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1.
Immunol Allergy Clin North Am ; 43(1): 17-26, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36411003

RESUMO

Physiologic changes during pregnancy have implications for both upper and lower airway function. Upper airway resistance increases, and total lung capacity decreases. Upper airway symptoms increase; some women develop pregnancy-induced rhinitis and there is an increased prevalence of sleep-disordered breathing compared to prepregnancy. Longitudinal studies examining changes in upper and lower airway function parameters are limited, particularly in women with asthma. Some studies have observed reduced lung function with advancing gestation; however, changes are small and unlikely to be of major clinical significance. Spirometry is therefore a useful tool for clinical assessment of women with asthma during pregnancy.


Assuntos
Asma , Síndromes da Apneia do Sono , Gravidez , Feminino , Humanos , Asma/diagnóstico , Asma/epidemiologia , Resistência das Vias Respiratórias
2.
Immunol Allergy Clin North Am ; 43(1): 199-208, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36411005

RESUMO

It is known that poor asthma control is common in pregnancy, and asthma in general disproportionally affects underserved communities. However, there is a paucity of data examining strategies to improve asthma control specifically among pregnant women from vulnerable populations. Identified barriers to optimal asthma care in other underserved groups include health literacy, financial constraints, cultural differences, and poor environmental controls. These deficiencies may also be targets for multimodal interventions geared toward improving asthma outcomes for underserved women during pregnancy.


Assuntos
Asma , Gravidez , Humanos , Feminino , Asma/diagnóstico , Asma/epidemiologia , Asma/terapia
3.
Immunol Allergy Clin North Am ; 43(1): 169-185, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36411002

RESUMO

Poorly controlled asthma can affect neonatal outcomes including congenital anomalies, which can be reduced with appropriate asthma care during pregnancy. Although there is a concern regarding the safety of asthma medication use during pregnancy and congenital anomalies, the risk of uncontrolled asthma outweighs any potential risks of controller and reliever medication use. Patient education before and during pregnancy is critical to ensure good compliance to therapy and reduce the risk of poor asthma control.


Assuntos
Antiasmáticos , Asma , Complicações na Gravidez , Gravidez , Recém-Nascido , Feminino , Humanos , Antiasmáticos/efeitos adversos , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/epidemiologia , Asma/tratamento farmacológico , Asma/epidemiologia
4.
Immunol Allergy Clin North Am ; 43(1): 65-85, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36411009

RESUMO

Asthma is one of the most common potentially serious medical problems to complicate pregnancy. Optimal management of asthma during pregnancy is thus important for both mother and baby. Treating asthmatic women requires understanding the effects of pregnancy on the course of asthma, and, conversely, the effects of asthma on pregnancy outcomes. Successful management also requires an understanding the barriers to asthma control in this population of patients. Evidence has shown that it is essential that the allergist-immunologist, obstetrician, and patient work as a team during pregnancy to achieve optimal maternal and neonatal outcomes.


Assuntos
Asma , Doença Enxerto-Hospedeiro , Lactente , Recém-Nascido , Gravidez , Humanos , Feminino , Alergistas , Asma/diagnóstico , Asma/epidemiologia , Asma/terapia , Família
5.
Otolaryngol Clin North Am ; 56(1): 65-81, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36266106

RESUMO

The "unified airway" describes the concept that inflammation affects upper and lower airways by similar mechanisms; this often manifests as rhinitis, rhinosinusitis, and/or nasal polyposis in the upper airway with associated asthma or bronchial inflammation in the lower airways. The relationships between eosinophilic diseases of the upper and lower airways are highlighted by examining their prevalence and treatment regimens along with the synergistic effects of treatment on upper and lower airway symptoms. It is important to recognize the interrelatedness of upper and lower airway eosinophilic disease to assess and manage patients accurately and holistically.


Assuntos
Asma , Rinite , Sinusite , Humanos , Prevalência , Rinite/epidemiologia , Rinite/terapia , Asma/complicações , Asma/epidemiologia , Asma/terapia , Sinusite/epidemiologia , Sinusite/terapia , Sinusite/complicações , Inflamação/complicações
6.
Otolaryngol Clin North Am ; 56(1): 1-10, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36266105

RESUMO

Upper and lower airways diseases are very common, with population prevalence of 10% to 40%. The conditions are usually interlinked and referred to as "unified airway disease" or "the united airways." Especially in phenotypes with more severe disease, type 2 immunologic endotype is often noted. Comorbid upper and lower airway diseases are usually caused by similar underlying immunologic response. Any patient with rhinitis or rhinosinusitis should have their lower respiratory tract evaluated. A multidisciplinary approach in the diagnosis and treatment of airway disease is advised, especially, for more severe phenotypes.


Assuntos
Asma , Rinite , Sinusite , Humanos , Asma/diagnóstico , Asma/epidemiologia , Asma/terapia , Rinite/diagnóstico , Rinite/epidemiologia , Rinite/terapia , Sinusite/diagnóstico , Sinusite/epidemiologia , Sinusite/terapia , Sistema Respiratório , Comorbidade
7.
Environ Res ; 216(Pt 3): 114713, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36347392

RESUMO

BACKGROUND: The rapid increase of food allergy (FA) has become the "second wave" of allergy epidemic and is now a major global public health concern. Mounting evidence indicates that early life exposure to air pollution is associated with the "first wave" of allergy epidemic (including asthma, allergic rhinitis and eczema) in children, but little is known about its association with FA. OBJECTIVES: We hypothesize FA has triple exposure pathways, gut-skin-airway, and investigate the effects of airway exposure to outdoor and indoor air pollution on childhood FA. METHODS: A cohort study of 2598 preschool children aged 3-6 years old was conducted in Changsha, China. The prevalence of FA was surveyed using a standard questionnaire by International Study of Asthma and Allergies in Childhood (ISAAC). Exposure to indoor air pollution was assessed by four indicators: new furniture, redecoration, mold or dampness, and window condensation. Exposure to outdoor air pollution was evaluated by the concentrations of PM10, SO2 and NO2, which were obtained from the monitored stations. Both prenatal and postnatal exposure windows were considered. The association between exposure to outdoor/indoor air pollution and childhood FA was estimated by multiple logistic regression models using odds ratio (OR) and a 95% confidence interval (CI). RESULTS: A total of 14.9% children reported FA. The prevalence was significantly associated with exposure to indoor air pollution, OR (95% CI) = 1.93 (1.35-2.75) for prenatal exposure to mold/dampness and 1.49 (1.07-2.10) and 1.41 (1.04-1.89) respectively for postnatal exposure to new furniture and window condensation. The prevalence of FA was also associated with prenatal and postnatal exposure to outdoor air pollution, particularly the traffic-related air pollutant NO2, with adjusted ORs (95% Cls) respectively 1.24 (1.00-1.54) and 1.38 (1.03-1.85) per interquartile range (IQR) increase. Sensitivity analysis showed that the association between outdoor/indoor air pollution and childhood FA was significant only in young children aged 3-4 years. CONCLUSION: Early-life exposure to high levels of outdoor and indoor air pollution in China due to the rapid economic growth and fast urbanization in the past decades may contribute to the rapid increase of food allergy (FA) in children. Our study indicates that, in addition to gut and skin, airway may be a new route of food sensitization. Air pollution leads to the first and second waves of allergy epidemics, suggesting a concept of 'one allergy' disease.


Assuntos
Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluição do Ar , Asma , Hipersensibilidade Alimentar , Rinite Alérgica , Gravidez , Pré-Escolar , Feminino , Humanos , Criança , Dióxido de Nitrogênio/análise , Estudos de Coortes , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Poluentes Atmosféricos/análise , Poluição do Ar em Ambientes Fechados/efeitos adversos , Poluição do Ar em Ambientes Fechados/análise , Rinite Alérgica/epidemiologia , Asma/epidemiologia , Hipersensibilidade Alimentar/epidemiologia , Hipersensibilidade Alimentar/etiologia , Fungos , China/epidemiologia , Exposição Ambiental/análise
8.
Environ Res ; 216(Pt 1): 114485, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36206924

RESUMO

BACKGROUND: The new WHO air quality guidelines indicate that the air pollution disease burden is greater than previously reported. We aimed to estimate the air pollution disease burden and its economic cost in Barcelona to inform local action. METHODS: We used a quantitative health impact assessment to estimate the non-accidental mortality and incidence of childhood asthma and lung cancer attributable to long-term air pollution exposure in the city of Barcelona (Spain) in 2018-2019. We used the population weighted mean of PM2.5 and NO2 assigned at the geocoded address during the study period and the 2021 WHO air quality guidelines as counterfactual scenario to estimate new annual cases attributable to each pollutant separately and combined. We estimated the social cost of attributable deaths and the health care cost of childhood asthma and lung cancer attributable cases. We also estimated attributable mortality by city district and the mortality avoidable by achieving the WHO air quality interim targets. RESULTS: Mean exposure was 17 µg/m3 for PM2.5 and 39 µg/m3 for NO2. Total combined air pollution attributable mortality was 13% (95%CI = 9%-17%), corresponding to 1,886 deaths (95%CI = 1,296-2,571) and a social cost of €1,292 million (95%CI = 888-1,762) annually. Fifty-one percent (95%CI = 21%-71%) and 17% (95%CI = 7%-29%) of new cases of childhood asthma and lung cancer were attributable to air pollution with a health care cost of €4.3 and €2.7 million, respectively. Achieving the first unmet WHO air quality interim targets for PM2.5 and for NO2 would avoid 410 deaths and €281 million annually. CONCLUSION: Air pollution in Barcelona represents a huge disease and economic burden, which is greater than previous estimates. Much stronger measures to reduce PM2.5 and NO2 levels are urgently needed. Until the WHO air quality guidelines are met in the city, achieving each WHO air quality interim targets would avoid hundreds of deaths each year.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Asma , Neoplasias Pulmonares , Humanos , Poluentes Atmosféricos/análise , Material Particulado , Dióxido de Nitrogênio , Poluição do Ar/análise , Efeitos Psicossociais da Doença , Asma/epidemiologia , Neoplasias Pulmonares/epidemiologia , Exposição Ambiental/análise
9.
Environ Res ; 216(Pt 2): 114489, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36208788

RESUMO

BACKGROUND: There is rapidly growing evidence indicating that extreme temperature is a crucial trigger and potential activator of asthma; however, the effects of extreme temperature on asthma are inconsistently reported and the its potential mechanisms remain undefined. OBJECTIVES: This review aims to estimate the impacts of extreme heat, extreme cold, and temperature variations on asthma by systematically summarizing the existing studies from epidemiological evidence to biological plausibility. METHODS: We conducted a systematic search in PubMed, Embase, and Web of Science from inception to June 30, 2022, and we retrieved articles of epidemiology and biological studies which assessed associations between extreme temperatures and asthma. This protocol was registered with PROSPERO (CRD42021273613). RESULTS: From 12,435 identified records, 111 eligible studies were included in the qualitative synthesis, and 37 articles were included in the meta-analysis (20 for extreme heat, 16 for extreme cold, and 15 for temperature variations). For epidemiological evidence, we found that the synergistic effects of extreme temperatures, indoor/outdoor environments, and individual vulnerabilities are important triggers for asthma attacks, especially when there is extreme heat or cold. Meta-analysis further confirmed the associations, and the pooled relative risks for asthma attacks in extreme heat and extreme cold were 1.07 (95%CI: 1.03-1.12) and 1.20 (95%CI: 1.12-1.29), respectively. Additionally, this review discussed the potential inflammatory mechanisms behind the associations between extreme temperatures and asthma exacerbation, and highlighted the regulatory role of immunological pathways and transient receptor potential ion channels in asthma triggered by extreme temperatures. CONCLUSIONS: We concluded that both extreme heat and cold could significantly increase the risk of asthma. Additionally, we proposed a potential mechanistic framework, which is important for understanding the disease pathogenesis that uncovers the complex mechanisms of asthma triggered by extreme temperatures and protects the sensitive individuals from impacts of extreme weather events and climate change.


Assuntos
Asma , Calor Extremo , Humanos , Temperatura , Temperatura Alta , Temperatura Baixa , Asma/epidemiologia , Asma/etiologia
10.
Microbiol Res ; 266: 127234, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36279647

RESUMO

BACKGROUND: Differences in the clinical phenotypes and outcomes of fungus-associated asthma remain unclear. We aimed to investigate the presentation of asthmatics with fungal sensitization and/or positive fungal isolates. METHODS: Clinical characteristics, pulmonary function, microbiological data, allergy test reports, emergency department (ED) visits and hospitalizations were retrieved from the Chang Gung Research Database between 2010 and 2018; the largest electronic medical record-based database in Taiwan. Follow-up care was provided to each patient for 3 years. RESULTS: A total of 30,754 asthmatics were enrolled, and 7976 were eligible for analysis after applying the exclusion criteria. Of these patients, 694 had sputum examinations for fungi. The patients were divided into four groups: group 1, neither fungal sensitization nor fungal isolates in the sputum (n = 386); group 2, positive fungal sensitization (n = 58); group 3, positive fungal isolates (n = 217); and group 4, concomitant positive fungal sensitization and positive fungal isolates (n = 33). Asthmatic patients with fungal sensitization (groups 2 and 4) demonstrated significantly higher IgE levels compared with those without (groups 1 and 3). Group 4 patients had a higher frequency of hospitalization. Amongst patients under Global Initiative for Asthma (GINA) step 4-5 therapies, group 4 asthmatics possessed significantly higher incidence of respiratory failure. CONCLUSIONS: The prevalence of fungal sensitization and fungal isolates from sputum were even across asthmatic severities, but the clinical impact of fungi may be more significant among patients with more severe disease.


Assuntos
Asma , Imunoglobulina E , Imunoglobulina E/uso terapêutico , Taiwan/epidemiologia , Asma/epidemiologia , Asma/tratamento farmacológico , Prevalência , Fungos
11.
Environ Res ; 216(Pt 2): 114538, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36252839

RESUMO

BACKGROUND: The prevalence of childhood allergies has increased during past decades leading to serious hospitalization and heavy burden worldwide, yet the key factors responsible for the onset of early symptoms and development of diagnosed diseases are unclear. OBJECTIVE: To explore the role of early life exposure to ambient air pollution and indoor environmental factors on early allergic symptoms and doctor diagnosed allergic diseases. METHODS: A retrospective cohort study of 2598 preschool children was conducted at 36 kindergartens in Changsha, China from September of 2011 to February of 2012. A questionnaire was developed to survey each child's early onset of allergic symptoms (wheeze and rhinitis-like symptoms) and doctor diagnosis of allergic diseases (asthma and rhinitis) as well as home environments. Each mother's and child's exposures to ambient air pollutants (PM10, SO2, and NO2) and temperature were estimated for in utero and postnatal periods. The associations of early symptoms and diagnosed diseases with outdoor air pollution and indoor environmental variables were examined by logistic regression models. RESULTS: Childhood early allergic symptoms (33.9%) including wheeze (14.7%) and rhinitis-like symptoms (25.4%) before 2 years old were not associated with outdoor air pollution exposure but was significantly associated with maternal exposure of window condensation at home in pregnancy with ORs (95% CI) of 1.33 (1.11-1.59), 1.30 (1.01-1.67) and 1.27 (1.04-1.55) respectively, and was associated with new furniture during first year after birth with OR (95% CI) of 1.43 (1.02-2.02) for early wheeze. Childhood diagnosed allergic diseases (28.4%) containing asthma (6.7%) and allergic rhinitis (AR) (7.2%) were significantly associated with both outdoor air pollutants (mainly for SO2 and NO2) during first 3 years and indoor new furniture, redecoration, and window condensation. We found that sex, age, parental atopy, maternal productive age, environmental tobacco smoke (ETS), antibiotics use, economic stress, early and late introduction of complementary foods, and outdoor air pollution modified the effects of home environmental exposure in early life on early allergic symptoms and diagnosed allergic diseases. CONCLUSION: Our study indicates that early life exposure to indoor environmental factors plays a key role in early onset of allergic symptoms in children, and further exposure to ambient air pollution and indoor environmental factors contribute to the later development of asthma and allergic rhinitis.


Assuntos
Poluentes Atmosféricos , Poluição do Ar em Ambientes Fechados , Poluição do Ar , Asma , Rinite Alérgica , Rinite , Pré-Escolar , Gravidez , Feminino , Humanos , Dióxido de Nitrogênio/análise , Poluição do Ar em Ambientes Fechados/análise , Rinite/epidemiologia , Estudos Retrospectivos , Poluentes Atmosféricos/toxicidade , Poluentes Atmosféricos/análise , Exposição Ambiental , Asma/epidemiologia , Asma/etiologia , Sons Respiratórios , Rinite Alérgica/epidemiologia , Rinite Alérgica/etiologia , China/epidemiologia
12.
Sci Total Environ ; 857(Pt 3): 159792, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36306842

RESUMO

Interest in assessing the effects of exposure to greenspace on human health has been increasing due to rapid urbanization, and rising trends of physical inactivity and air pollution. However, findings on the link between greenspace and child respiratory health, especially asthma, are inconsistent. We investigated the association between greenspace surrounding residential addresses and asthma in children. A city-wide cross-sectional study was conducted, involving 16,605 children aged 3-12 years, in Shanghai, China. Data on asthma symptoms and covariates were collected from validated self-reported questionnaires. Residential greenspace was measured using satellite-derived normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). Information on ambient temperature and particulate matter with dynamic diameter <1 µm (PM1) and 2.5 µm (PM2.5) was also collected from satellite data. Logistic regression models were performed to assess the associations of greenspace exposure with childhood asthma as well as the effect modification by covariates. The prevalence of current asthma in children was 4.8 % in this study. An interquartile range increase in mean NDVI from 2016 to 2018 was associated with decreased odds of asthma in 2019 at 500 m, and 250 m resolutions (0.82, 95 % confidence interval (CI): 0.74 to 0.93; and 0.82, 95 % CI: 0.72 to 0.94, respectively) after adjustment for covariates. The greenspace-asthma association was modified by ambient temperature and residential area. Sensitivity analyses using various models and EVI exposure showed the robustness of the results. In conclusion, higher individual-level exposure to greenspace was associated with decreased odds of asthma in children, and the association appeared to be modified by different environmental and socio-demographic factors. These findings provide additional evidence for promoting urban greenness to protect children's health and well-being.


Assuntos
Poluição do Ar , Asma , Humanos , Criança , Estudos Transversais , Parques Recreativos , China/epidemiologia , Material Particulado/efeitos adversos , Material Particulado/análise , Asma/epidemiologia , Exposição Ambiental
13.
Allergol. immunopatol ; 50(6): 100-106, 01 nov. 2022. tab
Artigo em Inglês | IBECS | ID: ibc-211525

RESUMO

Asthma and chronic obstructive pulmonary disease (COPD) have traditionally been approached as separate entities that must be researched and treated separately. There is growing recognition, however, that a substantial proportion of patients with obstructive lung disease have characteristics of both asthma and COPD (termed the asthma–COPD overlap syndrome (ACOS)). Lung disease experts have difficulty defining ACOS, and many still resist accepting the possibility that asthma and COPD may be linked. It is likely that practicing clinicians may be equally confused about how to identify and treat ACOS. This narrative review aims to clarify concepts of ACOS definition, argues that the best way to understand ACOS is to view the chronic lung disease process longitudinally rather than cross-sectionally, and presents evidence that ACOS can be the end result of the natural history of severe asthma. The review also points out the serious gaps in knowledge regarding therapy for ACOS and presents emerging data supporting the intracellular respiratory pathogen Chlamydia pneumoniae as a possible common etiologic agent in severe asthma and ACOS (AU)


Assuntos
Humanos , Asma/diagnóstico , Asma/epidemiologia , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Síndrome
14.
BMC Pulm Med ; 22(1): 397, 2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36329425

RESUMO

BACKGROUND: Asthma severity is typically assessed through a retrospective assessment of the treatment required to control symptoms and to prevent exacerbations. The joint British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN) guidelines encourage a stepwise approach to pharmacotherapy, and as such, current treatment step can be considered as a severity categorisation proxy. Briefly, the steps for adults can be summarised as: no controller therapy (Step 0), low-strength Inhaled Corticosteroids (ICS; Step 1), ICS plus Long-Acting Beta-2 Agonist (LABA; Step 2), medium-dose ICS + LABA (Step 3), and finally either an increase in strength or additional therapies (Step 4). This study aimed to investigate how BTS/SIGN Steps can be estimated from across a large cohort using electronic prescription records, and to describe the incidence of each BTS/SIGN Step in a general population. METHODS: There were 41,433,707 prescriptions, for 671,304 individuals, in the Asthma Learning Health System Scottish cohort, between 1/2009 and 3/2017. Days on which an individual had a prescription for at least one asthma controller (preventer) medication were labelled prescription events. A rule-based algorithm was developed for extracting the strength and volume of medication instructed to be taken daily from free-text data fields. Asthma treatment regimens were categorised by the combination of medications prescribed in the 120 days preceding any prescription event and categorised into BTS/SIGN treatment steps. RESULTS: Almost 4.5 million ALHS prescriptions were for asthma controllers. 26% of prescription events had no inhaled corticosteroid prescriptions in the preceding 120 days (Step 0), 16% were assigned to BTS/SIGN Step 1, 7% to Step 2, 21% to Step 3, and 30% to Step 4. The median days spent on a treatment step before a step-down in treatment was 297 days, whereas a step-up only took a median of 134 days. CONCLUSION: We developed a reproducible methodology enabling researchers to estimate BTS/SIGN asthma treatment steps in population health studies, providing valuable insights into population and patient-specific trajectories, towards improving the management of asthma.


Assuntos
Antiasmáticos , Asma , Prescrição Eletrônica , Adulto , Humanos , Administração por Inalação , Estudos Retrospectivos , Asma/tratamento farmacológico , Asma/epidemiologia , Corticosteroides/uso terapêutico , Antiasmáticos/uso terapêutico , Quimioterapia Combinada
15.
Allergy Asthma Proc ; 43(6): e65-e71, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36335422

RESUMO

Background: Cat allergen sensitization is a significant risk factor for allergic rhinitis and asthma. There are insufficient data on the preferences and attitudes of cat owners who have a cat allergy. Objective: To investigate the clinical characteristics of adults sensitized to cats and their association with cat ownership, and to assess owners' attitudes and behaviors. Methods: The study evaluated adult patients, ages between 19 and 74 years, who were sensitized to cat allergen as confirmed by skin-prick tests. The demographic and clinical data of the patients were obtained retrospectively from the hospital medical records system. A telephone interview with patients was conducted to evaluate whether they owned a cat and their attitudes toward cat allergy. A total of 143 patients who could not be reached by telephone or who refused to participate in the study were excluded. Patients were categorized into never owned a cat, early cat ownership (having a cat or cats in the first 2 years of the patient's life), and past and current cat ownership according to the status of patients at the time of their skin-prick test. Current cat owners were questioned whether they relinquished their cats and the presence and the degree of symptoms of both patients who relinquished their cats and patients who continued to live with their cats. Results: A total of 245 patients (women/men, 151/94) with a mean age of 31.56 ± 11.33 were included in the study. Eighty-three patients (33.9%) were current cat owners. After the skin-prick test, 54 cat owners (66.1%) continued living with their cats. Two-thirds of these owners were symptomatic, with 95% experiencing nasal symptoms. Only five of the patients with symptoms (14.3%) reported worsening symptoms. Any significant impact on symptoms was not determined with regard to number of cats, cat breeds, and precautionary measures. Conclusion: Cat allergen is a potential risk for public health. The clinician must engage in shared decision-making as to what type of environmental changes that the patient is willing to make and what treatment options, if any, they are ready to accept, recognizing that most patients will prefer to keep their cats.


Assuntos
Asma , Propriedade , Gatos , Animais , Feminino , Humanos , Estudos Retrospectivos , Testes Cutâneos/efeitos adversos , Alérgenos , Asma/diagnóstico , Asma/epidemiologia , Asma/etiologia
16.
Allergol Immunopathol (Madr) ; 50(6): 60-67, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36335446

RESUMO

BACKGROUND: It is as fact that dual-specificity phosphatase 1 (DUSP1) regulates the T cell activation, pro-allergic response, and inflammation to engage with the pathogenesis of asthma, but its clinical role in children with asthma is unclear. The present study aimed to explore the expression of DUSP1, its association with exacerbation risk, severity, and inflammatory cytokines in children with asthma. METHOD: Around 52 children with asthma-exacerbation, 50 children in asthma-remission, and 50 healthy children were chosen for the study. The serum levels of DUSP1, as well as tumor necrosis factor-α (TNF-α), interleukin (IL)-1ß, IL-6, and IL-17 were detected by the enzyme-linked immunosorbent assay. RESULTS: The levels of DUSP1 was the highest in healthy children (median (IQR)=34.305 (25.892- 43.693) ng/mL), the second highest in children in asthma-remission (median (IQR)=21.471 (18.581-27.934) ng/mL), and the lowest in children with asthma-exacerbation (median (IQR)=13.982 (7.901-21.624) ng/mL) (P<0.001). At the same time, DUSP1 was also related to decreased asthma risk with area under curve (AUC) (95%CI) of 0.847 (0.780-0.914), and correlated with its lower exacerbation risk with AUC (95%CI) of 0.755 (0.661-0.849). Besides, DUSP1 was negatively linked with exacerbation severity (rs =-0.338, P=0.014), immunoglobulin E (rs =-0.277, P=0.047), TNF-α (rs =-0.423, P=0.002), IL-1ß (rs =-0.389, P=0.004), and IL-17 (rs =-0.293, P=0.035), but not related with other disease features in children with asthma-exacerbation. Meanwhile, DUSP1 was only negatively associated with TNF-α (rs=-0.300, P=0.034) and IL-1ß (rs =-0.309, P=0.029) in children in asthma-remission. However, no correlation was found in DUSP1 with inflammatory cytokines or other disease features in healthy children (all P>0.05). CONCLUSION: DUSP1 reflects the reduced exacerbation risk, and associates with lower exacerbation severity and inflammatory cytokines in children with asthma-exacerbation; it also associates with inflammatory cytokines in children in asthma-remission. These findings suggest that DUSP1 may help to improve the management of asthmatic children.


Assuntos
Asma , Citocinas , Criança , Humanos , Citocinas/metabolismo , Interleucina-17 , Fator de Necrose Tumoral alfa , Asma/epidemiologia , Asma/metabolismo , Inflamação
17.
Allergol Immunopathol (Madr) ; 50(6): 100-106, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36335452

RESUMO

Asthma and chronic obstructive pulmonary disease (COPD) have traditionally been approached as separate entities that must be researched and treated separately. There is growing recognition, however, that a substantial proportion of patients with obstructive lung disease have characteristics of both asthma and COPD (termed the asthma-COPD overlap syndrome (ACOS)). Lung disease experts have difficulty defining ACOS, and many still resist accepting the possibility that asthma and COPD may be linked. It is likely that practicing clinicians may be equally confused about how to identify and treat ACOS. This narrative review aims to clarify concepts of ACOS definition, argues that the best way to understand ACOS is to view the chronic lung disease process longitudinally rather than cross-sectionally, and presents evidence that ACOS can be the end result of the natural history of severe asthma. The review also points out the serious gaps in knowledge regarding therapy for ACOS and presents emerging data supporting the intracellular respiratory pathogen Chlamydia pneumoniae as a possible common etiologic agent in severe asthma and ACOS.


Assuntos
Síndrome de Sobreposição da Doença Pulmonar Obstrutiva Crônica e Asma , Asma , Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Asma/diagnóstico , Asma/epidemiologia
18.
Front Immunol ; 13: 1045795, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36389800

RESUMO

Background: In recent decades, dramatic changes in modern environmental exposures and lifestyles have resulted in a steep rise in the prevalence of allergic diseases such as asthma, allergic rhinitis, atopic dermatitis and food allergies. Evidence is mounting that the microbiota plays a crucial role in allergic disorder development and evolution. Therefore, a better understanding of allergic diseases within the context of the microbiota is urgently needed. This work aimed to comprehensively outline general characteristics, research hotspots, evolution routes, and emerging trends in this area. Methods: Relevant publications from January 2002 to December 2021 were obtained from the Web of Science Core Collection on 5 August 2022. Bibliometric and visual analyses were performed using CiteSpace; VOSviewer; an online bibliometric platform; and Microsoft Excel 2019. Results: In total, 2535 documents met the requirements. The annual number of publications has shown rapid growth in the last two decades. The USA, University of California System, and Isolauri E of the University of Turku were the most productive and influential country, institution, and author, respectively. The Journal of Allergy and Clinical Immunology was the most prolific and most cocited journal. High-frequency keywords included "gut microbiota", "asthma", "atopic dermatitis", "children", and "probiotics". Recent studies have focused on "atopic dermatitis", "skin", "asthma", and "probiotics", according to the cocitation analysis of references. Burst detection analysis of keywords showed that "community", "skin microbiome", "microbiome", "Staphylococcus aureus", and "chain fatty acid" were emerging research frontiers, which currently have ongoing bursts. Conclusion: In the last 20 years, studies of the microbiota in allergic diseases have been flourishing, and the themes have been increasing in depth. These findings provide valuable references on the current research hotspots and gaps and development trends in the link between the microbiota and allergic diseases.


Assuntos
Asma , Dermatite Atópica , Microbioma Gastrointestinal , Microbiota , Humanos , Bibliometria , Dermatite Atópica/epidemiologia , Asma/epidemiologia
19.
BMJ Open ; 12(11): e066215, 2022 11 18.
Artigo em Inglês | MEDLINE | ID: mdl-36400726

RESUMO

OBJECTIVE: The study was aimed to determine the prevalence and contributing factors of insomnia among patients with bronchial asthma. DESIGN: A multicentre cross-sectional survey was used. SETTING: This study was carried out from January to March 2022 in three university comprehensive specialised hospitals in Northwest Ethiopia. PARTICIPANTS: 422 patients with bronchial asthma were approached of which 93.8% completed the survey. OUTCOMES: The degree of asthma control and the severity of insomnia were evaluated using the Asthma Control Test and Insomnia Severity Index (ISI), respectively. The characteristics of the participants were presented, arranged and summarised using descriptive statistical analysis, and correlations between predictors and outcome variables were examined using logistic regression. The cut-off point was a p value of 0.05. RESULTS: Participants' ages ranged from 33.6 to 65.2 years on average. Just under three-fourths (71.4%) of the participants had at least one episode of insomnia as per the ISI measurement (score ≥10). The odds of insomnia episodes were about 5.4 and 1.93 times higher in patients with uncontrolled asthma and partially controlled asthma status, with adjusted OR (AOR)=5.4 (95% CI 4.4 to 6.79, p<0.001) and AOR=1.93 (95% CI 1.21 to 4.11, p<0.001), respectively. CONCLUSION: Insomnia episodes were substantially higher in bronchial patients with asthma. Insomnia is accompanied by asthma severity, and uncontrolled asthma and partially controlled asthma status are the two most determining factors for experiencing sleep disturbance. Furthermore, a prospective follow-up study must determine the real association found between insomnia and asthma control.


Assuntos
Asma , Distúrbios do Início e da Manutenção do Sono , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/complicações , Estudos Transversais , Prevalência , Etiópia/epidemiologia , Universidades , Seguimentos , Estudos Prospectivos , Asma/complicações , Asma/epidemiologia , Hospitais Especializados
20.
BMJ Open ; 12(11): e066851, 2022 11 22.
Artigo em Inglês | MEDLINE | ID: mdl-36414301

RESUMO

OBJECTIVES: We aim to establish daily risk estimates of the relationships between grass, tree and weed pollen and asthma health outcomes. DESIGN: Time series regression analysis of exposure and health outcomes using interaction by month to determine risk estimates all year round. SETTING: Metropolitan Adelaide, South Australia. PARTICIPANTS: Health outcomes for asthma are based on 15 years of hospital admissions, 13 years emergency presentations and ambulance callouts. In adults (≥18 years), there were 10 381 hospitalisations, 26 098 emergency department (ED) presentations and 11 799 ambulance callouts and in children (0-17 years), 22 114, 39 813 and 3774, respectively. OUTCOME MEASURES: The cumulative effect of 7 day lags was calculated as the sum of the coefficients and reported as incidence rate ratio (IRR) related to an increase in 10 grains of pollen/m3. RESULTS: In relation to grass pollen, children and adults were disparate in their timing of health effects. Asthma outcomes in children were positively related to grass pollen in May, and for adults in October. Positive associations with weed pollen in children was seen from February to May across all health outcomes. For adults, weed pollen-related health outcomes were restricted to February. Adults were not affected by tree pollen, while children's asthma morbidity was associated with tree pollen in August and September. In children, IRRs ranged from 1.14 (95% CI 1.06 to 1.21) for ED presentations for tree pollen in August to 1.98 (95% CI 1.06 to 3.72) for weed pollen in February. In adults, IRRs ranged from 1.28 (95% CI 1.01 to 1.62) for weed pollen in February to 1.31 (95% CI 1.08 to 1.57) for grass pollen in October. CONCLUSION: Monthly risk assessment indicated that most pollen-related asthma health outcomes in children occur in the colder part of the year, while adults are affected in the warm season. The findings indicate a need for year-round pollen monitoring and related health campaigns to provide effective public health prevention.


Assuntos
Asma , Rinite Alérgica Sazonal , Criança , Adulto , Humanos , Poaceae , Árvores , Austrália do Sul/epidemiologia , Fatores de Tempo , Pólen/efeitos adversos , Asma/epidemiologia , Asma/etiologia , Análise de Regressão , Avaliação de Resultados em Cuidados de Saúde
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