New Diagnosis Of Asthma Research Articles

Sinus inflammation and chronic rhinosinusitis are associated with a diagnosis of new onset asthma in the following year.

Chronic rhinosinusitis (CRS) and asthma commonly co-occur. No studies have leveraged large samples needed to formally address whether preexisting CRS is associated with new onset asthma over time. We evaluated whether prevalent CRS [identified in two ways: validated text algorithm applied to sinus computerized tomography (CT) scan or two diagnoses] was associated with new onset adult asthma in the following year. We used electronic health record data from Geisinger from 2008 to 2019. For each year we removed persons with any evidence of asthma through the end of the year, then identified those with new diagnosis of asthma in the following year. Complementary log-log regression was used to adjust for confounding variables (e.g., sociodemographic, contact with the health system, comorbidities), and hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. A total of 35,441 persons were diagnosed with new onset asthma and were compared to 890,956 persons who did not develop asthma. Persons with new onset asthma tended to be female (69.6%) and younger (mean [SD] age 45.9 [17.0] years). Both CRS definitions were associated (HR, 95% CI) with new onset asthma, with 2.21 (1.93, 2.54) and 1.48 (1.38, 1.59) for CRS based on sinus CT scan and two diagnoses, respectively. New onset asthma was uncommonly observed in persons with a history of sinus surgery. Prevalent CRS identified with two complementary approaches was associated with a diagnosis of new onset asthma in the following year. The findings may have clinical implications for the prevention of asthma.

Association of Asthma With Treatments and Outcomes in Children With Critical Influenza

Hospitalization for severe influenza infection in childhood may result in postdischarge sequelae. To evaluate inpatient management and postdischarge sequelae in children with critical respiratory illness owing to influenza with or without preexisting asthma. This was a prospective, observational multicenter study of children (aged 8 months to 17 years) admitted to a pediatric intensive care or high-acuity unit (in November 2019 to April 2020) for influenza. Results were stratified by preexisting asthma. Prehospital status, hospital treatments, and outcomes were collected. Surveys at approximately 90 days after discharge evaluated postdischarge health resource use, functional status, and respiratory symptoms. A total of 165 children had influenza: 56 with preexisting asthma (33.9%) and 109 without it (66.1%; 41.1% and 39.4%, respectively, were fully vaccinated against influenza). Fifteen patients with preexisting asthma (26.7%) and 34 without it (31.1%) were intubated. More patients with versus without preexisting asthma received pharmacologic asthma treatments during hospitalization (76.7% vs 28.4%). Of 136 patients with 90-day survey data (82.4%; 46 with preexisting asthma [33.8%] and 90 without it [66.1%]), a similar proportion had an emergency department/urgent care visit (4.3% vs 6.6%) or hospital readmission (8.6% vs 3.3%) for a respiratory condition. Patients with preexisting asthma more frequently experienced asthma symptoms (78.2% vs 3.3%) and had respiratory specialist visits (52% vs 20%) after discharge. Of 109 patients without preexisting asthma, 10 reported receiving a new diagnosis of asthma (11.1%). Respiratory health resource use and symptoms are important postdischarge outcomes after influenza critical illness in children with and without preexisting asthma. Less than half of children were vaccinated for influenza, a tool that could mitigate critical illness and its sequelae.

Effectiveness and Treatment Compliance of Salmeterol-Fluticasone Easyhaler® Among Patients with Asthma, COPD, or Asthma-COPD Overlap Syndrome: Real-World Study Findings.

For inhalation therapies to be effective, it is crucial that patients manage inhaler use correctly in their everyday life and achieve treatment compliance. We investigated the effectiveness of the salmeterol-fluticasone propionate Easyhaler® (SF EH) device-metered dry powder inhaler in a real-world setting in Hungary among adult patients with asthma, chronic obstructive pulmonary disease (COPD), or asthma-COPD overlap syndrome (ACO). A prospective, open-label, multicenter, noninterventional, investigator-sponsored study was conducted in outpatient pneumonology centers. Eligible patients were aged ≥ 18years with either a new diagnosis of asthma, COPD, or ACO, or whose disease was not controlled with preexisting medication. Data were collected at baseline and 12 + 4weeks, including the asthma control test (ACT), COPD assessment test (CAT), spirometry parameters [including forced expiratory volume for 1s (FEV1)], and physician- and patient-reported outcomes. Five hundred sixteen patients were recruited from 103 centers: 376 with asthma; 104 with COPD; and 36 with ACO. At week 12, there were significant improvements from baseline in both mean ACT score in patients with asthma (14.4 ± 4.2 versus 21.4 ± 2.8; P < 0.001) and mean CAT score in patients with COPD (24.0 ± 6.1 versus 16.0 ± 5.8; P < 0.001). Significant improvement was observed when the switch from the most frequently used previous inhalers was analyzed separately. Mean FEV1 improved from 76.0% ± 17.2 to 84.7% ± 16.1 (P < 0.001) and from 53.8% ± 15.0 to 59.9% ± 15.0 (P < 0.001) in patients with asthma or COPD, respectively. The study demonstrated improved physician-rated overall treatment compliance and patient preference for the SF EH over 3months use compared with previous inhaler treatment, with patients effectively adopting the SF EH into everyday life. Treatment with SF EH significantly improved patients' lung function parameters and disease control.

Secular trends in smoking in relation to prevalent and incident smoking-related disease: A prospective population-based study.

INTRODUCTIONWe examined changes in smoking habits in the general population according to prevalence and incidence of chronic diseases affected by smoking.METHODSWe included 12283 individuals enrolled from 2003 in the Copenhagen General Population Study and re-examined from 2014. Participants were classified as either healthy or suffering from chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus, heart disease or stroke.RESULTSAt entry, smoking prevalence was 15.4% in healthy participants, 29.8% with COPD, 15.8% with asthma, 21.7 % with diabetes mellitus, 17.2 % with ischemic heart disease/heart failure and 18.6% in participants with previous stroke. Smoking prevalence declined during the 10 years of observation. Among healthy subjects who developed one of the above mentioned diseases during follow-up, those who developed COPD had the highest initial smoking prevalence (51.5%). Quit rates were highest in those who developed asthma resulting in smoking prevalence of 8.2% versus 27.7% in COPD. After adjustment for age, smoking severity and genotype previously associated with heavy smoking (CHRNA3 rs1051730 AA), significant predictors of quitting were new diagnosis of ischemic heart disease/heart failure (OR=2.33, 95 % CI: 1.61–3.42), new diagnosis of asthma (OR=1.84, 95% CI: 1.18–2.90) and low number of pack-years.CONCLUSIONSIndividuals with prevalent smoking related diseases continued to smoke more than healthy individuals. Incident heart disease and asthma, but not incident COPD, stroke or diabetes were associated with a higher chance of quitting. Special focus on smokers with COPD, asthma, diabetes, stroke and ischemic heart disease/heart failure is warranted to decrease smoking prevalence in these groups. Smokers with a new diagnosis of diabetes, stroke and COPD need special smoking cessation support.

Prenatal particulate matter affects new asthma via airway hyperresponsiveness in schoolchildren.

The most relevant time of PM10 exposure to affect airway hyperresponsiveness (AHR) and new development of asthma in school-aged children is unclear. The aims of this study were to investigate the most critical time of PM10 exposure to affect AHR and new diagnosis of asthma from AHR in school-aged children. Elementary schoolchildren (n=3570) have been enrolled in a nationwide prospective 4-year follow-up survey in Korea from 2005 to 2006. Individual annual PM10 exposure was estimated by using an ordinary kriging method from the prenatal period to 7years of age. AHR at 7years was defined by a methacholine PC20 ≤8mg/mL. PM10 exposure during pregnancy and at 1year of age showed significant effects on AHR (aOR: 1.694, 95% CI: 1.298-2.209; and aOR: 1.750, 95% CI: 1.343-2.282, respectively). PM10 exposure during pregnancy was associated with the risk of a new diagnosis of asthma (aOR: 2.056, 95% CI: 1.240-3.409), with the highest risk in children with AHR at age 7 (aOR: 6.080, 95% CI: 2.150-17.195). PM10 exposure in the second trimester was associated with the highest risk of a new diagnosis of asthma in children with AHR at age 7 (aOR: 4.136, 95% CI: 1.657-10.326). Prenatal PM10 exposure in the second trimester is associated with an increased risk of a new diagnosis of asthma in school-aged children with AHR at 7years. This study suggests that PM10 exposure during a specific trimester in utero may affect the onset of childhood asthma via AHR.

Effect of enterovirus infections on asthma in young children: Anational cohort study.

We conducted a cohort study to determine the relationship between enterovirus (EV) infection and asthma. From the National Health Insurance Research Database of Taiwan, we identified patients who received a new diagnosis of asthma and concurrent treatment between January 2000 and December 2011 (EV cohort: n=208213; non-EV cohort: n=208213). Cox proportional hazards regression analysis was performed to determine and compare the adjusted hazard ratios (aHRs) of asthma between these 2 cohorts. Kaplan-Meier analysis was conducted to assess the differences in the cumulative incidence curves of asthma between the 2 cohorts. The overall aHR of asthma was 1.48-fold higher in the EV cohort than in the non-EV cohort (95% confidence interval=1.45-1.50). The aHR of asthma was higher in the EV cohort than in the non-EV cohort, comprising children aged ≤5years, regardless of sex, sociodemographic factors (urbanization level and parental occupation) or comorbidities. The risk of asthma was higher in 1-3, 4-6, 7-9 and 10-12months (all P<.001), particularly in those with a higher frequency of admission (>5 per year). The incidence of asthma was higher in the EV cohort than in the non-EV cohort, comprising children aged ≤5years, regardless of sex, urbanization level, parental occupation or season. In particular, the risk of asthma was higher in children with a higher frequency of admission, even in the absence of atopy or other respiratory infections.

Implementing Respiratory Integrated Care: the Future for COPD Diagnosis and Management?

Ireland has the highest rate of admissions for COPD in the Organisation for Economic Co-operation and Development (OECD) countries.1 Part of the explanation for this may reside in lack of resources for diagnosis and management in the community. An integrated model of care was developed as part of the Clinical Care programme for chronic disease management. The first respiratory integrated care post commenced in April 2016 providing the services of a clinical nurse specialist (CNSp) and/or a respiratory specialist physiotherapist to both primary and secondary care. Caseload comprised of patients with asthma and COPD. Challenges and successes were documented in a diary, patient outcomes recorded on an excel spreadsheet. Patients are selected and booked in by G.P practice. The CNSp assesses patients and records notes directly onto G.P software. The specialist consultant in secondary care then reviews this assessment and assists CNSp in accurately reporting on the patients’ spirometry results. From the first clinic July 19th to 30th of September 2016 patient statistics were collated, 45 patients were reviewed by the CNSp. Of these 22 had asthma and 15 COPD, 20 had the GP diagnosis confirmed, 10 had new diagnosis of asthma and 7 COPD, 3 had an alternative diagnosis found. Three patients were unable to perform spirometry for varying reasons, 2 patients had respiratory disease ruled out. All patients received health advice to support the self-management of their condition including inhaler technique and emergency self-management plans. Preliminary feedback from G.Ps and patients has been very positive. Challenges identified were difficulty with electronic communication between primary & secondary care and lack of overall IT set-up/planning for the programme. Respiratory integrated care (RIC) provides accurate diagnosis with evidence based cohesive management in primary care. More collaboration and communication is required to streamline this service further.

Interprofessional Pulmocheck care pathway: An innovative approach to managing pediatric asthma care in the Netherlands

ABSTRACTObjectives: Under-diagnosis and suboptimal asthma control in children persists. An innovative care pathway was developed by a hospital department of pediatrics with the aim to detect pulmonary problems in children and provide appropriate treatment possibilities through systematic feedback towards the referring primary care physician. Primary care physicians can use this pathway to refer children with asthma-like symptoms for a one-day assessment. Goals are to measure the usage of the pathway by primary care general practitioners (GPs), the outcomes in terms of new diagnoses of asthma, the reduction in regular referrals, generated recommendations/therapy and the adequacy of asthma follow-up. Methods: We collected all feedback letters sent to the GP concerning children who underwent the Pulmocheck in 2010, 2011 and 2012. Furthermore, all GPs, who had referred a child to the Pulmocheck in this period and that subsequently was diagnosed with asthma and was further managed in primary care, were sent a follow-up questionnaire in 2014. Results: There were 121 referrals from 51 GPs in 3 years to this pathway. In 59.5% of these referrals a new diagnosis of asthma was established. In 90.9% one or more changes in clinical management were advised. The response rate to the follow-up questionnaires was 65.7% of which 4.8% of the children with new established asthma were reviewed four times or more in the follow-up period, 17.4% two times, 65.2% once, and in 8.7% were not followed. Conclusions: The specialty pediatric asthma care pathway revealed a high number of children with newly diagnosed asthma, but was also helpful to exclude this diagnosis. However, the referral rate of GPs to this pathway was low, but in the children, that were referred several changes in the clinical management were advised and the frequency of monitoring of the children with diagnosed asthma was not in accordance with the asthma guidelines.

Adult asthma is associated with an increased risk of herpes zoster: A population-based cohort study

ABSTRACTObjective: The objective of this study was to determine whether a new diagnosis of asthma is associated with a later diagnosis of herpes zoster (HZ) in a nationwide, retrospective, non-age limited, population-based cohort. Methods: We used data from the National Health Insurance Research Database in Taiwan. The asthma group consisted of all 40 069 patients in the database with newly diagnosed asthma and using asthma medications from 2000 through 2005. The nonasthma group comprised 40 069 age- and sex-matched patients without any asthma diagnosis. Cox proportional hazards regression analysis was applied to calculate the hazard ratio of HZ in the patients with asthma relative to those without asthma. Results: During a mean follow-up period of 8.77 years, the risk of HZ was 1.48-fold higher in the asthma group compared with that in the nonasthma group after adjustment for sex, age, comorbidities, inhaled and systemic corticosteroid use, and annual outpatient department visits to dermatologists. Additional stratified analyses revealed that the risk of HZ was significantly higher in patients of both sexes and those aged older than 21 years. Conclusions: Newly diagnosed adult patients with asthma have a significantly higher risk of developing HZ than do those without asthma.

A new diagnosis of asthma or COPD is linked to smoking cessation - the Tromsø study.

BackgroundPatients with COPD have had a lower tendency to quit smoking compared to patients with coronary heart disease (CHD). We wanted to investigate if this is still true in a Norwegian population.MethodsOur data came from the fifth and sixth Tromsø surveys, which took place in 2001–2002 and 2007–2008. The predictors of smoking cessation were evaluated in a cohort of 4,497 participants who had stated their smoking status in both surveys.ResultsOf the 4,497 subjects in the cohort, 1,150 (25.6%) reported daily smoking in Tromsø 5. In Tromsø 6, 428 had quit (37.2%). A new diagnosis of obstructive lung disease (asthma or COPD) and CHD were both associated with increased quitting rates, 50.6% (P=0.01) and 52.1% (P=0.02), respectively. In multivariable logistic regression analysis with smoking cessation as outcome, the odds ratios (ORs) of a new diagnosis of obstructive lung disease and of CHD were 1.7 (1.1–2.7) and 1.7 (1.0–2.9), respectively. Male sex had an OR of 1.4 (1.1–1.8) compared to women in the multivariable model, whereas the ORs of an educational length of 13–16 years and ≥17 years compared to shorter education were 1.6 (1.1–2.2) and 2.5 (1.5–4.1), respectively.ConclusionThe general trend of smoking cessation in the population was confirmed. Increased rates of smoking cessation were associated with a new diagnosis of heart or lung disease, and obstructive lung disease was just as strongly linked to smoking cessation as was CHD. This should encourage the pursuit of early diagnosis of COPD.

Effect of catastrophic wildfires on asthmatic outcomes in obese children: breathing fire

BackgroundAir pollutants from wildfires and obesity independently exacerbate asthma, yet no study has determined the combined effects of these 2 variables on asthma outcomes. ObjectiveTo determine the effect of 2 catastrophic wildfires affecting the Southern California region (in 2003 and 2007) on several asthma outcomes in a cohort of children. MethodsTo investigate the association between wildfire exposure and asthma outcomes, we stratified our study population by body mass index categories (underweight, normal, overweight, and obese) and zip codes (to distinguish individuals who were closer to the fires vs farther away). The primary outcome was the prevalence of physician-dispensed short-acting β-agonist (SABAs). Secondary outcomes included the rate of emergency department visits and/or hospitalizations for asthma, the frequency of oral corticosteroid use for asthma, and number of new diagnoses of asthma. ResultsA total of 2,195 and 3,965 asthmatic children were analyzed as part of our retrospective cohort during the 2003 and 2007 wildfires, respectively. SABA dispensing increased the most in the obese group after the 2003 wildfires (P < .05). Increased prevalence of SABA dispensing was also noted in the obese group in 2007, but this was not statistically higher than the increases seen in other body mass index groups. There was no observed increase in emergency department and/or hospitalization rates, oral corticosteroid dispensing frequency, or new asthma diagnoses after either wildfire. ConclusionCatastrophic wildfires lead to worsening asthma outcomes, particularly in obese individuals. This study gives further evidence of a link between obesity and asthma severity and suggests that air pollutants released during wildfires can have substantial detrimental effects on asthma control.

Effect of Prenatal Maternal Trait Anxiety on Atopic Dermatitis and Immunoglobulin E Level: Cocoa Study

U E S D A Y 855 Phenotypes of Atopic Dermatitis in School Children Eun Lee, Si Hyeon Lee, Ji-Won Kwon, Song I. Yang, MD, Young Ho Jung, MD, Hyung-Young Kim, Ju-Hee Seo, MD, Byoung-Ju Kim, MD, PhD, Hyo-Bin Kim, MD, PhD, So Yeon Lee, MD, PhD, HoJang Kwon, MD PhD, Soo-Jong Hong, MD, PhD; Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Asan Institute for Life Sciences, University of ulsan College of Medicine, Department of Pediatrics, Bundang CHA Medical Center, CHA University College of Medicine, Childhood Asthma Atopy Center, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea, Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Department of Pediatrics, Korea Cancer Center Hospital, Seoul, South Korea, Department of Pediatrics, Hae-undae Paik Hospital, Inje University College of Medicine, Busan, South Korea, Department of Pediatrics,Inje University Sanggye Paik Hospital, Seoul, South Korea, Department of Pediatrics, Hallym University College of Medicine, Seoul, South Korea, Dankook University, Cheonan. RATIONALE: Atopic dermatitis (AD) develops from a complex interplay between environmental and immunologic factors incomplete understanding of its pathophysiology. AD is characterized by heterogeneous features in its onset and severity. The aim was to define the distinct phenotypes of AD children aged 6 to 13 years. METHODS: 242 children diagnosed with AD ever and AD symptoms during the last 12 months were included from the first survey of Children’s Health and Environmental Research survey (n52491). Variables such as personal characteristics, age at onset of AD, treatment during the last 12 months, number of positive skin prick tests (SPTs), total serum IgE levels and eosinophil were included. After 4 years, lung function tests, methacholine provocation tests, and blood test including IgE and eosinophil were performed. RESULTS: We identified 4 AD phenotypes. Class types were characterized as ‘‘early onset with low atopy’’ (26.4% of sample, Group 1), ‘‘early onset with high atopy’’ (48.3%, Group 2), ‘‘late onset with low atopy’’ (9.9%, Group 3), ‘‘intermediate onset with high atopy’’ (15.3%, Group 4). At 4 year follow-up, although group 2 and 4 showed persistently elevated IgE levels, only group 2 showed persistently elevated eosinophil level, increased prevalence of new onset of bronchial hyper-responsiveness (BHR) (13.5%) and new diagnosis of asthma (8.5%), and higher positive SPTs, compared to group 4. CONCLUSIONS: The LCA revealed four distinct AD phenotypes in school children. Cluster analysis of ADmay lead to a better understanding of the pathophysiology of AD, a better prediction of the prognosis, and furthermore, an ideal application of personalized therapy in future.

Low FEV1, smoking history, and obesity are factors associated with oxygen saturation decrease in an adult population cohort.

BackgroundWorsening of pulmonary diseases is associated with a decrease in oxygen saturation (SpO2). Such a decrease in SpO2 and associated factors has not been previously evaluated in a general adult population.AimWe sought to describe SpO2 in a sample of adults, at baseline and after 6.3 years, to determine whether factors predicting low SpO2 in a cross-sectional study were also associated with a decrease in SpO2 in this cohort.MethodsAs part of the Tromsø Study, 2,822 participants were examined with pulse oximetry in Tromsø 5 (2001/2002) and Tromsø 6 (2007/2008). Low SpO2 by pulse oximetry was defined as an SpO2 ≤95%, and SpO2 decrease was defined as a ≥2% decrease from baseline to below 96%.ResultsA total of 139 (4.9%) subjects had a decrease in SpO2. Forced expiratory volume in 1 second (FEV1) <50% of the predicted value and current smoking with a history of ≥10 pack-years were the baseline characteristics most strongly associated with an SpO2 decrease in multivariable logistic regression (odds ratio 3.55 [95% confidence interval (CI) 1.60–7.89] and 2.48 [95% CI 1.48–4.15], respectively). Male sex, age, former smoking with a history of ≥10 pack-years, body mass index ≥30 kg/m2, and C-reactive protein ≥5 mg/L were also significantly associated with an SpO2 decrease. A significant decrease in FEV1 and a new diagnosis of asthma or chronic obstructive pulmonary disease during the observation period most strongly predicted a fall in SpO2. A lower SpO2 decrease was observed in those who quit smoking and those who lost weight, but these tendencies were not statistically significant.ConclusionA decrease in SpO2 was most strongly associated with severe airflow limitation and a history of smoking. Smoking cessation and reducing obesity seem to be important measures to target for avoiding SpO2 decreases in the general population.

Underdiagnosis of childhood asthma: A comparison of survey estimates to clinical evaluation

Diagnostic patterns play a role in asthma prevalence estimates and could have implications for disease management. We sought to determine the extent to which questionnaire-derived estimates of childhood asthma reflect the disease's true occurrence. Children aged 6-12 years from Katowice, Poland, were recruited from a cross-sectional survey (N = 1822) via primary schools. Students were categorized into three mutually exclusive groups based on survey responses: "Asthma" (previously diagnosed asthma); "Respiratory symptoms" (no previous diagnosis of asthma and one or more respiratory symptoms during last year), "No respiratory symptoms" (no previous diagnosis of asthma or respiratory symptoms). A sample of children from each group (total N = 456) completed clinical testing to determine asthma presence according to GINA recommendations. Based on the survey, 5.4% of children were classified with asthma, 27.9% with respiratory symptoms, and 66.7% with no respiratory symptoms or asthma. All previously known 41 cases of asthma were confirmed. New diagnoses of asthma were made in 21 (10.9%) and 8 (3.6%) of subjects from the "Respiratory symptoms" (N = 192) and "No respiratory symptoms" (N = 223) groups, respectively. The overall prevalence of childhood asthma, incorporating the results of clinical examination, was 10.8% (95% CI: 9.4-12.2), compared to the questionnaire-derived figure of 5.4% (95% CI: 4.4-6.5%) and affected females more than males. Asthma prevalence was underestimated in this population possibly resulting from under-presentation or under-diagnosis. This could have potential implications for proper management and well-being of children. Questionnaire estimates of prevalence should be considered carefully in the context of regional diagnostic patterns.

A MULTISTATE LIFE TABLE MODEL INCLUDING DISEASE RECOVERY FOR ASSESSING THE HEALTH IMPACTS OF CHRONIC ENVIRONMENTAL EXPOSURES

Background and Aims: Multistate life tables, which model the movement of individuals within a population over time between various health states, provide benefits over standard life tables since they account for the many chronic health conditions associated with environmental exposures. However, these models have not previously included disease recovery. This is an important omission for certain conditions, such as asthma, from which people may recover during their lifetime. As such, this work aims to develop and apply a tool capable of including disease recovery for use in environmental risk assessment. Methods: We present details of a new multistate life table model. The starting point for the method is age- and disease-specific mortality, disease prevalence and incidence rates. Individuals within the population may move between good health, several disease states, a recovered state and, ultimately, death. Time spent with disease is weighted for reduced quality-of-life. The model estimates quality-adjusted life expectancy (QALE) and can be used to study patterns of mortality and morbidity over time in response to changes in environmental exposures. Results: We describe illustrative examples of the application of the model for health impact assessments of housing interventions in England and Wales. In particular, we show that a relatively modest decrease (3 μg m-3) in average indoor PM2.5 exposure results in an increase in QALE at birth of around two months, with ~600 fewer new diagnoses of asthma in children under 15 and ~3,000 fewer new cases of coronary heart disease per year. Conclusions: The new model provides substantial benefits for performing environmental health impact assessments. Including disease recovery is an important step towards modelling the effects on population health of complex actions and interventions in a comprehensive manner. The model will provide useful information for policy-makers, helping them to more effectively determine the health impacts of environmental policies.

Early interventions with inhaled corticosteroids in asthma: benefits and risks

the present review examines the effects of early intervention with inhaled corticosteroids (ICSs) on clinical efficacy and natural history of asthma based on two recent clinical trials: the Inhaled Steroid Treatment as Regular Therapy in Early Asthma (START) and Prevention of Early Asthma in Kids (PEAK) trials, and a comparison of the effect of regular vs. intermittent therapy based on the Improving Asthma Control Trial (IMPACT). in most patients, both adults and children, who have a new diagnosis of asthma and whose symptoms are mild but persistent, treatment with ICS should be recommended as soon as the diagnosis is made. This is a cost-effective and well tolerated treatment. However, symptoms may recur and lung function may decline again if treatment is discontinued. ICS is the most cost-effective initial treatment for both adults and children with a new diagnosis of asthma. If patients are reluctant to use ICS daily for long periods, it would be reasonable to delay the onset of treatment with ICS. Initial therapy with leukotriene receptor antagonist is not likely to be as effective as initial therapy with ICS. Biomarkers of airway inflammation such as sputum cell counts and exhaled nitric oxide are probably not necessary to treat patients with mild intermittent asthma.

Risk factors for adult‐onset asthma: A 14‐year longitudinal study

Few longitudinal studies have examined the risk factors and natural history of adult-onset asthma. This study assessed the subject characteristics and lifestyle factors that predicted the new diagnosis of asthma in adulthood and how these factors changed over time in those who developed asthma compared with those who do not. The study enrolled 1554 adults from the Busselton Health Study seen in 1981 and again in 1994-1995 who initially reported never having had doctor-diagnosed asthma. Questionnaire measures were used to assess doctor-diagnosed asthma, respiratory history and tobacco smoking. Height, weight and spirometric measures of lung function were measured. Atopy was assessed by skin prick tests. Logistic regression analysis was used to identify risk factors for adult-onset asthma and changes over time. Reported wheeze, rhinitis, chronic cough, smoking and lower levels of lung function in 1981 each predicted asthma diagnosis by 1994-1995. Neither initial skin-prick reactivity nor newly positive skin-prick tests at follow up were associated with adult-onset asthma. Those diagnosed with asthma were more likely to have new wheeze, new rhinitis, new habitual snoring, weight gain and excess decline in lung function. Adult-onset asthma has risk factors that are distinct from those observed in childhood asthma. The presence of upper airway symptoms including rhinitis, as well as lifestyle factors, such as smoking, predicts those at greatest risk. However, neither pre-existing atopy nor new atopy as measured by skin prick tests was associated with adult-onset asthma.

World Trade Center Disaster and Asthma Type: Thomas et al. Respond

We appreciate the question raised by Ziem regarding the type of asthma reported in children exposed to the World Trade Center (WTC) disaster of 11 September 2001 (9/11) (Thomas et al. 2008). In our study we found an increase in age-specific asthma prevalence among children < 12 years of age, and a new diagnosis of asthma was strongly correlated with a report of exposure to the dust and debris cloud that occurred as buildings collapsed on 9/11. Among children < 5 years of age, we observed an increased prevalence in asthma diagnosis even among those not exposed to the dust cloud. We cannot confirm or disprove Ziem’s very reasonable suggestion that the asthma seen here was irritant rather than allergen induced. The data on asthma diagnoses were reported by parents or other guardians of the children, using a very simple standardized question. We asked whether a medical provider had ever said the child had asthma, and if yes, whether this occurred before or after 9/11. We did not collect information on severity, treatment, or duration, and did not review medical records. A follow-up survey of the children is under way and includes questions to characterize the asthma illness, but those data are not yet available. In small children, in addition to airborne irritants and atopy, respiratory viruses may also play a role in initiation or exacerbation of asthma (Schwarze and Gelfand 2000). It is difficult or impossible in a general pediatric setting to differentiate the type of asthma in children, and many pediatricians use the term “reactive airway disease” in children with recurrent wheezing whether or not there appears to be an allergic component. The airborne contaminants immediately following the 9/11 attacks included a highly alkaline mixture of gypsum, concrete, and synthetic vitreous fibers, further contaminated by metals, organochlorine compounds such as polychlorinated biphenyls and dioxins, and polycylic aromatic hydrocarbons. Later on, settled dust in indoor environments, including residences where many children lived, was found to consist of both fine, coarse, and “supercoarse” (> 10 μm in diameter) particulate matter (Lioy et al. 2006); thus, there was a clear potential for exposure to biologic or allergenic substances. Also, as the cleanup for homes, as well as public areas, was prolonged and difficult, molds could have occurred in some environments and contributed to allergic reactions. Based on earlier studies, Landrigan et al. (2004) noted that “high alkalinity of WTC dust produced bronchial hyperreactivity, persistent cough, and increased risk of asthma.” Increased asthma was subsequently reported in evaluations of 68,444 adults enrolled in the WTC Health Registry (Farfel et al. 2008). Wheeler et al. (2007) found a dose response with increased exposure to the 16-acre “pile” of debris associated with the buildings’ collapse and burning. In an overview of health effects in other adults, Farfel et al. (2008) found an association of asthma with exposure to the initial dust cloud generated by the collapse of the twin towers. We agree with Ziem that, in both children and adults, the exposures observed are more likely related to particulates and other irritants. Further work that includes more detailed histories accompanied by pulmonary function testing is needed to better characterize the pulmonary illness in these individuals.

Methacholine challenge in children with sickle cell disease: A case series

Lung disease is a major cause of morbidity in children with sickle cell disease (SCD). Asthma in children with SCD is associated with a twice greater rate of pain and acute chest syndrome (ACS) episodes when compared to children with SCD but without asthma. Provocation challenges with methacholine are used to diagnose asthma when spirometry is normal, bronchodilator reactivity is absent, or the clinical picture is ambiguous. There have been only limited descriptions of use of methacholine challenge in individuals with SCD. We conducted a retrospective cohort study of 21 children with SCD and recurrent respiratory tract symptoms who were challenged with methacholine to determine if airway hyper responsiveness (AHR) was present. Fourteen (67%) of the children had a positive challenge. Of the 14 patients, four were given a new diagnosis of asthma based on the presence of chronic chest symptoms and the newly determined AHR and started on inhaled corticosteroids (ICS). In each positive challenge, forced expiratory volume in one second (FEV(1)) was reversed to at least 90% of baseline 15 min after bronchodilator treatment. Oxygen saturation decreased in 93% of those with a positive challenge, but returned to baseline values 15 min after bronchodilator treatment. No patient developed a pain or ACS episode within at least 1 month after the challenge. Evaluation of AHR with methacholine challenge in patients with SCD appears to be well tolerated and may elucidate a cause of SCD morbidity.

Does early intervention with inhaled corticosteroids alter the natural history of mild persistent asthma?

In most patients, both adults and children, who have a new diagnosis of asthma and whose symptoms are mild but persistent, treatment with inhaled corticosteroids (ICS) should be recommended as soon as the diagnosis is made. This is a cost-effective and safe treatment. Patients should be cautioned that their asthma will not be cured with short-term treatment and that their symptoms may recur and their lung function may decline again if treatment is discontinued. If patients are reluctant to use ICS daily for long periods of time, it would be reasonable to delay the onset of treatment with ICS. They could subsequently be managed with intermittent therapy with either ICS or in combination with other medications, such as long-acting beta-agonists. Initial therapy with leukotriene receptor antagonist is not likely to be as effective as initial therapy with ICS. Since treatment adjustments based on eosinophil counts in sputum can reliably predict short-term responses to corticosteroids and help identify the appropriate add-on therapy, it may be useful to use this measurement, when available, to guide intermittent therapy.