. RESULTS Three BMI trajectory groups were identified; normal BMI, "early rising" excess BMI from 2 years, and "late rising" excess BMI from 5 years. Differences were found between normal and excess BMI in children at 14 years of age. In addition, children with an early rising BMI trajectory had statistically significantly higher central adiposity and a more atherogenic lipoprotein profile at age 14 years than children with a late rising BMI trajectory (P < .05). No differences between BMI trajectory groups in vascular structure or function was identified at age 14 years. CONCLUSIONS Earlier onset of an elevated BMI trajectory persisting from birth to age 14 years results in an unfavorable cardiometabolic risk profile at age 14 years, including central adiposity and more atherogenic lipoproteins, independent of achieved BMI.
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Affiliation(s)
- Jennifer Y Barraclough
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Heart Research Institute, Sydney, Australia.
| | - Frances L Garden
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia; Sydney Local Health District, New South Wales, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Glebe, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Louise A Baur
- University of Sydney, Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia
| | - Julian G Ayer
- University of Sydney, Discipline of Child and Adolescent Health, The Children's Hospital at Westmead Clinical School, Westmead, New South Wales, Australia; The Heart Center for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Heart Research Institute, Sydney, Australia
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24
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Barraclough JY, Skilton MR, Garden FL, Toelle BG, Marks GB, Celermajer DS. Early and late childhood telomere length predict subclinical atherosclerosis at age 14 yrs. - The CardioCAPS study. Int J Cardiol 2018; 278:250-253. [PMID: 30595356 DOI: 10.1016/j.ijcard.2018.12.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/22/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Carotid Intima Media Thickness (CIMT) is a marker of subclinical atherosclerosis, associated with cardiovascular risk in adults. Telomere length (TL) is a marker of cellular ageing. We sought to determine whether telomere length in early childhood and/or at 14-years is associated with CIMT in adolescence, in a community-based cohort study. METHODS 118 children had TL measured at mean age 3.6-years and 165 children had TL and CIMT, measured at 14-years, from the community-based Childhood Asthma Prevention Study. RESULTS TL in early childhood was significantly inversely associated with CIMT at 14 years, p = 0.04. TL in teenage life was also significantly inversely associated with CIMT at 14 years, p = 0.03. This latter association was no longer significant, however, after adjusting for early life TL. CONCLUSION TL measured in early childhood and adolescence is significantly associated with CIMT at 14-years, suggesting that telomere length is a biological marker or even early determinant of late cardiovascular risk.
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Affiliation(s)
- Jennifer Y Barraclough
- Sydney Medical School, University of Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Heart Research Institute, Sydney, Australia.
| | - Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Australia
| | - Frances L Garden
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia; Heart Research Institute, Sydney, Australia
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Knibbs LD, Cortés de Waterman AM, Toelle BG, Guo Y, Denison L, Jalaludin B, Marks GB, Williams GM. The Australian Child Health and Air Pollution Study (ACHAPS): A national population-based cross-sectional study of long-term exposure to outdoor air pollution, asthma, and lung function. Environ Int 2018; 120:394-403. [PMID: 30125857 DOI: 10.1016/j.envint.2018.08.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [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: 05/14/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 06/08/2023]
Abstract
Most studies of long-term air pollution exposure and children's respiratory health have been performed in urban locations with moderate pollution levels. We assessed the effect of outdoor nitrogen dioxide (NO2), as a proxy for urban air pollution, on current asthma and lung function in Australia, a low-pollution setting. We undertook a national population-based cross-sectional study of children aged 7-11 years living in 12 Australian cities. We collected information on asthma symptoms from parents via questionnaire and measured children's lung function (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC]) and fractional exhaled nitric oxide [FeNO]). We estimated recent NO2 exposure (last 12 months) using monitors near each child's school, and used a satellite-based land-use regression (LUR) model to estimate NO2 at each child's school and home. Our analysis comprised 2630 children, among whom the prevalence of current asthma was 14.9%. Mean (±SD) NO2 exposure was 8.8 ppb (±3.2) and 8.8 ppb (±2.3) for monitor- and LUR-based estimates, respectively. Mean percent predicted post-bronchodilator FEV1 and FVC were 101.7% (±10.5) and 98.8% (±10.5), respectively. The geometric mean FeNO concentration was 9.4 ppb (±7.1). An IQR increase in NO2 (4.0 ppb) was significantly associated with increased odds of having current asthma; odds ratios (ORs) were 1.24 (95% CI: 1.08, 1.43) and 1.54 (95% CI: 1.26, 1.87) for monitor- and LUR-based estimates, respectively. Increased NO2 exposure was significantly associated with decreased percent predicted FEV1 (-1.35 percentage points [95% CI: -2.21, -0.49]) and FVC (-1.19 percentage points [95% CI: -2.04, -0.35], and an increase in FeNO of 71% (95% CI: 38%, 112%). Exposure to outdoor NO2 was associated with adverse respiratory health effects in this population-based sample of Australian children. The relatively low NO2 levels at which these effects were observed highlight the potential benefits of continuous exposure reduction.
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Affiliation(s)
- Luke D Knibbs
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD 4006, Australia; Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia.
| | | | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia; Sydney Local Health District, Sydney, NSW 2050, Australia
| | - Yuming Guo
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; Department of Epidemiology and Biostatistics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Lyn Denison
- ERM Services Australia, Melbourne, VIC 3000, Australia
| | - Bin Jalaludin
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; Population Health, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia; Ingham Institute, Liverpool, NSW 2170, Australia
| | - Guy B Marks
- Centre for Air Pollution, Energy and Health Research, Glebe, NSW 2037, Australia; Woolcock Institute of Medical Research, The University of Sydney, NSW 2006, Australia; South Western Sydney Clinical School, The University of New South Wales, Liverpool, NSW 2170, Australia
| | - Gail M Williams
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
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Hansell AL, Bakolis I, Cowie CT, Belousova EG, Ng K, Weber-Chrysochoou C, Britton WJ, Leeder SR, Tovey ER, Webb KL, Toelle BG, Marks GB. Childhood fish oil supplementation modifies associations between traffic related air pollution and allergic sensitisation. Environ Health 2018; 17:27. [PMID: 29587831 PMCID: PMC5870687 DOI: 10.1186/s12940-018-0370-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Studies of potential adverse effects of traffic related air pollution (TRAP) on allergic disease have had mixed findings. Nutritional studies to examine whether fish oil supplementation may protect against development of allergic disease through their anti-inflammatory actions have also had mixed findings. Extremely few studies to date have considered whether air pollution and dietary factors such as fish oil intake may interact, which was the rationale for this study. METHODS We conducted a secondary analysis of the Childhood Asthma Prevention Study (CAPS) birth cohort, where children were randomised to fish oil supplementation or placebo from early life to age 5 years. We examined interactions between supplementation and TRAP (using weighted road density at place of residence as our measure of traffic related air pollution exposure) with allergic disease and lung function outcomes at age 5 and 8 years. RESULTS Outcome information was available on approximately 400 children (~ 70% of the original birth cohort). Statistically significant interactions between fish oil supplementation and TRAP were seen for house dust mite (HDM), inhalant and all-allergen skin prick tests (SPTs) and for HDM-specific interleukin-5 response at age 5. Adjusting for relevant confounders, relative risks (RRs) for positive HDM SPT were RR 1.74 (95% CI 1.22-2.48) per 100 m local road or 33.3 m of motorway within 50 m of the home for those randomised to the control group and 1.03 (0.76-1.41) for those randomised to receive the fish oil supplement. The risk differential was highest in an analysis restricted to those who did not change address between ages 5 and 8 years. In this sub-group, supplementation also protected against the effect of traffic exposure on pre-bronchodilator FEV1/FVC ratio. CONCLUSIONS Results suggest that fish oil supplementation may protect against pro-allergic sensitisation effects of TRAP exposure. Strengths of this analysis are that supplementation was randomised and independent of TRAP exposure, however, findings need to be confirmed in a larger experimental study with the interaction investigated as a primary hypothesis, potentially also exploring epigenetic mechanisms. More generally, studies of adverse health effects of air pollution may benefit from considering potential effect modification by diet and other factors. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry. www.anzctr.org.au Registration: ACTRN12605000042640 , Date: 26th July 2005. Retrospectively registered, trial commenced prior to registry availability.
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Affiliation(s)
- Anna L Hansell
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.
- Public Health and Primary Care Directorate, Imperial College Healthcare NHS Trust, London, UK.
| | - Ioannis Bakolis
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Christine T Cowie
- South West Sydney Clinical School, UNSW Australia, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Elena G Belousova
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Kitty Ng
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | | | - Warwick J Britton
- Centenary Institute of Cancer Medicine & Cell Biology, University of Sydney, Sydney, NSW, Australia
| | - Stephen R Leeder
- School of Public Health and Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Euan R Tovey
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Karen L Webb
- School of Public Health and Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
- Nutrition Policy Institute, University of California, College of Agriculture and Natural Resources, Berkeley, California, USA
| | - Brett G Toelle
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
| | - Guy B Marks
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory Medicine, Liverpool Hospital, Liverpool, NSW, Australia
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Johns DP, Das A, Toelle BG, Abramson MJ, Marks GB, Wood-Baker R, Walters EH. Improved spirometric detection of small airway narrowing: concavity in the expiratory flow-volume curve in people aged over 40 years. Int J Chron Obstruct Pulmon Dis 2017; 12:3567-3577. [PMID: 29263661 PMCID: PMC5732561 DOI: 10.2147/copd.s150280] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and objective We have explored whether assessing the degree of concavity in the descending limb of the maximum expiratory flow–volume curve enhanced spirometric detection of early small airway disease. Methods We used spirometry records from 890 individuals aged ≥40 years (mean 59 years), recruited for the Burden of Obstructive Lung Disease Australia study. Central and peripheral concavity indices were developed from forced expired flows at 50% and 75% of the forced vital capacity, respectively, using an ideal line joining peak flow to zero flow. Results From the 268 subjects classified as normal never smokers, mean values for post-bronchodilator central concavity were 18.6% in males and 9.1% in females and those for peripheral concavity were 50.5% in males and 52.4% in females. There were moderately strong correlations between concavity and forced expired ratio (forced expiratory volume in 1 second/forced vital capacity) and mid-flow rate (forced expiratory flow between 25% and 75% of the FVC [FEF25%–75%]; r=−0.70 to −0.79). The additional number of individuals detected as abnormal using the concavity indices was substantial, especially compared with FEF25%–75%, where it was approximately doubled. Concavity was more specific for symptoms. Conclusion The inclusion of these concavity measures in the routine reports of spirometry would add information on small airway obstruction at no extra cost, time, or effort.
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Affiliation(s)
- David P Johns
- Faculty of Health, NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania
| | - Aruneema Das
- Faculty of Health, NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania
| | - Brett G Toelle
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney.,Sydney Local Health District, Sydney, New South Wales
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria
| | - Guy B Marks
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales
| | - Richard Wood-Baker
- Faculty of Health, NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania
| | - E Haydn Walters
- Faculty of Health, NHMRC Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania.,Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Guevara-Rattray EM, Garden FL, James AL, Wood-Baker R, Abramson MJ, Johns DP, Sonia Buist A, Burney PGJ, Haydn Walters E, Toelle BG, Marks GB. Atopy in people aged 40 years and over: Relation to airflow limitation. Clin Exp Allergy 2017; 47:1625-1630. [PMID: 28972658 DOI: 10.1111/cea.13038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/11/2017] [Accepted: 08/23/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous studies have reached conflicting conclusions about the role of atopy as a risk factor for COPD. In part, this is attributable to variation in the definitions of airflow limitation and the treatment of people with asthma. OBJECTIVE To establish whether there is any independent association between atopy and post-bronchodilator airflow limitation in the general population aged 40 years and over. METHODS A cross-sectional survey was conducted in a general population sample of 2415 people aged 40 years and over in Australia. A history of ever being diagnosed with asthma was elicited by questionnaire. Atopy was defined as any skin prick test weal to common aeroallergens ≥4 mm. Airflow limitation was defined as post-bronchodilator spirometric (FEV1 /FVC) ratio <lower limit of normal. Analyses were adjusted for potential confounding due to age, sex, smoking, race and socio-economic status. RESULTS The prevalence of atopy, ever diagnosed asthma and post-bronchodilator airflow obstruction was 44.8%, 19.3% and 7.5%, respectively. In the population as a whole, atopy was associated with lower FEV₁ (adjusted difference -0.068L, 95% confidence interval (CI) -0.104 to -0.032), FVC (adj. difference -0.043L, 95% CI -0.086 to -0.0009) and post-bronchodilator FEV₁/FVC ratio (adj. difference -0.011, 95% CI -0.017 to -0.0055). The effect of atopy on lung function was no longer apparent when participants who reported ever diagnosed asthma were excluded (FEV₁ -0.011L, [95% CI -0.05 to 0.028L], FVC -0.012L [95% CI -0.060 to 0.036] and FEV₁/FVC ratio -0.0012 [95% CI -0.0072 to 0.0047L]). CONCLUSION AND CLINICAL RELEVANCE The apparent association between atopy and post-bronchodilator airflow limitation in the general population appears to be explained by the association between atopy and having ever diagnosed asthma and the effect of asthma on lung function.
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Affiliation(s)
- E M Guevara-Rattray
- Respiratory Sleep and Environmental Health, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - F L Garden
- Respiratory Sleep and Environmental Health, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - A L James
- Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - R Wood-Baker
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - M J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - D P Johns
- University of Tasmania, Hobart, TAS, Australia
| | - A Sonia Buist
- Pulmonary& Critical Care Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - E Haydn Walters
- Faculty of Health, University of Tasmania, Hobart, TAS, Australia
| | - B G Toelle
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,Sydney Local Health District, NSW, Australia
| | - G B Marks
- Respiratory Sleep and Environmental Health, Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.,Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
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29
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Movin M, Garden FL, Protudjer JLP, Ullemar V, Svensdotter F, Andersson D, Kruse A, Cowell CT, Toelle BG, Marks GB, Almqvist C. Impact of childhood asthma on growth trajectories in early adolescence: Findings from the Childhood Asthma Prevention Study (CAPS). Respirology 2016; 22:460-465. [PMID: 27859946 DOI: 10.1111/resp.12928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/18/2016] [Accepted: 08/18/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE Understanding the associations between childhood asthma and growth in early adolescence by accounting for the heterogeneity of growth during puberty has been largely unexplored. The objective was to identify sex-specific classes of growth trajectories during early adolescence, using a method which takes the heterogeneity of growth into account and to evaluate the association between childhood asthma and different classes of growth trajectories in adolescence. METHODS Our longitudinal study included participants with a family history of asthma born during 1997-1999 in Sydney, Australia. Hence, all participants were at high risk for asthma. Asthma status was ascertained at 8 years of age using data from questionnaires and lung function tests. Growth trajectories between 11 and 14 years of age were classified using a latent basis growth mixture model. Multinomial regression analyses were used to evaluate the association between asthma and the categorized classes of growth trajectories. RESULTS In total, 316 participants (51.6% boys), representing 51.3% of the entire cohort, were included. Sex-specific classes of growth trajectories were defined. Among boys, asthma was not associated with the classes of growth trajectories. Girls with asthma were more likely than girls without asthma to belong to a class with later growth (OR: 3.79, 95% CI: 1.33, 10.84). Excluding participants using inhaled corticosteroids or adjusting for confounders did not significantly change the results for either sex. CONCLUSION We identified sex-specific heterogeneous classes of growth using growth mixture modelling. Associations between childhood asthma and different classes of growth trajectories were found for girls only.
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Affiliation(s)
- Maria Movin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Frances L Garden
- Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Jennifer L P Protudjer
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - Vilhelmina Ullemar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Frida Svensdotter
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - David Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Andreas Kruse
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Chris T Cowell
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,The Children's Hospital at Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Local Health District, Sydney, New South Wales, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institute, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden
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30
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Skilton MR, Nakhla S, Ayer JG, Harmer JA, Toelle BG, Leeder SR, Jones G, Marks GB, Celermajer DS. Telomere length in early childhood: Early life risk factors and association with carotid intima-media thickness in later childhood. Eur J Prev Cardiol 2015; 23:1086-92. [PMID: 26405259 DOI: 10.1177/2047487315607075] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/30/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reduced telomere length is a measure of biological aging that is predictive of cardiac events in adults, and has been mechanistically implicated in the onset and progression of atherosclerosis. We sought to describe the early life factors associated with leukocyte telomere length in early childhood, and to determine whether telomere length measured during early childhood is associated with arterial wall thickening later in childhood. DESIGN A longitudinal birth cohort recruited antenatally in Sydney from 1997 to 1999. METHODS Leukocyte telomere length was measured in 331 children at age 3.6 years (SD 1.0); of whom 268 children without diabetes had carotid intima-media thickness assessed by ultrasound at age 8 years. RESULTS Male sex, younger paternal age and higher maternal body mass index were associated with shorter telomere length in early childhood, which in turn was associated with greater carotid intima-media thickness at age 8 years (standardised β = -0.159, P = 0.01). There was a graded association across quartiles of telomere length (Ptrend = 0.001) with the highest odds of elevated intima-media thickness (>75th percentile) being in children with the shortest telomeres (odds ratio 4.00 (95% confidence interval 1.58 to 10.14) relative to those with the longest telomeres, P = 0.003). This association remained after adjustment for early life risk factors (Ptrend = 0.001). CONCLUSIONS Reduced telomere length in early childhood is independently associated with arterial wall thickness in later childhood, suggesting that reduced telomere length during early childhood may be a marker of vascular disease risk.
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Affiliation(s)
- Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Australia Sydney Medical School, University of Sydney, Australia
| | | | - Julian G Ayer
- Sydney Medical School, University of Sydney, Australia The Heart Centre for Children, The Children's Hospital at Westmead, Australia
| | | | - Brett G Toelle
- Woolcock Institute of Medical Research, University of Sydney, Australia Sydney Local Health District, Australia
| | - Stephen R Leeder
- Sydney Medical School, University of Sydney, Australia Sydney School of Public Health, and Menzies Centre for Health Policy, University of Sydney, Australia
| | - Graham Jones
- School of Science and Health, University of Western Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Australia South Western Sydney Clinical School, University of New South Wales, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Australia Heart Research Institute, Sydney, Australia Sydney Local Health District, Australia
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Stelzer-Braid S, Tovey ER, Willenborg CM, Toelle BG, Ampon R, Garden FL, Oliver BG, Strachan R, Belessis Y, Jaffe A, Reddel HK, Crisafulli D, Marks GB, Rawlinson WD. Absence of back to school peaks in human rhinovirus detections and respiratory symptoms in a cohort of children with asthma. J Med Virol 2015; 88:578-87. [PMID: 26331908 DOI: 10.1002/jmv.24371] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 01/01/2023]
Abstract
Much of what is known about the seasonality of human rhinovirus (hRV) infections has been learned from the study of acute asthma exacerbations presenting to emergency care, including those among children at the start of the school term. Much less is known about the patterns of hRVs in the community. In this study, viruses and day-to-day symptoms of asthma and colds were monitored twice weekly in 67 children with asthma aged 5-12 years, over a 15 month period in Sydney, Australia. Overall hRV was detected in 314/1232 (25.5%) of nasal wash samples and 142/1231 (11.5%) of exhaled breath samples; of these, 231 and 24 respectively were genotyped. HRVs were detected with similar prevalence rate throughout the year, including no peak in hRV prevalence following return to school. No peaks were seen in asthma and cold symptoms using twice-weekly diary records. However, over the same period in the community, there were peaks in asthma emergency visits both at a large local hospital and in state-wide hospitalizations, following both return to school (February) and in late autumn (May) in children of the same age. This study suggests that hRV infections are common throughout the year among children, and differences in virus prevalence alone may not account for peaks in asthma symptoms.
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Affiliation(s)
- Sacha Stelzer-Braid
- Virology Research Laboratory, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Australia
| | - Euan R Tovey
- Woolcock Institute of Medical Research, University of Sydney, Australia
| | | | - Brett G Toelle
- Woolcock Institute of Medical Research, University of Sydney, Australia.,Sydney Local Health District, Sydney, Australia
| | - Rose Ampon
- Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Frances L Garden
- Woolcock Institute of Medical Research, University of Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia
| | - Brian G Oliver
- Woolcock Institute of Medical Research, University of Sydney, Australia.,University of Technology, Sydney, Australia
| | | | - Yvonne Belessis
- Sydney Children's Hospital, Randwick, Australia.,School of Women's and Children's Health, University of New South Wales, Australia
| | - Adam Jaffe
- Sydney Children's Hospital, Randwick, Australia.,School of Women's and Children's Health, University of New South Wales, Australia
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Daniel Crisafulli
- Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Australia.,South Western Sydney Clinical School, University of New South Wales, Australia
| | - William D Rawlinson
- Virology Research Laboratory, SEALS, Prince of Wales Hospital, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Australia.,School of Biotechnology and Biomolecular Sciences, University of New South Wales, Australia
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Tovey ER, Stelzer-Braid S, Toelle BG, Oliver BG, Reddel HK, Willenborg CM, Belessis Y, Garden FL, Jaffe A, Strachan R, Eyles D, Rawlinson WD, Marks GB. Rhinoviruses significantly affect day-to-day respiratory symptoms of children with asthma. J Allergy Clin Immunol 2015; 135:663-9.e12. [PMID: 25476729 PMCID: PMC7173323 DOI: 10.1016/j.jaci.2014.10.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/29/2014] [Accepted: 10/14/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Viruses are frequently associated with acute exacerbations of asthma, but the extent to which they contribute to the level of day-to-day symptom control is less clear. OBJECTIVE We sought to explore the relationship between viral infections, host and environmental factors, and respiratory symptoms in children. METHODS Sixty-seven asthmatic children collected samples twice weekly for an average of 10 weeks. These included nasal wash fluid and exhaled breath for PCR-based detection of viral RNA, lung function measurements, and records of medication use and asthma and respiratory symptoms in the previous 3 days. Atopy, mite allergen exposure, and vitamin D levels were also measured. Mixed-model regression analyses were performed. RESULTS Human rhinoviruses (hRVs) were detected in 25.5% of 1232 nasal samples and 11.5% of breath samples. Non-hRV viruses were detected in less than 3% of samples. hRV in nasal samples was associated with asthma symptoms (cough and phlegm: odds ratio = 2.0; 95% CI = 1.4-2.86, P = .0001; wheeze and chest tightness: odds ratio = 2.34, 95% CI = 1.55-3.52, P < .0001) and with cold symptoms, as reported concurrently with sampling and 3 to 4 days later. No differences were found between the 3 hRV genotypes (hRV-A, hRV-B, and hRV-C) in symptom risk. A history of inhaled corticosteroid use, but not atopic status, mite allergen exposure, or vitamin D levels, modified the association between viruses and asthma symptoms. CONCLUSION The detection of nasal hRV was associated with a significantly increased risk of day-to-day asthma symptoms in children. Host, virus genotype, and environmental factors each had only a small or no effect on the relationship of viral infections to asthma symptoms.
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Affiliation(s)
- Euan R Tovey
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia.
| | - Sacha Stelzer-Braid
- Virology Research Laboratory, SEALS, Prince of Wales Hospital, Sydney, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Brett G Toelle
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; Sydney Local Health District, Sydney, Australia
| | - Brian G Oliver
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; University of Technology Sydney, Sydney, Australia
| | - Helen K Reddel
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | | | - Yvonne Belessis
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Sydney Children's Hospital, Sydney, Australia
| | - Frances L Garden
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; Ingham Institute of Applied Medical Research, New South Wales, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
| | - Adam Jaffe
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia; Sydney Children's Hospital, Sydney, Australia
| | | | - Darryl Eyles
- Queensland Brain Institute, University of Queensland, Brisbane, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, Australia
| | - William D Rawlinson
- Virology Research Laboratory, SEALS, Prince of Wales Hospital, Sydney, Australia; Sydney Children's Hospital, Sydney, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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Cooksley NA, Atkinson D, Marks GB, Toelle BG, Reeve D, Johns DP, Abramson MJ, Burton DL, James AL, Wood-Baker R, Walters EH, Buist AS, Maguire GP. Prevalence of airflow obstruction and reduced forced vital capacity in an Aboriginal Australian population: The cross-sectional BOLD study. Respirology 2015; 20:766-74. [DOI: 10.1111/resp.12482] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 01/04/2023]
Affiliation(s)
| | - David Atkinson
- Rural Clinical School Of Western Australia; University of WA and Kimberley Aboriginal Medical Services Council; Broome Western Australia Australia
| | - Guy B. Marks
- Department of Respiratory and Environmental Epidemiology; Woolcock Institute of Medical Research; Sydney New South Wales Australia
| | - Brett G. Toelle
- Department of Respiratory and Environmental Epidemiology; Woolcock Institute of Medical Research; Sydney New South Wales Australia
- Sydney Local Health District; Sydney New South Wales Australia
| | - David Reeve
- Health Promotion Strategy Unit; Northern Territory Government; Darwin Northern Territory Australia
| | - David P. Johns
- School of Medicine; University of Tasmania; Hobart Tasmania Australia
| | - Michael J. Abramson
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - Deborah L. Burton
- School of Biomedical Sciences; Charles Sturt University; Orange New South Wales Australia
| | - Alan L. James
- Department of Pulmonary Physiology and Sleep Medicine; Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | | | - E. Haydn Walters
- School of Medicine; University of Tasmania; Hobart Tasmania Australia
| | - A. Sonia Buist
- School of Medicine; Oregon Health and Sciences University; Portland Oregon USA
| | - Graeme P. Maguire
- Baker IDI Central Australia; Alice Springs Hospital; Alice Springs Northern Territory Australia
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Hansell AL, Rose N, Cowie CT, Belousova EG, Bakolis I, Ng K, Toelle BG, Marks GB. Weighted road density and allergic disease in children at high risk of developing asthma. PLoS One 2014; 9:e98978. [PMID: 24949625 PMCID: PMC4064977 DOI: 10.1371/journal.pone.0098978] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 05/09/2014] [Indexed: 11/18/2022] Open
Abstract
Background Evidence for an association between traffic-related air pollution and allergic disease is inconsistent, possibly because the adverse effects may be limited to susceptible subgroups and these have not been identified. This study examined children in the Childhood Asthma Prevention Study (CAPS), potentially susceptible to air pollution effects because of a family history of asthma. Methods We examined cross-sectional associations at age eight years between road density within 75 m and 50 m of home address weighted by road type (traffic density), as a proxy for traffic-related air pollution, on the following allergic and respiratory outcomes: skin prick tests (SPTs), total and specific serum IgE, pre- and post-bronchodilator lung function, airway hyperresponsiveness, exhaled NO, and reported asthma and rhinitis. Results Weighted road density was positively associated with allergic sensitisation and allergic rhinitis. Adjusted relative risk (RR) for house dust mite (HDM) positive SPT was 1.25 (95% CI: 1.06–1.48), for detectable house dust mite-specific IgE was 1.19 (95% CI: 1.01–1.41) and for allergic rhinitis was 1.30 (95% CI: 1.03–1.63) per 100 m local road or 33.3 m motorway within 50 m of home. Associations were also seen with small decrements of peak and mid-expiratory flows and increased risk of asthma, current wheeze and rhinitis in atopic children. Conclusion Associations between road density and allergic disease were found in a potentially susceptible subgroup of children at high risk of developing atopy and asthma.
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Affiliation(s)
- Anna L. Hansell
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
- Public Health and Primary Care Directorate, Imperial College Healthcare NHS Trust, London, United Kingdom
- * E-mail:
| | - Nectarios Rose
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- New South Wales Health Ministry, Sydney, New South Wales, Australia
| | - Christine T. Cowie
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Elena G. Belousova
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Ioannis Bakolis
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
| | - Kitty Ng
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Brett G. Toelle
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Guy B. Marks
- Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia
- South West Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Department of Respiratory Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
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Shah S, Roydhouse JK, Toelle BG, Mellis CM, Jenkins CR, Edwards P, Sawyer SM. Recruiting and retaining general practitioners to a primary care asthma-intervention study in Australia. Aust J Prim Health 2014; 20:98-102. [PMID: 23257505 DOI: 10.1071/py12093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/27/2012] [Indexed: 11/23/2022]
Abstract
The need for more evidence-based interventions in primary care is clear. However, it is challenging to recruit general practitioners (GPs) for interventional research. This paper reports on the evaluation of three methods of recruitment that were sequentially used to recruit GPs for a randomised controlled trial of an asthma communication and education intervention in Australia. The recruitment methods (RMs) were: general practices were contacted by project staff from a Department of General Practice, University of Sydney (RM1); general practices were contacted by staff from an independent research organisation (RM2); and general practices were contacted by a medical peer (chief investigator) (RM3). A GP was defined as 'recruited' once they consented and were randomised to a group, and 'retained' if they provided baseline data and did not notify staff of their intention to withdraw at any time during the 12-month study. RM1 was used for the first 6 months, during which 34 (4%) GPs were recruited and 21 (62%) retained from a total of 953 invitations. RM2 was then used for the next 5 months, during which 32 (6%) GPs were recruited and 26 (81%) were retained. Finally over the next 7 months, RM3 recruited 84 (12%) GPs and retained 75 (89%) GPs. In conclusion, use of a medical peer as the first contact was associated with the highest recruitment and retention rate.
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Affiliation(s)
- Smita Shah
- Primary Health Care Education and Research Unit, Sydney West Local Health District, Sydney, NSW 2145, Australia
| | - Jessica K Roydhouse
- Sydney Nursing School, CNRU, University of Sydney, Sydney, NSW 2006, Australia
| | - Brett G Toelle
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Craig M Mellis
- Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | | | - Peter Edwards
- Holroyd Medical Practice, Merrylands, NSW 2160, Australia
| | - Susan M Sawyer
- Department of Paediatrics, The Royal Children's Hospital, Melbourne, Vic. 3052, Australia
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Lau EMT, Morgan PE, Belousova EG, Toelle BG, Ayer JG, Celermajer DS, Marks GB. Asymmetric dimethylarginine and asthma: results from the Childhood Asthma Prevention Study. Eur Respir J 2014; 41:1234-7. [PMID: 23633615 DOI: 10.1183/09031936.00162212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Skilton MR, Marks GB, Ayer JG, Garden FL, Garnett SP, Harmer JA, Leeder SR, Toelle BG, Webb K, Baur LA, Celermajer DS. Weight gain in infancy and vascular risk factors in later childhood. Pediatrics 2013; 131:e1821-8. [PMID: 23713097 DOI: 10.1542/peds.2012-2789] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We hypothesized that early weight gain would be associated with incident obesity, higher blood pressure, systemic inflammation, and arterial wall thickening in later childhood. METHODS A longitudinal birth cohort was recruited antenatally from 2 maternity hospitals in Sydney, Australia, between September 1997 and December 1999. Three hundred ninety-five nondiabetic children who were followed to age 8 years had complete data for early weight gain and arterial wall thickness. RESULTS Independent predictors of excess early weight gain (age 0-18 months; adjusted for height gain) included male gender (0.411 kg [SE: 0.103], P < .001), fewer weeks' gestation (-0.121 kg [SE: 0.044] per week, P = .006), birth length (0.156 kg [SE: 0.024] per cm, P < .001), and failure to breastfeed to 6 months of age (0.498 kg [SE: 0.108], P < .001). Early height-adjusted weight gain was significantly associated with later childhood overweight (odds ratio [OR]: 1.67 [95% confidence interval (CI): 1.26 to 2.20] per kg) and obesity (OR: 2.07 [95% CI: 1.53 to 2.79] per kg), excess central adiposity (OR: 1.54 [95% CI: 1.20 to 1.98] per kg), higher systolic blood pressure (1.24 mm Hg [SE: 0.33] per kg, P < .001), higher C-reactive protein (0.17 mg/dL [SE: 0.06] per 100% increase in weight gain, P = .006), and greater carotid intima-media thickness (0.012 mm [SE: 0.004] per kg, P = .002). CONCLUSIONS Early postnatal weight gain from birth to age 18 months is significantly associated with later childhood overweight and obesity, excess central adiposity, and greater arterial wall thickness.
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Abramson MJ, Toelle BG, James AL, Wood-Baker R, Burton D, Xuan W, Johns DP, Buist AS, Marks GB. Asthma diagnosis and treatment - 1016. Is atopy in people aged 40 and over related to fixed airflow obstruction? World Allergy Organ J 2013; 6 Suppl 1:P16. [PMID: 23819569 PMCID: PMC3643561 DOI: 10.1186/1939-4551-6-s1-p16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Toelle BG, Xuan W, Bird TE, Abramson MJ, Atkinson DN, Burton DL, James AL, Jenkins CR, Johns DP, Maguire GP, Musk AWB, Walters EH, Wood-Baker R, Hunter ML, Graham BJ, Southwell PJ, Vollmer WM, Buist AS, Marks GB. Respiratory symptoms and illness in older Australians: the Burden of Obstructive Lung Disease (BOLD) study. Med J Aust 2013; 198:144-8. [PMID: 23418694 DOI: 10.5694/mja11.11640] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 11/08/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To measure the prevalence of chronic obstructive pulmonary disease (COPD) among people aged 40 years or older in Australia. DESIGN, SETTING AND PARTICIPANTS A cross-sectional study of people in the community aged ≥ 40 years, selected at random using electoral rolls, in six sites chosen to reflect the sociodemographic and geographic diversity of Australia, conducted between 2006 and 2010. Standardised questionnaires were administered by interview. Forced expiratory volume in 1 second (FEV₁), forced vital capacity (FVC), and the FEV1/FVC ratio were measured by spirometry, before and after bronchodilator administration. MAIN OUTCOME MEASURE Prevalence of COPD, classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006 criteria. RESULTS Complete data were available for 1620 men (participation rate, 26%) and 1737 women (participation rate, 28%). The prevalence of GOLD Stage II or higher COPD (defined as post-bronchodilator FEV₁/FVC ratio < 0.70 and FEV₁ < 80% predicted) was 7.5% (95% CI, 5.7%-9.4%) among people aged ≥ 40 years, and 29.2% (95% CI, 18.1%-40.2%) among those aged ≥ 75 years. Among people aged ≥ 40 years, the prevalence of wheeze in the past 12 months was 30.0% (95% CI, 27.5%-32.5%), and prevalence of shortness of breath when hurrying on the level or climbing a slight hill was 25.2% (95% CI, 22.7%-27.6%). CONCLUSIONS Symptoms and spirometric evidence of COPD are common among people aged 40 years or older and increase with age. Further research is needed to better understand the diagnosis and management of COPD in Australia, along with continuing efforts to prevent the disease.
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Affiliation(s)
- Brett G Toelle
- Department of Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, Sydney, NSW, Australia.
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40
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Cowie CT, Rose N, Ezz W, Xuan W, Cortes-Waterman A, Belousova E, Toelle BG, Sheppeard V, Marks GB. Respiratory health before and after the opening of a road traffic tunnel: a planned evaluation. PLoS One 2012; 7:e48921. [PMID: 23209560 PMCID: PMC3510202 DOI: 10.1371/journal.pone.0048921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/01/2012] [Indexed: 11/18/2022] Open
Abstract
Objective The construction of a new road tunnel in Sydney, Australia, and concomitant reduction in traffic on a major road presented the opportunity to study the effects of this traffic intervention on respiratory health. Methods We made measurements in a cohort of residents in the year before the tunnel opened (2006) and in each of two years afterwards (2007–2008). Cohort members resided in one of four exposure zones, including a control zone. Each year, a respiratory questionnaire was administered (n = 2,978) and a panel sub-cohort (n = 380) performed spirometry once and recorded peak expiratory flow and symptoms twice daily for nine weeks. Results There was no consistent evidence of improvement in respiratory health in residents living along the bypassed main road, despite a reduction in traffic from 90,000 to 45,000 vpd. Residents living near tunnel feeder roads reported more upper respiratory symptoms in the survey but not in the panel sub-cohort. Residents living around the tunnel ventilation stack reported more upper and lower respiratory symptoms and had lower spirometric volumes after the tunnel opened. Air pollutant levels measured near the stack did not increase over the study period. Conclusion The finding of adverse health effects among residents living around the stack is unexpected and difficult to explain, but might be due to unmeasured pollutants or risk factors or an unrecognized pollutant source nearby. The lack of improvement in respiratory health among people living along the bypassed main road probably reflects a minimal change in exposure due to distance of residence from the road.
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Skilton MR, Sullivan TR, Ayer JG, Harmer JA, Toelle BG, Webb K, Marks GB, Celermajer DS. Carotid extra-medial thickness in childhood: early life effects on the arterial adventitia. Atherosclerosis 2012; 222:478-82. [PMID: 22534523 DOI: 10.1016/j.atherosclerosis.2012.03.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 03/23/2012] [Accepted: 03/24/2012] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Structural modification of the arterial adventitia may be an early event in atherosclerosis. Carotid extra-medial thickness is a new measure of arterial adventitial thickness. We examined the association of cardiovascular risk factors with extra-medial thickness, in childhood. METHODS Carotid extra-medial thickness was assessed by high-resolution ultrasound in 389 non-diabetic children aged 8-years. A non-fasting blood sample was collected from 314 participants. Associations of gender, age, lipoproteins, blood pressure, BMI z-score, waist:height ratio and parental history of early vascular disease, with extra-medial thickness were examined. RESULTS Carotid extra-medial thickness was lower in girls (r=-.163, P=.001) and directly associated with systolic (r=.128, P=.009), diastolic blood pressure (r=.130, P=.009), and height (r=.170, P=.0006). These associations remained after adjustment for carotid intima-media thickness. In multivariable analysis including carotid intima-media thickness, only gender and height were significantly associated with carotid extra-medial thickness. In gender-stratified analysis, the strongest associations with extra-medial thickness were BMI z-score (r=.181, P=.01), height (r=.210, P=.003) and diastolic blood pressure (r=.167, P=.02) for boys; and systolic blood pressure (r=.153, P=.03) and parental history of premature cardiovascular disease (r=.139, P=.05) for girls. The association of BMI z-score with extra-medial thickness differed by gender (P-interaction=.04). CONCLUSIONS Carotid extra-medial thickness is independently associated with gender and height in childhood. Extra-medial thickness may provide important information concerning early arterial health, particularly related to the arterial adventitia.
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Affiliation(s)
- Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Australia.
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Shah S, Sawyer SM, Toelle BG, Mellis CM, Peat JK, Lagleva M, Usherwood TP, Jenkins CR. Improving paediatric asthma outcomes in primary health care: a randomised controlled trial. Med J Aust 2011; 195:405-9. [PMID: 21978349 DOI: 10.5694/mja10.11422] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of the Practitioner Asthma Communication and Education (PACE) Australia program, an innovative communication and paediatric asthma management program for general practitioners. DESIGN Randomised controlled trial. SETTING General practices from two regions in metropolitan Sydney. PARTICIPANTS 150 GPs, who were recruited between 2006 and 2008, and 221 children with asthma in their care. INTERVENTION GPs in the intervention group participated in two 3-hour workshops, focusing on communication and education strategies to facilitate quality asthma care. MAIN OUTCOME MEASURES Patient outcomes included receipt of a written asthma action plan (WAAP), appropriate medication use, parent days away from work, and child days away from school or child care. GP outcomes included frequency of providing a WAAP and patient education, communication and teaching behaviour, and adherence to national asthma guidelines regarding medication use. RESULTS More patients of GPs in the intervention group reported receipt of a WAAP (difference, 15%; 95% CI, 2% to 28%; adjusted P=0.046). In the intervention group, children with infrequent intermittent asthma symptoms had lower use of inhaled corticosteroids (difference, 24%; 95% CI, -43% to -5%; P=0.03) and long-acting bronchodilators (difference, 19%; 95% CI, -34% to -5%; P=0.02). GPs in the intervention group were more confident when communicating with patients (difference 22%; 95% CI, 3% to 40%; P=0.03). A higher proportion of GPs in the intervention group reported providing a WAAP more than 70% of the time (difference, 23%; 95% CI, 11% to 36%; adjusted P=0.002) and prescribing spacer devices more than 90% of the time (difference, 29%; 95% CI, 16% to 42%; adjusted P=0.02). CONCLUSIONS The PACE Australia program improved GPs' asthma management practices and led to improvements in some important patient outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12607000067471.
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Affiliation(s)
- Smita Shah
- Primary Health Care Education and Research Unit, Westmead Hospital, University of Sydney, Sydney, NSW.
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Roydhouse JK, Shah S, Toelle BG, Sawyer SM, Mellis CM, Usherwood TP, Edwards P, Jenkins CR. A snapshot of general practitioner attitudes, levels of confidence and self-reported paediatric asthma management practice. Aust J Prim Health 2011; 17:288-93. [PMID: 21896266 DOI: 10.1071/py11009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/21/2011] [Indexed: 11/23/2022]
Abstract
The prevalence of asthma in Australia is high. Previous findings have suggested that asthma management, particularly in primary care, remains suboptimal and recent government initiatives to improve asthma management and encourage the use of written asthma action plans (WAAPs) in general practice have been implemented. We aimed to assess the attitudes, confidence and self-reported paediatric asthma management practices of a convenience sample of Australian general practitioners (GPs). A baseline questionnaire was administered to GPs as part of a randomised controlled trial. General practitioners (GPs) were recruited from two areas of greater metropolitan Sydney, NSW between 2006 and 2008. Invitations were sent to an estimated 1200 potentially eligible GPs. Of 150 (12.5%) GPs that enrolled, 122 (10.2%) completed the baseline questionnaire. Though 89% were aware of the Australian National Asthma Guidelines, less than 40% were familiar with guideline recommendations. While 85.2% had positive attitudes towards WAAPs, only 45.1% reported providing them frequently. For children with frequent symptoms, 90% agreed they should prescribe daily, inhaled corticosteroids (ICS), and 83% reported currently prescribing ICS to such patients. These findings indicate gaps between GP attitudes and behaviours and highlights opportunities for interventions to improve paediatric asthma management.
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Abstract
There is conflicting evidence concerning the relationship between breast feeding and wheezing illness. The objective of this study was to investigate whether there is any association between breast feeding and wheezing in children aged over 5 years and to discover possible sources of heterogeneity. An electronic search of MEDLINE and EMBASE databases was conducted from January 2000 to June 2010. In addition, reference lists from relevant publications were searched. Birth cohort, cross-sectional and case-control studies were included if they measured any breast feeding or exclusive breast feeding for 3 or 4 months. Wheezing illness, including asthma, was identified based on symptoms, reported diagnosis or objective criteria. Thirty-one publications were identified for meta-analysis. There was no association found between any or exclusive breast feeding and wheezing illness, although there was a high level of heterogeneity between the studies. Subgroup analysis revealed that any breast feeding slightly lowers the odds of wheeze (pooled odds ratio 0.92 [0.86, 0.98]) but slightly increases the odds of asthma defined by specific criteria (pooled odds ratio 1.10 [1.00, 1.22]). This meta-analysis does not provide evidence that breast feeding is protective against wheezing illness in children aged 5 years and over. The difference in the effects of breast feeding according to the nature of the wheezing illness highlights the importance of the heterogeneity of illness phenotypes.
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Affiliation(s)
- Bronwyn K Brew
- Woolcock Institute of Medical Research, The University of Sydney, NSW, Australia.
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Marshall NS, Ayer JG, Toelle BG, Harmer JA, Phillips CL, Grunstein RR, Celermajer DS, Marks GB. Snoring is not associated with adverse effects on blood pressure, arterial structure or function in 8-year-old children: the Childhood Asthma Prevention Study (CAPS). J Paediatr Child Health 2011; 47:518-23. [PMID: 21535282 DOI: 10.1111/j.1440-1754.2011.02014.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To study the association between childhood snoring and cardiovascular risk factors. METHODS Cross-sectional analyses of a population-based birth cohort, who had been participants in a randomised controlled trial of interventions to prevent asthma and who were assessed at age 8 years. The presence and frequency of snoring were assessed by parent-completed questionnaire. We measured a wide range of cardiovascular function markers including non-fasting serum lipoproteins, blood pressure, high-sensitivity C-reactive protein, carotid artery intima media thickness (by ultrasound), brachial pulse wave velocity and augmentation index (by applanation tonometry). RESULTS Of 409 children whose snoring status was assessed at age 8 years, 321 had lipid and 386 had arterial structure and function measurements. Snoring was not independently associated with blood pressure, carotid artery intima media thickness or measures of arterial stiffness (all P > 0.05). Increasing snoring frequency was independently associated with lower high-density lipoprotein cholesterol (-0.032 g/dL per step, 95% confidence interval -0.060 to -0.003), although the difference in high-density lipoprotein between snorers and non-snorers was not significant (P = 0.052). An association of snoring frequency with brachial pulse wave velocity differed according to body mass index (P = 0.03) and was the reverse of that expected. CONCLUSIONS Parentally reported snoring was not independently associated with adverse measurements of metabolic markers, vascular structure or function in 8-year-old children. Parental reports of snoring may be below the treatment threshold without additional diagnosis via sleep studies.
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Shah S, Toelle BG, Sawyer SM, Roydhouse JK, Edwards P, Usherwood T, Jenkins CR. Feasibility study of a communication and education asthma intervention for general practitioners in Australia. Aust J Prim Health 2011; 16:75-80. [PMID: 21133302 DOI: 10.1071/py09056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor-patient communication. The impact ofthe modified PACE Australia program on the processes and outcomes ofGP care ofchildren with asthma is now being measured in a randomised controlled trial.
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Affiliation(s)
- Smita Shah
- Primary Health Care Education and Research Unit, Primary and Community Health Network, Sydney West Area Health Service, Sydney, NSW 2145, Australia.
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47
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Marks GB, Ezz W, Aust N, Toelle BG, Xuan W, Belousova E, Cosgrove C, Jalaludin B, Smith WT. Respiratory health effects of exposure to low-NOx unflued gas heaters in the classroom: a double-blind, cluster-randomized, crossover study. Environ Health Perspect 2010; 118:1476-82. [PMID: 20663737 PMCID: PMC2957932 DOI: 10.1289/ehp.1002186] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [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: 03/18/2010] [Accepted: 07/20/2010] [Indexed: 05/08/2023]
Abstract
BACKGROUND There are long-standing concerns about adverse effects of gas appliances on respiratory health. However, the potential adverse effect of low-NOx (nitrogen oxide) unflued gas heaters on children's health has not been assessed. OBJECTIVES Our goal was to compare the respiratory health effects and air quality consequences of exposure to low-NOx unflued gas heaters with exposure to non-indoor-air-emitting flued gas heaters in school classrooms. METHODS We conducted a double-blind, cluster-randomized, crossover study in 400 primary school students attending 22 schools in New South Wales, Australia. Children measured their lung function and recorded symptoms and medication use twice daily. Nitrogen dioxide (NO2) and formaldehyde concentrations were measured in classrooms using passive diffusion badges. RESULTS NO2 concentrations were, on average, 1.8 times higher [95% confidence interval (CI), 1.6-2.1] and formaldehyde concentrations were, on average, 9.4 ppb higher (95% CI, 5.7-13.1) during exposure to unflued gas versus flued gas heaters. Exposure to the unflued gas heaters was associated with increased cough reported in the evening [odds ratio (OR) = 1.16; 95% CI, 1.01-1.34] and wheeze reported in the morning (OR = 1.38; 95% CI, 1.04-1.83). The association with wheeze was greater in atopic subjects. There was no evidence of an adverse effect on lung function. CONCLUSIONS We conclude that classroom exposure to low-NOx unflued gas heaters causes increased respiratory symptoms, particularly in atopic children, but is not associated with significant decrements in lung function. It is important to seek alternative sources of heating that do not have adverse effects on health.
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Affiliation(s)
- Guy B Marks
- Respiratory and Environmental Epidemiology, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.
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Toelle BG, Ng KKW, Crisafulli D, Belousova EG, Almqvist C, Webb K, Tovey ER, Kemp AS, Mellis CM, Leeder SR, Marks GB. Eight-year outcomes of the Childhood Asthma Prevention Study. J Allergy Clin Immunol 2010; 126:388-9, 389.e1-3. [PMID: 20646752 DOI: 10.1016/j.jaci.2010.04.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 04/07/2010] [Accepted: 04/08/2010] [Indexed: 11/12/2022]
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Deshmukh VM, Toelle BG, Usherwood T, O'Grady B, Jenkins CR. The association of comorbid anxiety and depression with asthma-related quality of life and symptom perception in adults. Respirology 2008; 13:695-702. [PMID: 18513245 DOI: 10.1111/j.1440-1843.2008.01310.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE There are limited data on the association and interaction between anxiety and depression comorbidity and asthma-related quality of life (AQOL) and symptom perception. This study evaluated these associations in patients subsequent to an emergency department (ED) visit for asthma. METHODS This was a cross-sectional study of 110 (38 male) adult asthma patients (mean age 42 years), who had visited an ED in the previous 18 months. Participants completed the hospital anxiety and depression scale, measures of AQOL and the asthma symptom checklist. RESULTS Depression symptoms independently showed a significant negative association with AQOL after controlling for depression/anxiety, age, gender, smoking status and ED visits in the previous 12 months (ED-12). Overall, anxiety and depression symptoms accounted for 28.3% of the variance in AQOL. Greater anxiety was associated with increased perception of asthma-specific panic-fear and hyperventilation symptoms during an asthma attack, irrespective of depression status. Categorical analyses of groups of patients, differentiated by psychometric properties on the hospital anxiety and depression scale (anxiety vs normal, anxiety and depression vs normal depression) confirmed most results. However, for the anxiety group there was a significant association with the AQOL domains of emotional functioning and response to environmental stimuli, after controlling for depression symptoms. CONCLUSIONS The negative association of depression symptom scores with AQOL and of anxiety with increased panic-fear and hyperventilation symptoms suggests a potential role for interventions addressing this psychological comorbidity, in order to improve AQOL.
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Marks GB, Abramson MJ, Jenkins CR, Kenny P, Mellis CM, Ruffin RE, Stosic R, Toelle BG, Wilson DH, Xuan W. Asthma management and outcomes in Australia: a nation-wide telephone interview survey. Respirology 2007; 12:212-9. [PMID: 17298453 DOI: 10.1111/j.1440-1843.2006.01010.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Asthma is a high-burden disease for which effective treatment is available. In Australia, there has been a public health campaign directed at increasing the implementation of effective management with the aim of improving asthma outcomes. The aim of this study was to assess the burden of asthma and describe current asthma management in Australia. METHODS A computer-assisted telephone interview survey was conducted in 2003/04 among randomly selected participants. Current asthma was defined as self-reported asthma, confirmed by doctor, which was still present and/or associated with symptoms in the last 12 months. RESULTS From 46,855 eligible telephone numbers dialled there were 14,271 (30.5%) responses to the screening questionnaire. Among 1734 respondents with current asthma, 1205 (69.5%) completed the detailed questionnaire. Among these, 24.2% of adults and 14.3% children had symptoms during the day or night on most days; 11.3% of adults and 6.0% of children avoided exercise because of asthma symptoms during exercise and 19.4% of adults and 29.7% of children had sought urgent medical care because of an exacerbation of asthma during the preceding year. Among adults with asthma, only 35.6% with daily symptoms and 41.4% with symptoms on most days were taking inhaled steroids. Only 31.1% of adults with daily symptoms had a written asthma action plan. CONCLUSION Compared with similar international studies, this study revealed a lower prevalence of frequent asthma symptoms and a higher prevalence of use of inhaled steroids among people with asthma. However, there remains ample scope for improvement in management of patients with frequent symptoms.
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Affiliation(s)
- Guy B Marks
- Woolcock Institute of Medical Research, Sydney, New South Wales, Australia.
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