Cases Of Asthma Research Articles

P1119 Increased risk of chronic respiratory disease among individuals with Inflammatory Bowel Disease in a prospective cohort study

Abstract Background Cross-sectional evidence suggests a higher burden of chronic respiratory diseases in people with inflammatory bowel disease (IBD), but there is a lack of prospective evidence to clarify the direction of their associations. This study aimed to investigate the association of IBD with the risk of two major chronic respiratory diseases, chronic obstructive pulmonary disease (COPD) and asthma. Methods We included 430,414 participants from UK Biobank and followed them from recruitment (2006-2010) to 2021. COPD and asthma cases were obtained from inpatient data and death register. Using Cox proportional hazards models, we estimated the multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CIs) of developing COPD and asthma in participants with IBD compared with IBD-free groups. We also investigated the association among Crohn's disease (CD) and ulcerative colitis (UC) with the risk of COPD and asthma. Results Over a median follow-up of 143 months, there were 11,196 incident COPD and 9831 asthma cases. The adjusted HRs of developing COPD (HR=1.54, 95% CI: 1.33-1.79) and asthma (HR=1.52, 95% CI: 1.29-1.79) were higher for those with IBD when compared with IBD-free participants. Participants with CD and UC were also found to have a higher risk of COPD (CD: HR=1.71; 95% CI: 1.36-2.15; UC: HR=1.45; 95% CI: 1.20-1.75) and asthma (CD: HR=1.73; 95%CI: 1.33-2.25; UC: HR=1.41; 95%CI: 1.15-1.73) when compared with those free of IBD (Table 1). Conclusion This study suggested that individuals with IBD have a higher risk of developing COPD and asthma, highlighting the importance of preventing chronic respiratory diseases among IBD patients.

Predictive Value of Fractional Exhaled Nitric Oxide (FeNO) in the Diagnosis of Asthma for Epidemiological Purposes-An 8-Year Follow-Up Study.

The follow-up included 128 (out of 447) children, 70 girls and 58 boys. The FeNO was measured at baseline only. The prevalence of asthma-like symptoms was measured with the adopted version of the ISAAC questionnaire. After 8 years of FeNO measurement, 5 new cases of asthma, 2 cases of attacks of dyspnoea, 1 case of wheezy in the chest, and 18 cases of allergic rhinitis occurred. The FeNO values, measured at the baseline of the study, for new cases of the above diseases were 53.4 ± 75.9 ppb, 11 ± 1.5 ppb, 12.0 ppb, and 16.3 ± 12.4 ppb, respectively. The best diagnostic accuracy parameters were found in the new cases of asthma, where the sensitivity was 40.0%, the specificity was 98.6%, and the AUC was 66.6%. The diagnostic odds ratio was 46.9 when considering the FeNO cut-off >35 ppb. The FeNO measurement is a fair method for asthma prognosis in early school-aged children with asthma-like symptoms measured on the population level but requires further confirmation at the clinical level with more accurate diagnostic tools.

Application of a user experience design approach for an EHR-based clinical decision support system.

We applied a user experience (UX) design approach to clinical decision support (CDS) tool development for the specific use case of pediatric asthma. Our objective was to understand physicians' workflows, decision-making processes, barriers (ie, pain points), and facilitators to increase usability of the tool. We used a mixed-methods approach with semi-structured interviews and surveys. The coded interviews were synthesized into physician-user journey maps (ie, visualization of a process to accomplish goals) and personas (ie, user types). Interviews were conducted via video. We developed physician journey maps and user personas informed by their goals, systems interactions, and experiences with pediatric asthma management. The physician end-user personas identified were: efficiency, relationship, and learning. Features of a potential asthma CDS tool sought varied by physician practice type and persona. It was important to the physician end-user that the asthma CDS tool demonstrate value by lowering workflow friction (ie, difficulty or obstacles), improving the environment surrounding physicians and patients, and using it as a teaching tool. Customizability versus standardization were important considerations for uptake. Different values and motivations of physicians influence their use and interaction with the EHR and CDS tools. These different perspectives can be captured by applying a UX design approach to the development process. For example, with the importance of customizability, one approach may be to build a core module with variations depending on end-user preference. A UX approach can drive design to help understand physician-users and meet their needs; ultimately with the goal of increased uptake.

Correlation between changes in serum YKL-40, LXRs, PPM1A, and TGF-β1 levels and airway remodeling and lung function in patients with bronchial asthma

Objective This study investigates the correlation between serum levels of YKL-40, LXRs, PPM1A, and TGF-β1 and airway remodeling and lung function in bronchial asthma patients. Methods The study involved 80 bronchial asthma patients and 92 healthy individuals. Serum cytokines, airway remodeling, and lung function markers were compared across mild, moderate, and severe asthma cases using high-resolution CT, t-tests, ANOVA, and Pearson correlation analysis. Results Asthmatic patients exhibited higher levels of serum YKL-40, LXRα, LXRβ, TGF-β1, airway wall thickness (T)/outer diameter (D), and WA% of total cross-sectional area compared to controls. Conversely, their serum PPM1A, Peak Expiratory Flow (PEF), and Forced Expiratory Volume in 1 s (FEV1) were lower. Serum YKL-40 and TGF-β1 levels were positively correlated with T/D and WA%, and negatively correlated with PEF and FEV1. PPM1A levels were strongly associated with T/D, WA%, PEF, and FEV1. Conclusion The severity of bronchial asthma is associated with increased serum levels of YKL-40, LXRα, LXRβ, and TGF-β1 and decreased PPM1A. The levels of YKL-40, PPM1A, and TGF-β1 have a significant correlation with airway remodeling and lung function.

Significance of Mrudu Virechan (laxatives) and Specific Medicines in the Management of Bronchial Asthma: A Case Report

Difficulty in breathing, shortness of breath, fever, and cough are common respiratory complaints seen in bronchial asthma. It is the most prevalent chronic health issue affecting individuals in the paediatric age group. Tamaka Shwasa is one among the five varieties of Shwasa Roga in Ayurveda. The purpose of present case study was to examine how an Ayurvedic treatment plan might be applied to cases of bronchial asthma. Hereby, the authors present a case report of a 10-year-old female child who was brought to the clinic by her parents, presenting with complaints of difficulty in breathing, shortness of breath, and occasional sneezing. Based on the history taken and clinical examination, she was diagnosed as a case of Tamaka Shwasa, having suffered from it since, the age of five. The child was treated according to the treatment protocol cited in classic text books of Ayurveda that is Virechana and other medications, for a period of two months, divided into two sittings. After two months, there was a notable decline in clinical features, such as cough, breathlessness, and cold, as reported by her mother. Additionally, there was a decrease in the eosinophil count. The present case study demonstrates the role of Ayurveda in the management of bronchial asthma.

Relief of Airflow Limitation and Airway Inflammation by Endoscopic Sinus Surgery in a Patient with Severe Asthma with Eosinophilic Chronic Rhinosinusitis.

Although endoscopic sinus surgery (ESS) is beneficial in improving asthma symptoms, its impact on the lung function in patients with asthma and chronic rhinosinusitis remains unclear. We herein report a case of severe asthma with eosinophilic chronic rhinosinusitis, in which ESS substantially improved airflow limitation and concomitantly reduced fractional exhaled nitric oxide and blood eosinophil counts. ESS likely relieved airflow limitation by suppressing type 2 inflammatory pathways. This case highlights ESS as a promising strategy for achieving clinical remission in patients with severe asthma and chronic rhinosinusitis.

Retrospective analysis of laboratory results in 18 cases of severe asthma treated with omalizumab

Retrospective analysis of laboratory results in 18 cases of severe asthma treated with omalizumab

Бронхіальна астма як професійне та екологічно-обумовлене захворювання: сучасні погляди на проблему згідно рекомендацій міжнародної організації праці 2022 року

Abstract. According to the International Labour Organization (ILO), the annual incidence of occupational bronchial asthma (OBA) ranges from 12 to 300 cases per million workers. Unlike in European countries, bronchial asthma in Ukraine remains an «under-recognised» occupational disease, accounting for less than 0.2 % of occupational pathology. The aim of the study: to analyse the algorithm for diagnosing and recognising bronchial asthma as an occupational disease according to the ILO 2022 recommendations, to compare its main provisions with the current one in Ukraine in order to adapt the system of registration of OBA to the requirements of the European Union because of the European integration process. Materials and methods. An analytical review of scientific publications using the abstract databases of scientific libraries PubMed, Medline and text databases of scientific publishers PubMed, Central, BMJ group and other VIP databases. The main legislative documents of Ukraine and the ILO regulating the process of recognising occupational diseases were analysed. The methods of system and content analysis were used. The results. Population risk assessments show that the development of 9–15 % of asthma cases in working population is directly related to exposure to harmful factors in the workplace. The risk of disease development is significantly increased due to air pollution with chemical and toxic substances as a result of hostilities in Ukraine. A comparative analysis of the international principles of diagnosis and recognition of bronchial asthma as an occupational disease with a similar system in Ukraine revealed significant differences: Ukrainian documents do not contain important information on the properties of various forms of chemical compounds, their toxicological profile, the minimum duration of exposure that causes an occupational disease, and the latency period. The lack of reference to these legally defined indicators affects the objectivity of diagnosis, the unification of diagnoses, which leads to a distortion of statistical indicators of occupational morbidity in Ukraine. Conclusions. The system of diagnosis and recording of occupational diseases, including OBA, should be improved according to the current ILO 2022 recommendations because of the reintegration processes of Ukraine’s accession to the European Union. Key words: occupational bronchial asthma, sensitizers, irritants.

Effect of interventional health educational program on clinical improvement in a sample of Egyptian school-age asthmatic children

Background/aim Asthma is one of the most widespread chronic disorders. To achieve better control over the disease, health intervention education programs could be applied to manage asthma and its consequences effectively to have a better quality of life. This study aimed to evaluate the impact of interventional health education programs on asthma symptoms and the quality of life of Egyptian asthmatic children. Patients and methods This study was conducted as an interventional study on asthmatic children and patients aged 6–16 years. Potential asthmatics according to GINA guidelines were enrolled in the study. Pulmonary function tests were applied including forced expiratory volume in the first second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio. 97 asthmatic cases were evaluated by asthma scoring, asthma control, and pediatric asthma quality of life questionnaire. All the study procedures were conducted at the start of the study and after applying the educational intervention program. Results The present results reported marked significant improvement (P<0.05) in the respiratory symptoms after the application of the intervention education program including cough, night symptoms, dyspnea, and chest pain. In addition significant improvement (P<0.05) occurred in the posteducational pulmonary function tests, including FEV1, prebronchodilator and postbronchodilators while there is no significant difference pre and postbronchodilator, FVC compared with the pre-educational pulmonary function tests. Conclusion The interventional health education program has been useful for the improvement of clinical symptoms, pulmonary function, and quality of life of Egyptian school-age asthmatic patients and the performance of their families.

Impacts of Matrix Metalloproteinase-9 Promoter Genotypes on Asthma Risk.

The overexpression of matrix metalloproteinase-9 (MMP9) has been observed in asthmatic patients, yet the role of MMP9 genotype in determining asthma susceptibility remains unresolved. This study aimed to elucidate the contribution of MMP9 promoter rs3918242 genotype to asthma risk in Taiwan. A cohort comprising 453 non-asthmatic healthy controls and 198 asthmatic cases was assembled, and the MMP9 rs3918242 genotypes were determined using polymerase chain reaction-restriction fragment length polymorphism methodology. Our findings indicated that people carrying the variant CT or TT genotype of MMP9 rs3918242 did not demonstrate an elevated risk of asthma compared to wild-type CC carriers (odds ratio=1.28 and 1.72, 95% confidence interval=0.87-1.87 and 0.72-4.13; p=0.2417 and 0.3201, respectively). Furthermore, individuals carrying the T allele at MMP9 rs3918242 did not exhibit a higher risk of asthma than those carrying the C allele (odds ratio=1.31, 95% confidence interval=0.96-1.79, p=0.0869). Interestingly, a positive association was observed between MMP9 rs3918242 CT or TT genotypes and the severity of asthma symptoms among asthmatic patients (p=0.0035). Although the T allele at MMP9 rs3918242 was not associated with asthma risk, it may serve as a predictor for asthma symptom severity. These findings warrant validation in larger and more diverse populations to further elucidate the significance of MMP9 in asthma etiology.

Overview on the treatment of severe bronchial asthma

Childhood asthma, often linked with atopic conditions, poses a challenge when classified as severe and uncontrolled. The 2023 GINA guidelines define severe asthma in children as asthma that remains uncontrolled despite optimized treatment with high-dose ICS-LABA or requires high-dose ICS-LABA to prevent it from becoming uncontrolled. This category encompasses about 5% of pediatric asthma cases, emphasizing the need for innovative therapeutic exploration. Advances in understanding asthma phenotypes and endotypes enable personalized treatment based on biomarkers. Monoclonal antibodies offer targeted solutions, reducing exacerbations, improving lung function, and minimizing corticosteroid use in pediatric patients. Integrating these therapies requires a personalized approach by healthcare providers, enhancing outcomes in severe and refractory cases.

Heavy metal levels are positively associated with serum periostin and miRNA-125b levels, but inversely associated with miRNA-26a levels in pediatric asthma cases. A case-control study

BackgroundThe study investigated heavy metals levels [urinary cadmium (U-Cd), erythrocytic cadmium (E-Cd), urinary arsenic (U-As), and whole blood lead (WB-Pb)] in children with bronchial asthma (BA) and tested their associations with serum periostin, miRNA-125b and miRNA-26a levels, and with asthma severity clinically and laboratory [blood eosinophils count (BEC) and serum total immunoglobin E (IgE)]. Also, we tested cut-off points, for the studied parameters, to distinguish BA cases from healthy children. MethodsThis case-control study included 158 children divided into control group; n = 72 and BA group; n = 86. Heavy metals were measured by an inductively coupled plasma-optical emission spectrophotometer. Serum periostin and IgE levels were measured by their corresponding ELISA kits. miRNAs relative expressions were estimated by RT-qPCR using the 2-ΔΔCT method. ResultsHeavy metals, serum periostin, and miR-125b levels were significantly high in BA group (p < 0.001). Heavy metals levels correlated positively with serum periostin, miR-125b and IgE levels, BEC, and asthma severity. The reverse was observed regarding serum miR-26a levels. Receiver operating characteristics (ROC) curve analysis showed good to excellent abilities of U-Cd, E-Cd, U-As, WB-Pb, serum periostin, miRNA-125b, and miRNA − 26a, and total IgE levels to distinguish BA cases from healthy children. ConclusionsHeavy metal toxicity in children is associated with BA severity, increased serum periostin and miRNA-125b levels, and decreased miRNA-26a levels. Specific measures to reduce children's exposure to heavy metals should be taken. Future research should consider blocking miRNA-125b action or enhancing miRNA-26a action to manage BA cases.

Association of GAB1 gene with asthma susceptibility and the efficacy of inhaled corticosteroids in children

Asthma is a polygenic disease that may onset during childhood. Inhaled corticosteroids (ICS) are the main therapy in asthma, although their efficacy varies among individuals. Nuclear factor κB (NF-κB) is an important target of ICS treatment of asthma. Recent research has reported that GRB2 associated binding protein 1 (GAB1) gene may participate in the pathogenesis of asthma by regulating the NF-κB pathway. Therefore, we used the technique of an improved multiplex ligation detection reaction to sequence GAB1 gene and investigated the involvement of Single-nucleotide variants (SNVs) in GAB1 gene in asthma and ICS efficacy in asthmatic children. We found no differences between asthma cases and controls in allele or genotype frequencies of GAB1. Haplotype analysis showed an increased tendency for AGGAGC frequency in asthma patients compared with controls (OR = 2.69, p = 0.018). The percentage of EOS and genotype distribution of rs1397527 were associated (p = 0.007). The EOS percentage was higher in GT genotype when compared to the GG genotype (5.50 vs 3.00, Bonferroni adjusted p = 0.005). After 12-weeks ICS treatment, GAB1 rs1397527 TT and GT genotype carriers had a smaller change in forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) than GG carriers (p = 0.009), and rs3805236 GG and AG genotype carriers also had a smaller change in FEV1/FVC than AA carriers (p = 0.025). For ICS response, the frequency of GG genotype of rs1397527 was significantly higher in good responders (p = 0.038). The generalized multifactor dimensionality reduction (GMDR) analysis showed a best significant four-order model (rs1397527, allergen exposure, environmental tobacco smoke exposure, and pet exposure) involving gene-environment interactions (p = 0.001). In summary, we found that GAB1 SNVs were not associated with asthma susceptibility. Haplotype AGGAGC was a risk factor for asthma. GAB1 variants were associated with eosinophils and ICS response in asthmatics. Furthermore, gene-environment interaction was observed.

Global burden of asthma in young adults in 204 countries and territories, 1990–2019: Systematic analysis of the Global burden of disease study 2019

Asthma is a common chronic respiratory disease, with onset usually occurring during childhood or adolescence. The aim of this study was to estimate the dynamic changes in the burden of asthma disease among adolescents (aged 15–39 years). Between 1990 and 2019, our comprehensive analysis spanned 204 nations and territories to ascertain the global prevalence of asthma. This extensive evaluation meticulously quantified the disease's burden by examining a range of critical metrics—including mortality rates, prevalence figures, and disability-adjusted life-years (DALYs)—across diverse demographics. Our investigation systematically segmented the data by age, gender, and year, as well as by geographical regions and the Socio-demographic Index (SDI), offering an in-depth perspective on the multifaceted impact of asthma worldwide. From 1990 to 2019, there was a global increase in the incidence cases of asthma among young adults, with the number rising from 6487957.18 (95 %UI: 4578735.08–8736387.55) to 7604488.39 (95 % UI:5428024.98–10177808.25). The prevalence rate of asthma among young adults exhibited a decline from 580.09 per 1,00,000 (95 %UI:481.37–757.28) to 504.28 per 1,00,000 (95 %UI:400.64–633.26). It is also noteworthy that the incidence rates in the remaining SDI regions, although lower, also showed varying degrees of increase in 2015. The age-standardized disease burden rate for asthma among young adults has exhibited a decline over the course of the previous three decades. Nevertheless, regions characterized by lower SDI demonstrate elevated age-standardized mortality rates for asthma, thereby warranting focused attention and prioritized allocation of medical resources.

Changes in industrial air pollution and the onset of childhood asthma in Quebec, Canada

Ambient air pollution has been associated with asthma onset and exacerbation in children. Whether improvement in air quality due to reduced industrial emissions has resulted in improved health outcomes such as asthma in some localities has usually been assessed indirectly with studies on between-subject comparisons of air pollution from all sources and health outcomes. In this study we directly assessed, within small areas in the province of Quebec (Canada), the influence of changes in local industrial fine particulate matter (PM2.5), nitrogen dioxide (NO2), and sulfur dioxide (SO2) concentrations, on changes in annual asthma onset rates in children (≤12 years old) with a longitudinal ecological design. We identified the yearly number of new cases of childhood asthma in 1282 small areas (census tracts or local community service centers) for the years 2002, 2004, 2005, 2006, and 2015. Annual average concentrations of industrial air pollutants for each of the geographic areas, and three sectors (i.e., pulp and paper mills, petroleum refineries, and metal smelters) were estimated by the Polair3D chemical transport model. Fixed-effects negative binomial models adjusted for household income were used to assess associations; additional adjustments for environmental tobacco smoke, background pollutant concentrations, vegetation coverage, and sociodemographic characteristics were conducted in sensitivity analyses. The incidence rate ratios (IRR) for childhood asthma onset for the interquartile increase in total industrial PM2.5, NO2, and SO2 were 1.016 (95% confidence interval, CI: 1.006–1.026), 1.063 (1.045–1.090), and 1.048 (1.031–1.080), respectively. Positive associations were also found with pollutant concentrations from most individual sectors. Results suggest that changes in industrial pollutant concentrations influence childhood asthma onset rates in small localities.

The influence of urban trees and total vegetation on asthma development in children.

We aimed to assess whether the influence of urban vegetation on asthma development in children (<13 years) varies by type (e.g., total vegetation, tree type, and grass) and season. We used a cohort of all children born in Montreal, Canada, between 2000 and 2015. Children and cases were identified from linked medico-administrative databases. Exposure to residential vegetation was estimated using the Normalized Difference Vegetation Index (NDVI) for total vegetation and using the total area covered by deciduous and evergreen crowns for trees in 250 m buffers centered on residential postal codes. Seasonal variations in vegetation were modeled by setting values to zero on days outside of pollen and leaf-on seasons. Cox models with vegetation exposures, age as a time axis, and adjusted for sex, material deprivation, and health region were used to estimate hazard ratios (HR) for asthma development. We followed 352,946 children for a total of 1,732,064 person-years and identified 30,816 incident cases of asthma. While annual vegetation (total and trees) measures did not appear to be associated with asthma development, models for pollen and leaf-on seasons yielded significant nonlinear associations. The risk of developing asthma was lower in children exposed to high levels (>33,300 m2) of deciduous crown area for the leaf-on season (HR = 0.69; 95% confidence interval [CI] = 0.67, 0.72) and increased for the pollen season (HR = 1.07; 95% CI =1.02, 1.12), compared with unexposed children. Similar results were found with the Normalized Difference Vegetation Index. The relationship between urban vegetation and childhood asthma development is nonlinear and influenced by vegetation characteristics, from protective during the leaf-on season to harmful during the pollen season.

Combination of Eucheuma Cottonii and Corticosteroids has a Superior Immunomodulatory Effect on Asthma

Asthma prevalence has been increasing globally which is commonly treated using corticosteroid as gold standard treatment. However, corticosteroids have adverse effects and cases of corticosteroid-resistant asthma are emerging. Eucheuma cottonii (EC) has been shown to potentially attenuate inflammatory response in type I hypersensitivity. This study aimed to investigate the effect of Eucheuma cottonii extract and methylprednisolone combination on IL-4, IL-10, and histamine levels in Ovalbumin-induced asthma BALB/c mice. Thirty female BALB/c mice were randomly assigned to 6 groups : (1) Sham; (2) Ovalbumin-induced asthma mice; (3) Ovalbumin-induced asthma mice treated with methylprednisolone (MP) 0.24 mg/day; (4) Ovalbumin-induced asthma mice treated with EC extract 300 mg/kgBW/day; (5) Ovalbumin-induced asthma mice treated with combination of both. Treatments were given respectively for 7 days. Plasma IL-4, IL-10, and histamine levels were measured using ELISA method. The combination group showed both the lowest IL-4 levels (89.30 ± 1.37 pg/ml) and the highest IL-10 levels (487.03 ± 20.57 pg/ml) compared to other asthma-like mouse groups (p = 0.001). No significant difference was observed in histamine levels among all treatments (p &gt; 0.05). The administration of a combination of methylprednisolone and Eucheuma cottonii extract significantly affected plasma IL-4 and IL-10 levels compared to monotherapies. However, there was no significant difference in plasma histamine levels compared to monotherapies.

Molecular mechanism of interleukin-17A regulating airway epithelial cell ferroptosis based on allergic asthma airway inflammation

Interleukin-17A (IL-17A) levels are elevated in patients with asthma. Ferroptosis has been identified as the non-apoptotic cell death type associated with asthma. Data regarding the relation of ferroptosis with asthma and the effect of IL-17A on modulating ferroptosis in asthma remain largely unclear. The present work focused on investigating the role of IL-17A in allergic asthma-related ferroptosis and its associated molecular mechanisms using public datasets, clinical samples, human bronchial epithelial cells, and an allergic asthma mouse model. We found that IL-17A was significantly upregulated within serum in asthma cases. Adding IL-17A significantly increased ferroptosis within human bronchial epithelial cells (BEAS-2B). In ovalbumin (OVA)-induced allergic asthmatic mice, IL-17A regulated and activated lipid peroxidation induced ferroptosis, whereas IL-17A knockdown effectively inhibited ferroptosis in vivo by protection of airway epithelial cells via the xCT-GSH-GPX4 antioxidant system and reduced airway inflammation. Mouse mRNA sequencing results indicated that the tumor necrosis factor (TNF) pathway was the differential KEGG pathway in the OVA group compared to healthy controls and the OVA group compared to the IL-17A knockout OVA group. We further used N-acetylcysteine (TNF inhibitor) to inhibit the TNF signaling pathway, which was found to protect BEAS-2B cells from IL-17A induced lipid peroxidation and ferroptosis damage. Our findings reveal a novel mechanism for the suppression of ferroptosis in airway epithelial cells, which may represent a new strategy for the use of IL-17A inhibitors against allergic asthma.

Air pollution and oxidative stress in adults suffering from airway diseases. Insights from the Gene Environment Interactions in Respiratory Diseases (GEIRD) multi-case control study

Air pollution is a leading risk factor for global mortality and morbidity. Oxidative stress is a key mechanism underlying air-pollution-mediated health effects, especially in the pathogenesis/exacerbation of airway impairments. However, evidence lacks on subgroups at higher risk of developing more severe outcomes in response to air pollution. This multi-centre study aims to evaluate the association between air pollution and oxidative stress in healthy adults and in patients affected by airway diseases from the Italian GEIRD (Gene Environment Interactions in Respiratory Diseases) multi-case control study. Overall, 1841 adults (49 % females, 20–83 years) were included from four Italian centres: Pavia, Sassari, Turin, and Verona. Following a 2-stage screening process, we identified 1273 cases of asthma, chronic bronchitis, rhinitis, or COPD and 568 controls. Systemic oxidative stress was quantified by urinary 8-isoprostane and 8-OH-dG. Individual residential exposures to NO2, PM10, PM2.5, and O3 were derived using an innovative five-stage machine-learning-based approach. Linear mixed regression models tested the association between oxidative stress biomarkers and air pollution tertiles, adjusting by age, sex, BMI, smoking, education and season, with recruiting centres as random intercept. Only cases exhibited higher levels of log-transformed 8-isoprostane and 8-OH-dG in association with NO2 (β: 0.30 95 % CI: 0.08–0.52 and 0.20 95 % CI: 0.03–0.37), PM10 (0.34 95 % CI: 0.12–0.55 and 0.21 95 % CI: 0.05–0.37) and PM2.5 (0.27 95 % CI: 0.09–0.49 and 0.18 95 % CI: 0.02–0.34) as compared to the first tertile of exposure. No significant associations were observed for summer O3. Our findings suggest that exposure to air pollution may increase systemic oxidative stress levels in people suffering from airway diseases. This introduces a potential novel approach available for future epidemiological studies and Public Health for effective prevention strategies oriented at the quantification of early biological effects in susceptible people, whose additional risk level might be currently underrated. Air-pollution-mediated exacerbations, driven by oxidative stress, still deserve our attention.

Validation of adult asthma case definitions for primary care sentinel surveillance.

Most asthma diagnoses and patient care take place in primary care settings. Electronic medical records (EMRs) offer an opportunity to utilize technology to improve asthma diagnosis and care. The purpose of this study was to create and validate separate case definitions for suspected and confirmed asthma in primary care EMRs, to enable surveillance, benchmarking, and quality improvement in primary care settings. The objective of this study was to develop a case definition for suspected and confirmed asthma for use in a primary care sentinel surveillance system. A single chart abstractor conducted a manual audit of 776 randomly selected patient charts from an academic primary care practice EMR in Kingston, Ontario. Following the single chart abstractor classification, a consensus on chart classification as "not asthma", "suspected asthma", or "confirmed asthma" was achieved between the abstractor, a family physician, and a respirologist using Canadian Thoracic Society (CTS) criteria. Case definition algorithms based on billing codes, clinical data elements and medications were applied to the site's Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data for the same charts and compared to abstractor classifications to determine each algorithm's measurement properties. The prevalence of suspected and confirmed asthma were 7.3% (n = 54) and 2.4% (n = 18), respectively. None of the proposed case definitions could differentiate between suspected and confirmed asthma. One algorithm consisting of billing, clinical, and medication elements had the highest Youden's Index for either suspected or confirmed asthma. The algorithm had a sensitivity of 81%, a specificity of 96%, positive predictive value of 71%, negative predictive value of 98%, and a Youden's Index of 0.77 for combined suspected or confirmed asthma cases. An EMR case definition for suspected or confirmed adult asthma has been validated for use in CPCSSN. Implementation of this case definition will enable the development of a surveillance electronic tool (eTool) for adult asthma that can foster quality improvement.