Digitally-enabled, person-centred care (PCC) in allergen immunotherapy: An ARIA-EAACI Position Paper.

In rhinitis and asthma, several mHealth apps have been developed but only a few have been validated. However, these apps have a high potential for improving person-centred care (PCC), especially in allergen immunotherapy (AIT). They can provide support in AIT initiation by selecting the appropriate patient and allergen shared decision-making. They can also help in (i) the evaluation of (early) efficacy, (ii) early and late stopping rules and (iii) the evaluation of (carried-over) efficacy after cessation of the treatment course. Future perspectives have been formulated in the first report of a joint task force (TF)-Allergic Rhinitis and Its Impact on Asthma (ARIA) and the European Academy of Allergy and Clinical Immunology (EAACI)-on digital biomarkers. The TF on AIT now aims to (i) outline the potential of the clinical applications of mHealth solutions, (ii) express their current limitations, (iii) make proposals regarding further developments for both clinical practice and scientific purpose and (iv) suggest which of the tools might best comply with the purpose of digitally-enabled PCC in AIT.

Prenatal and early life exposure to air pollution and the risk of severe lower respiratory tract infections during early childhood: the Espoo Cohort Study.

BACKGROUND: There is inconsistent evidence of the effects of exposure to ambient air pollution on the occurrence of lower respiratory tract infections (LRTIs) in early childhood. We assessed the effects of individual-level prenatal and early life exposure to air pollutants on the risk of LRTIs in early life. METHODS: We studied 2568 members of the population-based Espoo Cohort Study born between 1984 and 1990 and living in 1991 in the City of Espoo, Finland. Exposure assessment was based on dispersion modelling and land-use regression for lifetime residential addresses. The outcome was a LRTI based on data from hospital registers. We applied Poisson regression to estimate the incidence rate ratio (IRR) of LTRIs, contrasting incidence rates in the exposure quartiles to the incidence rates in the first quartile. We used weighted quantile sum (WQS) regression to estimate the joint effect of the studied air pollutants. RESULTS: The risk of LRTIs during the first 2 years of life was significantly related to exposure to individual and multiple air pollutants, measured with the Multipollutant Index (MPI), including primarily sulphur dioxide (SO2), particulate matter with a dry diameter of up to 2.5 µm (PM2.5) and nitrogen dioxide (NO2) exposures in the first year of life, with an adjusted IRR of 1.72 per unit increase in MPI (95% CI 1.20 to 2.47). LRTIs were not related to prenatal exposure. CONCLUSIONS: We provide evidence that ambient air pollution exposure during the first year of life increases the risk of LRTIs during the first 2 years of life. SO2, PM2.5 and NO2 were found to contribute the highest weights on health effects.

Fires as a source of annual ambient PM2.5 exposure and chronic health impacts in Europe.

Chronic exposure to ambient PM2.5 is the largest environmental health risk in Europe. We used a chemical transport model and recent exposure response functions to simulate ambient PM2.5, contribution from fires and related health impacts over Europe from 1990 to 2019. Our estimation indicates that the excess death burden from exposure to ambient PM2.5 declined across Europe at a rate of 10,000 deaths per year, from 0.57 million (95 % confidence intervals: 0.44-0.75 million) in 1990 to 0.28 million (0.19-0.42 million) in the specified period. Among these excess deaths, approximately 99 % were among adults, while only around 1 % occurred among children. Our findings reveal a steady increase in fire mortality fractions (excess deaths from fires per 1000 deaths from ambient PM2.5) from 2 in 1990 to 13 in 2019. Notably, countries in Eastern Europe exhibited significantly higher fire mortality fractions and experienced more pronounced increases compared to those in Western and Central Europe. We performed sensitivity analyses by considering fire PM2.5 to be more toxic as compared to other sources, as indicated by recent studies. By considering fire PM2.5 to be more toxic than other PM2.5 sources results in an increased relative contribution of fires to excess deaths, reaching 2.5-13 % in 2019. Our results indicate the requirement of larger mitigation and adaptation efforts and more sustainable forest management policies to avert the rising health burden from fires.

Associations between landscape fires and child morbidity in southern Mozambique: a time-series study.

BACKGROUND: Epidemiological evidence linking exposure to landscape fires to child health remains scarce. We assessed the association between daily landscape fire smoke and child hospital visits and admissions in the Manhiça district, Mozambique, an area characterised by frequent forest and cropland fires. METHODS: In this time-series analysis (2012-20), our primary metric for exposure to landscape fires was fire-originated PM2·5 from smoke dispersion hindcasts. We also assessed total and upwind fire exposure using daily satellite-derived fire density data. Daily numbers of hospital visits and admissions were extracted from an ongoing paediatric morbidity surveillance system (children aged ≤15 years). We applied quasi-Poisson regression models controlling for season, long-term trend, day of the week, temperature, and rainfall, and offsetting by annual population-time at risk to examine lag-specific association of fires on morbidity. FINDINGS: A 10 µg/m3 increase in fire-originated PM2·5 was associated with a 6·12% (95% CI 0·37-12·21) increase in all-cause and a 12·43% (5·07-20·31) increase in respiratory-linked hospital visits on the following day. Positive associations were also observed for lag 0 and the cumulative lag of 0-1 days. Null associations were observed for hospital admissions. Landscape fires mostly occurred in forested areas; however, associations with child morbidity were stronger for cropland than for forest fires. INTERPRETATION: Landscape fire smoke was associated with all-cause and respiratory-linked morbidity in children. Improved exposure assessment is needed to better quantify the contribution of landscape fire smoke to child health in regions with scarce air pollution monitoring. FUNDING: H2020 project EXHAUSTION, Academy of Finland, Spanish Ministry of Science and Innovation, Generalitat de Catalunya, and Government of Mozambique and Spanish Agency for International Cooperation and Development.

Associations between landscape fires and child morbidity in southern Mozambique: a time-series study

Background: Epidemiological evidence linking exposure to landscape fires to child health remains scarce. We assessed the association between daily landscape fire smoke and child hospital visits and admissions in the Manhiça district, Mozambique, an area characterised by frequent forest and cropland fires. Methods: In this time-series analysis (2012-20), our primary metric for exposure to landscape fires was fire-originated PM2·5 from smoke dispersion hindcasts. We also assessed total and upwind fire exposure using daily satellite-derived fire density data. Daily numbers of hospital visits and admissions were extracted from an ongoing paediatric morbidity surveillance system (children aged ≤15 years). We applied quasi-Poisson regression models controlling for season, long-term trend, day of the week, temperature, and rainfall, and offsetting by annual population-time at risk to examine lag-specific association of fires on morbidity. Findings: A 10 µg/m3 increase in fire-originated PM2·5 was associated with a 6·12% (95% CI 0·37-12·21) increase in all-cause and a 12·43% (5·07-20·31) increase in respiratory-linked hospital visits on the following day. Positive associations were also observed for lag 0 and the cumulative lag of 0-1 days. Null associations were observed for hospital admissions. Landscape fires mostly occurred in forested areas; however, associations with child morbidity were stronger for cropland than for forest fires. Interpretation: Landscape fire smoke was associated with all-cause and respiratory-linked morbidity in children. Improved exposure assessment is needed to better quantify the contribution of landscape fire smoke to child health in regions with scarce air pollution monitoring. Funding: H2020 project EXHAUSTION, Academy of Finland, Spanish Ministry of Science and Innovation, Generalitat de Catalunya, and Government of Mozambique and Spanish Agency for International Cooperation and Development.