What 2012 asthma and wheezing

WHAT YOU SHOULD HAVE READ BUT….2012

 asthma
Attilio Boner
University of
Verona, Italy

Trends in the prevalence of asthma and allergic
rhinitis in Italy between 1991 and 2010
R. de Marco, Eur Respir J 2012;39:883

Overall mean prevalence
 The same screening
questionnaire by mail
or phone.

 Random samples of the
general population
(age 20–44 yrs).

 (1991–1993; n=6,031)
(1998–2000; n=18,873)
(2007–2010; n=10,494)

Trends in the prevalence of asthma and allergic
rhinitis in Italy between 1991 and 2010
R. de Marco, Eur Respir J 2012;39:883

Overall mean prevalence
 The same screening
The asthma epidemic
questionnaire by mail
or is not over in Italy.
phone.
During the past 20 yrs,
asthma prevalence has
 Random samples of the
increased by 38%,
general population
(age 20–44 with a similar
in parallel yrs).
increase in asthma-like
symptoms and
 (1991–1993; n=6,031)
allergic rhinitis.
(1998–2000; n=18,873)
(2007–2010; n=10,494)

Effect of urbanisation on asthma, allergy and
airways inflammation in a developing country setting
Robinson Thorax 2011;66:1051
 1441 adolescents Rates of lifetime wheezing
25 -
aged 13-15 yrs enrolled
from 2 settings:
- a peri-urban shanty town 20 - 22%
in Lima (n=725);
- 23 rural villages 15 –
in Tumbes (n=716). p<0.001
 Questionnaires 10 –
asthma and allergy, 10%
environmental exposures.
05 –
 Spirometry,
exhaled nitric oxide (eNO), 0
allergy skin testing. Lima Tumbes

 1441 adolescents Boxplots of median particulate matter
aged 13-15 yrs enrolled concentrations (approximate PM2.5) in
from 2 settings: Lima and Tumbes
- a peri-urban shanty town
in Lima (n=725);
- 23 rural villages
in Tumbes (n=716).
 Questionnaires
asthma and allergy,
 Spirometry,
exhaled nitric oxide (eNO),
allergy skin testing.

Current Asthma Current Rhinitis Current Eczema
25 -

20 -
23%
15 – p<0.001

p<0.001
10 –
12% 12% 12%
p<0.001
05 – 3%
0.4%
0
Lima

Tumbes

Symptom-based classification of wheeze: how does it
work in infants? Syrjänen, JACI 2011;128:1111

• European Respiratory Society
proposed a classification % with ≥1 episode of wheezing
of wheeze into episodic viral confirmed by a physician.
and multiple-trigger wheeze. 100 –
• 160 full-term, steroid-free,
infection-free children 080 –
aged 4 to 26 months referred
for investigation of recurrent 060 –
81%
lower respiratory tract
symptoms. 040 –
• Lung function testing,
dosimetric methacholine 020 –
challenge test and
FENO measurement. 00

Forced expiratory flow at functional
% children with BHR
residual capacity (V‘max,FRC)
in multiple-trigger wheezers
and non-wheezers.
and non-wheezers.

Airway responsiveness
and non-wheezers.
and non-wheezers.
Forced expiratory flow
at functional residual
capacity (V‘max,FRC)
in multiple-trigger
wheezers
was significantly lower
than that seen
in non-wheezers.

Increased airway
% children with BHR
responsiveness
and non-wheezers.
and non-wheezers.

(the provocative dose of
methacholine causing a 40%
decrease in V‟max,FRC
[PD40 V‟max,FRC])
of 0.90 mg or less
was significantly
more common in
multiple-trigger
wheezers than
in nonwheezers.

Lung function was significantly lower and increased airway
responsiveness more(V‘max,FRC)
residual capacity common in multiple-trigger wheezers
than in non-wheezers. non-wheezers.
and
and non-wheezers.

However, there were no differences in any other
features capacity (V‘max,FRC)2 wheezing groups with similar
residual between the
prevalences of atopy,
in multiple-trigger wheezers exposure to environmental
and non-wheezers.
and non-wheezers.
tobacco smoke and FENO levels.

Moreover, the symptom-based
classification max,FRCwheeze isAirway responsiveness
residual capacity (V‘ of ) likely to change
in significantly wheezers a single calendar year.
multiple-trigger within
and non-wheezers.
and non-wheezers.

Comparison of childhood wheezing phenotypes in 2 birth
cohorts: ALSPAC and PIAMA. Savenije JACI 2011;127:1505

 Wheezing phenotypes
Phenotypes identified in the
the Avon Longitudinal
PIAMA study (Netherlands) had
Study of Parents And
wheezing patterns that
Children (ALSPAC)
were similar
(5760) and the
to those previously reported
Prevention and
in ALSPAC (Scotland) ,
Incidence of Asthma
adding further evidence
and Mite Allergy
to the existence of an
(PIAMA) study
intermediate-onset phenotype
(2810).
with onset of wheeze after 2
 Reports of wheezing years of age.
from 0 to 8 years.


 Wheezing phenotypes
Phenotypes identified in the
the Avon Longitudinal
PIAMA study (Netherlands) had
Associations with
Study of Parents And
wheezing patterns that
Children (ALSPAC)
asthma, atopy, were similar
(5760) and the lung
BHR, and to those previously reported
Prevention and
function were
Incidence of Asthma
in ALSPAC (Scotland) ,
remarkably adding further evidence
and Mite Allergy
to the existence of an
(PIAMA) studyin the
similar
intermediate-onset phenotype
(2810). 2 cohorts.
with onset of wheeze after 2
 Reports of wheezing years of age.
from 0 to 8 years.


Estimated prevalence of wheeze Estimated prevalence of wheeze
at each time point from birth to at each time point from birth to
age 8 years for each wheezing age 8 years for each wheezing
phenotype in ALSPAC free 6-class phenotype in PIAMA optimal
model (N = 5760). 5-class model (N = 2810).

Exclusive viral wheeze and allergic wheeze: evidence for
discrete phenotypes Strippoli ERJ 2011;38:472

 Leichestershire Cohort
Studies.
 Children recruited in For each age , we assessed
1998 at an age associations between the
of 1-4 yrs. three classes of triggers
 Followed up in 1999, using log-linear models:
2001, 2003 and 2006. A. exercise and allergens,
 Questions about B. exercise and infection;
respiratory symptoms C. allergens and infection.
during the previous 12
months and

Exclusive viral wheeze and allergic wheeze: evidence for
discrete phenotypes Strippoli ERJ 2011;38:472

Our findings provide support for
an old concept proposing that
infection and allergy can cause
airway narrowing
in susceptible individuals, either
by acting directly
(as trigger factors) or by
induction of bronchial
hyperresponsiveness
Triggers and inducers:
(as inducing factors).
model of possible mechanisms.
BHR: bronchial Exercise, in contrast, is merely a
hyperresponsiveness, trigger, which leads to airway
#: in susceptible individuals. narrowing only in the presence of
bronchial hyperresponsiveness
caused by other factors.

Different inflammatory phenotypes in adults and children
with acute asthma Wang ERJ 2011;38:567

 Adults with stable (n=29)
or acute (=22) asthma. The asthma phenotype
was predominantly
 Healthy adults (n=11).
eosinophilic in children
 Children with stable with acute asthma (50%)
(n=49) or acute (n=28) but neutrophilic in
asthma.
adults with acute
 Healthy children (n=9). asthma (82%).
 Sputum induction.

Proportion of neutrophils and eosinophils for adults
and children with asthma.

Neutrophils Neutrophils
in adult in
population. paediatric
group.

Eosinophils
Eosinophils
in
in adult
paediatric
population.
group.

AAA: adults with acute asthma, ASA: adults with stable asthma, HC: healthy controls,
CAA: children with acute asthma, CSA: children with stable asthma, CHC: child health control.

Possible explanations
for the eosinophil
response seen in CAAs
in adult in
population. allergen exposure,
include paediatric
less maintenance group.
corticosteroid therapy
or a different response Eosinophils
Eosinophils to triggers
in
in adult
of
population. acute asthma. paediatric
group.

AAA: adults with acute asthma, ASA: adults with stable asthma, HC: healthy
controls, CAA: children with acute asthma, CSA: children with stable

The mixed
eosinophil–neutrophil
responses in CAAs
in suggest that concurrent
adult in
population. paediatric
exposure to multiple group.
triggers (e.g. allergens
and virus infection) may
Eosinophils an explanation
be Eosinophils
in
in adult the inflammatory
for paediatric
population.
response observed. group.

AAA: adults with acute asthma, ASA: adults with stable asthma, HC: healthy controls,
CAA: children with acute asthma, CSA: children with stable asthma, CHC: child health control.

Relation of early childhood growth and wheezing
phenotypes to adult lung function
Sherrill Pediatr Pulmonol 2011;46:956

•Weight growth (between 3
 Participants in the Tucson and 6 years) was positively
Children's Respiratory associated with higher levels
Study. of FVC at age 16 and
 Pulmonary function assessed 22 years (P = 0.0001) among
at ages 16 and 22. subjects who did not have
preschool wheezing.
 Longitudinal models were •However, this association was
used to determine completely absent among
predictors of FVC and FEV1 subjects who had wheezing
at ages 16 and 22 years. lower respiratory tract
illnesses in the first 3 years
of life.

Relation of early childhood growth and wheezing
phenotypes to adult lung function
Sherrill Pediatr Pulmonol 2011;46:956

•Weight growth (between 3
 Participants in the Tucson and 6 years) was positively
Children's Respiratory associated with higher levels
The rate of weight gain
Study. of FVC at age 16 and
between 3 and 6 yrs is
significantly positively
 Pulmonary function assessed 22 years (P = 0.0001) among
at ages 16 and 22. FVC
related to adult subjects who did not have
and FEV1 and this preschool wheezing.
association is modified
 Longitudinal models were •However, this association was
by early wheezy
used to determine completely absent among
phenotypes.
predictors of FVC and FEV1 subjects who had wheezing
at ages 16 and 22 years. lower respiratory tract
illnesses in the first 3 years
of life.

Factors influencing asthma remission: a longitudinal
study from childhood to middle age
Burgess Thorax 2011;66:508
% patients with asthma remission
80 –
 In 1968 the Tasmanian
Longitudinal Health Study 70 –
enrolled 7-year-old

65%
60 –
schoolchildren (n=8583).
50 –
 Re-surveyed in 2004.
40 –
 Asthma remission, defined as 30 –
no asthma attack for 2 years
20 –
and no current asthma
medication. 10 –

0


OR for remission
1.0 –

0.75
0.5 – 0.66 0.66 0.66
0.56
0.42
0.38

0.0 childhood passive
childhood later-onset childhood later-onset maternal
allergic rhinitis allergic rhinitis eczema eczema asthma chronic bronchitis smoking


OR for remission.
Childhood-onset asthma (OR=3.76)
1.0 –
was more likely to remit than
adult-onset asthma
0.75
0.5 – 0.66 0.66 0.66
0.56
0.42
0.38

0.0 childhood passive
childhood later-onset childhood later-onset maternal
allergic rhinitis allergic rhinitis eczema eczema asthma chronic bronchitis smoking


Conclusion

While inherited factors cannot be changed,
the effect of allergic rhinitis or eczema
on asthma remission might be altered by early,
aggressive treatment.

Every effort should be made to lessen
passive exposure to tobacco smoke.

Pet shop workers: exposure, sensitization, and
work-related symptoms. Renström A, Allergy 2011;66:1081
% subjects presenting
60 -

53%
50 –

 Subjects (n = 59) from
40 –
24 pet shops.

 Questionnaire and lung
30 –
34%
function tests and skin
prick tests.
20 –
22%
10 –

0
nasal eye asthma
symptoms

% subjects presenting
60 -

53%
50 –
However,only
40 –
24 pet shops. (7%)
4 workers
were previously 30 –
34%
diagnosed with
asthma
prick tests
20 –
22%
10 –

0
nasal eye asthma
symptoms


% subjects sensitized to
work-related allergens
30 –

24 pet shops.
29%
20 –
prick tests 10 –

0


% subjects sensitized to
work-related allergens

The findings stress 30 –
the importance of
24 pet shops. the
improving 29%
knowledge of 20 –
health risks and
allergen avoidance
measures among
prick tests 10 –
pet shop staff

0

EAACI Position Paper: Prevention of work-related
respiratory allergies among pre-apprentices or apprentices
and young workers Moscato G, Allergy 2011;66:1164

 The physician in charge for the baseline health assessment should
discuss the results with the young adult helping her/him in making
the professional choice.

 The young adult should be educated to adopt all preventive measures
to limit occupational exposure to potential allergens and respiratory
irritants and to recognize and report immediately all possible
symptoms suggestive of onset of work-related respiratory allergies
or work-related exacerbations.

 Medical surveillance should be prioritized in the
first 2–3 years of exposure and scheduled according
to the clinical profile, exposure details, and
reliability of available tests.

Familial aggregation of allergen-specific sensitization and
asthma Kurzius-Spencer, Pediatr Allergy Immunol 2012;23:21

 1151 families in the Crude estimates of
Tucson Children‟s parent–offspring (P–O)
Respiratory Study and and sibling correlations
435 families in the 2.26%
were statistically
Tucson Epidemiological significant for most
Study of Airway
allergens, ranging from
Obstructive Disease
0.03 to 0.29
 SPTs
 Physician-diagnosed
asthma at age ≥8 yr

Familial aggregation of allergen-specific sensitization and
asthma Kurzius-Spencer, Pediatr Allergy Immunol 2012;23:21

Sibling correlations for
 1151 families in the specific response to
Tucson Children‟s allergens were
Respiratory Study and consistently higher than
435 families in the 2.26%
parent–offspring (P–O)
Tucson Epidemiological
correlations, but this
Study of Airway
difference was significant
Obstructive Disease
only for dust mite and
 SPTs weed mix
 Physician-diagnosed
asthma at age ≥8 yr

African ancestry, early life exposures and
respiratory morbidity in early childhood.
Kumar, Clin Exp Allergy 2012;42:265

Background Racial disparities persist in early childhood
wheezing and cannot be completely explained by known
risk factors.
Objective To evaluate the associations of genetic
ancestry and self-identified race with early childhood
recurrent wheezing, accounting for socio-economic
status (SES) and early life exposures.


% of children with
recurrent wheezing
1034 children in an urban, 10, –
multi-racial, prospective
7,5 –
birth cohort in USA.
Genetic ancestry. 5,0 – 6.1%
Recurrent wheezing. 2,5 –

0


OR for recurrent wheezing
01.5 –

1034 children in an
urban, multi- 01.0 –
1.17
racial, prospective birth
cohort in USA. 0.84
00.5 – p=0.005
Genetic ancestry. p=0.004

Recurrent wheezing.
00.0
African European
ancestry ancestry


OR for recurrent wheezing
01.5 –
Genetic ancestry may be
1034 children into evaluate
a powerful way an urban,
wheezing disparities
multi-racial, prospective 01.0 – 1.17
birth cohortain USA.
and proxy
for differentially distributed 0.84
Genetic ancestry. life 00.5 –
genetic and early
p=0.005
risk factors associated p=0.004
Recurrent wheezing.
with childhood
recurrent wheezing.
00.0
African European
ancestry ancestry

Maternal obesity during pregnancy as a risk for
early-life asthma. Lowe, JACI 2011;128:1107

 Data from Swedish
national registers. % of mothers
25 –
 All children
(189783 children born
20 –
to 129239 mothers). 20.1%
 Maternal BMI at each 15 –
pregnancy at 8-10 weeks
after conception. 10 –
 Asthma medication
of ≥1 prescription 05 – 7.2%
of inhaled steroids
or montelukast. 00
OBESE OVERWEIGHT
 Hospital admission BMI ≥30 Kg/m2 BMI 25-29.9 Kg/m2
for asthma.


OR for asthma medication in children
1.5 –

1.16 1.36 1.46
1.0 –
1.0

0.5 –

00
18.5-24.9 25.0-29.9 30.0-34.9 ≥35
MATERNAL BMI (Kg/m2)


OR for asthma medication in children
1.5 –

1.16 1.36 1.46
1.0 –
1.0

0.5 –
If the association between maternal BMI
and asthma risk in the child is causal in nature,
00
it might explain between 11% and 13%
18.5-24.9 25.0-29.9 30.0-34.9 ≥35
of childhoodBMI (Kg/m2)
MATERNAL asthma.

Oral contraceptive pill use before pregnancy
and respiratory outcomes in early childhood
Hancoc Pediat Allergy Immunol 2011;22:528

 OCP use before pregnancy. •Combined pills
were used much
 Lower respiratory tract more commonly than
infections in 60,225 children progestin-only pills.
followed to 6 months old.
•Taking combined pills
 Wheezing in 42,520 children before pregnancy was
followed to 18 months not associated with
old, and asthma in 24,472 lower respiratory tract
children followed to infections, wheezing,
36 months old. or asthma.

Oral contraceptive pill use before pregnancy
and respiratory outcomes in early childhood
Hancoc Pediat Allergy Immunol 2011;22:528

Progestin-only pill
 OCP use before pregnancy. •Combined pills
were used much
use in the year more commonly than
 Lower respiratory tract
before pregnancy
infections in 60,225 children progestin-only pills.
had a slight
positive association •Taking combined pills
 Wheezingwheezing children
with in 42,520 at before pregnancy was
followed to 18 months old, not associated with
6-8 months old lower respiratory tract
and asthma in 24,472 children
aOR =1.19 infections, wheezing,
or asthma.

Prenatal or Early-Life Exposure to Antibiotics and Risk
of Childhood Asthma: A Systematic Review
Murk Pediatrics 2011;127:1125

OR for asthma if exposed to
 Studies published 3 –
antibiotic in the first yr of life
between 1950 and
July 1, 2010, that
assessed associations 2 –
between antibiotic 2.04
exposure during
1.52 1.25
pregnancy or in the 1 –
first year of life
and asthma at
ages 0 to 18 yrs. 0
all studies retrospective prospective
studies studies


 Studies published 3 –
between 1950 and
Risk estimate
July 1, 2010, that
assessed studies
for associations
2 –
between adjusted
that antibiotic 2.04
for respiratory
exposure during
1.52 1.25
pregnancy or in the
infections is 1 –
first year 1.16
OR of life
and asthma at
ages 0 to 18 yrs. 0
studies studies


 Studies published to
Antibiotics seem 3 –
between 1950 and
slightly increase
July 1, 2010, that
the risk of
assessed associations
childhood asthma. 2 –
between antibiotic
Reverse causality and 2.04
exposure during
protopathic bias seem
1.52 1.25
pregnancy possible
to be or in the 1 –
first year of life
confounders for
and asthma at
this relationship.
ages 0 to 18 yrs. 0
studies studies

Infant antibiotic use and wheeze and asthma risk:
a systematic review and meta-analysis
Penders ERJ 2011;38:295

2 – OR for
wheeze/asthma

 18 longitudinal studies.

 Effect of antibiotic use
on wheeze/ asthma.
1 –
1.27
0
Early antibiotic
use

Infant antibiotic use and wheeze and asthma risk:
a systematic review and meta-analysis
Penders ERJ 2011;38:295

When we eliminated OR for
2 –
studies with possible wheeze/asthma
reverse causation
 18 longitudinal studies.
and respiratory tract
infections leading
 Effect of antibiotic use
to antibiotic use,
on wheeze/ asthma.
the pooled risk estimate
1 –
1.27
was attenuated
to OR 1.12. 0
Early antibiotic
use

First- and Second-Trimester Fetal Size and Asthma
Outcomes at Age 10 Years
Turner AJRCCM 2012;184:407

Rationale
Greater early fetal size is associated with reduced
asthma risk and improved lung function in early childhood.

Objectives
To test the hypothesis that associations between
early fetal size, asthma symptoms, and lung function persist
into later childhood.


% reduction % increase
927 children. in risk in FEV1
First- and second-trimester +10 – of asthma
fetal measurements.
+6%
++5 –
At 10 years of age:
+00 –
respiratory questionnaire
spirometry, --5 – -6%
bronchial challenge, and
skin prick testing. -10 –
For each millimeter increase

-6%
in first trimester size.


OR for Asthma
3.0 –
927 children.
First- and second-trimester
2.5 – 2.8
fetal measurements. 2.0 –

At 10 years of age: 1.5 –
respiratory questionnaire 1.0 –
spirometry,
bronchial challenge, and 0.5 -
skin prick testing. 0.0
Persistent low growth in
I and II trimesters compared
with persistent high growth.


OR for Asthma
3.0 –
927 children.
Reduced fetal size
First- and second-trimester
2.5 – 2.8
from the I trimester
fetal measurements. 2.0 –
is associated with
At 10increased risk
years of age: 1.5 –
respiratory questionnaire
for asthma and 1.0 –
spirometry,
obstructed lung 0.5 -
bronchial challenge, and
function in childhood.
skin prick testing. 0.0
Persistent low growth in
I and II trimesters compared
with persistent high growth.

Is large birth weight associated with asthma risk in
early childhood?
To, Arch Dis Child 2012;97:169

 All single live birth Compared with
(n=687194) born normal-birth-weight
between 1 April 1995 and infants,
31 March 2001
large-birth-weight infants
 Followed until their 6th (2.3% of total) had a
birthday slightly
 Birth weight was lower risk of developing
categorized as asthma by age 6 after
low (<2.5 kg), adjusting
normal (2.5-4.5 kg), for confounders
large (4.6-6.5 kg) and (adjusted RR = 0.90)
extremely large (>6.5 kg)

early childhood?

 All single live birth
(n=687194) born
between 1 April 1995 and There was a trend
31 March 2001 towards
 Followed until their 6th increased risk of
birthday asthma
 Birth weight was among extremely
categorized as large-birth-weight
low (<2.5 kg), infants
normal (2.5-4.5 kg), (RR = 1.21)
large (4.6-6.5 kg) and

early childhood?

 All single live birth
(n=687194) born
Interventions to
between 1 April 1995 and There was a trend
reduce the
31 March 2001 towards
incidence of increased risk of
 Followed untillarge 6th
extreme their
birthday weight
birth
asthma
 Birthmay help to
weight was among extremely
categorized as risk
reduce the large-birth-weight
of asthma
low (<2.5 kg), infants
normal (2.5-4.5 kg), (RR = 1.21)
large (4.6-6.5 kg) and

early childhood?

Adjusted RRs of incidence of asthma, asthma hospitalisation and asthma
emergency departments visits

Also low-birth-weight is associated with an
increased risk of asthma

Low birth weight and respiratory hospitalizations
in adolescence Walter Pediatr Pulmonol 2011;46:473

Estimated cumulative incidence of
 A population-based hospitalization for respiratory illness as
a function of birth weight category
retrospective cohort study
using birth certificates
from 1987 to 1994 to
identify exposed
(low birth weight) and
unexposed (normal birth
weight) subjects.

 Moderately-low-birth weight
(1,500–2,499 g) and
very- low-birth weight The cumulative incidence of hospitalization
increases with decreasing birth weight
(<1,500 g).


Adjusted Hazard Ratios for Hospitalization for Specific Respiratory
Diagnoses in Adolescence as a Function of Birth Weight

1Adjusted for birth year, sex, maternal age, race, income, marital status, and smoking status


Adjusted Hazard Ratios for Hospitalization for Specific Respiratory
Diagnoses in Adolescence as a Function of Birth Weight

Low birth weight was associated with an increased
risk of respiratory hospitalizations in adolescence.
Comorbidities explained some of this risk.
However, low birth weight remained independently
associated with an increased risk of hospitalization.

1Adjusted for birth year, sex, maternal age, race, income, marital status, and smoking status


During adolescence Hazard Ratios for hospitalization for

Asthma Respiratory
Infections
4 –
3.76
3 –

2 –
1.99
1.18 1.04
1 –

0
NBW MLBW VLBW NBW MLRW VLBW

Association of late pre-term birth with asthma
in young children: practice-based study
Goyal, Pediatrics 2011;128:e830
% children with a diagnosis of
asthma at age 18 mo.
10 –
 Retrospective cohort
study.
 7925 born in 2007
05 –
8.3%
at 34 to 42 weeks of
gestation.
 Monitored from birth
to 18 months.
00

Proportions of asthma-related outcomes
according to gestational-age category
compared with the reference group
at 39 to 42 weeks of gestation (p <0.05).
 Retrospective cohort
study.
 7925 born in 2007
gestation.
to 18 months.

at 39 to 42 weeks of gestation (p <0.05).
 Retrospective cohort Term infant
study. Low-normal
gestation
 7925 born in 2007
at 34 to 42 weeks of Late pre-term
gestation.
to 18 months.

Birth at late-preterm at 39 to 42 weeks of gestation (p <0.05).
and low-normal
 Retrospective cohort Term infant
gestational ages might
study. Low-normal
be an important risk gestation
 7925 born in 2007
factor for the
development of asthma Late pre-term
gestation. increased
and for
 Monitoredservice use
health from birth
to in early childhood.
18 months.

Maternal exposure to magnetic fields during pregnancy in
relation to the risk of asthma in offspring
Li APAM 2011;165:945
Kaplan-Meier estimates of asthma
risk by maternal magnetic field (MF)
 626 children with exposure level during pregnancy
asthma.
0.95
 Followed up for 13
years.

 A meter to measure
their MF levels
(mobile phone,
wireless connections)
during pregnancy.

Li APAM 2011;165:945
Kaplan-Meier estimates of asthma
risk by maternal magnetic field (MF)
Every 1- milligauss
 626 children with of exposure level during pregnancy
(mG) increase
asthma.
maternal MF level 0.95
during pregnancy
was associated with
years.
a 15% increased
 A meter of measure
rate to asthma
their MF levels
in offspring
during pregnancy.
(adjusted hazard
ratio 1.15)

Li APAM 2011;165:945

aHR for asthma
4 –
 626 children with
asthma.
3 –
3.52
0.95
years. 2 –

1 –
1.74
their MF levels
(mobile 1
phone, wireless 00
≤0.3 mG >0.3-2.0 mG >2.0 mG
connections) during
magnetic field exposure during pregnancy (MF level)
pregnancy.

Li APAM 2011;165:945

aHR for asthma
4 –
High maternal
asthma.
Magnetic Fields 3 –
3.52
0.95
levels in
pregnancy may
years. 2 –
increase the
 Arisk of asthma
meter to measure
1 –
1.74
their MF levels
in offspring. 1
(mobile phone,
wireless connections) 00
≤0.3 mG >0.3-2.0 mG >2.0 mG
during pregnancy.

Li APAM 2011;165:945

gene expression aHR for asthma
4 –
or changes in
asthma. repair
DNA 3 –
3.52
0.95
 Followedresult 13
may up for by
years. exposures.
MF 2 –

1 –
1.74
their MF levels
(mobile 1
phone, wireless 00
≤0.3 mG >0.3-2.0 mG >2.0 mG
connections) during
pregnancy.

A recurring question. Are there health effects of
power-frequency magnetic fields?
Editorial APAM 2011;165:959

• An ongoing scientific and public debate has raged over the
possibile health effects of power-frequency (50-60 Hz)
magnetic fields (MFs).

• Comprehensive scientific reviews conducted by various
agencies, all have found that power-frequency MFs may play a
role in childhood disorders but were unable to establish a
mechanism or animal model to definitively support their
findings.


• Prolonged exposure of children to MFs higher than a threshold
of about 4 milligauss is associated with an approximate
2-fold elevation in leukemia risk.

• Li et al (APAM 2011;165:945) provide us with evidence of a
somewhat novel and relatively understudied helath effect
associated with MFs: an association with childhood asthma.


• Prolonged exposure of children to MFs higher than a threshold
of about The potentialassociatedhealth
4 milligauss is public with an approximate
implications of this work are
2-fold elevation in leukemia risk.
significant since
MF exposures are widespread,
• Li et al (APAM 2011;165:945) provide women evidence
affecting about 14% of us with in of a
somewhat novel and relatively understudied helath effect
associated with MFs: an association withasthma asthma.
the United States, and childhood is
a relatively common disease.

Perinatal
Protective
factors

Mode and place of delivery, gastrointestinal microbiota
and their influence on asthma and atopy
Nimwegen, JACI 2011;128:948
In children with colonization by
 Birth Cohort Study. Clostridium difficile at age 1 mo
OR for
 Birth characteristics, 3.0 –
lifestyle factors.
 Atopic manifestations.
2.0 -
 Fecal samples at age 1 mo 2.06 1.43
(n= 1176) to determine
microbiota composition. 1.0 –

 Blood samples
at ages 1, 2, and 6 to 7 yrs to
00
determine specific IgE levels. Asthma at Eczema
age 6-7 yrs

In children with vaginal home
 Birth Cohort Study. delivery compared with vaginal
hospital delivery OR for
 Birth characteristics,
lifestyle factors.
1.0 –
 Fecal samples at age 1 mo 0.84
0.59 0.61
(n= 1176) to determine 0.5 –
microbiota composition.
 Blood samples
00
at ages 1, 2, and 6 to 7 yrs to Asthma at sIgE to Eczema
determine specific IgE levels. age 6-7 yrs foods

After stratification
for parental history hospital delivery OR for
of atopy,
lifestyledecreased risk
the factors. 1.0 –
of sensitization
to food allergens 0.84
 Fecal samples at age= 10.52)
(adjusted odds ratio mo
0.61
and asthma (aOR = 0.47)
0.5 – 0.59
among vaginally
 Blood samples infants
home-born
wasages 1, 2, and 6 to 7 yrs to
at only found for children 00
Asthma at sIgE to Eczema
with atopic parents.

hospital delivery OR for
Mode and place
lifestyle factors.affect
of delivery 1.0 –
the gastrointestinal
microbiota composition, 0.84
 Fecal samples at age 1 mo
which subsequently 0.61
influences the risk 0.5 – 0.59
of atopic
 Blood manifestations.
samples
00
at ages 1, 2, and 6 to 7 yrs to Asthma at sIgE to Eczema

Duration and exclusiveness of breastfeeding and
childhood asthma-related symptoms
Sonnenschein-van der Voort, Eur Respir J 2012;39:81

OR in children never-breastfed
 Prospective cohort vs those breasfed for 6 months for
study of 2 –
5,368 children.

 Breastfeeding 1.57
duration. 1.44 1.26
1 – 1.25
 Wheezing,
shortness of breath,
dry cough and
persistent phlegm
by questionnaires. 0
shortness persistent
wheezing dry cough
of breath phlegma


 Prospective cohort vs those breasfed for 6 months for
study ofstrongest
The 2 –
5,368 children.
associations
per symptom
 Breastfeeding
per year were 1.57
duration.
observed for 1.44 1.26
wheezing at
1 – 1.25
 Wheezing,
1 and 2 yrs
dry cough and
persistent phlegm
wheezing dry cough
of breath phlegma


Shorter duration of
 Prospective cohort
breastfeeding were vs those breasfed for 6 months for
associated with
study of 2 –
5,368 children. of
increased risks
asthma-related
 Breastfeedingpreschool
symptoms in
children. 1.57
duration. associations 1.44 1.26
These
seemed, at least 1 – 1.25
 Wheezing, be explained
partly, to
by infectious,
dry but notand atopic
cough by
persistent phlegm
mechanisms
wheezing dry cough
of breath phlegma

Folic Acid Use in Pregnancy and the Development of
Atopy, Asthma, and Lung Function in Childhood
Magdelijns Pediatrics 2011;128:e144

 KOALA Birth Cohort •Maternal folic acid
Study (n=2834). supplement use during
 Data on eczema pregnancy was not associated
and wheeze at with increased risk of wheeze,
3, 7, 12, and 24 months, lung function, asthma, or
4 to 5 years, and related atopic outcomes in the
6 to 7 years. offspring.
•Maternal ICF level in late
 Intracellular folic acid pregnancy was inversely
(ICF) determined in
associated with asthma risk at
blood samples taken at
~35 weeks of pregnancy age 6 to 7 years in a
(n=837). dose-dependent manner
(p for trend =0.05).


 KOALA Birth Cohort not
Our results do •Maternal folic acid
confirm the mouse model of
Study (n=2834). supplement use during
any meaningful association pregnancy was not associated
 Data between folic acid
on eczema
andsupplement use during
wheeze at with increased risk of
3, 7, 12, and 24and atopic
pregnancy
wheeze, lung
months, in the offspring.
diseases 4 function, asthma, or related
to 5 years, and
Higher ICF levels atopic outcomes in the
6 toin pregnancy tended,
7 years. offspring.
at most, toward a small
 Intracellular folic acid
•Maternal ICF level in late
decreased risk pregnancy was inversely
(ICF) determined in
for developing associated with asthma risk at
blood samples taken at
asthma. age 6 to 7 years in a
~35 weeks of pregnancy
(n=837). dose-dependent manner


Prevalence of wheeze (A) and eczema (B) at different ages


OR for asthma at 6-7 yrs
1.0 –
1.0
p<0.005 for trend
0.73
0.5 –
0.46 0.41
0.31
0.0
1st Quintile 2nd Quintile 3rd Quintile 4th Quintile 5th Quintile
(≤ 480 nmol/L) (481–643 (644–862 (863–1139 (≥ 1140 nmol/L)
nmol/L) nmol/L) nmol/L)
Intracellular folic acid Levels (Divided Into Quintiles)

Maternal depression related to infant‘s wheezing
Lefevre Pediat Allergy Immunol 2011;22:608

In cases vs controls OR
 136 cases aged for maternal
2.0 –
<36 mo suffering
from wheezing and
1.5 –
1.98
matched healthy
controls.
1.55
1.0 –
 State Trait Anxiety
Inventory and the 0.5 –
Beck Depression
Inventory short 0
Depression Anxiety
form.
During pregnancy


OR for maternal depression
 136 cases aged in wheezers vs controls
<36 mo suffering 7.0 –

from wheezing and
matched healthy
6.0 –

5.0 –
6.7
controls. 4.0 –

3.0 –
2.2
Beck Depression 1.0 –

Inventory short 0.0
Mild Moderate-Severe
form.
Depression


OR for severe wheezing
5.0 –
 136 cases aged
<36 mo suffering
from wheezing and
4.0 –
4.25
matched healthy 3.0 –
controls.
2.0 –
Beck Depression 1
Inventory short 0.0
form.
Mother
Depression


OR for severe wheezing
5.0 –
 136 cases aged
<36 mo suffering
from wheezing and
4.0 –
4.25
It is important
matched healthy 3.0 –
controls. depressive
assess
symptoms in 2.0 –
 Statemothers of
Trait Anxiety
Inventory and the
infants with 1.0 –
Beck Depression
asthma. 1
Inventory short 0.0
form.
Mother
Depression

State-trait Anxiety
Inventory State
How do you feel RIGHT
NOW, at this moment:
1, not at all; 2, somewhat;
3, moderate; 4, very much.

Beck
Depression
Inventory
short form.

Relationship between maternal demoralization, wheeze,
and immunoglobulin E among inner-city children
Reyes Ann Allergy Asthma Immunol 2011;107:42
Mean prenatal demoralization
score on wheeze presentations
within the first 5 years of a
child's life.
 Women aged 18 to 35 years p<0.05
p<0.05
residing in New York City.

 Maternal demoralization
(ie, psychological distress).

 Questionnaire and total and
indoor allergen sIgE
(at birth and ages
2, 3, and 5
years).


Maternal Demoralization
Maternal demoralization was measured by the 27-item PERI-D scale at every visit (5
repeated measures). The PERI-D is a composite of 8 domains (perceived physical
health, sadness, poor self-esteem, dread, anxiety, confused thinking,
hopelessness/helplessness, and psychophysiological symptoms) encompassing the single
construct of demoralization. 21,27 Each question was rated on a 5-point Likert scale
(scored 0 to 4), where a higher score indicated greater psychological distress, and
queried about symptoms within the last year. Developed for epidemiologic research in
community samples and validated in a New York City sample, the PERI-D demonstrates
adequate internal consistency in minority and Spanish-speaking immigrant populations
(Cronbach α of 0.91 for African Americans, 0.93 for English-speaking Mexican
Americans, and 0.95 for Spanish-speaking Mexican Americans).22,27
21. Clarke DM, Kissane DW. Demoralization: its phenomenology and importance.
Aust N Z J Psychiatry. 2002;36:733–742. [PubMed]
27. Dohrenwend BP, Shrout PE, Egri G, Mendelsohn FS. Nonspecific psychological
distress and other dimensions of psychopathology: measures for use in the general
population. Arch Gen Psychiatry. 1980;37:1229–1236.

A model of
demoralization.

Clarke DM, Kissane
DW. Demoralization:
its phenomenology and
importance. Aust N Z
J Psychiatry.
2002;36:733–742.

Clarke DM, Kissane DW. Demoralization: its phenomenology
and importance. Aust N Z J Psychiatry. 2002;36:733–742.

Mean prenatal demoralization
score on wheeze presentations
within the first 5 years of a
child's life.
 Women aged 18 to 35 years p<0.05
p<0.05
residing this inner-city
In in New York City.
cohort, prenatal
 Maternal demoralization
demoralization was
(ie, psychological distress).
associated with
transient and
 Questionnaire and total and
indoor allergen wheeze. IgE
persistent specific
(at birth and ages 2, 3,
and 5 years).

Parental Stress Increases the Detrimental Effect of
Traffic Exposure on Children‘s Lung Function
Islam AJRCCM 2012;184:822

Rationale
Emerging evidence indicates that psychosocial stress enhances
the effect of traffic exposure on the development of asthma.

Objectives
We hypothesized that psychosocial stress would also modify the
effect of traffic exposure on lung function deficits.


Pollutant effects
were significantly larger in
1,399 participants in the the high-stress compared with
Southern California lower-stress households
Children‟s Health Study. (interaction P value = 0.007 and
Lung function testing 0.05 for residential and
(mean age, 11.2 yr). school total oxides of nitrogen
(Nox), respectively).
Traffic-related
air pollution and stress. No significant NOx effects
were observed in children from
low-stress households.

Effect of traffic related pollution on lung function measurements, stratified by parental
stress level (low or high)*

Definition of abbreviations: CI = confidence interval; MMEF = FEF25–75; NO = nitric oxide; NO2 = nitrogen dioxide; NOx = total oxides of
nitrogen.
* Models adjusted for log height and square term for log height, body mass index and square term for body mass index, sex, age, age–sex
interaction, race, Hispanic ethnicity, respiratory illness at time of lung function, field technician, and community. Percent (%) change was
scaled to 2 SD (NOx = 21.8 ppb; NO = 16.2 ppb; and NO2 = 7.3 ppb) of the TRP difference between home and school (averaged across
schools).

Psychological Stress: A Social Pollutant That May
Enhance Environmental Risk Wright AJRCCM 2012;184:752

Psychological factors influence the programming of neuroendocrine,
autonomic, and immune inflammatory processes implicated in respiratory
development.
Psychological stress is conceptualized as a social pollutant that, when
“breathed” into the body, disrupts biological systems overlapping with
those altered by physical pollutants and toxicants
(e.g., immune and nonimmune inflammatory processes).
Under stress, physiological systems may operate at higher or lower
levels than in normal homeostatic conditions.
Disturbed regulation of stress systems (e.g., hypothalamic-pituitary-
adrenal [HPA] axis, autonomic nervous system) may modulate immune
function leading to increased airway inflammation, remodeling, and
altered airway reactivity.

Resilience in low-socioeconomic-status children
with asthma: adaptations to stress.
Chen, JACI 2011;128:970

Background:
Low socioeconomic status (SES) is a strong predictor of many
health problems, including asthma impairment;
however, little is understood about why some patients defy this trend
by exhibiting good asthma control despite living in adverse
environments.
Objective:
This study sought to test whether a psychological characteristic,
the shift-and-persist strategy (dealing with stressors by reframing
them more positively while at the same time persisting in optimistic
thoughts about the future), protects low-SES children with asthma.

Chen, JACI 2011;128:970

Chen, JACI 2011;128:970

 121 children aged 9 to 18 yrs
with asthma.
1) „„I thought about the
 Shift-and-persist scores.
things I was learning
 The tendency to shift oneself from the situation or
in response to stressors about something good
was measured by using the
that would come from it‟‟.
Cognitive Restructuring scale
of the Responses to Stress
questionnaire. 2) „„I always feel good about
Smith, J Consult Clin Psychol 2000;68:976. my future‟‟.
 Higher scores indicated a higher
tendency to positively reappraise
stressful situations.

Chen, JACI 2011;128:970

with asthma. Children
who came from
low-SES backgrounds
 The tendency to shift oneself but who engaged in
in response to stressors shift-and-persist strategies
displayed less asthma
inflammation at baseline
questionnaire. (p <0.05)
Smith, J Consult Clin Psychol 2000;68:976. as well as
less asthma impairment
(p <0.01)
stressful situations. at the 6-mo period.

Chen, JACI 2011;128:970

with asthma. Children
In
who came from
contrast, low-SES backgrounds
 The tendency to shift oneself but who engaged in
shift-and-persist
in response to stressors shift-and-persist strategies
strategies
displayed less asthma
were not beneficial
inflammation at baseline
among high-SES
questionnaire. (p <0.05)
as well as
children with
Smith, J Consult Clin Psychol 2000;68:976.
less asthma impairment
asthma.
(p <0.01)
stressful situations. at the 6-mo period.

Salivary cortisol levels and allergy in children: The
ALADDIN birth cohort. Stenius, JACI 2011;128:1335

Background:
Pre- and postnatal stress have been related to allergy in children,
but evidence from prospective studies is limited.
Several environmental factors can influence
the salivary cortisol level, which is used as a measure of activity
of the hypothalamic-pituitary-adrenal axis.
Objective:
The aim of this study was to assess the association between
salivary cortisol levels at 6 months of age and allergic manifestations
during the first 2 years of life.


Geometric mean of
salivary cortisol (nmol/L)
15 –
 Salivary samples
for cortisol level at 6 mo 11.7
on 3 occasions during 1 day. 10 –

 203 children.
 Blood samples 5.1
05 –
at 6, 12, and 24 mo 2.9
for specific IgE.
0
Morning Afternoon Evening


Geometric mean of
Salivary cortisol levels salivary cortisol (nmol/L)
on all sampling occasions 15 –
were related
 Salivary samples to the
prevalence of
for cortisol level at 6 mo 11.7
on 3 occasions and eczema 10 –
sensitization during 1 day.
during the first 2 yrs of
 203 children.life,
with increasing levels
 Blood samples leading to 5.1
05 –
of cortisol
at 6, 12, and 24 mo of
higher prevalence 2.9
for specific IgE. and
sensitization
eczema. 0
Morning Afternoon Evening

OR and 95% CI for allergic sensitization and
allergy-related disease during the first 2 yrs in
relation to the saliva cortisol level in 6 mo-olds
at different time points of the same day.

 Salivary samples
for cortisol level at 6 mo
on 3 occasions during 1 day.
 203 children.
 Blood samples
at 6, 12, and 24 mo
for specific IgE.

at different time points of the same day.
An association
 Salivary samples and
between pre-
for postnatal stress mo
cortisol level at 6
and subsequent
development of
 203 children.
allergic diseases
 Blood samples
has previously been
at 6, 12, and 24 mo
indicated …
for specific IgE.

… furthermore, at different time points of the same day.

 Salivary samplesshown
it has been
for cortisol infants 6 mo
that level at
predisposed
to allergic disease
 203 children. levels
have higher
of cortisol
 Blood samples
prior 24 mo
at 6, 12, and to the
foronset ofIgE.
specific disease.

Stressful life events and the onset of asthma
Lietzén ERJ 2011;37:1360
HR for new asthma
 Prospective, onset
population-based 2 –
cohort study.
 16.881 males and females,
aged 20-54 yrs 1.96
and free of diagnosed 1 –
asthma at the beginning
of the follow-up
(January 1, 2004).
 Stressful life events 0
gathered with a postal Exposure to stressful
survey. life events

HR for new asthma
 Prospective,
This association onset
population-based
was robust 2 –
cohort study.
to adjustment
 16.881smoking and having
for males and females,
aged 20-54 yrs at home
a cat/dog
1.96
and free of diagnosed
and it was observed
1 –

of the follow-up those
both among
(January 1,and without
with 2004).
allergic rhinitis
 Stressful life events
at baseline.
gathered with a postal
0
Exposure to stressful
survey. life events

Of the 10 most HR for new asthma
 Prospective, life popula
stressful events: onset
tion-based cohort 2 –
study. illness of a family
• the
member,
 16.881 males and
females, aged 20-54 yrs
• marital problems, 1.96
and free of diagnosed
divorce or separation 1 –
and
of the follow-up
• (January 1, 2004).a supervisor
conflicts with
were associated
 Stressful life events
with the onset
gathered with a postal
0
Exposure to stressful
survey. of asthma. life events

Children With Asthma Hospitalized With Seasonal
or Pandemic Influenza, 2003–2009
Dawood Pediatrics 2011;128:e27

% children hospitalized with
 2003–2009 influenza
influenza who had asthma
seasons. 50 –

 2009 pandemic. 40 –
44%
 Surveillance of 5.3
32%
30 –
million children aged
17 yrs or younger. 20 –

 Hospitalization with 10 –
laboratory-confirmed
influenza and 0
identified those 2003–2009 2009
with asthma. influenza seasons pandemic


% children hospitalized with
 2003–2009 influenza
influenza who had asthma
seasons.
Compared with 50 –

asthmatic children
 2009 pandemic.
with seasonal influenza,
40 –
44%
Surveillance of 5.3
a higher proportion with
32%
30 –
2009 pandemic H1N1
17 influenza required
yrs or younger. 20 –
intensive care
 Hospitalization with
(16% vs 22%; 10 –
laboratory-confirmed
influenzaP=0.01)
and 0
identified those 2003–2009 2009
with asthma. influenza seasons pandemic

% asthmatic children with
 2003–2009 influenza diagnoses of asthma exacerbations
seasons.
60 –
 2009 pandemic.
50 –

 Surveillance of 5.3 40 –
51%
17 yrs or younger. 30 –

 Hospitalization with 20 – 29%
laboratory-confirmed 10 –
influenza and
0
identified those influenza A influenza B
with asthma. (seasonal or pandemic)

Association between human rhinovirus C and severity
of acute asthma in children Bizzintino ERJ 2011;37:1037
% children with virus detection
during asthma exacerbations
90 –
80 –
87.5%
 128 children with acute 70 –
asthma (age 2-16 yrs). 60 –
50 –
 Presentation to an 40 –
emergency department. 30 –
20 –
 Respiratory viruses in a
nasal aspirate. 10 –
14.8%
0
human other
rhinovirus respiratory
viruses

% children with human
rhinovirus C (HRVC)
60 –

 128 children with acute
asthma (age 2-16 yrs).
50 –

40 –
59.4%
emergency department.
20 –

 Respiratory viruses in a 10 –
nasal aspirate.
0
associated with more
severe asthma

% children with human
rhinovirus C (HRVC)
HRCV 60 –
accounts for the majority
of asthma attacks
in children presenting to
50 –

40 –
59.4%
hospital and causes more
severe attacks
20 –
than previously known
HRV groups 10 –
nasal aspirate.
and other viruses. 0
associated with more
severe asthma

Frequency of human rhinovirus (HRV)
and other common respiratory viruses
identified in 128 children
with asthma exacerbation.

 Presentation to an

nasal aspirate.

Relatioship between human rhinovirus
(HRV) C infection and severity of
asthma exacerbation in 128 children.
p=0.016
 128 children with acute p=0.018
p=0.009


nasal aspirate.

The finding that asthma exacerbation in 128 children.
HRVCs are more p=0.016
pathogenic
p=0.009
than other HRVs
in acute asthma
 Presentation to anwith
is consistent
a recent study
of children hospitalised
with symptoms
nasal aspirate.
of a respiratory
infection

asthma exacerbation in 128 children.
…those infected with p=0.016
HRVC were more likely
p=0.009
asthma (agerequire
to 2-16 yrs).
supplemental oxygen
than those infected
with HRVA.
nasal Miller J Clin Virol
aspirate.
2009;46:85

Lower Airway Rhinovirus Burden and the Seasonal Risk
of Asthma Exacerbation
Denlinger AJRCCM 2012;184:1007

Rationale
Most asthma exacerbations are initiated by viral upper
respiratory illnesses.
It is unclear whether human rhinovirus (HRV)–induced
exacerbations are associated with greater viral replication
and neutrophilic inflammation compared with HRV colds.

Objectives
To evaluate viral strain and load in a prospective asthma
cohort during a natural cold.


52 persons with asthma % subjects developed
and 14 control. asthma exacerbation
50 –

Adults enrolled at the
first sign of a cold, with
40 –
48%
daily monitoring of 30 – 25/52
symptoms, medication
use, and peak expiratory 20 –
flow.
10 –
Serial nasal lavage and
induced sputum samples. 0


52 persons with asthma
and 14 control.

Adults enrolled at the Detection of HRVs
first sign of a cold, with in the preceding 5 days
daily monitoring of was the most common
symptoms, medication attributable exposure
use, and peak expiratory
flow.
related to exacerbation.

induced sputum samples.


52 persons with asthma
and 14 control.
Those by
Adults enrolled group
a minor at the Detection of HRVs
first sign of a cold, with
A HRV were in the preceding 5 days
daily monitoring of was the most common
4.4-fold more
symptoms, medication
likely to cause attributable exposure
use, and peak expiratory
flow. exacerbation
related to exacerbation.
( p=0.038 ).
induced sputum samples.


Rhinovirus and sputum neutrophil burden in acute samples
stratified by the presence or absence of an exacerbation.

Decreased lung function after preschool wheezing
rhinovirus illnesses in children at risk to develop asthma
Guilbert JACI 2011;128:532
Children with RV wheezing illnesses had significantly
lower FEV1 at ages 5 through 8 yrs. In contrast with
 Relationship of RV, children with RSV wheezing illnesses did not have
virus-specific significant differences in FEV1 at any age compared
wheezing illnesses with children who did not wheeze with RSV.
and lung function.
 Longitudinal cohort
of 238 children
at risk of asthma.
 Followed from birth
to 8 yrs of age.

RV= Rhinovirus
RSV= Respiratory Syncitial Virus

Decreased lung function after preschool wheezing
rhinovirus illnesses in children at risk to develop asthma
Guilbert JACI 2011;128:532
Children with RV wheezing illnesses had significantly
 Whether lower FEV1 at ages 5 through 8 yrs. In contrast with
Relationship of
RV, children with RSV wheezing illnesses did not have
virus-specificfunction
low lung significant differences in FEV1 at any age compared
wheezing a cause
is illnesses with children who did not wheeze with RSV.
and lung function.
and/or effect of
 Longitudinal cohort
RV wheezing
of 238 children
illnesses
at risk of asthma.
is yet to be
 Followed from birth
determined.
to 8 yrs of age.

RV= Rhinovirus
RSV= Respiratory Syncitial Virus

Repeated virus identification in the airways of patients
with mild and severe asthma during prospective
follow-up. Turchiarelli V, Allergy 2011;66:1099

Background: Respiratory viruses may persist in the airways
of asthmatics between episodes of clinical worsening.
We hypothesized that patients with clinically stable,
severe asthma exhibit increased and more prolonged viral
presence in the airways as compared to mild asthmatics and
healthy controls.

What 2012 asthma and wheezing

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