June 17, 2008
Vitamin D and asthma and COPD (70? references)
William B. Grant, Ph.D.
Sunlight, Nutrition, and Health Research Center (SUNARC)
P.O. Box 641603
San Francisco, CA 94164-1603, USA
RSV infection seems to be an important factor for asthma.
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J Allergy Clin Immunol. 2007 Nov;120(5):1031-5. Epub 2007 Oct 24.
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. augusto.litonjua@channing.harvard.edu
In the 1960s, the prevalence of asthma and allergic diseases began to increase worldwide. Currently, the burden of the disease is more than 300 million people affected. We hypothesize that as populations grow more prosperous, more time is spent indoors, and there is less exposure to sunlight, leading to decreased cutaneous vitamin D production. Coupled with inadequate intake from foods and supplements, this then leads to vitamin D deficiency, particularly in pregnant women, resulting in more asthma and allergy in their offspring. Vitamin D has been linked to immune system and lung development in utero, and our epidemiologic studies show that higher vitamin D intake by pregnant mothers reduces asthma risk by as much as 40% in children 3 to 5 years old. Vitamin D deficiency has been associated with obesity, African American race (particularly in urban, inner-city settings), and recent immigrants to westernized countries, thus reflecting the epidemiologic patterns observed in the asthma epidemic. Providing adequate vitamin D supplementation in pregnancy may lead to significant decreases in asthma incidence in young children.
Am J Clin Nutr. 2007 Mar;85(3):853-9.
Devereux G, Litonjua AA, Turner SW, Craig LC, McNeill G, Martindale S, Helms PJ, Seaton A, Weiss ST.
Department of Environmental, University of Aberdeen, Aberdeen, United Kingdom.
BACKGROUND: Maternal intake of vitamin D in pregnancy is a potentially modifiable but understudied risk factor for the development of asthma in children. OBJECTIVE: We investigated whether maternal vitamin D intake in pregnancy is associated with decreased risks of wheezing symptoms in young children. DESIGN: Subjects were from a birth cohort recruited in utero with the primary objective of identifying associations between maternal diet during pregnancy and asthma and allergies in children. A random sample of 2000 healthy pregnant women was recruited while attending antenatal clinics at the Aberdeen Maternity Hospital, Scotland, at approximately 12 wk gestation. Maternal vitamin D intake was ascertained from a food-frequency questionnaire completed at 32 wk of gestation. The main outcome measures were wheezing symptoms, spirometry, bronchodilator response, atopic sensitization, and exhaled nitric oxide at 5 y. RESULTS: Respiratory details through 5 y and maternal food-frequency-questionnaire data were available for 1212 children. In models adjusted for potential confounders, including the children's vitamin D intake, a comparison of the highest and lowest quintiles of maternal total vitamin D intake conferred lower risks for ever wheeze [odds ratio (OR): 0.48; 95% CI: 0.25, 0.91], wheeze in the previous year (OR: 0.35; 95% CI: 0.15, 0.83), and persistent wheeze (OR: 0.33; 95% CI: 0.11, 0.98) in 5-y-old children. In addition, lower maternal total vitamin D intakes in pregnancy were also associated with decreased bronchodilator response (P = 0.04). No associations were observed between maternal vitamin D intakes and spirometry or exhaled nitric oxide concentrations. CONCLUSION: Increasing maternal vitamin D intakes during pregnancy may decrease the risk of wheeze symptoms in early childhood.
Thorax. 2007 Sep;62(9):773-9. Epub 2007 Mar 27.
Comment in:
Willers SM, Devereux G, Craig LC, McNeill G, Wijga AH, Abou El-Magd W, Turner SW, Helms PJ, Seaton A.
Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University, P O Box 80178, 3508 TD Utrecht, The Netherlands. S.Willers@iras.uu.nl
BACKGROUND: Associations between maternal vitamin E, vitamin D and zinc intakes during pregnancy and asthma, wheeze and eczema in 5-year-old children have previously been reported. A study was undertaken to investigate whether maternal intake of specific foods during pregnancy is associated with asthma and allergic outcomes in the same children. METHODS: A longitudinal birth cohort study was conducted in 1,924 children born to women recruited during pregnancy. Maternal diet during pregnancy was assessed by food frequency questionnaire (FFQ). Cohort children were followed up at 5 years by symptom questionnaire and FFQ. Food groups of interest were fruit, vegetables, fruit juice, whole grain products, fish, dairy products and fat spreads. Trends across outcome groups defined by level of food intake are presented. RESULTS: 1,253 children participated at 5 years and maternal FFQ data were available for 1,212. No consistent associations were found between childhood outcomes and maternal intake of the analysed foods except for apples and fish. Maternal apple intake was beneficially associated with ever wheeze (OR highest vs lowest tertile 0.63, 95% CI 0.42 to 0.95), ever asthma (OR 0.54, 95% CI 0.32 to 0.92) and doctor-confirmed asthma (OR 0.47, 95% CI 0.27 to 0.82) in the children. Maternal fish consumption was beneficially associated with doctor-confirmed eczema (OR >or=1/week vs never 0.57, 95% CI 0.35 to 0.92). CONCLUSION: There was no evidence for associations between maternal intake of most foods during pregnancy and asthma, respiratory and allergic outcomes in 5-year-old children, except for apples and fish. Consumption of apples and fish during pregnancy may have a protective effect against the development of childhood asthma and allergic disease.
Public Health Rep. 2005 Mar-Apr;120(2):109-16.
Smith LA, Hatcher-Ross JL, Wertheimer R, Kahn RS.
Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA. lauren.smith@bmc.org
OBJECTIVE: Past studies of the prevalence of childhood asthma have yielded conflicting findings as to whether racial/ethnic disparities remain after other factors, such as income, are taken into account. The objective of this study was to examine the association of race/ethnicity and family income with the prevalence of childhood asthma and to assess whether racial/ethnic disparities vary by income strata. METHODS: Cross-sectional data on 14,244 children aged <18 years old in the 1997 National Health Interview Survey were examined. The authors used logistic regression to analyze the independent and joint effects of race/ethnicity and income-to-federal poverty level (FPL) ratio, adjusting for demographic covariates. The main outcome measure was parental report of the child having ever been diagnosed with asthma. RESULTS: Bivariate analyses, based on weighted percentages, revealed that asthma was more prevalent among non-Hispanic black children (13.6%) than among non-Hispanic white children (11.2%; p<0.01), but the prevalence of asthma did not differ significantly between Hispanic children (10.1%) and non-Hispanic white children (11.2%; p=0.13). Overall, non-Hispanic black children were at higher risk for asthma than non-Hispanic white children (adjusted odds ratio [OR]=1.20; 95% confidence interval [CI] 1.03, 1.40), after adjustment for sociodemographic variables, including the ratio of annual family income to the FPL. Asthma prevalence did not differ between Hispanic children and non-Hispanic white children in adjusted analyses (adjusted OR=0.85; 95% CI 0.71, 1.02). Analyses stratified by income revealed that only among children from families with incomes less than half the FPL did non-Hispanic black children have a higher risk of asthma than non-Hispanic white children (adjusted OR=1.99; 95% CI 1.09, 3.64). No black vs. white differences existed at other income levels. Subsequent analyses of these very poor children that took into account additional potentially explanatory variables did not attenuate the higher asthma risk for very poor non-Hispanic black children relative to very poor non-Hispanic white children. CONCLUSIONS: Non-Hispanic black children were at substantially higher risk of asthma than non-Hispanic white children only among the very poor. The concentration of racial/ethnic differences only among the very poor suggests that patterns of social and environmental exposures must overshadow any hypothetical genetic risk.
Obstet Gynecol. 2005 Jul;106(1):66-72.
Carroll KN, Griffin MR, Gebretsadik T, Shintani A, Mitchel E, Hartert TV.
Vanderbilt University School of Medicine, Department of Pediatrics, Nashville, TN 37232, USA.
OBJECTIVE: Little is known about racial differences in asthma outcomes during pregnancy. We performed a cohort study to estimate racial differences in maternal asthma outcomes in a low-income population of pregnant women in which blacks and whites have similar medical care access and benefits. METHODS: We conducted a population-based cohort study of asthma-related morbidity in black and white pregnant women enrolled in Tennessee's Medicaid Program, TennCare. Pregnant women were identified through TennCare enrollment files linked to birth certificates, 1995-2001. Prepregnancy, women with asthma were identified using International Classification of Diseases, 9th Revision, codes for health care visits and pharmacy files for asthma medication. Adjusted relative rates (RR) of rescue corticosteroid prescriptions, emergency department (ED) visits, and hospitalizations during pregnancy were compared by race using Poisson regression. RESULTS: We identified 4,315 women with asthma (4%) from a population of 112,171 pregnant women of black or white race with at least 180 days of continuous enrollment in TennCare before pregnancy. Blacks were more likely to receive a course of rescue corticosteroids than whites (14.6% versus 11.9%, adjusted RR 1.35, 95% confidence interval [CI] 1.14-1.61), have an emergency department visit (16.7% versus 8.7%, adjusted RR 1.89, 95% CI 1.57-2.27), or be hospitalized for asthma (9.0% versus 5.2%, adjusted RR 1.73, 95% CI 1.34-2.24). CONCLUSION: Pregnant women with asthma had high asthma-related morbidity. Black women had clinically significantly more morbidity than whites. There is a need to improve the medical care of low-income women with asthma, particularly black women. LEVEL OF EVIDENCE: II-2.
Am J Respir Cell Mol Biol. 2006 Nov;35(5):513-8. Epub 2006 Jun 15.
Department of Physiology & Biophysics, University of Calgary, HSC 1627, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1 Canada. dproud@ucalgary.ca
Substantial evidence implicates common respiratory viral infections in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). Children who experience recurrent virally induced wheezing episodes during infancy are at greater risk for developing asthma. In addition, respiratory viral infections are a major trigger for acute exacerbations of both asthma and COPD. Despite the importance of viral infections in asthma and COPD, the mechanisms by which viruses predispose to, or cause exacerbations of, these diseases remain poorly understood. It is clear that viral infections lead to enhanced airway inflammation and can cause airways hyperresponsiveness. The epithelial cell is the principal site of viral infection in the airways and plays a central role in viral modulation of airway inflammation via release of a variety of cytokines, chemokines, and growth factors. The mechanisms by which viral infections modulate epithelial function, therefore, is a topic of intense investigation. The epithelium also contributes to the host innate defense response to viral infection by releasing products that are antiviral and/or can lead to increased recruitment of dendritic cells and lymphocytes. Some evidence supports a role for the epithelial cell in specific immunity, although the response of more conventional cells of the immune system to viral infections is likely the dominant factor in this regard. Although current therapies may help combat virally induced disease exacerbations, they are less than ideal. A better understanding of the mechanisms underlying viral modulation of these diseases, therefore, may lead to new therapeutic approaches.
Proc Am Thorac Soc. 2007 Jul;4(3):267-70.
Department of Respiratory Medicine, National Heart and Lung Institute, Wright Fleming Institute of Infection and Immunity, Imperial College London, Norfolk Place, London W2 1PG, UK. s.johnston@imperial.ac.uk
The major asthma morbidity, mortality, and health care costs are a result of acute exacerbations. However, exacerbations are only partially responsive to current therapies and new approaches to treatment are needed. The great majority of acute asthma exacerbations are associated with respiratory viral infections and, of viruses implicated, approximately 60% are human rhinoviruses (RVs). The mechanisms of RV-induced asthma exacerbations are poorly understood. We have previously shown that adults with asthma have increased susceptibility to naturally occurring RV infections. Our recent studies have investigated mechanisms of innate host defense against RV infection. First, primary bronchial epithelial cells from subjects with asthma were shown to replicate RV in vitro to several logs, whereas those of normal control subjects were resistant to infection. This resistance was a result of rapid induction of apoptosis and of interferon (IFN)-beta in the normal cells, whereas these responses were deficient in asthmatic cells. These studies were recently extended to a novel family of three related proteins, the IFN-lambdas 1-3, production of which was also deficient in vitro and related to asthma exacerbation severity in vivo. These studies identify novel mechanisms for the increased susceptibility of subjects with asthma to RV infection. Further studies are now required to investigate whether administration of IFN-beta or IFN-lambda may be beneficial in the treatment of asthma exacerbations, to determine whether similar deficiencies are observed in children and in subjects with nonatopic asthma, and to investigate the mechanisms of deficient IFN production in asthma to help identify better therapeutic strategies for asthma exacerbations.
Allergol Int. 2008 Mar 1;57(1):21-31 [Epub ahead of print]
Hashimoto S, Matsumoto K, Gon Y, Ichiwata T, Takahashi N, Kobayashi T.
Division of Respiratory Medicine, Department of Medicine, Nihon University School of Medicine.
In bronchial asthma, respiratory virus infection involves several issues: 1) respiratory virus infection in infancy is a risk factor for, and may predispose to, the development of asthma later in life; 2) respiratory virus infection is associated with the acute exacerbation of bronchial asthma; and, 3) glucocorticosteroids (GC) are not adequate for controlling asthma-related symptoms upon respiratory virus infection. Various cells, inflammatory mediators and cytokines participate in the production of airway inflammation upon respiratory virus infection. Bronchial epithelial cells are a site of infection and replication of respiratory virus. They actively participate in the production of airway inflammation: 1) they produce various proinflammatory cytokines, chemokines and mediators; and, 2) they undergo apoptosis, thereby impairing the repair process. It is therefore important to understand the role of bronchial epithelial cells in the pathophysiology of bronchial asthma. In this review, the interaction between viral infection and asthma is discussed to elucidate the role of bronchial epithelial cells in viral infection.
Clin Chest Med. 2000 Jun;21(2):289-300.
Tuffaha A, Gern JE, Lemanske RF Jr.
Department of Medicine, University of Wisconsin Medical School, Madison, USA.
Respiratory infections can have dual effects related to asthma. First, there is increasing evidence that severe infections with RSV and PIV in infancy can alter lung development and physiology to increase the risks of subsequent wheezing and asthma. Second, infections with common cold viruses and influenza commonly precipitate wheezing symptoms in children and adults who already have established asthma, and RV appears to be the most important virus in producing exacerbations of the disease. The principal mechanisms by which this occurs appears to be viral replication in epithelial cells, triggering a cascade of inflammation involving granulocytes, macrophages, T cells, and secreted cytokines and mediators. The inflammatory process, although essential to clear the infection, augments pre-existing airway inflammation in asthma, leading to increased airway obstruction and lower respiratory tract symptoms. Greater understanding of virus-induced changes in inflammation and corresponding changes in airway physiology may lead to new therapeutic approaches to the treatment and prevention of virus-induced airway dysfunction.
Pediatrics. 2005 May;115(5):1254-60.
Akinbami LJ, Rhodes JC, Lara M.
Infant, Child, and Women's Health Studies Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. lea8@cdc.gov
BACKGROUND: Racial and ethnic disparities exist in reported childhood asthma prevalence, but it is unclear if disparities stem from true prevalence differences or a different likelihood of receiving a diagnosis from a health professional. Concern has been raised that asthma may be underdiagnosed, particularly among minority children who have more restricted access to high-quality health care. OBJECTIVE: To examine racial/ethnic differences among currently symptomatic children in acquiring an asthma diagnosis to determine if relative underdiagnosis among minorities exists. Children for whom no symptoms were reported (a group that includes those with well-controlled symptoms) were excluded from the analysis. METHODS: The 1999 National Health Interview Survey includes a nationally representative sample of children with reported wheezing symptoms. We included children 3 to 17 years old in the study and analyzed racial/ethnic differences in asthma diagnosis, controlling for young age, gender, parental education, single-parent household, central-city residence, region of residence, health insurance, having a usual place of care, and parent-reported severity of wheezing symptoms. RESULTS: Among those reported to have wheezed in the past year (n = 946), 83% of Puerto Rican, 71% of non-Hispanic black, and 65% of Mexican children were diagnosed with asthma compared with 57% of non-Hispanic white children. Using non-Hispanic white children as the reference group, the approximate adjusted relative risk for physician diagnosis of asthma given wheezing in the past year was 1.43 (95% confidence interval [CI]: 1.04, 1.63) for Puerto Rican, 1.22 (95% CI: 1.03, 1.37) for non-Hispanic black, and 1.19 (95% CI: 0.94, 1.39) for Mexican children. Minority children were reported to have greater severity of wheezing symptoms. Even after accounting for this increased severity, children in racial and ethnic minority groups were as or more likely to have a reported asthma diagnosis than non-Hispanic white children. CONCLUSIONS: Our findings do not provide evidence for the hypothesis that symptomatic minority children are underdiagnosed with asthma compared with non-Hispanic white children. To the contrary, among currently symptomatic children, minority children were more likely to be diagnosed than non-Hispanic white children even after accounting for the higher wheezing severity among minority children.
Nutr Clin Pract. 2008 Feb;23(1):49-62.
The Johns Hopkins Hospital, Division of Gastroenterology, 600 North Wolfe Street, Carnegie Building, Room 464, Baltimore, MD 21287. gmullin1@jhmi.edu.
Current Western therapies for inflammatory diseases are suboptimal; increasingly, patients are turning to complementary and alternative medicine for symptom relief and improved quality of life. There is emerging evidence that many of these therapies have the ability to modulate the immune system and disrupt the proinflammatory cascade through a variety of mechanisms, including antioxidant effects, alterations in cell signaling (in particular the nuclear factor (NF)-kappaB pathway), cytokines, proinflammatory mediators, and disruption of bacterial flora. Using inflammatory bowel disease (IBD) as a model of inflammation, we explore the principal complementary and alternative medicine treatments that show promise in this regard, namely, resveratrol, green tea, curcumin, boswellia, fish oil, vitamin D, and probiotics. With each agent, we detail the mechanisms that have been described with regard to immune modulation, discuss the medical conditions for which it has been evaluated, and explore the data to date for the prevention or treatment of IBD.
Pediatrics. 2006 May;117(5):e868-77.
McDaniel M, Paxson C, Waldfogel J.
The Urban Institute, Center on Labor, Human Services, and Population, Washington, DC, USA.
OBJECTIVE: To examine differences in asthma prevalence and emergency department (ED) visits for asthma between non-Hispanic black and white children, and factors that might explain those differences, in a large, nationally representative sample covering the period 1997 to 2003. METHODS: Bivariate and multivariate regression analyses (with logit and multinomial logit methods) were conducted with a sample consisting of all non-Hispanic black and white children (<18 years of age) from the 1997 to 2003 rounds of the National Health Interview Survey. Models included a progressively larger set of controls for factors that might explain racial differences in asthma prevalence and ED visits for asthma. RESULTS: Being black was associated with a greater likelihood of currently having asthma and with a greater likelihood of having gone to the ED for asthma treatment in the past 1 year. Elevated asthma risks for black children were robust after controlling for a host of child and family characteristics that might explain them. CONCLUSIONS: Black children are more likely to have asthma and to experience ED visits for asthma, compared with otherwise comparable white children, and these racial disparities cannot be explained by differences in measurable child or family characteristics. These results suggest that racial disparities in asthma continue to pose risks for black children, and they point to the need for additional research into potential explanations and remedies.
Clin Chest Med. 2006 Sep;27(3):423-30, vi.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. jford@jhsph.edu
Racial disparities in asthma morbidity and mortality are greater than differences in asthma prevalence. This finding suggests that following the diagnosis of asthma, blacks receive substantially different care than non-Hispanic whites, through available health care systems and their social support networks, and racial differences in relevant environ-mental exposures contribute to differences in morbidity and mortality. An overview of factors that may contribute to disparities in asthma prevalence, morbidity, and mortality,including contextual factors, is provided.
Clin Chest Med. 2006 Mar;27(1):1-15, v.
Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, P.O. Box 2641, Durham, NC 27710, USA. njira.lugogo@duke.edu
The epidemiology of asthma is complex but essential in enhancing the understanding of a disease that affects millions of patients. Asthma is associated with significant morbidity and mortality. Asthma prevalence rates in the United States reached a plateau after 1998 with an estimated overall prevalence of 3.8% in 2003. Racial disparities exist and there are staggering differences in morbidity and mortality. The analysis of data collected from epidemiologic studies continues to be a critical part of enhancing the understanding of the pathophysiology of asthma, which will lead to improved patient outcomes.
Rev Prat. 2007 Oct 31;57(16):1759-66.
[Article in French]
Brouard J, Vabret A, Nimal-Cuvillon D, Bach N, Bessière A, Arion A, Freymuth F.
Service de pédiatrie, CHU de Caen, 14033 Caen. brouard-j@chu-caen.fr
More than 200 antigenically distinct viruses have been documented as causes of sporadic or epidemic respiratory infections in infants and children. The lung itself is rarely sampled directly, and sputum representing lower-airway secretions can rarely be obtained from children. In addition culture of secretions from upper respiratory tract is not useful since the normal flora includes the bacteria commonly responsible for pneumonia. Clinical and radiology data only suggest the diagnosis. The development of techniques to detect antigens of the causative agent in nasopharyngeal secretions, nucleic acid by means of the polymerise-chain reaction assays has significantly improved the identification of the responsible pathogen and the choice of appropriate treatment. Since more 30 years rhinovirus, coronavirus, enterovirus, parainfluenza virus and respiratory syncytial virus were added to influenza, adenovirus and measles virus as causes of respiratory tract infections. This list of pathogens was extended last years with the discovery of human metapneumovirus, bocavirus, polyomavirus. In restricted patient groups, such as the immunocompromised, members of the family of herpesvirus have also been associated with respiratory disease.
Pediatrics. 2006 Aug;118(2):e363-70.
Davis AM, Kreutzer R, Lipsett M, King G, Shaikh N.
American Lung Association of California, 1900 Powell St, Suite 800, Emeryville, California 94608, USA. adavis@alaebay.org
OBJECTIVES: Asthma prevalence for different ethnic groups in the United States, beyond white, black and Hispanic, is seldom reported. We compared the prevalence of asthma diagnosis among various Hispanic and Asian American ethnic subgroups using data collected from the school-based California Healthy Kids Survey. METHODS: The California Healthy Kids Survey was administered to 462 147 public school students in the seventh, ninth, and 11th grades throughout California during the 2001-2002 and 2002-2003 school years. Prevalence of lifetime asthma diagnosis was calculated for 11 Asian American Pacific Islander subgroups and 8 Hispanic subgroups. RESULTS: Asthma prevalence among Hispanic subgroups ranged from 13.2% for Mexican American students to 22.8% for Puerto Rican students and 23.0% among Cuban American students. Lifetime asthma diagnosis among the 11 Asian American Pacific Islander subgroups ranged from 10.9% among Korean American students to 23.8% among Filipino American students. CONCLUSIONS: The survey revealed substantial variation in asthma prevalence between the different Hispanic and Asian American Pacific Islander subgroups and that Pacific Islanders, Filipinos, Cubans, and Puerto Ricans are at elevated risk for asthma. Differences in the distributions of characteristics related to country of birth, residential history, generational status, and/or degree of acculturation might account for much of the observed differences in asthma prevalence between ethnic subgroups. Previous asthma prevalence estimates for Asians or Hispanics are in part a function of the particular ethnic composition of the population under investigation. We suggest that asthma studies that include a substantial number of Asian Pacific Islander and Hispanic persons use a more detailed categorization of race/ethnicity.
Eur Respir J. 1997 Aug;10(8):1780-6.
[No authors listed]
Little information is available on the epidemiology of childhood respiratory disorders in Southern Europe. We investigated the prevalence of asthma and respiratory symptoms in a large sample of schoolchildren, according to gender, latitude, urbanization, and socioeconomic status. Questionnaires including the International Study of Asthma and Allergies in Childhood (ISAAC) core module on wheeze, as well as questions about other respiratory symptoms (including cough and phlegm), were completed by the parents of 18,737 schoolchildren aged 6-7 yrs, from eight centres of northern and central Italy. Wheeze in the last 12 months was reported for 9% of males and 6% of females, and severe wheezing attacks for 1.4 and 0.8%, respectively. Asthma during lifetime was reported for 11% of males and 6.4% of females. The prevalence of physician-diagnosed asthma increased with level of urbanization, but reported wheezing did not, suggesting a labelling bias. Socioeconomic status was not associated with the prevalence of most wheezing symptoms or of physician-diagnosed asthma, but was negatively correlated with the number of hospital admissions because of asthma. Unlike wheezing symptoms, the prevalence of chronic cough and phlegm was associated with increasing urbanization and decreasing socioeconomic level. Urbanization and socioeconomic level have little effect on the prevalence of wheezing in this area, but they might influence the diagnosis and the management of asthma, as well as the prevalence of chronic cough and chronic phlegm.
Occup Environ Med. 2004 Jul;61(7):609-15.
Weiland SK, Hüsing A, Strachan DP, Rzehak P, Pearce N; ISAAC Phase One Study Group.
Department of Epidemiology, University of Ulm, Ulm, Germany. stephan.weiland@medizin.uni-ulm.de
AIMS: To investigate the association between climate and atopic diseases using worldwide data from 146 centres of the International Study of Asthma and Allergies in Childhood (ISAAC). METHODS: Between 1992 and 1996, each centre studied random samples of children aged 13-14 and 6-7 years (approx. 3000 per age group and centre) using standardised written and video questionnaires on symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema during the past 12 months. Data on long term climatic conditions in the centres were abstracted from one standardised source, and mixed linear regression models calculated to take the clustering of centres within countries into account. RESULTS: In Western Europe (57 centres in 12 countries), the prevalence of asthma symptoms, assessed by written questionnaire, increased by 2.7% (95% CI 1.0% to 4.5%) with an increase in the estimated annual mean of indoor relative humidity of 10%. Similar associations were seen for the video questionnaire and the younger age group. Altitude and the annual variation of temperature and relative humidity outdoors were negatively associated with asthma symptoms. The prevalence of eczema symptoms correlated with latitude (positively) and mean annual outdoor temperature (negatively). CONCLUSIONS: Results suggest that climate may affect the prevalence of asthma and atopic eczema in children.
Allergy. 2004 Mar;59(3):306-14.
Zanolin ME, Pattaro C, Corsico A, Bugiani M, Carrozzi L, Casali L, Dallari R, Ferrari M, Marinoni A, Migliore E, Olivieri M, Pirina P, Verlato G, Villani S, Marco R; ISAYA Study Group.
Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy.
BACKGROUND: Variations in the prevalence of respiratory symptoms according to geo-climatic factors could provide important clues to the knowledge of the aetiology of asthma. METHODS: Geo-climatic variations in the prevalence of current asthma, allergic rhinitis and chronic cough, and phlegm were assessed on a random sample of 18 873 subjects (response rate = 72.7%) from different climatic regions of Italy. An ecological analysis, supported by robust statistical methods, was employed to investigate potential trends. RESULTS: The prevalence of all symptoms was significantly heterogeneous throughout the peninsula. Only asthma-like symptoms showed a north-south trend: the prevalence increased at a decreasing latitude [odds ratio (OR) varies from 0.92 to 0.96, P < 0.05], at a decreasing distance from the sea (OR: 0.90-0.93 for 30 km distance, P < 0.05), at higher annual mean temperatures (OR: 1.11-1.14, P < 0.05) and at smaller annual temperature ranges (OR: 0.94-0.95, P < 0.05). Of the geo-climatic variables considered, temperature range had the greatest influence on most asthma-like symptoms. No association was found between geo-climatic variables and allergic rhinitis or chronic cough and phlegm. CONCLUSIONS: Asthma prevalence seems to be significantly affected by climate as asthma-like symptoms were more common in central-southern Italy, with a Mediterranean climate, than in areas with a continental climate (northern Italy).
Lancet. 1998 Apr 25;351(9111):1225-32.
Comment in:
Lancet. 1998 Apr 25;351(9111):1220-1.
Lancet. 2001 Jan 27;357(9252):313-4.
[No authors listed]
BACKGROUND: Systematic international comparisons of the prevalences of asthma and other allergic disorders in children are needed for better understanding of their global epidemiology, to generate new hypotheses, and to assess existing hypotheses of possible causes. We investigated worldwide prevalence of asthma, allergic rhinoconjunctivitis, and atopic eczema. METHODS: We studied 463,801 children aged 13-14 years in 155 collaborating centres in 56 countries. Children self-reported, through one-page questionnaires, symptoms of these three atopic disorders. In 99 centres in 42 countries, a video asthma questionnaire was also used for 304,796 children. FINDINGS: We found differences of between 20-fold and 60-fold between centres in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema, with four-fold to 12-fold variations between the 10th and 90th percentiles for the different disorders. For asthma symptoms, the highest 12-month prevalences were from centres in the UK, Australia, New Zealand, and Republic of Ireland, followed by most centres in North, Central, and South America; the lowest prevalences were from centres in several Eastern European countries, Indonesia, Greece, China, Taiwan,