Secondary Prevention Of Asthma Research Articles

Exposome Profiles and Asthma among French Adults.

Rationale: Although previous studies in environmental epidemiology focused on single or a few exposures, a holistic approach combining multiple preventable risk factors is needed to tackle the etiology of multifactorial diseases such as asthma. Objectives: To investigate the association between combined socioeconomic, external environment, early-life environment, and lifestyle-anthropometric factors and asthma phenotypes. Methods: A total of 20,833 adults from the French NutriNet-Santé cohort were included (mean age, 56.2 yr; SD, 13.2; 72% women). The validated asthma symptom score (continuous) and asthma control (never asthma, controlled asthma, and uncontrolled asthma) were considered. The exposome (n = 87 factors) covered four domains: socioeconomic, external environment, early-life environment, and lifestyle-anthropometric. Cluster-based analyses were performed within each exposome domain, and the identified profiles were studied in association to asthma outcomes in negative binomial (asthma symptom score) or multinomial logistic (asthma control) regression models. Measurements and Main Results: In total, 5,546 (27%) individuals had an asthma symptom score ⩾1, and 1,206 (6%) and 194 (1%) had controlled and uncontrolled asthma, respectively. Three early-life exposure profiles ("high passive smoking-own dogs," "poor birth parameters-daycare attendance-city center," or "⩾2 siblings-breastfed" compared with "farm-pet owner-molds-low passive smoking") and one lifestyle-anthropometric profile ("unhealthy diet-high smoking-overweight" compared with "healthy diet-nonsmoker-thin") were associated with more asthma symptoms and uncontrolled asthma. Conclusions: This large-scale exposome-based study revealed early-life and lifestyle exposure profiles that were at risk for asthma in adults. Our findings support the importance of multiinterventional programs for the primary and secondary prevention of asthma, including control of specific early-life risk factors and promotion of a healthy lifestyle in adulthood.

Knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to paediatric wards in Gampaha District

Introduction: Asthma is considered to be one of the major public health problems. The accurate knowledge of caregiver on asthma is important for the management. Objectives: To describe the knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to the paediatric wards in the district of Gampaha Methods: A descriptive cross-sectional study was carried out among 577 caregivers of inward asthmatic children. Pre-tested interviewer- and self-administered questionnaires were used to assess the knowledge on asthma. The grand score of knowledge on asthma was calculated out of 34. The 75th percentile value was considered to differentiate ‘good’ knowledge from ‘poor’ knowledge. Multiple logistic regression was applied to determine the factors associated with poor knowledge on asthma. Results were expressed in adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: The mean score for knowledge on asthma was 20.6 (SD=4.42) ranging from 7 to 30. Among the caregivers, 369 (64%) had poor knowledge on asthma. Low educational level of the caregiver (aOR=2.48; 95% CI=1.59, 3.86) and being under prophylaxis treatment for less than one year (aOR=2.49; 95% CI=1.50, 4.13) were the determinants of poor knowledge on asthma. Conclusions: Majority of the caregivers’ knowledge on asthma was poor. The caregivers’ low educational level and shorter duration of prophylaxis treatment for the children were associated with poor knowledge on asthma.

Passport of sensitization of schoolchildren as a tool for the prevention of asthma

Molecular allergy diagnosis allows to identify sensitization to a large range of respiratory allergens, which is important in the diagnosis of allergic asthma. Moreover, based on the reactive IgE profile detected at an early age, it is possible to predict the development of allergic respiratory diseases even at the preclinical stage. The goal of the pilot project was to create a children's passport sensitization using a multiplex panel to be able to identify groups at risk for the development of asthma in children of early school age. Materials and methods. Parents of 33 students studying in the second grade of the Tashkent gymnasium were questioned using the ISAAC questionnaire for the clinical manifestations of respiratory diseases in their children. Their children’s sera were tested for the presence of IgE to various allergenic molecules using the MeDALL research method. Results. 30% of children were sensitized to at least one allergen, and 30% of them were born by Caesarean section. and 30% of them were born by Caesarean section. In total, 68 of the 176 allergenic molecules located on the MeDALL microchip were recognized. 80% of sensitized children had a genuine polysensitization to 3 or more major allergens. In 18% of children, IgE to household molecules of the risk of developing asthma, such as Alt a 1, Bla g 1, Bla g 2, Can f 1, Fel d 1, were detected. Conclusions. In general, clinical manifestations in the form of wheezing and obstruction were detected in 60% of sensitized children, but only 40% of these children were under the supervision of an allergist or received symptomatic treatment. In 20% of already sensitized children, clinical symptoms were absent. Molecular testing of the profile of IgE sensitization and the creation of an allergic passport allows us to identify a group of children at risk for developing asthma. This information can be used to assign therapy and secondary prevention of asthma in the early school years.

Unmet needs in asthma.

Despite advances in the diagnosis and management of asthma, uncontrolled disease is still associated with a substantial mortality and morbidity burden. Patients often overestimate their level of asthma control while also reporting that asthma symptoms affect their quality of life and ability to work or study. There is some evidence of success with primary prevention measures in high-risk children and the secondary prevention of asthma in sensitized individuals or those at risk of developing occupational asthma. There are challenges with diagnosis – with under- and overdiagnosis and misdiagnosis being common – and in the treatment of asthma, despite clear treatment guidelines. In particular, severe asthma presents a huge challenge to the clinician, and its complex and heterogeneous nature warrants a personalized medicine approach to match therapies to individual patients. However, the tools for this are currently lacking in primary care. This article reviews the current unmet need in the diagnosis and clinical management of asthma, and provides an overview of the limitations of current therapies.

Allergy and asthma prevention 2014.

Asthma and allergic diseases have become one of the epidemics of the 21st century in developed countries. Much of the success of other areas of medicine, such as infectious diseases, lies on preventive measures. Thus, much effort is also being placed lately in the prevention of asthma and allergy. This manuscript reviews the current evidence, divided into four areas of activity. Interventions modifying environmental exposure to allergens have provided inconsistent results, with multifaceted interventions being more effective in the prevention of asthma. Regarding nutrition, the use of hydrolyzed formulas in high-risk infants reduces the incidence of atopic dermatitis, while there is for now not enough evidence to recommend other dietary modifications, prebiotics, probiotics, or other microbial products. Pharmacologic agents used until now for prevention have not proved useful, while there is hope that antiviral vaccines could be useful in the future. Allergen-specific immunotherapy is effective for the treatment of allergic patients with symptoms; the study of its value for primary and secondary prevention of asthma and allergy is in its very preliminary phases. The lack of success in the prevention of these disorders lies on their complexity, which involves many genetic, epigenetic, and environmental interactions. There is a need to identify target populations, involved mechanisms and interactions, and the best interventions. These must be effective, feasible, implementable, and affordable.

Viral infections and the development of asthma in children.

Viral aetiology, host susceptibility (in particular allergic predisposition and sensitization), and illness severity, timing and frequency all appear to contribute as synergistic factors to the risk of developing asthma. Experimental models have shown both innate and adaptive immune responses contribute to this risk with lung inflammatory cells showing marked differences in phenotype and function in young compared with older animals, and these differences are further enhanced following virus infection. Findings to date strongly suggest that the impact of infant and preschool viral infections on the maturing immune system and developing lung that subsequently result in an asthma phenotype occur during a critical susceptibility period, and in a genetically susceptible host. There are currently no therapeutic strategies that allow primary or secondary prevention of asthma following early life viral respiratory infections in high-risk children, thus a focus on understanding the mechanisms of progression from viral wheezing in infants and preschool children to asthma development are urgently needed. This review summarizes the data reporting the role of the two most common viruses, that is, respiratory syncytial virus and human rhinovirus, that result in asthma development, comparing risk factors for disease progression, and providing insight into strategies that might be adopted to prevent asthma development.

Viral infections and atopy in asthma pathogenesis: new rationales for asthma prevention and treatment

Prospective birth cohort studies tracking asthma initiation and consolidation in community cohorts have identified viral infections occurring against a background of allergic sensitization to aeroallergens as a uniquely potent risk factor for the expression of acute severe asthma-like symptoms and for the ensuing development of asthma that can persist through childhood and into adulthood. A combination of recent experimental and human studies have suggested that underlying this bipartite process are a series of interactions between antiviral and atopic inflammatory pathways that are mediated by local activation of myeloid cell populations in the airway mucosa and the parallel programming and recruitment of their replacements from bone marrow. Targeting key components of these pathways at the appropriate stages of asthma provides new opportunities for the treatment of established asthma but, more crucially, for primary and secondary prevention of asthma during childhood.

Der Zusammenhang zwischen Body-Mass-Index (BMI) und Asthma

Background In 2004, we published an evidence-based and consented guideline on primary and secondary prevention of asthma, allergic rhinitis and atopic eczema. In order to update this guideline, we repeated a systematic literature search in 2008.

Can inhaled corticosteroids influence the natural history of asthma?

Asthma is characterised by variable airflow obstruction, airway inflammation and hyper-responsiveness. Persistent inflammation is thought to lead to 'remodelling' of the airway, which in turn leads to the progressive loss of lung function seen in asthmatics. It would appear logical that anti-inflammatory drugs such as inhaled corticosteroids (ICS) would influence the natural history of asthma by reducing inflammation, subsequent remodelling, and thus preventing the decline in lung function. This review will summarise the effects of ICS on the secondary prevention of asthma, lung function and remodelling. Many published studies show a reduction in airway inflammation, improvement in clinical symptoms and prebronchodilator lung function whilst taking ICS. Few studies, however, examine their effect on the natural history of asthma. Several recent studies have targeted very young children with asthma using ICS, and despite their differing target populations and treatment strategies, have failed to show any difference in lung function. Studies in adults with mild persistent asthma show similar findings. ICS appear to reverse some of the processes involved in airway remodelling, but not all. Although ICS are effective in controlling symptoms they do not appear to alter the natural history of asthma.

Secondary Prevention of Asthma by the Use of Inhaled Fluticasone Propionate in Wheezy Infants (IFWIN): Double-Blind, Randomised, Controlled Study

Murray CS, Woodcock A, Langley SJ, Morris J, Custovic A; IFWIN Study Team. Lancet. 2006;368:754–762 PURPOSE OF THE STUDY. To determine if the early use of inhaled fluticasone propionate in wheezy infants helps to prevent loss of lung function and progression of asthma later in childhood. STUDY POPULATION. High-risk children (N = 1073) identified by having 1 atopic parent were followed prospectively until 2 wheezing episodes occurred or there was 1 wheezing episode longer than 1 month. Of these patients, 206 who met the inclusion criteria were randomly assigned: 104 to placebo and 102 to treatment. The median age was 1.2 years (range: 0.5–4.9 years). Eighty-six percent continued to be followed by their fifth birthday. METHODS. Children were excluded if they had wheeze caused by bronchiolitis, were preterm (<34 weeks’ gestation), had other chronic lung disease or chronic illness, had previous inhaled corticosteroid (ICS) use, or were unable to use the inhaler. The treatment group was started on fluticasone propionate 100 μg twice daily. Randomly assigned patients were followed by monthly telephone calls for the first 3 months, if controlled, and then every 3 months until their fifth birthday. If symptoms were not under control by 3 months, then open-label fluticasone propionate 100 μg was added. Treatment was adjusted to the minimum necessary to control symptoms. Participants were allowed to use β agonists as needed. Parents were asked to keep daily diaries of symptom scores, reliever use, and unscheduled visits. At the age of 5, specific airway resistance (sRAW), forced expiratory volume in 1 second (FEV1), airway reactivity, and postbronchodilator lung function were measured and compared. RESULTS. There was no significant difference between those in the treatment group versus placebo in the proportion of children with current wheeze, physician-diagnosed asthma, use of asthma medication, or current wheeze, even when factoring the addition of those participants who added open-label medication. There was also no significant difference in FEV1 (baseline or postbronchodilator), sRAW, or airway reactivity at 5 years of age in these groups. The 2 groups were similar in the number of children who required, and in the length of time to adding, open-label drug. Symptom scores, use of reliever medication, and unscheduled visits to the family doctor were similar until the third month, when children in the treatment group had lower median daily symptom scores, a trend toward less reliever medication, and significantly fewer visits than those in the placebo group. In the 2 open-label drug groups, there was a greater risk of current wheeze, current use of asthma medications, and current wheeze with asthma medications compared with those in the placebo group, although there was no difference in baseline or postbronchodilator FEV1. However, there was a significantly higher sRAW in the treated groups, which represented decreased lung function. CONCLUSIONS. The use of ICS in young children at risk for asthma with the earliest sign of recurrent wheezing had no significant effect on the natural history of wheezing, lung function, or airway reactivity by 5 years of age and only showed a small improvement on symptom scores and unscheduled physician visits after the third month of the study. Higher postbronchodilator sRAW showing reduced lung function was seen in children in the treated group compared with those in the placebo group. REVIEWER COMMENTS. Evidence for the efficacy of ICS in infants and very young children remains unclear. It has been suggested that early use of ICS could be detrimental to the lung development on the basis of the sRAW scores of ICS-treated patients. However, children in both the treatment and placebo groups required the addition of fluticasone equally, which suggests that perhaps those in the treatment group had worse disease. Prestudy lung function was not tested, and individual atopic status was not assessed to determine if these 2 groups were truly equivalent. Studies are needed to determine if atopy is a confounding factor and whether controlling for allergen exposure in addition to ICS has an effect on asthma outcomes. This study and other similar studies suggest that ICS can improve asthma symptoms, but early use does not modify the disease.

Feasibility and applicability of secondary prevention of asthma in allergy practice

Feasibility and applicability of secondary prevention of asthma in allergy practice

Risk factors associated with allergic and non‐allergic asthma in adolescents

Risk factors for asthma have been investigated in a large number of studies in adults and children, with little progress in the primary and secondary prevention of asthma. The aim of this investigation was to investigate risk factors associated with allergic and non-allergic asthma in adolescents. In this study, 959 schoolchildren (13-14 years old) answered a questionnaire and performed exhaled nitric oxide (NO) measurements. All children (n = 238) with reported asthma, asthma-related symptoms and/or increased NO levels were invited to a clinical follow-up which included a physician evaluation and skin-prick testing. Asthma was diagnosed in 96 adolescents, whereof half had allergic and half non-allergic asthma. Children with both allergic and non-allergic asthma had a significantly higher body mass index (BMI) (20.8 and 20.7 vs. 19.8 kg/m(2)) (p < 0.05) and a higher prevalence of parental asthma (30% and 32% vs. 16%) (p < 0.05). Early-life infection (otitis and croup) [adjusted odds ratio (OR) (95% confidence interval (CI)): 1.99 (1.02-3.88) and 2.80 (1.44-5.42), respectively], pets during the first year of life [2.17 (1.16-4.04)], window pane condensation [2.45 (1.11-5.40)] and unsatisfactory school cleaning [(2.50 (1.28-4.89)] was associated with non-allergic but not with allergic asthma. This study indicates the importance of distinguishing between subtypes of asthma when assessing the effect of different risk factors. While the risk of both allergic and non-allergic asthma increased with increasing BMI, associations between early-life and current environmental exposure were primarily found in relation to non-allergic asthma.

Prevention of asthma in childhood

The prevalence of asthma is increasing in many parts of the world, particularly in developed countries. The present review focuses on recent literature regarding asthma prevention in childhood. Several environmental exposures in infancy or early childhood are associated with reduced prevalence of asthma, but the mechanisms leading to these associations remain unknown. Recent studies have demonstrated limited success in the prevention of asthma or asthma symptoms with the use of asthma medications, once the therapy is discontinued. Immunotherapy offers another strategy for asthma prevention, and groups treated with this intervention have demonstrated reduced atopy and asthma. Several multi-interventional trials have demonstrated a reduced asthma symptom burden but have not demonstrated significant differences in objective measures such as lung function or bronchial hyper-responsiveness between intervention groups. The most promising asthma prevention strategies to date have been those that use a multi-interventional approach employing both dietary and environmental manipulations. More research is needed to assess the long-term follow-up of multi-interventional trials and to evaluate novel intervention strategies in the primary or secondary prevention of asthma in childhood.

Secondary prevention of asthma by the use of Inhaled Fluticasone propionate in Wheezy INfants (IFWIN): double-blind, randomised, controlled study

Wheezing and asthma often begins in early childhood, but it is difficult to predict whether or not a wheezy infant will develop asthma. Some researchers suggest that treatment with inhaled corticosteroids at the first signs of wheezing in childhood could prevent the development of asthma later in life. However, other investigators have reported that although such treatment could help control symptoms, the benefits can disappear within months of stopping treatment. We tested our hypothesis that to prevent loss of lung function and worsening asthma later in childhood, anti-inflammatory treatment needs to be started early in life. We did a randomised, double-blind, controlled study of inhaled fluticasone propionate 100 mug twice daily in young children who were followed prospectively and randomised after either one prolonged (>1 month) or two medically confirmed wheezy episodes. The dose of study drug was reduced every 3 months to the minimum needed. If the symptoms were not under control by 3 months, open-label fluticasone propionate 100 mug twice daily was added to the treatment. Children were followed-up to 5 years of age, at which point we gave their parents or guardians questionnaires, and measured the children's lung function (specific airways resistance [sR(aw)], forced expiratory volume in 1s [FEV1]) and airway reactivity (eucapnic voluntary hyperventilation [EVH] challenge). This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN86717853. We followed 1073 children prospectively, of whom 333 were eligible, and 200 of these began treatment (130 male, median age 1.2 years [range 0.5-4.9]; 101 placebo, 99 treatment); 173 (85 treatment, 88 placebo) completed the follow-up at age five years. The groups did not differ significantly in the proportion of children with current wheeze, physician-diagnosed asthma or use of asthma medication, lung function, or airway reactivity (percentage change in FEV1, adjusted mean for placebo 5.5% [95% CI -2.5 to 13.4]) vs for treatment 5.0% [-2.2 to 12.2], p=0.87). There were no differences in the results after adjustment for open-label fluticasone propionate, nor between the two groups in the time before the open-label drug was added (estimated hazard ratio 1.12 [95% CI 0.73-1.73], p=0.60), or the proportion needing the open-label drug (43 [42.57%] placebo, 41 [41.41%] treatment). The early use of inhaled fluticasone propionate for wheezing in preschool children had no effect on the natural history of asthma or wheeze later in childhood, and did not prevent lung function decline or reduce airway reactivity.

Chronic obstructive pulmonary disease, asthma and protective effects of food intake: from hypothesis to evidence?

Evidence for a role of diet in asthma and chronic obstructive pulmonary disease (COPD) has been accumulating rapidly over the past decade. Associations have been reported between the intake of fruit, fish, antioxidant vitamins, fatty acids, sodium or magnesium, and indicators of asthma and COPD. Several issues need to be addressed before causality of these associations can be established. The role of diet in the development of disease and the induction time and reversibility of the effect needs further investigation. The role of smoking habits in the relation of diet and respiratory disease also needs to be elucidated. Nevertheless, based on the available evidence, dietary guidelines could be proposed for the primary and secondary prevention of asthma and COPD that are in line with existing dietary guidelines for the prevention of coronary heart disease and cancer.

Maturation of immune responses at the beginning of asthma

The prevalence of childhood asthma appears to be increasing worldwide. A critical element in the development of childhood asthma is maturation of the child’s immune system. Most asthmatic children have a history of recurrent lower respiratory tract illnesses associated with airway obstruction during the first year of life. Most infants and young children who will go on to have persistent wheezing and asthma show high IgE production and eosinophilic immune responses at the time of their first viral lower respiratory tract illness. Understanding the genetic and environmental factors that regulate the maturation of the immune response during early life will greatly enhance the development of strategies for the primary and secondary prevention of asthma. (J Allergy Clin Immunol 1999;103:355-61.)