Drugs Food Cigarette Smoke Emotions Weather Obesity/Nutrition Physical Activity
Author(s):
Yoshida
S ; Mikami
H ; Nakagawa
H ; Hasegawa
H ; Onuma
K ; Ishizaki
Y ; Shoji
T ; Amayasu
H
Affiliation: Dental Allergy Research Group, Clinical Research Division,
AOKI International Medical Center, Yokohama, Japan. Title: Amalgam allergy associated with exacerbation of
aspirin-intolerant asthma. Source: Clin Exp Allergy (Clinical and experimental allergy : journal of
the British Society for Allergy and Clinical Immunology.) 1999 Oct; 29(10):
1412-4
Abstract: BACKGROUND: Aspirin-intolerant asthma can be induced not only by acidic
analgesics (including acetylsalicylic acid), which effectively inhibit
cyclo-oxygenase, but also by cross-reactivity with paraben, and other chemical
additives. OBJECTIVE: We examined whether amalgam allergy is involved in the
pathogenesis of a aspirin-intolerant asthma. METHODS: We present the first case
of aspirin-intolerant asthma that improved after the removal of dental amalgam.
In addition, we performed both the methacholine provocation testing and
sulpyrine provocation testing before and after the removal of dental amalgam.
RESULTS: In addition, the methacholine concentration causing a 20% fall in FEV1
in provocation tests rose significantly, though hypersensitivity to analgesics
evaluated with sulpyrine provocation testing did not decrease. These results
suggest that amalgam sensitization is involved in bronchial hyperresponsiveness
in aspirin-intolerant asthma. CONCLUSION: Sensitivity to amalgam may cause
exacerbation of aspirin-intolerant asthma in some patients. To the best of our
knowledge, this is the first case report of amalgam allergy associated with
aspirin-intolerant asthma.
Author(s): Krautheim
AB ; Jermann
TH ; Bircher
AJ
Affiliation: Allergy Unit, Department of Dermatology, University
Hospital, Petersgraben 4, 4031 Basel, Switzerland.
Title: Chlorhexidine
anaphylaxis: case report and review of the literature. Source: Contact Dermatitis (Contact dermatitis.) 2004
Mar; 50(3): 113-6
Abstract:
Chlorhexidine is a widely used
antiseptic and disinfectant. Compared to its ubiquitous use in medical and non-medical
environments, the sensitization rate seems to be low. Multivarious
hypersensitivity reactions to the agent have been reported, including delayed
hypersensitivity reactions such as contact dermatitis, fixed drug eruptions and
photosensitivity reactions. An increasing number of immediate-type allergies
such as contact urticaria, occupational asthma and anaphylactic shock have been
reported. In the case report, we describe anaphylaxis due to topical skin
application of chlorhexidine, confirmed by skin testing and sulfidoleukotriene
stimulation test (CAST(R): cellular antigen stimulation test). The potential
risk of anaphylactic reactions due to the application of chlorhexidine is well
known, especially that application to mucous membranes can cause anaphylactic
reactions and was therefore discouraged. The use of chlorhexidine at a 0.05%
concentration on wounds and intact skin was so far thought to be safe. Besides
our patient, only one other case of severe anaphylactic reaction due to
application of chlorhexidine on skin has been reported. Hypersensitivity to
chlorhexidine is rare, but its potential to cause anaphylactic shock is
probably underestimated. This review should remind all clinicians of an
important potential risk of this widely used antiseptic.
Author(s):
Kamijo
Y ; Soma
K ; Inoue
A ; Nagai
T ; Kurihara
K
Affiliation: Department of Emergency and Critical Care Medicine,
Kitasato University, School of Medicine, 1-15-1 Kitasato, Sagamihara Kanagawa
228-8555, Japan.
Title: Acute
respiratory distress syndrome following asthma-like symptoms from massive
ingestion of a monoethanolamine-containing detergent. Source: Vet Hum Toxicol (Veterinary and human
toxicology.) 2004 Apr; 46(2): 79-80
Abstract: A 65-y-old man ingested about 600 mL of an alkaline detergent (pH 11.7)
containing 3.3% monoethanolamine (MEA). After vomiting with choking several
times, he presented to the emergency center with asthma-like symptoms 95 min
after ingestion. Despite treatment with bronchodilators, steroids, and
epinephrine, respiratory dysfunction progressed to acute respiratory distress
syndrome resulting in death on the 4th hospital day. This is the first report
of serious acute oral ingestion of an MEA-containing product; MEA aspirated
into the respiratory tract may cause not only bronchial asthma symptoms, but
may also severely injure the lung parenchyma.
Author(s):
Rivera
JO ; Hughes
HW ; Stuart
AG
Affiliation: University of Texas at El Paso/University of Texas
(UTEP/UT)-Austin Cooperative Pharmacy Program, El Paso, TX 79902-4153, USA.
jrivera@utep.edu
Title: Herbals and
asthma: usage patterns among a border population. Source: Ann Pharmacother (The Annals of pharmacotherapy.)
2004 Feb; 38(2): 220-5
Abstract: BACKGROUND: The use of herbal products (HP) is rising in the US. Higher
rates of HP use have been documented in the US/Mexico border population, as
well as increasing concerns about herbal-related adverse events. OBJECTIVE: To
evaluate the prevalence of HP use in adult asthmatic patients requiring
hospitalization and the frequency of HP documentation in medical records.
METHODS: We conducted a retrospective chart review of admissions for asthma to
determine the frequency of HP documentation. Additionally, during a 12-month
period, a bilingual interviewer conducted prospective, semistructured
interviews with patients with asthma exacerbations to record data on HPs used
specifically for the treatment of asthma. RESULTS: A total of 67 cases were
chart-reviewed retrospectively; 60 patients were interviewed prospectively. We
found no documentation of HP use by chart review, while prospective interviews
showed that 42% of patients reported using HPs for the treatment of asthma. The
most common HPs used were oregano 28%, chamomile 20%, garlic 16%, eucalyptus
12%, and lime 12%. Ten patients reported taking an HP that could potentially
exacerbate their asthma and 18 patients reported using an HP that could
interact with other medications or cause other types of adverse events.
CONCLUSIONS: An obvious lack of documentation for HP use was observed in the
medical records reviewed. Because a number of HPs that are commonly used by
residents along the border can interact with antiasthmatic agents and/or result
in compromised asthma control, questions about HP use should be included in
routine history taking.
Affiliation: Department of Family Medicine, Faculty of Health Sciences,
Ben-Gurion University of the Negev, Israel.
Title: Acute
asthma associated with sustained-release verapamil. Source: Ann Pharmacother (The Annals of pharmacotherapy.)
1997 May; 31(5): 593-5
Abstract: OBJECTIVE: To describe a patient with asymptomatic bronchial asthma and
hypertension who developed an acute asthma attack after receiving
sustained-release verapamil. CASE SUMMARY: A 66-year-old white woman with a
10-year history of hypertension and bronchial asthma was switched from
immediate-release verapamil hydrocloride 40 mg tid to sustained-release
verapamil 240 mg/d po for better hypertension control. After taking the first
tablet, she developed dyspnea, cough, and wheezing. Antiasthmatic medications
were prescribed, but the asthma symptoms did not improve. She continued taking
verapamil for 6 months, then, on her own, stopped all medications including the
sustained-release verapamil, and her asthma symptoms disappeared. On
rechallenge she developed severe dyspnea, cough, and wheezing 20 minutes after
administration. The asthma resolved within 24 hours following three albuterol
inhalations. The next day similar symptoms developed with rechallenge of the
same brand of sustained-release verapamil in a 120-mg formulation, and
verapamil was discontinued. Six months later she was again prescribed
sustained-release verapamil 240 mg in another clinic where the physician was
unaware of her previous reaction. Once again, severe dyspnea, cough, and
wheezing developed. DISCUSSION: On four separate occasions the patient was
challenged advertently or inadvertently, with sustained-release verapamil.
Similar symptoms developed after each challenge and resolved after
discontinuing this preparation. Although dyspnea associated with verapamil
administration has been reported, this is the first report of an elderly
asymptomatic asthmatic patient with hypertension who developed an acute asthma
attack following sustained-release verapamil administration. CONCLUSIONS:
Sustained-release verapamil is thought to be the cause of the asthma attack in
this patient because she was not taking any other preparations; the symptoms
started with the administration of sustained-release verapamil and were
relieved after its discontinuation.
Author(s):
Ford
ES ; Mannino
DM ; Williams
SG
Affiliation: Division of Environmental Hazards and Health Effects,
National Center for Environmental Health, Centers for Disease Control and
Prevention, 4770 Buford Highway NE, Mailstop K66, Atlanta, GA 30341, USA.
esf2@cdc.gov
Title: Asthma and
influenza vaccination: findings from the 1999-2001 National Health Interview
Surveys. Source: Chest (Chest.)
2003 Sep; 124(3): 783-9
Abstract: STUDY OBJECTIVES: People with asthma are at high risk for complications
from influenza; therefore, the Centers for Disease Control and Prevention
recommends an annual influenza vaccination for people with asthma. Because
little is known about such vaccination rates among adults, especially those
aged 18 to 49 years and 50 to 64 years, we sought to estimate influenza vaccination
rates among US adults. DESIGN: Cross-sectional analyses of the 1999 to 2001
National Health Interview Surveys. SETTING: US population. PARTICIPANTS:
Representative samples of US adults aged > or =18 years. MEASUREMENTS AND
RESULTS: Asthma status and receipt of influenza vaccination during the past 12
months were self-reported. We found that 35.1% (95% confidence interval [CI],
33.0 to 37.0%), 36.7% (95% CI, 34.7 to 38.6%), and 33.3% (95% CI, 31.6 to
35.0%) of participants with asthma reported having had an influenza vaccination
in 1999 (n = 2,620), 2000 (n = 3,007), and 2001 (n = 3,582), respectively.
Among participants aged 18 to 49 years, the vaccination rates were 20.9% (SE
1.2%), 22.7% (SE 1.2%), and 21.1% (SE 1.0%), respectively. Among participants aged
50 to 64 years, the vaccination rates were 46.2% (SE 2.6%), 47.8% (SE 2.3%),
and 42.3% (SE 2.1%), respectively. Vaccination rates increased strongly with
age and with education in each year. Associations with sex or with race or
ethnicity were inconsistent during the 3 years. CONCLUSIONS: The suboptimal
vaccination rates among people with asthma aged 18 to 64 years suggest the need
to increase influenza vaccination rates in this age group.
Author(s):
Carson
HJ ; Zweigart
M ; Lueck
NE
Affiliation: Department of Pathology, Mercy Medical Center, Cedar
Rapids, Iowa 52403, USA. hjcmd@earthlink.net
Title: Death from
asthma associated with sertraline overdose. Source: Am J Forensic Med Pathol (The American journal of
forensic medicine and pathology : official publication of the National
Association of Medical Examiners.) 2000 Sep; 21(3): 273-5
Abstract: The authors report a case of a young woman for whom autopsy confirmed the cause of death to be due to an acute asthma attack. In addition, she had high serum levels of sertraline hydrochloride (Zoloft). The decedent had a recent prescription for sertraline filled, from which most of the pills were missing, suggesting a large consumption of medication. She was found dead at home, immersed in a bath. Autopsy revealed anatomic evidence of a severe recent asthma attack. Quantitative blood assay for sertraline was very high (620 ng/ml). Fatalities from sertraline alone are virtually nonexistent. The effects of sertraline on asthma, however, are not well-studied. Why the patient ingested so much sertraline is unclear. However, it is possible that, in a variant of the serotonin syndrome, a large dose of a selective serotonin reuptake inhibitor participated in precipitating an asthma attack or prevented her from being aware of the evolution of such an exacerbation. Additional observations in the future will be useful in assessing the role of this class of drugs in patients with asthma.
Drugs Food Cigarette Smoke Emotions Weather Obesity/Nutrition Physical Activity
Author(s): Kawano
T ; Matsuse
H ; Kondo
Y ; Machida
I ; Saeki
S ; Tomari
S ; Mitsuta
K ; Obase
Y ; Fukushima
C ; Shimoda
T ; Kohno
S
Affiliation: Second Department of Internal Medicine, Nagasaki University
School of Medicine, Nagasaki, Japan.
Title: Acetaldehyde induces histamine release from human airway mast cells to cause bronchoconstriction.
Source: Int Arch Allergy Immunol (International archives of allergy and immunology.)
2004 Jul; 134(3): 233-9
Abstract: BACKGROUNDS: Approximately half of the Japanese asthmatics experience
exacerbation of asthma after alcohol consumption. We previously reported that
this phenomenon is probably caused by histamine release from mast cells by
acetaldehyde stimulation. However, no reports have described the effects of
acetaldehyde on human airway mast cells. The purpose of the present study was
to demonstrate acetaldehyde-induced histamine release from human airway mast
cells with subsequent airway smooth muscle contraction and to investigate the
ensuing mechanisms. METHODS: Human tissue samples were prepared from the lungs
resected from patients with lung cancer. The effect of acetaldehyde on airway
muscle tone and the concentration of chemical mediators released in the organ
bath were measured before and after acetaldehyde stimulation. Mast cells were
prepared from lung parenchyma by the immunomagnetic method and then stimulated
with acetaldehyde to determine the chemical mediators released. RESULTS:
Acetaldehyde (>3 x 10(-4) M) increased airway muscle tone, which was
associated with a significant increase in the release of histamine, but not
thromboxane B2 or cysteinyl-leukotrienes. A histamine (H1 receptor) antagonist
completely inhibited acetaldehyde-induced bronchial smooth muscle contraction.
Acetaldehyde also induced a significant histamine release from human lung mast
cells and degranulation of mast cells. CONCLUSIONS: The present results
strongly suggest that acetaldehyde stimulates human airway mast cells to
release histamine, which may be involved in bronchial smooth muscle contraction
following alcohol consumption.
Author(s):
Lee
SY ; Lee
KS ; Hong
CH ; Lee
KY
Affiliation: Department of Pediatrics, Ajou University School of
Medicine, San 5, Won-Chon Dong, Pal-Dal Ku, Suwon 442-749, South Korea.
Title: Three cases
of childhood nocturnal asthma due to buckwheat allergy. Source: Allergy (Allergy.) 2001 Aug; 56(8):
763-6
Abstract: BACKGROUND: Buckwheat flour (BF) is known as a potent food allergen.
Sensitization to it usually occurs by ingestion but also by inhalation in
occupational or domestic exposure. Buckwheat chaff-stuffed pillows (BCP) can be
contaminated with BF during the process of pilling, and many Korean children
and adults use BCP for health reasons. METHODS AND RESULTS: We here present
three cases of BF allergy in children using BCP, who had been treated as
nonatopic asthmatics after undergoing the routine allergy skin tests and
serologic tests. We took careful clinical histories, and performed skin prick
tests (SPT), the radioimmunoassay (RIA) for specific IgE, the BCP-elimination
test, the BF bronchial provocation test, and IgE Western blot. All three
children showed positive skin reactions to BF, but none of them had positive
reactions to house-dust mites. Nocturnal asthmatic symptoms were improved
during 7 days of BCP elimination, and asthmatic responses were observed by
bronchial provocation tests with homemade BF extract. Serum BF-specific IgE
antibodies and several IgE-binding proteins were detected by RIA and Western
blot analysis, respectively. CONCLUSIONS: Thus, a small amount of BF attached
to BCP can induce BF sensitization, and BCP should be considered a main cause
of childhood nocturnal asthma in those asthmatics exposed to these pillows.
Author(s): Asero R ; Mistrello G ;
Roncarolo D ;
Amato S
Affiliation: Ambulatorio di Allergologia, Clinica San Carlo, Paderno
Dugnano, Milan, Italy. r.asero@libero.it
Title: Relationship
between peach lipid transfer protein specific IgE levels and hypersensitivity
to non-Rosaceae vegetable foods in patients allergic to lipid transfer protein.
Source:
Ann Allergy Asthma Immunol (Annals of allergy, asthma &
immunology : official publication of the American College of Allergy, Asthma,
& Immunology.) 2004 Feb; 92(2): 268-72
Abstract: BACKGROUND: Lipid transfer protein (LTP), the major allergen in Rosaceae
in geographic areas where the prevalence of birch pollen allergy is low, is a
widely cross-reacting pan-allergen, but the pattern of cross-reactivity to
plant-derived foods botanically unrelated to Rosaceae shows much variability.
OBJECTIVE: To examine the relationship between peach LTP specific IgE levels
and cross-reactivity to several non-Rosaceae, plant-derived foods. METHODS: IgE
specific for peach LTP was measured by enzyme-linked immunosorbent assay in
serum samples from 40 patients with Rosaceae allergy monosensitized to LTP.
Patients were considered monosensitized to this protein in the absence of
sensitization to other cross-reacting, plant-derived foods as shown by negative
skin prick test (SPT) results with both birch and mugwort pollen. SPTs with
commercial extracts of walnut, hazelnut, peanut, celery, maize, rice, tomato,
orange, and onion were performed to detect possible immunologic
cross-reactivity to these foods. RESULTS: Patients with negative SPT results
with non-Rosaceae foods showed significantly lower levels of IgE to peach LTP
than patients showing skin reactivity to one or more non-Rosaceae foods (P <
.001). A significant difference in specific IgE to peach LTP between patients
with positive or negative SPT results was observed with each individual food (P
< .001 in all cases). The level of IgE to peach LTP was strongly related to
the number of positive SPT results with non-Rosaceae foods (r = 0.78; P <
.001). Increasing levels of IgE to peach LTP were associated with skin
reactivity to nuts (29/40 [72%]), peanut (27/40 [67%]), maize (16/39 [41%]),
rice (14/39 [36%]), onion (13/37 [35%]), orange (9/32 [28%]), celery (11/40
[27%]), and tomato (8/39 [20%]). CONCLUSIONS: This study suggests that all
allergenic determinants in LTP from vegetable foods other than peach
cross-react with peach LTP determinants, whereas only some peach LTP epitopes
cross-react with allergenic determinants on botanically unrelated, plant-derived
foods. The high levels of IgE to peach LTP seem to reflect the presence of IgE
targeting common allergenic determinants of LTP, causing cross-reactivity to
botanically unrelated, vegetable foods. In LTP-allergic patients, increasing
levels of IgE to peach LTP are paralleled by an increasing number of foods
other than Rosaceae positive on SPT that cause clinical symptoms.
Author(s):
Woods
RK ; Raven
JM ; Walters
EH ; Abramson
MJ ; Thien
FC
Affiliation: Department of Epidemiology and Preventive Medicine, Central
and Eastern Clinical School, Monash University and The Alfred Hospital,
Melbourne, Victoria 3004, Australia.
Title: Fatty acid
levels and risk of asthma in young adults. Source: Thorax (Thorax.) 2004 Feb; 59(2):
105-10
Abstract:
BACKGROUND: There is current
interest in the possible protective effect of long chain (n-3) fatty acids from
fish in chronic lung diseases such as asthma. The aim of this community based
cross sectional study was to determine whether plasma long chain (n-3) fatty
acids, as a measure of dietary intake, differed between 1601 young adults with
and without asthma. METHODS: Subjects of mean (SD) age 34.6 (7.1) years
completed a detailed respiratory questionnaire, food frequency questionnaire,
skin prick testing, and lung function tests including methacholine challenge
test for bronchial hyperreactivity (BHR) and had venous blood taken for
analysis of plasma fatty acids. Plasma fatty acid levels (%) were analysed
using multiple logistic regression with alternative definitions of asthma and
atopy as the outcomes. RESULTS: Atopy was not associated with any plasma fatty
acid. The n-3 polyunsaturated fatty acids and n-6:n-3 ratio were not
consistently associated with asthma or atopy. The n-6 polyunsaturated fatty
acid dihomo gamma-linolenic acid (DHGLA) was positively associated with current
asthma (OR=1.30, 95% CI 1.06 to 1.60), asthma (OR=1.34, 95% CI 1.13 to 1.60),
and doctor diagnosed asthma (OR=1.25, 95% CI 1.06 to 1.48). CONCLUSION: Plasma
n-3 fatty acids are not associated with a reduced risk of asthma or atopy among
young adults. The association of DHGLA with asthma warrants further research to
determine a cause-effect relationship.
Author(s):
Vally
H ; Carr
A ; El-Saleh
J ; Thompson
P
Affiliation: Asthma and Allergy Research Unit, Department of Medicine,
University of Western Australia, Queen Elizabeth II Medical Centre, Perth,
Nedlands, Australia.
Title: Wine-induced
asthma: a placebo-controlled assessment of its pathogenesis. Source: J Allergy Clin Immunol (The Journal of allergy and
clinical immunology.) 1999 Jan; 103(1) Pt 1: 41-6
Abstract: BACKGROUND: The sulfite family of food additives has been implicated in
the pathogenesis of wine-induced asthma. However, the evidence supporting this
is weak, and because wines have many hundreds of components,
nonsulfite-associated mechanisms may also play a role. OBJECTIVES: The aim of
the study was to assess the potential sensitivity of persons with asthma to
nonsulfite components in wine by using low-sulfite wine challenges. METHODS:
Sixteen adults with a strong history of wine-induced asthma were challenged
with both low-sulfite red and white wines and wine-placebo drinks. Challenges
were performed double blind, using a Latin square design, with lung function
being assessed before the challenge and at 5, 10, 15, 30, and 60 minutes after
the challenge. Subsequently, single-blind challenges with high-sulfite white
wine were also completed in 10 individuals whose lack of reactivity to
low-sulfite white wine suggested possible reactivity to sulfite additives.
RESULTS: The mean FEV1; forced expiratory flow, mid-expiratory phase; and peak
expiratory flow of subjects to low-sulfite red and white wines and red and
white placebo wines were not significantly different. Furthermore, with a
predetermined criterion of a fall in FEV1 of more than 15% representing a
positive challenge, only one individual exhibited a positive reaction in the presence
of a negative response to placebo. Only 2 of the 10 test individuals who were
challenged with a high-sulfite wine demonstrated a marked and rapid fall in
FEV1. Reactivity to low-sulfite wines appears to occur only in a small number
of individuals who report sensitivity to wines, suggesting that the sulfite
additives may be the major cause of wine-induced asthmatic reactions. However,
direct challenge with high-sulfite wine revealed only 2 clear reactions in this
asthma cohort. CONCLUSION: Wine-induced asthma appears to be a complex
phenomenon and may involve several mechanisms that are codependent.
Author(s):
Cuddy
R ; Li
G
Affiliation: Department of Emergency Medicine, The Johns Hopkins
Hospital, The Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
rcuddy@jhmi.edu
Title: The role of
alcohol in asthma: a review of clinical and experimental studies. Source: Am J Emerg Med (The American journal of
emergency medicine.) 2001 Oct; 19(6): 501-3
Abstract: Asthma is among the most common ED diagnoses. Asthma exacerbations are
generally treated by medications that cause bronchodilation and those that
reduce airway inflammation. The effect of alcohol on asthma has been studied by
investigators with mixed results. Some studies have reported that alcohol has a
beneficial effect on asthma; others report worsening of symptoms. It has been
suggested in some quarters that additives in alcoholic drinks cause
bronchoconstriction and that pure ethanol has a salutary effect on asthma. If
further research bears out this supposition, ethanol may play a limited therapeutic
role in asthma that is refractory to other therapy. Emergency physicians should
counsel asthmatic patients to avoid alcoholic beverages because they may cause
an exacerbation of asthma.
Author(s):
Armentia
A ; Bañuelos
C ; Arranz
ML ; Del
Villar V ; Martín-Santos
JM ; Gil
FJ ; Vega
JM ; Callejo
A ; Paredes
C
Affiliation: Allergy Section, Rio Hortega Hospital, Valladolid, Spain.
Title: Early
introduction of cereals into children's diets as a risk-factor for grass pollen
asthma. Source: Clin Exp Allergy (Clinical and experimental allergy : journal of the British Society
for Allergy and Clinical Immunology.) 2001 Aug; 31(8): 1250-5
Abstract: BACKGROUND: The prevalence of asthma has increased from the 1950s to the
1990s. The relationship between diet and asthma is an area of controversy that
has never been fully evaluated. Attempts at dietary prevention of asthma have
produced conflicting results. We have recently identified allergens from
cereals that show cross-reactivity with proteins in grass pollen. An early
intake of cereals in the diet during early life might cause IgE sensitization
to cereals. It is not known whether such sensitization predisposes the
development of allergy to pollen. METHODS: To test this hypothesis, a
cross-sectional study and an observational case-control analysis of reviewed
data were carried out on 16381 patients who had been admitted to our Allergy
Unit between 1989 and 1999. All the patients underwent allergy tests to
identify asthma risk-factors. All information in our data base was analysed
using the SPSS computer system. RESULTS: There has been an increase of 7.8% in
incidences of allergic asthma and a 7.3% increase in asthma due to grass pollen
in the last decade. Grass-pollen asthma was associated with sensitization to
cereals. The early introduction of cereals in the diet of children was found to
be a risk factor for grass-pollen asthma (OR = 5.95; 95% CI 3.89-9.10).
CONCLUSIONS: These findings document the progression of allergic asthma during
a decade in a large sample of people who were influenced by similar
environmental conditions and studied with the same diagnostic methods. This
study represents the largest database of patients in which a common food is
shown to be a risk factor for asthma.
Author(s):
Acero
S ; Tabar
AI ; Alvarez
MJ ; Garcia
BE ; Olaguibel
JM ; Moneo
I
Affiliation: Seccion Alergología, Hospital Virgen del Camino, Pamplona,
Spain.
Title: Occupational
asthma and food allergy due to carmine. Source: Allergy (Allergy.) 1998 Sep; 53(9):
897-901
Abstract: Carmine (E120), a natural red dye
extracted from the dried females of the insect Dactylopius coccus var. Costa
(cochineal), has been reported to cause hypersensitivity reactions. We report a
case of occupational asthma and food allergy due to carmine in a worker not
engaged in dye manufacturing. A 35-year-old nonatopic man, who had worked for 4
years in a spice warehouse, reported asthma and rhinoconjunctivitis for 5
months, related to carmine handling in his work. Two weeks before the visit, he
reported one similar episode after the ingestion of a red-colored sweet
containing carmine. Peak flow showed drops higher than 25% related to carmine
exposure. Prick tests with the cochineal insect and carmine were positive, but
negative to common aeroallergens, several mites, foods, and spices. The
methacholine test was positive. Specific bronchial challenge test with a
cochineal extract was positive with a dual pattern (20% and 24% fall in FEV1).
Double-blind oral challenge with E120 was positive. The patient's sera
contained specific IgE for various high-molecular-weight proteins from the
cochineal extract, as shown by immunoblotting. Carmine proteins can induce
IgE-mediated food allergy and occupational asthma in workers using products
where its presence could be easily overlooked, as well as in dye manufacture
workers.
Author(s):
Woods
RK ; Weiner
JM ; Abramson
M ; Thien
F ; Walters
EH
Affiliation: Department of Respiratory Medicine, Monash Medical School
and Alfred Hospital, Melbourne, Australia.
Title: Do dairy
products induce bronchoconstriction in adults with asthma? Source: J Allergy Clin Immunol (The Journal of allergy and
clinical immunology.) 1998 Jan; 101(1) Pt 1: 45-50
Abstract: BACKGROUND: Dairy products have often been implicated as a cause of
exacerbation of asthma, but there is little scientific evidence to support this
hypothesis. OBJECTIVE: We sought to determine whether dairy products induce
bronchoconstriction in a group of adults with asthma. METHODS: Twenty subjects
with asthma (13 women and 7 men) were recruited from respondents who had
previously completed a food and asthma questionnaire. Ten subjects perceived
that their asthma became worse with ingestion of dairy products (positive
perceivers), whereas ten were negative perceivers. None of the subjects had
positive skin prick test results with cow's milk. The study was a randomized,
cross-over, double-blind, placebo-controlled trial. Subjects complied with a
dairy-free diet throughout the study. The active challenge was a single-dose
drink equivalent to 300 ml of cow's milk. A positive reaction was defined as a
15% reduction in both FEV1 and peak expiratory flow (PEF) on the active
challenge day compared with results obtained at the same time on the placebo
day. RESULTS: For both FEV1 and PEF there were no statistically significantly
differences in group means between active challenge and placebo challenge,
between sequence of administration, or between perceptions. Nine subjects
showed FEV1 or PEF changes that were greater than 15% of baseline values: four
patients showed changes after both active and placebo treatment; two after treatment
with placebo only; and three after active treatment alone. Of the latter group,
two subjects showed changes only in PEF, and when one of these subjects
underwent a further detailed study, no asthmatic reaction could be
demonstrated. CONCLUSION: It is unlikely that dairy products have a specific
bronchoconstrictor effect in most patients with asthma, regardless of their
perception.
Author(s):
Monteleone
CA ; Sherman
AR
Affiliation: Department of Medicine, University of Medicine and
Dentistry of New Jersey Robert Wood Johnson Medical School, New Brunswick, USA.
Title: Nutrition
and asthma. Source: Arch Intern Med (Archives of internal medicine.) 1997 Jan 13; 157(1): 23-34
Abstract: Asthma is a syndrome that may have many causes resulting in airway
inflammation and hyperresponsiveness. The search for the causes of asthma has
led to the investigation of genetic, atopic, viral, and nutritional factors.
For the last 2 decades, a number of studies have linked particular nutrients to
asthma. The studies have examined both the suboptimal status of particular
nutrients as causes of asthma and supplements of specific nutrients as therapy
for asthma. We reviewed and analyzed data from these studies to determine the
role of nutritional therapy in the management of asthma. The studies on food
allergies reveal that IgE-mediated reactions to food are a minor cause of
respiratory symptoms, affecting more children than adults. Currently, there are
no available data to support the use of nutritional supplements in the
treatment of chronic asthma.
Author(s):
van
Ree R ; Antonicelli
L ; Akkerdaas
JH ; Pajno
GB ; Barberio
G ; Corbetta
L ; Ferro
G ; Zambito
M ; Garritani
MS ; Aalberse
RC ; Bonifazi
F
Affiliation: Central Laboratory of The Netherlands Red Cross Blood
Transfusion Service, University of Amsterdam, The Netherlands.
Title: Asthma
after consumption of snails in house-dust-mite-allergic patients: a case of IgE
cross-reactivity. Source: Allergy (Allergy.)
1996 Jun; 51(6): 387-93
Abstract: A group of 28 patients from Italy was studied who had asthma after
consumption of snail. All patients also had asthma and/or rhinitis caused by
house-dust mite. RAST analyses confirmed the combined sensitization to snail
and mite. In a few sera, IgE antibodies reactive with other foods of
invertebrate origin (mussel and shrimp) were detected. RAST inhibition showed
that most IgE antibodies against snail were cross-reactive with house-dust
mite. In contrast, the mite RAST was not significantly inhibited by snail. This
indicates that house-dust mite was the sensitizing agent. Immunoblot analyses
revealed multiple bands in snail extract recognized by IgE. In contrast to what
has been described for cross-reactivity between shrimp and mite, tropomyosin
played only a minor role as a cross-reactive allergen in these patients. The
observations in this study indicate that snail consumption can cause severe
asthmatic symptoms in house-dust-mite-allergic patients. It might, therefore,
be advisable to screen mite-allergic asthma patients for allergy to snail and
other invertebrate animal foods.
Author(s):
Spector
SL ; Surette
ME
Affiliation: University of California-Los Angeles, Los Angeles,
California, USA. calallergy@dnamail.com
Title: Diet and
asthma: has the role of dietary lipids been overlooked in the management of
asthma? Source: Ann Allergy Asthma Immunol (Annals of allergy, asthma & immunology : official
publication of the American College of Allergy, Asthma, & Immunology.)
2003 Apr; 90(4): 371-7; quiz 377-8, 421
Abstract: OBJECTIVE: This article discusses the role of diet in the management of
asthma. Readers will gain an understanding of how evolution of the western diet
has contributed to increased asthma prevalence and how dietary modification
that includes management of dietary lipids may reduce symptoms of asthma. DATA
SOURCES: Relevant studies published in English were reviewed. STUDY SELECTION:
Medline search to identify peer-reviewed abstracts and journal articles.
RESULTS: Asthma and obesity, which often occur together, have increased in
prevalence in recent years. Studies suggest adaption of a western diet has not
only contributed to obesity, but that increased intake of specific nutrients
can cause changes in the frequency and severity of asthma. Increased asthma
prevalence has also been proposed to arise from increased exposure to diesel
particles or lack of exposure to infectious agents or endotoxins during
childhood, generating a biased Th2 immune response, and increased cytokine and
leukotriene production. Antagonists directed against these pro-inflammatory
mediators include anticytokines and antileukotrienes. A reduction in the levels
of inflammatory mediators associated with asthma has also been seen with
dietary interventions, such as the administration of oils containing
gamma-linolenic acid and eicosapentaenoic acid. CONCLUSIONS: Evidence suggests
elevated body mass index and dietary patterns, especially intake of dietary
lipids, contribute to symptoms of asthma. Dietary modification may help
patients manage their asthma as well as contribute to their overall health.
Drugs Food Cigarette Smoke Emotions Weather Obesity/Nutrition Physical Activity
Author(s): Jang
AS ; Choi
IS ; Lee
S ; Nam
HS ; Kweon
SS ; Son
MH ; Lee
JH ; Park
SW ; Kim
DJ ; Uh
ST ; Kim
YH ; Park
CS
Affiliation: Department of Internal Medicine, Soonchunhyang University
Hospital, Bucheon, Korea.
Title: The effect
of passive smoking on asthma symptoms,atopy,and airway hyperresponsiveness in
schoolchildren. Source: J Korean Med Sci (Journal of Korean medical science.) 2004 Apr; 19(2): 214-7
Abstract: Passive smoking is a major cause of respiratory morbidity, and is
associated with increased bronchial responsiveness in children. To evaluate the
effect of smoking by a parent on asthma symptoms, atopy, and airway
hyperresponsiveness (AHR), we conducted a cross-sectional survey of 503
schoolchildren that involved questionnaires, spirometry, allergy testing, and a
bronchial challenge test. If the PC20 methacholine was less than 16 mg/mL, the
subject was considered to have AHR. The prevalence of a parent who smoked was
68.7%. The prevalence of AHR was 45.0%. The sensitization rate to common
inhalant allergens was 32.6%. Nasal symptoms such as rhinorrhea, sneezing,
nasal itching, and nasal obstruction were present in 42.7%. Asthma symptoms
such as cough and wheezing were present in 55.4%. The asthma symptoms were
significantly more prevalent in children who had a parent who smoked than in
those whose parents did not. The nasal symptoms, atopy, and AHR did not differ
according to whether a parent smoked. In a multiple logistic regression model,
the asthma symptoms and atopy were independently associated with AHR, when
adjusted for confounding variables. Passive smoking contributed to asthma
symptoms in schoolchildren and was not an independent risk factor of airway
hyperresponsiveness in an epidemiological survey.
Author(s):
Mitsunobu
F ; Ashida
K ; Hosaki
Y ; Tsugeno
H ; Okamoto
M ; Nishida
N ; Nagata
T ; Tanizaki
Y ; Tanimoto
M
Affiliation: Department of Medicine, Misasa Medical Center Second
Department of Internal Medicine, Okayama University Medical School, Yamada,
Misasa, Tottori, Japan. fumin@cc.okayama-u.ac.jp
Title: Influence
of long-term cigarette smoking on immunoglobulin E-mediated allergy, pulmonary
function, and high-resolution computed tomography lung densitometry in elderly
patients with asthma. Source: Clin Exp Allergy (Clinical and experimental allergy : journal of the
British Society for Allergy and Clinical Immunology.) 2004 Jan; 34(1):
59-64
Abstract: BACKGROUND: Smoking is the most
important cause of chronic obstructive pulmonary disease (COPD). However, the influence
of cigarette smoking on the pathogenesis of asthma in the elderly remains
controversial. This study attempted to clarify the influence of cigarette
smoking on elderly asthmatics. METHODS: Forty-eight asthmatics over 70 years
old (25 ex-smokers and 23 never-smokers) and 20 patients with COPD over 70
years old (all ex-smokers) were studied to determine the influence of cigarette
smoking on IgE-mediated allergy (total IgE, IgE antibodies against inhalant
allergens, bronchial hyper-responsiveness (BHR), generation of leukotriene (LT)
B4 and C4), pulmonary function, and the relative area of lung showing
attenuation values less than -950 Hounsfield units (RA950) on high-resolution
computed tomography scans. RESULTS: The incidence of positive IgE antibodies
against inhalant allergens, BHR, and the generation of leukotriene B4 (LTB4) by
leucocytes were significantly increased in patients with a history of smoking
compared with those without. Residual volume (%RV) was significantly increased,
and diffusing capacity for carbon monoxide was significantly decreased in
ex-smokers with asthma and COPD compared with never-smokers with asthma.
Inspiratory RA950 and ratio of expiratory RA950 to inspiratory RA950 were
significantly larger in asthmatics with a smoking history than in those
without, and in COPD patients than in asthmatics. CONCLUSION: Cigarette smoking
enhances the production of IgE antibodies, BHR, and generation of LTB4 by
leucocytes in elderly asthmatics. Increased hyper-inflation or emphysematous changes
of the lungs expressed by increased RA950, closely related to %RV, was more
frequently observed in ex-smokers compared with never-smokers.
Author(s):
Wallace
LA ; Mitchell
H ; O'Connor
GT ; Neas
L ; Lippmann
M ; Kattan
M ; Koenig
J ; Stout
JW ; Vaughn
BJ ; Wallace
D ; Walter
M ; Adams
K ; Liu
LJ
Affiliation: U.S. Environmental Protection Agency, Reston, Virginia
20191-4471, USA. wallace.lance@epa.gov Corp Author: Inner-City
Asthma Study
Title: Particle
concentrations in inner-city homes of children with asthma: the effect of
smoking, cooking, and outdoor pollution. Source: Environ Health Perspect (Environmental health
perspectives.) 2003 Jul; 111(9): 1265-72
Abstract: Inner-city children have high rates of asthma. Exposures to particles,
including allergens, may cause or exacerbate asthma symptoms. As part of an
epidemiologic study of inner-city children with asthma, continuous (10-min
average) measurements of particle concentrations were made for 2-week periods
in 294 homes drawn from seven cities. Measurements were made using an optical
scattering device that is most sensitive to fine particles. The concentrations
recorded by these devices were corrected to agree with colocated outdoor
gravimetric PM2.5 monitors. Indoor concentrations in the homes averaged 27.7
(standard deviation = 35.9) micro g/m3, compared with concurrent outdoor
concentrations of 13.6 (7.5) micro g/m3. A multivariate model indicated that outdoor
particles penetrated indoors with an efficiency of 0.48 and were therefore
responsible for only 25% of the mean indoor concentration. The major indoor
source was smoking, which elevated indoor concentrations by 37 micro g/m3 in
the 101 homes with smokers. Other significant sources included frying, smoky
cooking events, use of incense, and apartment housing, although the increases
due to these events ranged only from 3 to 6 micro g/m3. The 10-min averaging
time allowed calculation of an average diurnal variation, showing large
increases in the evening due to smoking and smaller increases at meal times due
to cooking. Most of the observed variance in indoor concentrations was day to
day, with roughly similar contributions to the variance from visit to visit and
home to home within a city and only a small contribution made by variance among
cities. The small variation among cities and the similarity across cities of
the observed indoor air particle distributions suggest that sources of indoor
concentrations do not vary considerably from one city to the next, and thus
that simple models can predict indoor air concentrations in cities having only
outdoor measurements.
Author(s):
Strachan
DP ; Cook
DG
Affiliation: Department of Public Health Sciences, St George's Hospital
Medical School, London, UK.
Title: Health
effects of passive smoking. 6. Parental smoking and childhood asthma:
longitudinal and case-control studies. Source: Thorax (Thorax.) 1998 Mar; 53(3):
204-12
Abstract: BACKGROUND: The relation of parental smoking to wheezing and asthma
occurring after the first year of life was assessed by a systematic
quantitative review of case-control and longitudinal studies, complementing
earlier reviews of cross sectional surveys and wheezing in early childhood.
METHODS: Fifty one relevant publications were identified after consideration of
1593 abstracts selected by electronic search of the Embase and Medline
databases using keywords relevant to passive smoking in children. The search
was completed in April 1997 and identified six studies of asthma incidence, seven
of prognosis, 22 case-control studies, and 10 case series addressing disease
severity. RESULTS: Maternal smoking was associated with an increased incidence
of wheezing illness up to age 6 (pooled odds ratio 1.31, 95% CI 1.22 to 1.41),
but less strongly thereafter (1.13, 95% CI 1.04 to 1.22). The long term
prognosis of early wheezing illness was better if the mother smoked. The pooled
odds ratio for asthma prevalence from 14 case-control studies was 1.37 (95% CI
1.15 to 1.64) if either parent smoked. Four studies suggest that parental
smoking is more strongly associated with wheezing among non-atopic children.
Indicators of disease severity including symptom scores, attack frequency,
medication use, hospital attendance, and life threatening bronchospasm were in
general positively related to household smoke exposure. CONCLUSIONS: The excess
incidence of wheezing in smoking households appears to be largely non-atopic
"wheezy bronchitis" with a relatively benign prognosis, but among
children with established asthma, parental smoking is associated with more
severe disease. This apparent paradox may be reconciled if environmental
tobacco smoke is considered a co-factor provoking wheezing attacks, rather than
a cause of the underlying asthmatic tendency.
Author(s): Beeber SJ
Title: Parental
smoking and childhood asthma. Source: J Pediatr Health Care (Journal of pediatric health
care : official publication of National Association of Pediatric Nurse
Associates & Practitioners.) 1996 Mar-Apr; 10(2): 58-62
Abstract: Parental smoking is hazardous to all children, especially those who have
asthma. Passive smoke exposure can cause an increase in asthma symptoms,
emergency department visits, and hospital admissions. Primary care providers
must protect these children by helping reduce this exposure. This article
describes the relationship between asthma and parental smoking, discusses the
provider's role in encouraging smoking cessation, and offers practical
alternatives for counseling parents who are unable to quit smoking. A
hierarchical system of levels is used to help the provider educate the parents
and give them a goal for which to strive.
Author(s):
Kim
YK ; Kim
SH ; Tak
YJ ; Jee
YK ; Lee
BJ ; Kim
SH ; Park
HW ; Jung
JW ; Bahn
JW ; Chang
YS ; Choi
DC ; Chang
SI ; Min
KU ; Kim
YY ; Cho
SH
Affiliation: Department of Internal Medicine, Seoul National University
College of Medicine, Seoul, Korea.
Title: High
prevalence of current asthma and active smoking effect among the elderly.
Source:
Clin Exp Allergy (Clinical and experimental
allergy : journal of the British Society for Allergy and Clinical Immunology.)
2002 Dec; 32(12): 1706-12
Abstract: BACKGROUND: Although asthma is a common cause of morbidity in adults,
relatively few objectively measured population studies of asthma prevalence in
adult populations have been conducted. OBJECTIVE: To evaluate the prevalence of
asthma, based on both a questionnaire and methacholine bronchial provocation
test, and to determine the risk factors of asthma prevalence in an adult population.
METHODS: A total of 2,467 adults, who were randomly selected from metropolitan
urban, non-metropolitan urban and rural areas, responded to the modified ISAAC
questionnaire, and underwent methacholine bronchial provocation tests and skin
prick tests to locally common aeroallergens. RESULTS: The prevalence of current
asthma based on the questionnaire and the methacholine challenge was 2.0% in
adults younger than 40, 3.8% in 40- to 54-year-olds, 7.7% in 55- to
64-year-olds and 12.7% in those aged 65 or higher. For subjects of 55-64 years,
active smoking was found to be significantly related with the prevalence of
current asthma and bronchial hyper-responsiveness, although smoking was
positively associated with percentage predictive value of forced expiratory
volume of 1 s (FEV1). CONCLUSION: The prevalence of current asthma is common
among the elderly, and active smoking may play an important role in the
development of asthma and bronchial hyper-responsiveness among the elderly.
Author(s):
Crombie
IK ; Wright
A ; Irvine
L ; Clark
RA ; Slane
PW
Affiliation: Department of Epidemiology and Public Health, University of
Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
i.k.crombie@dundee.ac.uk
Title: Does
passive smoking increase the frequency of health service contacts in children with
asthma? Source: Thorax (Thorax.)
2001 Jan; 56(1): 9-12
Abstract: BACKGROUND: Passive smoking is a major cause of respiratory morbidity in
children. However, few studies give accurate estimates of the health effects of
passive smoking in children with asthma using an objective measure of exposure.
The effects of passive smoking using salivary cotinine levels to measure
exposure were investigated. METHODS: A sample of 438 children aged 2-12 years
with asthma who had a parent who smoked were recruited in Tayside and Fife,
Scotland. Health service contacts for asthma, assessed from GP case records,
were used as a proxy for morbidity. RESULTS: A weak U-shaped relationship was
found between the salivary cotinine level and health service contacts for
asthma: compared with low cotinine levels those with moderate cotinine levels
had a reduced contact rate (relative rate (RR) = 0.91, 95% confidence interval
(CI) 0.80 to 1.05), whereas high cotinine levels were associated with an
increased rate of contact (RR = 1.19, 95% CI 1.05 to 1.37). In contrast, a
strong association was seen with the amount the parent reported smoking in
front of the child: the higher the level the fewer visits were made for asthma
(RR for everyday exposure = 0.66, 95% CI 0.56 to 0.77). This effect was not
seen for non-respiratory visits. Demographic factors, age of child, and number
of children in the family all had a powerful effect on the number of visits for
asthma. The parents' perception of asthma severity was associated with visit
frequency independent of actual severity (derived from drug treatment).
CONCLUSION: High levels of parental smoking in the home are associated with a
reduction in health care contacts for asthma. This could be due to a lack of
awareness of asthma symptoms among heavy smokers or a reluctance to visit the
GP. Children with asthma who have parents who smoke heavily may not be
receiving adequate management.
Author(s):
Weiss
ST ; Utell
MJ ; Samet
JM
Affiliation: Harvard Medical School, Department of Medicine, Channing
Laboratory, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
scott.weiss@channing.harvard.edu
Title: Environmental
tobacco smoke exposure and asthma in adults. Source: Environ Health Perspect (Environmental health
perspectives.) 1999 Dec; 107 Suppl 6: 891-5
Abstract: Environmental tobacco smoke (ETS) contaminates indoor air in homes and
workplaces. Although the adverse effects of active cigarette smoking on the
respiratory tract have been extensively characterized, the effects of ETS
exposure on adult asthma have not yet been investigated extensively and the
available data are limited. This article examines the evidence for ETS exposure
as a cause of asthma and asthma exacerbation in adults, and for ETS exposure in
the workplace specifically as contributing to these health effects. It
addresses methodological barriers that limit the available data and evaluates
the adequacy of the data for risk assessment.
Author(s):
Wahlgren
DR ; Hovell
MF ; Meltzer
EO ; Meltzer
SB
Affiliation: Center for Behavioral Epidemiology and Community Health,
Graduate School of Public Health, San Diego State University, CA, USA.
Title: Involuntary
smoking and asthma. Source: Curr Opin Pulm Med (Current opinion in pulmonary medicine.) 2000 Jan;
6(1): 31-6
Abstract: Involuntary smoking is the third leading preventable cause of death, and
among children it causes lower respiratory infections, middle ear disease,
sudden infant death syndrome, and asthma. Half the world's children may be
exposed to environmental tobacco smoke (ETS), exacerbating symptoms in 20% of
children with asthma. Recent studies have reinforced previous conclusions that
ETS exposure causes onset of childhood asthma and exacerbation of symptoms
throughout life. The exact mechanisms by which this is accomplished are still
unclear, as are the relative contributions of prenatal versus postnatal
exposure. However, favorable health outcomes can be attained with reduced
exposure. Among the few studies of ETS exposure reduction interventions,
low-intensity advice methods appeared ineffective, and counseling parent
smokers appeared successful. Direct counseling of school-aged children to avoid
ETS has yet to be tested. Community norms may need to shift further in favor of
protecting children and others from ETS before minimal interventions can be
successful. This will require combined and ongoing efforts of the medical and
public health establishments, in concert with legislation mandating
tobacco-free public places and with ETS-related media campaigns.
Drugs Food Cigarette Smoke Emotions Weather Obesity/Nutrition Physical Activity
Author(s):
Lehrer
PM ; Isenberg
S ; Hochron
SM
Affiliation: Robert Wood Johnson Medical School, Piscataway, New Jersey.
Title: Asthma and
emotion: a review. Source: J Asthma (The Journal of asthma : official journal of the Association for the
Care of Asthma.) 1993; 30(1): 5-21
Abstract: This review of the empirical literature on the relationship between
asthma and emotion presents an explanatory model of the connection between
them. Asthmatics tend to report and display a high level of negative emotion,
and asthma exacerbations have been linked temporally to periods of heightened
emotionality. Causality may be bidirectional. Hypothesized mediators for the
relationship between asthma and emotionality include vagal and
alpha-sympathetic hyperreactivity, predominant obstruction in the larger
airways, individual response stereotypy, direct effects of emotion-related
facial muscle tension on the airways, the emotional effects of asthma
medications, heightened respiratory drive, and hyperventilation. Predictions
are presented for research on this model of asthma and emotion, and for the
psychological treatment of asthma.
Author(s):
Ritz
T ; Steptoe
A ; DeWilde
S ; Costa
M
Affiliation: Department of Psychology, St. George's Hospital Medical
School, University of London, United Kingdom. tritz@sghms.ac.uk
Title: Emotions
and stress increase respiratory resistance in asthma. Source: Psychosom Med (Psychosomatic medicine.)
2000 May-Jun; 62(3): 401-12
Abstract: OBJECTIVES: Clinical reports suggest that various emotions and types of
stress can precipitate asthmatic symptoms, but there is little experimental
evidence to substantiate this claim. We studied the impact of different
emotional states and stress on respiratory resistance in asthmatic and
nonasthmatic individuals. METHODS: Participants (24 asthmatic and 24
nonasthmatic patients) viewed short film sequences selected to induce anxiety,
anger, depression, elation, happiness, contentment, or a neutral affective
state and completed two stressful tasks, mental arithmetic to induce active
coping efforts and viewing of medical slides to induce passive coping efforts.
Oscillatory resistance, heart rate, blood pressure, baroreflex sensitivity,
skin conductance level, respiration rate and volume, and self-reported
affective state were measured throughout the session. RESULTS: Uniform
increases in oscillatory resistance were found in all emotional states compared
with the neutral state and during mental arithmetic in both groups. Asthmatic
patients showed stronger reactions to the medical slides than healthy control
subjects, with significant increases in oscillatory resistance, blood pressure,
skin conductance level, and minute volume, as well as higher levels of
self-reported depression, arousal, and shortness of breath. Changes in
oscillatory resistance were inconsistently correlated with other physiological
indices. CONCLUSIONS: Various emotional states and stress increase oscillatory
resistance largely independently of concurrent increases in autonomic or
ventilatory activity. The particular sensitivity of asthmatics to passive
coping demand requires additional research.
Author(s):
Liangas
G ; Yates
DH ; Wu
D ; Henry
RL ; Thomas
PS
Affiliation: Faculty of Medicine, University of New South Wales, Sydney,
Australia.
Title: Laughter-associated
asthma. Source: J Asthma (The
Journal of asthma : official journal of the Association for the Care of Asthma.)
2004 Apr; 41(2): 217-21
Abstract: This study was conducted to assess the prevalence of laughter-induced
asthma, and to study any associations with asthma-related triggers and measures
of disease activity, using a questionnaire-based survey of asthma subjects in
both the community and on presentation to hospital. A total of 105 subjects
participated, and 44 (41.9%) reported laughter-associated asthma. Exercise and
laughter were strongly associated as triggers (p < 0.006), as well as molds
and grass pollen (p = 0.03). It seems to be associated with poor asthma control
as well, since hospital admissions are also more frequent in this group (p =
0.043). Laughter-induced asthma is strongly associated with exercise as a
trigger; the mechanism remains uncertain, but better understanding of this
problem may assist in controlling difficult asthma.
Author(s):
Lehrer
PM
Affiliation: UMDNJ-Robert Wood Johnson Medical School, Piscataway, New
Jersey 08854, USA.
Title: Emotionally
triggered asthma: a review of research literature and some hypotheses for
self-regulation therapies. Source: Appl Psychophysiol Biofeedback (Applied psychophysiology and
biofeedback.) 1998 Mar; 23(1): 13-41
Abstract: Asthma is a common disease whose
morbidity and mortality are rapidly increasing. Panic disorder is common in
asthma. Panic, other negative emotions, and a passive coping orientation may
affect asthma by producing hyperventilation, increased general autonomic
lability, a specific pattern of autonomic arousal that may cause
bronchoconstriction, and/or detrimental effects on health care behaviors.
Generalized panic is a risk factor for increased asthma morbidity. A repressive
coping style also appears to be a risk factor for asthma morbidity because it
is accompanied by an impaired ability to perceive symptoms, a necessary
prerequisite for taking appropriate remediation. Several self-regulation
strategies are hypothesized to be useful adjuncts to asthma treatment.
Preliminary research has been done on relaxation therapy, EMG biofeedback,
biofeedback for improved sensitivity in perceiving respiratory sensations, and
biofeedback training for increasing respiratory sinus arrhythmia. It is
hypothesized that finger temperature biofeedback also may be a promising
treatment method, and that relaxation-oriented methods will have their greatest
effect among asthmatics who experience panic symptoms, while improved
perceptual sensitivity will be helpful both for patients who panic and those
with repressive coping styles.
Author(s):
Gartland
HJ ; Day
HD
Affiliation: Texas Woman's University, Denton 76204-5470, USA.
Title: Family
predictors of the incidence of children's asthma symptoms: expressed emotion,
medication, parent contact, and life events. Source: J Clin Psychol (Journal of clinical psychology.)
1999 May; 55(5): 573-84
Abstract: Self-report measures of both parents' expressed emotion, their time
spent with their children, family life events, and children's medication
compliance were obtained from 32 pairs of parents with a 5- to 12-year-old
child with asthma and used to predict the number of the children's
asthma-related medical contacts and school absences in the preceding year.
Higher levels of fathers' expressed emotion, specifically critical comments,
were associated with higher school absenteeism, and the amount of time fathers
reported spending with their children on weekends was inversely related to the
number of times children had an asthma-related medical contact. These findings
were interpreted as reflecting the father's reactions to his child's asthma.
Implications for intervention are discussed.
Author(s):
Miller
BD ; Wood
BL
Affiliation: State University of New York at Buffalo, USA. brumil@acsu.buffalo.edu
Title: Influence
of specific emotional states on autonomic reactivity and pulmonary function in
asthmatic children. Source: J Am Acad Child Adolesc Psychiatry (Journal of the American Academy
of Child and Adolescent Psychiatry.) 1997 May; 36(5): 669-77
Abstract: OBJECTIVE: Research relating depression/hopelessness to cholinergic
activation suggests the hypothesis that sad emotional states evoke patterns of
autonomic reactivity that predispose to cholinergically mediated airway
constriction in asthma. A corollary hypothesis is that positive (e.g., happy)
emotional states evoke opposing effects. The purpose of the current study is to
assess whether specific emotional states (sadness and happiness) can be
reliably induced, physiologically differentiated, and related to
asthma-relevant physiologic (autonomic) reactivity and pulmonary function in
asthmatic children. METHOD: Twenty-four children, aged 8 to 17 years, with
moderate to severe asthma, viewed the movie E.T., The Extra-Terrestrial while
having their heart and respiration rate and oxygen saturation continuously
recorded. Specific scenes were identified and preselected to evoke sadness,
happiness, and a mixture of happiness and sadness. Self-report of emotion and
indices of physiologic response were analyzed for these targeted scenes.
RESULTS: Sadness was associated with greater heart rate variability and
instability of oxygen saturation compared with happiness, with mixed results
for mixed happiness and sadness. CONCLUSION: Results support sadness as evoking
patterns of autonomic influence consistent with cholinergically mediated airway
constriction. Happiness appears to effect autonomic patterns that would tend to
relieve airway constriction.
Author(s):
Barton
C ; Clarke
D ; Sulaiman
N ; Abramson
M
Affiliation: Department of Epidemiology and Preventive Medicine, Central
and Eastern Clinical School, Monash University, The Alfred Hospital, Melbourne,
Victoria 3004, Australia.
Title: Coping as a
mediator of psychosocial impediments to optimal management and control of
asthma. Source: Respir Med (Respiratory
medicine.) 2003 Jul; 97(7): 747-61
Abstract: Adherence to asthma medication regimens by asthma patients is often poor
and contributes to the continued and substantial burden of asthma in the
community. There is evidence of increased rates of behavioural problems,
anxiety and depression in people with moderate-to-severe asthma and these
factors may interfere with adherence and contribute to poor asthma control. An
alternative explanation is that the relationship between feelings of anxiety
and depression, and adherence to the treatment regimen may be more accurately
predicted from the coping styles used, rather than the experience of asthma
itself. The objective of this paper was to review evidence for associations
between coping strategies used by asthma patients, asthma management and health
outcomes. The Medline and PsychInfo databases were searched for articles
containing the terms "asthma" and "coping". Patients with
asthma tended to use different strategies for coping with stress and illness
compared to healthy participants and individuals with other chronic illnesses.
Emotion-focussed coping strategies such as denial were commonly used by patients
with poor medication adherence, those who attended emergency departments for
asthma, were admitted to hospital for asthma, or suffered near-fatal asthma
attacks. Interventions to improve coping strategies have been effective in
reducing symptoms and psychological distress. The availability of coping
resources to patients and/or their caregivers and the coping strategies that
are used are likely to mediate the influence of psychosocial factors on the
management of asthma. Further studies exploring the ways in which individuals
cope with asthma will improve our understanding of the mechanisms linking
psychological and social status to asthma morbidity and mortality.
Author(s):
Ritz
T ; Claussen
C ; Dahme
B
Affiliation: Department of Psychiatry, Stanford University and VA Palo Alto
Health Care System, 94304, USA. tritz@stanford.edu Title: Experimentally induced emotions, facial muscle
activity, and respiratory resistance in asthmatic and non-asthmatic
individuals. Source: Br J Med Psychol (The British journal of medical psychology.) 2001 Jun; 74(Pt) 2:
167-82
Additional Info: England Standard No: ISSN: 0007-1129; NLM Unique Journal
Identifier: 0370640 Language: English Abstract: We studied the effects of emotion induction on total
respiratory resistance, and their relationship with cardiac vagal activity and
facial muscle activity in asthma. Groups of 20 asthmatic and 20 non-asthmatic
participants were exposed to series of happy and depressing pictures or
self-referent Velten statements. Facial electromyographic activity over corrugator
supercilii, orbicularis oculi, and zygomaticus major regions was recorded
during periods of presentation and imagery of each stimulus. Following each
stimulus series, mood, respiratory resistance, ventilation, and cardiac
activity including respiratory sinus arrhythmia (RSA) were recorded.
Significant increases of respiratory resistance were observed in asthmatic
patients following depressing stimulation. Resistance increases were positively
correlated with RSA and heart period. No substantial group differences were
found in facial response to emotional stimuli. Changes in facial target muscle
sites during positive stimulation were inversely correlated with RSA following
stimulation. We conclude that respiratory resistance increases in asthmatics following
depressing stimulation are dependent on vagal activity. Greater facial muscle
activation during emotional stimulation can reduce vagal activation, which is
consistent with claims in the clinical literature of the benefits of emotional
expression in asthma.
Author(s):
Ritz
T ; Steptoe
A
Affiliation: Department of Psychiatry, Stanford University, VA Palo Alto
Health Science Center, CA 94304, USA. tritz@stanford.edu
Title: Emotion and
pulmonary function in asthma: reactivity in the field and relationship with
laboratory induction of emotion. Source: Psychosom Med (Psychosomatic medicine.) 2000 Nov-Dec; 62(6):
808-15
Abstract: OBJECTIVE: We investigated the modulation of pulmonary function by mood
states in the daily life of asthmatic patients and nonasthmatic control subjects
and its relationship to the airway effects of laboratory induction of emotion
using films. METHODS: Twenty asthmatic patients and 20 nonasthmatic control
subjects participated in a laboratory session in which various emotions (ie,
anxiety, anger, depression, happiness, elation, contentment, and neutrality)
were induced by films. Respiratory resistance (Ros) was measured by forced
oscillation. After this session, participants kept mood diaries, including
regular spirometric self-assessments, for at least 3 weeks. Episodes of strong
negative or positive mood were selected from these diaries and compared with
conditions of relative affective neutrality. RESULTS: In asthmatic patients,
negative mood states, and to a lesser degree positive mood states, were
associated with a reduction in forced expiratory volume in the first second
(FEV1) compared with neutral states. These effects were not observed in
nonasthmatic control subjects. Self-reports of arousal varied in a reciprocal
manner with FEV1, whereas physical activity did not vary systematically between
mood episodes. A moderate negative relationship between changes in FEV1 during
negative mood episodes and changes in Ros during viewing of the depressing film
was also observed in asthmatic patients. CONCLUSION: Pulmonary function of
asthmatic patients is negatively affected by strong mood states in daily life.
Airway effects of negative emotion induction, particularly depression, can
predict changes in pulmonary function in response to negative mood in the
field.
Author(s):
Wamboldt
FS ; O'Connor
SL ; Wamboldt
MZ ; Gavin
LA ; Klinnert
MD
Affiliation: National Jewish Medical and Research Center and University
of Colorado Health Sciences Center, Denver 80206, USA. wamboldtf@njc.org
Title: The five
minute speech sample in children with asthma: deconstructing the construct of
expressed emotion. Source: J Child Psychol Psychiatry (Journal of child psychology and psychiatry, and
allied disciplines.) 2000 Oct; 41(7): 887-98
Abstract: OBJECTIVE: To use the Five Minute Speech Sample (FMSS) to assess
Expressed Emotion (EE) in various samples of children with asthma in order to
clarify (1) developmental and validity issues for the EE construct and (2) the
use of the FMSS technique, specifically, in children with chronic medical
illness. METHOD: Data were collected on a sample of 84 adolescents with severe,
chronic asthma who had failed outpatient management. In addition, a sample of
30 children with asthma, ages 6-9. were recruited from an outpatient pediatric
clinic. A comparison sample of 15 children without any chronic illness, ages 6
9, were recruited by notices posted in the community. The primary caregiver of
each child was assessed using the FMSS. RESULTS: FMSS interviews were
reliability coded in all samples. Rates of high Criticism (FMSS CRIT),
Emotional Overinvolvement (FMSS EOI), and EE were comparable to rates
previously reported in child and adolescent samples. Although the validity for
ratings of FMSS CRIT was well supported, the validity of FMSS EOI ratings and
the overall EE construct were more problematic. CONCLUSIONS: The FMSS is a
useful and largely valid measure in children with asthma. Ratings of FMSS CRIT
were found to have strong validity. There was little problem shifting the
context of FMSS administration from chronic mental to chronic medical illness,
but a variety of developmental considerations arose, especially regarding FMSS
EOI ratings. Although we raise concerns about viewing EE as a valid construct,
it may remain a useful predictive index.
Drugs Food Cigarette Smoke Emotions Weather Obesity/Nutrition Physical Activity
Author(s):
Skowronski
ME ; Ciufo
R ; Nelson
JA ; McFadden
ER Jr
Affiliation: Division of Pulmonary and Critical Care Medicine,
University Hospitals of Cleveland, OH 44106-5067, USA.
Title: Effects of
skin cooling on airway reactivity in asthma. Source: Clin Sci (Lond) (Clinical science (London,
England : 1979)) 1998 May; 94(5): 525-9
Abstract: 1. Environmental contact with cold air is a common cause of respiratory distress
in obstructive lung disease, and direct and reflex changes in bronchial calibre
are well documented with this stimulus when it is inhaled or contacts the
exposed skin respectively. It is now known that skin chilling does not amplify
the effects of breathing cold air, but it is not established if this lack of
interaction is unique, or applies to other forms of airway constrictors. 2. To
provide data on this issue, 10 subjects with atopic asthma underwent
methacholine bronchoprovocations with and without chilling of the integument of
their heads and thoraces for 30 min. Chilling was accomplished with a specially
designed thermal garment. Spirometry as well as core and skin temperatures were
serially monitored during all experiments. 3. In the control phase (no
cooling), integumental temperatures rose slightly, the forced expiratory volume
in 1.0 s (FEV1.0) did not change, and the mean provocative concentration of
methacholine required to reduce the FEV1.0 by 20% (PC20 meth) was 0.47 +/- 0.17
mg/ml (2.4 +/- 0.87 mmol/l). In the cold trial, the temperature of the back
fell 5.1 +/- 1.7 degrees C to 28.7 +/- 1.8 degrees C (P < 0.01), core
temperatures did not change, and airway obstruction developed (delta FEV1.0 =
-6.7 +/- 2.1%; P < 0.05). The PC20 meth, however, was unaltered [PC20 meth =
0.45 +/- 0.13 mg/ml (2.3 +/- 0.66 mmol/l); P = 0.85]. 4. These results
demonstrate that although skin cooling produces mild airway obstruction in
subjects with asthma, it does not change the response to non-specific bronchoconstrictors
such as methacholine.
Author(s):
Wark
PA ; Simpson
J ; Hensley
MJ ; Gibson
PG
Affiliation: Respiratory Cell and Molecular Biology Research Division,
Southampton General Hospital, Southampton, UK. Title: Airway inflammation in thunderstorm asthma.
Source:
Clin Exp Allergy (Clinical and experimental
allergy : journal of the British Society for Allergy and Clinical Immunology.)
2002 Dec; 32(12): 1750-6
Additional Info: England Standard No: ISSN: 0954-7894; 1365-2222; NLM Unique
Journal Identifier: 8906443 Language: English Abstract: BACKGROUND: Epidemics of acute asthma associated with
thunderstorms occur intermittently worldwide, though airway inflammation during
these acute episodes has not been characterized. The aim of this study was to
characterize airway inflammation in thunderstorm asthma. METHODS: Cases were
recruited after presentation to the emergency room with acute asthma
immediately following a thunderstorm (n = 6). They were compared to two control
groups: a group of atopic asthmatics that had presented with acute asthma to the
emergency room prior to the thunderstorm (n = 12), and a second group of
corticosteroid naive asthmatics who presented to the emergency room in the
prior 12 months (n = 6). Subjects had spirometry, sputum induction and allergy
skin tests acutely and at review 4 weeks later. RESULTS: Thunderstorm (TS)
cases were more likely to have a history of hay fever and grass pollen allergy,
and less likely to be on inhaled corticosteroids (ICS) prior to presentation.
Cases and control groups had a similar degree of moderate to severe acute
airway obstruction (P = 1.0). TS cases had elevated sputum eosinophils (14.8%
of total cell count) compared to controls (1%, 2.6%, P < 0.01). TS cases had
higher sputum eosinophil cationic protein (ECP; 11,686 ng/mL) compared to controls
(1,883, 3,300, P = 0.02) acutely. TS cases had more cells positive for IL-5
(30%) compared to controls (1, 1.5%, P = 0.02). When adjusted for ICS use, TS
cases had a risk ratio for elevated sputum eosinophils of 2.4 (1.23-4.69).
CONCLUSION: Thunderstorm asthma is characterized by airway inflammation with
IL-5-mediated sputum eosinophilia and eosinophil degranulation. These results
are consistent with allergen exposure as the cause of the exacerbation, and are
consistent with the thunderstorm-induced grass pollen deluge as the cause of
epidemic asthma after thunderstorms.
Author(s):
Marks
GB ; Colquhoun
JR ; Girgis
ST ; Koski
MH ; Treloar
AB ; Hansen
P ; Downs
SH ; Car
NG
Affiliation: Institute of Respiratory Medicine, University of Sydney,
NSW 2050, Australia. g.marks@unsw.edu.au
Title: Thunderstorm
outflows preceding epidemics of asthma during spring and summer. Source: Thorax (Thorax.) 2001 Jun; 56(6):
468-71
Abstract: BACKGROUND: A study was undertaken to assess the importance of
thunderstorms as a cause of epidemics of asthma exacerbations and to
investigate the underlying mechanism. METHODS: A case control study was
performed in six towns in south eastern Australia. Epidemic case days (n = 48)
and a random sample of control days (n = 191) were identified by reference to
the difference between the observed and expected number of emergency department
attendances for asthma. The occurrence of thunderstorms, their associated
outflows and cold fronts were ascertained, blind to case status, for each of
these days. In addition, the relation of hourly pollen counts to automatic
weather station data was examined in detail for the period around one severe
epidemic of asthma exacerbations. The main outcome measure was the number of
epidemics of asthma exacerbations. RESULTS: Thunderstorm outflows were detected
on 33% of epidemic days and only 3% of control days (odds ratio 15.0, 95%
confidence interval 6.0 to 37.6). The association was strongest in late spring
and summer. Detailed examination of one severe epidemic showed that its onset
coincided with the arrival of the thunderstorm outflow and a 4-12 fold increase
in the ambient concentration of grass pollen grains. CONCLUSIONS: These
findings are consistent with the hypothesis that some epidemics of
exacerbations of asthma are caused by high concentrations of allergenic particles
produced by an outflow of colder air, associated with the downdraught from a
thunderstorm, sweeping up pollen grains and particles and then concentrating
them in a shallow band of air at ground level. This is a common cause of
exacerbations of asthma during the pollen season.
Drugs Food Cigarette Smoke Emotions Weather Obesity/Nutrition Physical Activity
Author(s):
Ford
ES
Affiliation: Division of Environmental Hazards and Health Effects,
National Center for Environmental Health, Centers for Disease Control and
Prevention, Atlanta, Georgia 30333, USA. esf2@cdc.gov
Title: Asthma,
body mass index, and C-reactive protein among US adults. Source: J Asthma (The Journal of asthma :
official journal of the Association for the Care of Asthma.) 2003; 40(7):
733-9
Abstract: Obesity, a state that may be characterized by a low-grade inflammation, has been associated with asthma. C-reactive protein, an acute phase reactant, is elevated in obese people. However, little is known about how asthma affects C-reactive protein concentrations. Using data from 14,224 participants of the Third National Health and Nutrition Examination Survey (1988-1994), the author examined C-reactive protein concentrations among participants with current asthma (n = 651), who formerly had asthma (n = 303), and who never had asthma (n = 13,270). Compared with 21% of participants with current asthma, 11% with former asthma (P < .001) and 15% without asthma (P = .018) had C-reactive protein concentrations > or = 85th percentile of the sex-specific distribution. Compared with participants without asthma, the age-adjusted odds ratios for having an elevated C-reactive protein concentration was 1.49 (95% confidence interval [CI]: 1.11, 2.00) for persons with current asthma. After adjusting for age, sex, race or ethnicity, years of education, cotinine concentration, body mass index, waist-hip ratio, physical activity level, aspirin use, oral corticosteroid use, and inhaled corticosteroid use, the odds ratio decreased to 1.15 (95% CI: 0.83, 1.59). Body mass index was the main reason for the attenuation of the odds ratio. Whether the inflammatory activity associated with body mass index contributes to the pathophysiology of asthma is unknown.
Author(s):
Kim
S ; Camargo
CA Jr
Affiliation: Department of Emergency Medicine, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, USA. Title: Sex-race differences in the relationship between
obesity and asthma: the behavioral risk factor surveillance system, 2000.
Source:
Ann Epidemiol (Annals of epidemiology.)
2003 Nov; 13(10): 666-73
Abstract: PURPOSE: Although prospective data are limited, recent cross-sectional
studies support obesity as a cause of asthma. They also suggest that the
association is present only among women. Our analysis examines possible
sex-race differences in the relationship between obesity and asthma. METHODS:
We examined data from the 2000 Behavioral Risk Factor Surveillance System. To
minimize diagnostic bias, the sample was limited to adults aged 18 to 34 years.
All cases had doctor-diagnosis of asthma and ongoing symptoms. Multiple
logistic regression was used to examine risk factors for current asthma vs.
never having asthma. RESULTS: Obesity and asthma were more strongly related
among women than men (test for interaction, p<0.01). Across increasing
categories of body mass index (BMI), we observed a dose-response relationship
among women (odds ratios: 0.9, 1.0 [reference], 1.0, 1.3, 1.5, 1.8, and 3.2)
but only a non-significant increased risk in severely obese men (odd ratio:
2.0). In subgroup analyses, however, the obesity-asthma association was present
in four of six sex-race/ethnicity subgroups, including black and Hispanic men.
CONCLUSIONS: Although the obesity-asthma association is stronger among women
than men, our analysis demonstrates a strong positive association among men
from minority groups. These race-specific results may help explain some of the
"inconsistencies" in prior studies.
Author(s):
Luder
E ; Ehrlich
RI ; Lou
WY ; Melnik
TA ; Kattan
M
Affiliation: Department of Pediatrics, Mount Sinai School of Medicine,
One Gustave L. Levy Place, Box 1202B, New York, NY 10029, USA.
elisabeth.luder@mssm.edu
Title: Body mass
index and the risk of asthma in adults. Source: Respir Med (Respiratory medicine.) 2004
Jan; 98(1): 29-37
Abstract: Asthma and obesity are both chronic conditions and their prevalences
have risen in affluent societies. A positive association between asthma and
being overweight or obese has been reported in children and women, but
associations in men are less clearly described. The objective of this study was
to explore the association between body mass index (BMI) and asthma in men and
women of diverse ethnic and socioeconomic background living in New York State,
USA. In this study, we analyzed cross-sectional data on 5524 subjects aged 18
years and older who were interviewed by telephone in the 1996 and 1997 New York
State Behavioral Risk Factor Surveillance System. Asthma (doctor-diagnosed),
and weight and height were self-reported. BMI (kg/m2) was used as a measure of
adiposity. Weighted logistic regression analysis, with stratification by gender
and age, was used to examine the relationship between asthma prevalence and
BMI, adjusting for race/ethnicity, education, health insurance, time since last
physical examination, physical activity and smoking status. The results showed
that the prevalence of asthma was 4.6% (CI: 3.6-5.5%) among men and 8.1% (CI:
7.1-9.1%) among women. In women, the prevalence of asthma was significantly
increased in those with a BMI 25 kg/m2 or higher (BMI 25-27.5: OR = 1.76, 95%
CI: 1.06-2.94; BMI 27.5-29.9: OR = 2.45, 95% CI: 1.41-4.25; BMI > or = 30:
OR = 2.67, 95% CI: 1.66-4.29) when compared to the reference category (BMI:
22-24.9 kg/m2). In men, the prevalence of asthma was increased in the lowest
weight category, BMI < 22 kg/m2 (OR = 3.05, 95% CI: 1.37-6.78) and in the
highest category, BMI > or = 30 kg/m2 (OR = 2.92, 95% CI: 1.39-6.14). This
U-shaped association persisted when restricting the analysis to men who had
never smoked and was more pronounced for those between 18 and 49 years of age.
In conclusion, this cross-sectional study showed that men and women differ
significantly in the association between BMI and asthma prevalence only with respect
to the lowest weight category. While women had a monotonic association, men
showed a U-shaped relationship, indicating that both extremes of weight are
associated with a higher prevalence of asthma.
Author(s):
To
T ; Vydykhan
TN ; Dell
S ; Tassoudji
M ; Harris
JK
Affiliation: Population Health Sciences, Research Institute, and the
Division of Respiratory Medicine, Hospital for Sick Children, Toronto, Ontario,
Canada. teresa.to@sickkids.ca
Title: Is obesity
associated with asthma in young children? Source: J Pediatr (The Journal of pediatrics.)
2004 Feb; 144(2): 162-8
Abstract: OBJECTIVE: The aim of this study was to evaluate the association between
obesity and asthma in a population-based sample of Canadian children. STUDY
DESIGN: Baseline data from the National Longitudinal Survey of Children and
Youth were used in this cross-sectional study. We included 11199 children age 4
to 11 years whose biological mother reported data on asthma, height, and
weight. Body mass index was categorized, and obesity was defined as body mass
index >or=85th percentile. Children with asthma had parents who reported the
diagnosis, and they took prescribed inhalants, had wheezing or an attack in the
previous year, or had their activities limited by asthma. Multiple logistic
regression was used. RESULTS: The prevalence of asthma was 9.9%. Maternal
history of asthma was a risk factor for asthma among all children. Single child
status and maternal depression were risk factors for girls. The odds ratio for
asthma, comparing highest and lowest body mass index categories, was 1.02 (99%
confidence interval, 0.70-1.46) for boys and 1.06 (99% confidence interval,
0.67-1.69) for girls. CONCLUSION: This study suggests that there is no
statistical association between obesity and asthma among Canadian children age
4 to 11 years.
Author(s):
Sin
DD ; Spier
S ; Svenson
LW ; Schopflocher
DP ; Senthilselvan
A ; Cowie
RL ; Man
SF
Affiliation: Pulmonary Division, the Department of Medicine, University
of Alberta, Edmonton, Canada. don.sin@ualberta.ca
Title: The
relationship between birth weight and childhood asthma: a population-based
cohort study. Source: Arch Pediatr Adolesc Med (Archives of pediatrics & adolescent medicine.)
2004 Jan; 158(1): 60-4
Abstract: BACKGROUND: Because obesity promotes inflammation and imposes mechanical
constraints to the airways, a high birth weight may be a risk factor for asthma
in childhood. However, to our knowledge, few studies have examined this
potential relationship. OBJECTIVE: To determine the relationship between high
birth weight and risk of emergency visits for asthma during childhood. DESIGN:
Population-based cohort study. SETTING: Alberta, Canada. PARTICIPANTS: All
neonates born at term (> or =37 weeks) between April 1, 1985, and March 31,
1988, in Alberta (N = 83,595). We divided the cohort into birth-weight
categories: low (<2.5 kg), normal (2.5-4.5 kg), or high (>4.5 kg). The
cohort was observed prospectively for 10 years.Main Outcome Measure Comparison
of risk of emergency visits for asthma over 10 years across the birth-weight categories.
RESULTS: Neonates born with a high birth weight had a significantly increased
risk of emergency visits for asthma during childhood compared with neonates
born with a normal birth weight (relative risk [RR], 1.16; 95% confidence
interval [CI], 1.04-1.29). The relationship between birth weight and emergency
visits for asthma beyond a birth weight of 4.5 kg was linear, such that every
increment of 0.10 kg in birth weight was associated with an additional 10% (95%
CI, 2%-19%) increase in the risk of emergency visits for asthma. Other factors
associated with an elevated risk for emergency asthma visits during childhood
included male sex (RR, 1.26; 95% CI, 1.22-1.30), aboriginal status (RR, 1.20;
95% CI, 1.11-1.29), and low-income status (RR, 1.11; 95% CI, 1.06-1.16).
CONCLUSIONS: A high, but not low, birth weight is a risk factor for increased
emergency visits during childhood. The risk increases linearly beyond a birth
weight of 4.5 kg.
Author(s):
Shaheen
SO ; Sterne
JA ; Montgomery
SM ; Azima
H
Affiliation: Department of Public Health Sciences, Guy's, King's and St
Thomas' School of Medicine, London SE1 3QD, UK.
Title: Birth
weight, body mass index and asthma in young adults. Source: Thorax (Thorax.) 1999 May; 54(5):
396-402
Abstract: BACKGROUND: Impaired fetal growth may be a risk factor for asthma
although evidence in children is conflicting and there are few data in adults.
Little is known about risk factors which may influence asthma in late childhood
or early adult life. Whilst there are clues that fatness may be important, this
has been little studied in young adults. The relations between birth weight and
childhood and adult anthropometry and asthma, wheeze, hayfever, and eczema were
investigated in a nationally representative sample of young British adults.
METHODS: A total of 8960 individuals from the 1970 British Cohort Study (BCS70)
were studied. They had recently responded to a questionnaire at 26 years of age
in which they were asked whether they had suffered from asthma, wheeze,
hayfever, and eczema in the previous 12 months. Adult body mass index (BMI) was
calculated from reported height and weight. RESULTS: The prevalence of asthma
at 26 years fell with increasing birth weight. After controlling for potential
confounding factors, the odds ratio comparing the lowest birth weight group
(<2 kg) with the modal group (3-3.5 kg) was 1.99 (95% CI 0.96 to 4.12). The
prevalence of asthma increased with increasing adult BMI. After controlling for
birth weight and other confounders, the odds ratio comparing highest with
lowest quintile was 1.72 (95% CI 1.29 to 2.29). The association between fatness
and asthma was stronger in women; odds ratios comparing overweight women (BMI
25-29.99) and obese women (BMI >/=30) with those of normal weight (BMI
<25) were 1.51 (95% CI 1.11 to 2.06) and 1.84 (95% CI 1. 19 to 2.84),
respectively. The BMI at 10 years was not related to adult asthma. Similar
associations with birth weight and adult BMI were present for wheeze but not
for hayfever or eczema. CONCLUSIONS: Impaired fetal growth and adult fatness
are risk factors for adult asthma.
Author(s):
Monteleone
CA ; Sherman
AR
Affiliation: Department of Medicine, University of Medicine and
Dentistry of New Jersey Robert Wood Johnson Medical School, New Brunswick, USA.
Title: Nutrition
and asthma. Source: Arch Intern Med (Archives of internal medicine.) 1997 Jan 13; 157(1): 23-34
Abstract: Asthma is a syndrome that may have many causes resulting in airway
inflammation and hyperresponsiveness. The search for the causes of asthma has
led to the investigation of genetic, atopic, viral, and nutritional factors. For
the last 2 decades, a number of studies have linked particular nutrients to
asthma. The studies have examined both the suboptimal status of particular
nutrients as causes of asthma and supplements of specific nutrients as therapy
for asthma. We reviewed and analyzed data from these studies to determine the
role of nutritional therapy in the management of asthma. The studies on food
allergies reveal that IgE-mediated reactions to food are a minor cause of
respiratory symptoms, affecting more children than adults. Currently, there are
no available data to support the use of nutritional supplements in the
treatment of chronic asthma.
Author(s):
Woods
RK ; Walters
EH ; Raven
JM ; Wolfe
R ; Ireland
PD ; Thien
FC ; Abramson
MJ
Affiliation: Department of Epidemiology & Preventive Medicine, Central
and Eastern Clinical School, Monash University, and The Alfred Hospital,
Melbourne, Victoria, Australia.
Title: Food and
nutrient intakes and asthma risk in young adults. Source: Am J Clin Nutr (The American journal of
clinical nutrition.) 2003 Sep; 78(3): 414-21
Abstract: BACKGROUND: Some aspects of diet are relatively newly recognized
potential risk factors for asthma, but the evidence to date is conflicting.
OBJECTIVE: The goal was to determine whether the food and nutrient intakes of
adults with asthma differ from those of adults without asthma. DESIGN: This was
a community-based, cross-sectional study of 1601 young adults ( +/- SD age:
34.6 +/- 7.1 y) who were initially recruited by random selection from the
federal electoral rolls in Melbourne in 1999. Subjects completed a detailed
respiratory questionnaire, a validated semiquantitative food-frequency
questionnaire, skin-prick testing, and lung function tests, including a
methacholine challenge test for bronchial hyperreactivity (BHR). A total of 25
nutrients and 47 food groups were analyzed by using multiple logistic
regression with alternate definitions of asthma and atopy as the outcomes.
RESULTS: Whole milk appeared to protect against current asthma (odds ratio:
0.66; 95% CI: 0.46, 0.97), doctor-diagnosed asthma (0.73; 0.54, 0.99), BHR
(0.68; 0.48, 0.92), and atopy (0.71; 0.54, 0.94). Conversely, soy beverage was
associated with an increased risk of current asthma (2.05; 1.19, 3.53),
doctor-diagnosed asthma (1.69; 1.04, 2.77), and BHR (1.65; 1.00, 2.71). Apples
and pears appeared to protect against current asthma (0.83; 0.71, 0.98), asthma
(0.88; 0.78, 1.00), and BHR (0.88; 0.77, 1.00). CONCLUSIONS: The consumption of
dairy products, soy beverages, and apples and pears, but not of nutrients per
se, was associated with a range of asthma definitions. Dietary modification
after diagnosis is one possible explanation for this finding. Intervention
studies using whole foods are required to ascertain whether such modifications
of food intake could be beneficial in the prevention or amelioration of asthma.
Author(s):
Smit
HA ; Grievink
L ; Tabak
C
Affiliation: Department of Chronic Disease and Environmental
Epidemiology, National Institute of Public Health and the Environment (RIVM),
Bilthoven, The Netherlands. Jet.smit@rivm.nl
Title: Dietary
influences on chronic obstructive lung disease and asthma: a review of the
epidemiological evidence. Source: Proc Nutr Soc (The Proceedings of the Nutrition Society.) 1999
May; 58(2): 309-19
Abstract: The epidemiological evidence for a relationship between diet and indicators
of asthma and chronic obstructive pulmonary disease (COPD) is evaluated. The
review focuses on the intake of Na, n-3 fatty acids, and antioxidant vitamins
as well as fruit and vegetables. Experimental studies suggest that a high-Na
diet has a small adverse effect on airway reactivity in asthma patients.
However, observational studies provide no clear evidence that high Na intake
has adverse effects on airway reactivity or asthma symptoms in open
populations. n-3 Polyunsaturated fatty acids, which are present in fish oils,
are metabolized into less broncho-constricting and inflammatory mediators than
n-6 polyunsaturated fatty acids. Studies in the general adult population
suggest that a high fish intake has a beneficial effect on lung function, but the
relationship with respiratory symptoms and clinically-manifest asthma or COPD
is less evident. Also, experimental studies in asthma patients have not
demonstrated an improvement in asthma severity after supplementations with fish
oil. Several studies showed a beneficial association between fruit and
vegetable intake and lung function, but the relationship with respiratory
symptoms and the clinically-manifest disease was less convincing. A similar
pattern was found for vitamin C in relation to indicators of asthma and COPD,
but there are still conflicting results with respect to vitamin E and
beta-carotene. In conclusion, the epidemiological evidence for a beneficial
effect on indicators of asthma and COPD of eating fish, fruit and vegetables is
increasing. However, the effectiveness of dietary supplementation in
open-population samples is often not demonstrated. Several unresolved questions
are raised, which should be addressed in future studies on the relationship
between diet and respiratory disease.
Author(s):
Raj
NS ; Misra
A ; Guleria
R ; Pande
JN
Affiliation: SRB Centre for Clinical Pharmacology, All India Institute
of Medical Sciences, Ansari Nagar, New Delhi. nsraj@medinst.ernet.in
Title: Theophylline
clearance in undernourished asthma patients. Source: Indian J Chest Dis Allied Sci (The Indian journal of chest
diseases & allied sciences.) 1998 Jul-Sep; 40(3): 175-8
Abstract: Theophylline clearance is altered by many drugs and diseases that may be
associated with undernutrition. Therefore, we studied theophylline clearance in
12 undernourished [body mass index (BMI) less than 19] and 12 well nourished
asthma patients (body mass index more than 19). Uncoated theophylline tablet
(200 mg, 300 mg dose 5 mg/kg approx) was administered orally to each asthma
patient after 12 hours overnight fasting. Serum theophylline concentrations
were estimated after 2, 4, 6, 8 hours of drug administration and it was
calculated from log conc: time curve. Undernourished asthma patients had a mean
theophylline clearance of 85.6 (SE = 6.2) ml/hr/kg while it was 125.6 (SE =
3.8) ml/hr/kg in well-nourished asthma patients. The difference between two
groups was highly significant (p < 0.01). We conclude that theophylline
clearance is significantly lower in undernourished asthma patients and they
will require a lower maintenance dose of theophylline.
Author(s):
Ford
ES
Affiliation: Division of Environmental Hazards and Health Effects,
National Center for Environmental Health, Centers for Disease Control and
Prevention, Atlanta, Georgia 30333, USA. esf2@cdc.gov
Title: Asthma,
body mass index, and C-reactive protein among US adults. Source: J Asthma (The Journal of asthma :
official journal of the Association for the Care of Asthma.) 2003; 40(7):
733-9
Abstract: Obesity, a state that may be characterized by a low-grade inflammation,
has been associated with asthma. C-reactive protein, an acute phase reactant,
is elevated in obese people. However, little is known about how asthma affects
C-reactive protein concentrations. Using data from 14,224 participants of the
Third National Health and Nutrition Examination Survey (1988-1994), the author
examined C-reactive protein concentrations among participants with current
asthma (n = 651), who formerly had asthma (n = 303), and who never had asthma
(n = 13,270). Compared with 21% of participants with current asthma, 11% with
former asthma (P < .001) and 15% without asthma (P = .018) had C-reactive
protein concentrations > or = 85th percentile of the sex-specific distribution.
Compared with participants without asthma, the age-adjusted odds ratios for
having an elevated C-reactive protein concentration was 1.49 (95% confidence
interval [CI]: 1.11, 2.00) for persons with current asthma. After adjusting for
age, sex, race or ethnicity, years of education, cotinine concentration, body
mass index, waist-hip ratio, physical activity level, aspirin use, oral
corticosteroid use, and inhaled corticosteroid use, the odds ratio decreased to
1.15 (95% CI: 0.83, 1.59). Body mass index was the main reason for the
attenuation of the odds ratio. Whether the inflammatory activity associated
with body mass index contributes to the pathophysiology of asthma is unknown.
Author(s): Tam M ; Gómez S ; González-Gross M ;
Marcos A
Affiliation: Departamento de Bioquímica y Fisiología, Instituto de
Nutrición e Higiene de los Alimentos, Centro Habana, Ciudad de La Habana, Cuba.
Title: Possible
roles of magnesium on the immune system. Source: Eur J Clin Nutr (European journal of clinical
nutrition.) 2003 Oct; 57(10): 1193-7
Abstract: During the last few years, magnesium (Mg) has been subject of research
due to its functionality in the organism. It is one of the most important
micronutrients, and therefore its role in biological systems has been
extensively investigated. Particularly, Mg has a strong relation with the
immune system, in both nonspecific and specific immune response, also known as
innate and acquired immune response. The aim of this paper is to review the
state of the art about the interactions between Mg and the immune system. We
discuss the link between dietary Mg and inflammation, apoptosis and alterations
in number and function of innate immune cell populations, described in animal
models. Furthermore, the immune system can be compromised in human populations
under certain circumstances, including athletes and elderly people. The
importance of a balanced Mg homeostasis and its interaction with the immune
system in these groups has also been reviewed. Although emerging data support
the relevant role of Mg in the immune response, further research is needed; and
special efforts should be made to establish the most adequate dose in
nutritional supplements to reach beneficial effects on health.
Author(s):
Harik-Khan
RI ; Muller
DC ; Wise
RA
Affiliation: Clinical Research Branch, National Institute on Aging,
National Institutes of Health, Baltimore, MD, USA. Title: Serum vitamin levels and the risk of asthma in
children. Source: Am J Epidemiol
(American journal of epidemiology.) 2004 Feb 15; 159(4): 351-7
Additional Info: United States Standard No: ISSN: 0002-9262; 1476-6256; NLM Unique
Journal Identifier: 7910653 Language: English Abstract: Dietary intake, especially of antioxidant vitamins A,
C, E, and the carotenoids, has been linked with the presence and severity of
asthma. From the Third National Health and Nutrition Examination Survey (NHANES
III), conducted in the United States between 1988 and 1994, the authors
selected 4,093 children (aged 6-17 years) for whom relevant medical,
socioeconomic, and anthropometric data were complete. The children were 50.6%
female, and 9.7% reported a diagnosis of asthma. Bivariate analyses showed that
asthma diagnosis was associated with lower levels of serum vitamin C,
alpha-carotene, beta-carotene, and beta-cryptoxanthin. However, antioxidant
levels may be surrogate markers for socioeconomic variables such as race,
poverty, tobacco exposure, or general nutritional status. In logistic models
that included age, body mass index, socioeconomic variables, antioxidant
levels, parental asthma, and household smoking, the only antioxidants significantly
associated with asthma were vitamin C (odds ratio = 0.72 per mg/dl, 95%
confidence interval = 0.55, 0.95) and alpha-carotene (odds ratio = 0.95 per
micro g/dl, 95% confidence interval = 0.90, 0.99). The odds ratio for asthma in
the highest quintile of serum vitamin C relative to the lowest was 0.65 (p <
0.05), whereas it was 0.74 for alpha-carotene (p = 0.066). The authors
concluded that low vitamin C and alpha-carotene intakes are associated with
asthma risk in children.
Author(s):
Broughton
KS ; Johnson
CS ; Pace
BK ; Liebman
M ; Kleppinger
KM
Affiliation: Nutrition/Department of Family and Consumer Science,
University of Wyoming, Laramie 82071, USA. BROUGHTO@UWYO.EDU
Title: Reduced
asthma symptoms with n-3 fatty acid ingestion are related to 5-series
leukotriene production. Source: Am J Clin Nutr (The American journal of clinical nutrition.) 1997
Apr; 65(4): 1011-7
Abstract: Asthma may respond to dietary modification, thereby reducing the need
for pharmacologic agents. This study determined the effectiveness of n-3
polyunsaturated fatty acid (PUFA) ingestion in ameliorating
methacholine-induced respiratory distress in an asthmatic population. The
ability of urinary leukotriene excretion to predict efficacy of n-3 PUFA
ingestion was assessed. After n-3 PUFAs in ratios to n-6 PUFAs of 0.1:1 and
0.5:1 were ingested sequentially for 1 mo each; patient respiratory indexes
were assessed after each treatment. Forced vital capacity (FVC), forced
expiratory volume for 1 s (FEV1), peak expiratory flow (PEF), and forced
expiratory flow 25-75% (FEF 25-75) were measured along with weekly 24-h urinary
leukotriene concentrations. With low n-3 PUFA ingestion, methacholine-induced
respiratory distress increased. With high n-3 PUFA ingestion, alterations in
urinary 5-series leukotriene excretion predicted treatment efficacy. Elevated
n-3 PUFA ingestion resulted in a positive methacholine bronchoprovocation dose
change in > 40% of the test subjects (responders). The provocative dose to
cause a 20% reduction (PD20) in FEV1, FVC, PEF, and FEF25-75 values could not
be calculated because of a lack of significant respiratory reduction.
Conversely, elevated n-3 PUFA ingestion caused some of the patients
(nonresponders) to further lose respiratory capacity. Five-series leukotriene
excretion with high n-3 PUFA ingestion was significantly greater for responders
than for nonresponders. A urinary ratio of 4-series to 5-series leukotrienes
< 1, induced by n-3 PUFA ingestion, may predict respiratory benefit.
Author(s):
Rust
GS ; Thompson
CJ ; Minor
P ; Davis-Mitchell
W ; Holloway
K ; Murray
V
Affiliation: National Center for Primary Care, Morehouse School of
Medicine, Atlanta, Georgia 30310, USA.
Title: Does
breastfeeding protect children from asthma? Analysis of NHANES III survey data.
Source:
J Natl Med Assoc (Journal of the National Medical
Association.) 2001 Apr; 93(4): 139-48
Abstract: We sought to determine whether breastfeeding (yes/no) or its duration
protects against the development of childhood asthma, its severity or age of
onset. We conducted a secondary analysis of youth files of the National Health
and Nutrition Examination Survey III (1988-94), and reviewed data from 6,783
children age 2 months to 6 years (3,316 breastfed), excluding children with a
history of low birth weight or treatment in a neonatal intensive care unit.
Study participants were breastfed an average of 157 days. The average age at
onset of asthma was 14.3 months. In the logistic regression model, "ever
breast-fed" was not a significant protective factor for developing asthma.
Significant predictive factors were the mother's age at child's birth (beta =
-0.08, p < 0.01), and a parent having asthma or hayfever (beta = 0.46, p
< 0.01). In the linear regression model, the duration of breastfeeding was
not a predictor for age at onset of asthma (beta = 0.01, p = 0.53). Only
maternal smoking during pregnancy was a significant predictor of age at onset
of asthma (beta = -7.59, p < 0.01). Breastfeeding does not appear to prevent
asthma, delay its onset, or reduce its severity. However, breastfeeding is
still recommended for its many other benefits.
Author(s):
Chulada
PC ; Arbes
SJ Jr ; Dunson
D ; Zeldin
DC
Affiliation: Office of Clinical Research, National Institute of
Environmental Health Sciences/NIH, PO Box 12233, Research Triangle Park, NC
27709, USA.
Title: Breast-feeding
and the prevalence of asthma and wheeze in children: analyses from the Third
National Health and Nutrition Examination Survey, 1988-1994. Source: J Allergy Clin Immunol (The Journal of allergy and
clinical immunology.) 2003 Feb; 111(2): 328-36
Abstract: BACKGROUND: Asthma prevalence has increased dramatically in recent
years, especially among children. Breast-feeding might protect children against
asthma and related conditions (recurrent wheeze), and this protective effect
might depend on the duration and exclusivity of the breast-feeding regimen.
OBJECTIVE: We sought to determine whether there is an association between
breast-feeding and asthma, recurrent wheeze, or both in children up to 72
months of age and whether the duration and exclusivity of breast-feeding affect
this association. METHODS: Data were from the third National Health and
Nutrition Examination Survey, a nationally representative cross-sectional
survey conducted from 1988 to 1994. We tested for significant associations between
breast-feeding and physician-diagnosed asthma and recurrent wheeze (> or =3
episodes in the past 12 months) before and after adjusting for potential
confounders. RESULTS: Crude analyses showed that breast-feeding was associated
with significantly reduced risks for asthma and recurrent wheeze in children 2
to 71 months of age, but after adjusting for potential confounders, these
overall protective associations attenuated and were no longer statistically
significant. However, 2 new and important associations were revealed after
adjusting for confounders: (1) compared with never breast-fed children, ever
breast-fed children had significantly reduced odds of being diagnosed with
asthma and of having recurrent wheeze before 24 months of age, and (2) among children
2 to 71 months of age who had been exposed to environmental tobacco smoke,
those who had ever been breast-fed had significantly reduced risks of asthma
and wheeze compared with those who had never been breast-fed. CONCLUSIONS:
Breast-feeding might delay the onset of or actively protect children less than
24 months of age against asthma and recurrent wheeze. Breast-feeding might
reduce the prevalence of asthma and recurrent wheeze in children exposed to
environmental tobacco smoke.
Author(s):
Chapman
RS ; Hadden
WC ; Perlin
SA
Affiliation: Office of Research and Development, National Center for
Environmental Assessment, Environmental Protection Agency, Research Triangle
Park, NC, USA.
Title: Influences
of asthma and household environment on lung function in children and
adolescents: the third national health and nutrition examination survey.
Source:
Am J Epidemiol (American journal of
epidemiology.) 2003 Jul 15; 158(2): 175-89
Abstract: The authors examined influences of asthma and household environment
(passive smoking, use of a gas stove, and having a dog or cat) on five measures
of spirometric lung function among 8- to 16-year-old subjects, as measured
cross-sectionally in the Third National Health and Nutrition Examination Survey
(NHANES III) (1988-1994). In regression models, independent variables included
asthma status, household environmental factors, age, and anthropometric
measurements. Regression analyses were weighted by the NHANES III examination
sample weighting factor, and results were adjusted for clustering in the
sampling design. There were distinct sex differences in the results. In girls,
lung function was lowest among active asthmatics taking prescription
respiratory medicine, whereas lung function in other active and inactive
asthmatics did not differ greatly from that in nonasthmatics. In boys, however,
all groups of asthmatics had substantially lower lung function than
nonasthmatics. Differences in lung function between active asthmatics and
nonasthmatics were stable with increasing age. However, the lung function of
inactive asthmatic girls and boys returned to and diverged from nonasthmatics'
levels, respectively. In asthmatic girls, passive smoking was associated with
reduced lung function; having a dog or cat was associated with increased lung
function; and gas stove use was associated with reduced lung function among
subjects not taking prescription respiratory medicine.
Author(s):
Knapp
HR
Affiliation: Department of Internal Medicine, University of Iowa College
of Medicine, Iowa City, USA.
Title: Omega-3
fatty acids in respiratory diseases: a review. Source: J Am Coll Nutr (Journal of the American College
of Nutrition.) 1995 Feb; 14(1): 18-23
Abstract: The health benefits of dietary omega-3 fatty acids have been
investigated in a variety of conditions but there have been few studies of
their effects in human respiratory diseases. Although many of the physiological
changes associated with omega-3 polyunsaturate ingestion have been attributed
to alterations in endogenous eicosanoid production, effects on blood rheology,
host-microbial interactions and lung surfactant production have also been
described. In reviewing the literature, there is little evidence that these
polyunsaturates have beneficial effects in allergic disorders, but they may
have potential as modulators of respiratory diseases involving chronic
inflammatory and infectious processes or impaired pulmonary blood flow. Further
work on the effects of omega-3 fatty acids in several chronic pulmonary
syndromes, for which there are currently no effective therapies, appears to be
warranted.
Author(s):
Stevenson
DD
Affiliation: Division of Allergy, Asthma and Immunology, Scripps Clinic
and the Scripps Research Institute, La Jolla, CA 92037, USA.
Title: Monosodium
glutamate and asthma. Source: J Nutr (The Journal of nutrition.) 2000 Apr; 130(4S) Suppl: 1067S-73S
Abstract: Allen et al. (1987) conducted oral monosodium glutamate (MSG) challenges
with 32 asthmatic volunteers and reported that 14 reacted to MSG. Another study
by Moneret-Vautrin (1987) also reported MSG-induced asthma attacks in 2 of 30
asthmatic patients. Four additional studies have been conducted and none has
confirmed the results of the above authors. These studies, by Schwartzstein et
al. (1987), Germano (1991), Woods et al. (1998) and Woessner et al. (1999),
challenged a total of 45 patients who gave a history of asthma attacks in
oriental restaurants. None of these patients experienced asthmatic reactions
after ingesting MSG (one-sided confidence interval of 0-0.066). Another 109
asthmatic patients, without a history of asthma in oriental restaurants, also did
not react to ingestion of MSG (one-sided confidence interval of 0-0.027). With
a confidence interval < 0.05 there is a >95% probability that MSG
history-negative asthmatic patients are not sensitive to MSG. For the MSG
history-positive asthmatics, 45 patients, in well-performed studies, underwent
negative challenges to MSG, contrasting with two studies reporting positive
challenges. Allen et al. (1987) and Moneret-Vautrin (1987), who reported positive MSG
challenge results, performed studies with the following characteristics: 1)
single blinded, conducted after discontinuing essential antiasthma medications;
2) used effort-dependent peak expiratory flow rate measurement of lung
function; 3) added AM bronchodilators in some patients; 4) ignored wandering baselines
on the placebo challenge days; and 5) conducted some challenges in the AM and
some at night. In summary, the existence of MSG-induced asthma, even in
history-positive patients, has not been established conclusively.
Drugs Food Cigarette Smoke Emotions Weather Obesity/Nutrition Physical Activity
Author(s):
Carlsen
KH ; Carlsen
KC
Affiliation: Voksentoppen National Hospital and Research Institute of
Asthma, Allergy and Chronic Lung Diseases in Children, Voksentoppen, Ullveien
14, Oslo, Norway.
Title: Exercise-induced
asthma. Source: Paediatr Respir Rev (Paediatric respiratory reviews.) 2002 Jun; 3(2): 154-60
Abstract: Exercise-induced asthma (EIA) is common in asthmatic children and adolescents.
Since it may cause limitations to daily life activities in up to 30%, mastering
EIA is important in asthma management. EIA consists of bronchial obstruction
occurring immediately, or soon after, physical exercise as a result of
increased respiratory water and heat loss due to increased ventilation during
exercise, with the subsequent release of mediators and stimulation of airways
receptors. Diagnosis is best made by standardised exercise tests, preferably
running on a treadmill for 6-8 minutes at an exercise load of 95% of maximum.
The sensitivity of the test may be increased by cold air inhalation. EIA is
best treated by inhaled steroids in addition to pre-treatment before exercise
by inhaled beta(2)-agonists, short or long acting, and/or leukotriene
antagonists. Physical training may improve physical fitness and quality of life
in asthmatic children but baseline lung function and bronchial responsiveness
are not improved.
Author(s):
Massie
J
Affiliation: Department of Respiratory Medicine, and Murdoch Children's
Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
massiej@cryptic.rch.unimelb.edu.au
Title: Exercise-induced
asthma in children. Source: Paediatr Drugs (Paediatric drugs.) 2002; 4(4): 267-78
Abstract: Exercise-induced asthma (EIA) is a relatively common problem in
children, but may not be recognized because children either do not report their
symptoms, or avoid activities that cause it. Clarifying the diagnosis of EIA,
in particular separating EIA from other causes of exertional dyspnea, is
essential. Treating EIA in children is challenging because of the nature of
their physical activities, which are often not planned, and may be prolonged.
Keeping children active is an important goal to ensure healthy physical and
social development. Many children with EIA are well managed with an inhaled
short-acting beta(2)-adrenoceptor agonist before exercise or if symptoms
develop. The approach to more troublesome EIA depends on whether the child has
persistent asthma and requires better prevention, or the EIA is an isolated
clinical problem. The options for treatment also depend on the timing,
frequency, and duration of activity that induces EIA. Options include the
addition of a cromone, a leukotriene modifier, an inhaled corticosteroid, or
switching to use a long-acting beta(2)-adrenoceptor agonist. The use of warm-up
exercises has been shown to be helpful by using the refractory period but is
not practical for most children with EIA. A final consideration for successful
management of EIA in children is that the delivery of medication needs to be
age-appropriate.
Author(s):
Anderson
SD ; Daviskas
E
Affiliation: Department of Respiratory Medicine, Royal Prince Alfred
Hospital, Camperdown, Australia.
Title: The
mechanism of exercise-induced asthma is ... Source: J Allergy Clin Immunol (The Journal of allergy and
clinical immunology.) 2000 Sep; 106(3): 453-9
Abstract: Exercise-induced asthma (EIA) refers to the transient narrowing of the airways that follows vigorous exercise. The mechanism whereby EIA occurs is thought to relate to the consequences of heating and humidifying large volumes of air during exercise. In 1978 airway cooling was identified as an important stimulus for EIA; however, severe EIA also occurred when hot dry air was inspired, and there was no abnormal cooling of the airways. In 1986 the thermal hypothesis proposed that cooling of the airways needed to be followed by rapid rewarming and that these two events caused a vasoconstriction and a reactive hyperemia of the bronchial microcirculation, together with edema of the airway wall, causing the airways to narrow after exercise. The osmotic, or airway-drying, hypothesis developed from 1982-1992 because neither airway cooling nor rewarming appeared to be necessary for EIA to occur. As water is evaporated from the airway surface liquid, it becomes hyperosmolar and provides an osmotic stimulus for water to move from any cell nearby, resulting in cell volume loss. It is proposed that the regulatory volume increase, after cell shrinkage, is the key event resulting in release of inflammatory mediators that cause airway smooth muscle to contract and the airways of asthmatic subjects to narrow. This event may or may not be associated with airway edema. The osmotic and thermal theories come together by considering that inspiration of cold air not only cools the airways but also increases the numbers of airway generations becoming dehydrated in the humidifying process.
Author(s):
Strunk
RC ; Sternberg
AL ; Bacharier
LB ; Szefler
SJ
Affiliation: Department of Pediatrics, Washington University School of
Medicine, Division of Allergy and Pulmonary Medicine, St Louis Children's
Hospital, MO 63110, USA.
Title: Nocturnal
awakening caused by asthma in children with mild-to-moderate asthma in the
childhood asthma management program. Source: J Allergy Clin Immunol (The Journal of allergy and
clinical immunology.) 2002 Sep; 110(3): 395-403
Abstract: BACKGROUND: Nocturnal symptoms of asthma are a cause of significant morbidity and are included as a central feature in the categorization of asthma severity. OBJECTIVES: Data from the Childhood Asthma Management Program were used to estimate the prevalence of nocturnal awakenings in 1041 children with mild-to-moderate asthma and to investigate the relationships between awakenings and peak flows, severity of asthma, and allergen sensitivity and exposure. METHODS: Daily diary care data were recorded during a 28-day interval in the Childhood Asthma Management Program screening process. The data on morning and evening peak flows, overall symptom codes, albuterol use for symptoms, and nocturnal awakenings for asthma symptoms were analyzed and compared with measures of personal characteristics, pulmonary function, and environmental characteristics of the patients. RESULTS: Three hundred fifty-one (33.7%) children experienced 1 or more night awakenings caused by asthma during the 28-day screening period while not taking any maintenance medications. Greater risk of night awakening was associated with more severe asthma (greater responsiveness to bronchodilator, airway reactivity to methacholine, peak flow variability, and use of albuterol for symptoms, all P <.0001) and atopy (increased IgE and allergy skin test reactivity, both P =.0002). Those with a positive skin test response to dog and a high level of dog allergen in the home had a greater risk of night awakening caused by asthma (P =.01), as did those with a positive skin test response to cat and a high level of cat allergen in the home (P =.04). Mean daily symptom code and use of albuterol for asthma symptoms increased in the 3 days immediately before a single awakening compared with in the 4 to 6 days before the awakening (P =.02 and P =.01, respectively); however, both morning and evening peak flows as a percentage of personal best were similar in both intervals. Mean daily symptom code and daily use of albuterol were greater in the 3 days after an awakening than in the 3 days before (P <.0001 and P =.0002, respectively). Mean evening peak flow percentage of personal best the day after an episode of awakening was lower when a second consecutive awakening occurred than when there was only a single awakening (P =.01). CONCLUSIONS: Nocturnal awakening occurred in one third of the children with mild-to-moderate asthma during a month of relative stability and appears to be an indicator of asthma that is becoming increasingly severe.
Author(s):
D'Ambrosio
CM ; Mohsenin
V
Affiliation: Department of Pulmonary and Critical Care Medicine, Yale
University School of Medicine, New Haven, Connecticut, USA.
Title: Sleep in
asthma. Source: Clin Chest Med
(Clinics in chest medicine.) 1998 Mar; 19(1): 127-37
Abstract: The nocturnal worsening of asthma is a major cause of morbidity and
mortality from this disease. The physiologic changes that occur during normal
sleep can have adverse effects on breathing patterns, arousal responses, and
airway clearance in asthmatics. Understanding of these alterations in airway
mechanics and airway inflammation may lead to better management of this
disease.
Author(s):
Syabbalo
N
Affiliation: Faculty of Medicine, Kuwait University, Safat, Kuwait.
Title: Chronobiology
and chronopathophysiology of nocturnal asthma. Source: Int J Clin Pract (International journal of
clinical practice.) 1997 Oct; 51(7): 455-62
Abstract: Asthma is increasing in prevalence and severity worldwide despite
effective treatment and innovative research developments. Chronobiology is the
study of biological rhythms and their mechanisms. Asthma is one of many
diseases that exemplifies a circadian pattern in intensity, frequency of
attacks and mortality. As many as 90% of asthmatics experience nocturnal
symptoms severe enough to awaken them from sleep. Increased airway narrowing at
night is thought to occur as a result of circadian variation in neurohormones
and intensification of airway inflammation. Furthermore, vagal tone, neurogenic
inflammation and airway hyperresponsiveness are increased at night. Many cells
contribute to the nocturnal inflammatory process in the asthmatic airways,
including mast cells, eosinophils, neutrophils and lymphocytes. These cells are
capable of secreting innumerable inflammatory mediators, such as histamine,
cytokines, leukotrienes, prostaglandins, neutral endopeptidase and superoxides,
which are potent bronchoconstrictors and secretogogues. They also cause
increased vascular permeability and airway oedema. All these chronobiological
events promote nocturnal worsening of asthma and increased nocturnal deaths.
Understanding the mechanisms of nocturnal asthma will help us learn more about
asthma, and how to implement appropriate chronotherapeutic interventions.