July 13, 2013

Major comorbid conditions in asthma and association with asthma-related hospitalizations and emergency department admissions in adults

Research article

Major comorbid conditions in asthma and association with asthma-related hospitalizations and emergency department admissions in adults: results from the German national health telephone interview survey (GEDA) 2010

Henriette Steppuhn, Ute Langen, Christa Scheidt-Nave and Thomas Keil

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BMC Pulmonary Medicine 2013, 13:46 doi:10.1186/1471-2466-13-46

Published: 12 July 2013

Abstract (provisional)

Background

It remains unclear to what extent asthma in adults is linked to allergic rhinitis (AR), gastroesophageal reflux disease (GERD), and acetylsalicylic acid exacerbated respiratory disease (AERD), and how these comorbidities may affect asthma outcomes in the general population. We therefore aimed to assess the prevalence of these major comorbidities among adults with asthma and examine their impact on asthma exacerbations requiring hospital care.

Methods

A total of 22,050 adults 18 years and older were surveyed in the German National Health Telephone Interview Survey (GEDA) 2010 using a highly standardized computer-assisted interview technique. The study population comprised participants with self-reported physician-diagnosed asthma, among which the current (last 12 months) prevalence of AR and GERD-like symptoms (GERS), and life-time prevalence of AERD was estimated. Weighted bivariate analyses and logistic regression models were applied to assess the association of each comorbid condition with the asthma outcome (any self-reported asthma-related hospitalization and/or emergency department (ED) admission in the past year).

Results

Out of 1,136 adults with asthma, 49.6% had GERS and 42.3% had AR within the past 12 months; 14.0% met the criteria of AERD, and 75.7% had at least one out of the three conditions. Overall, the prevalence of at least one exacerbation requiring emergency room or hospital admission within the past year was 9.0%. Exacerbation prevalence was higher among participants with comorbidities than among those without (9.8% vs. 8.2% for GERS; 11.2% vs. 7.6% for AR, and 22.2% vs. 7.0% for AERD), but only differences in association with AERD were statistically significant. A strong association between asthma exacerbation and AERD persisted in multivariable logistic regression analyses adjusting for sex, age group, level of body mass index, smoking status, educational attainment, and duration of asthma: odds ratio (OR) = 4.5, 95% confidence interval (CI) = 2.5--8.2.

Conclusions

Data from this large nation-wide study provide evidence that GERS, AR and AERD are all common comorbidities among adults with asthma. Our data underline the public health and clinical impact of asthma with complicating AERD, contributing considerably to disease-specific hospitalization and/or ED admission in a defined asthma population, and emphasize the importance of its recognition in asthma care.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

July 11, 2013

Impact of Maternal Obesity on Inhaled Corticosteroid Use in Childhood

OPEN ACCESS PEER-REVIEWED

RESEARCH ARTICLE

Impact of Maternal Obesity on Inhaled Corticosteroid Use in Childhood: A Registry Based Analysis of First Born Children and a Sibling Pair Analysis

Adrian J. Lowe mail,

Cecilia Ekeus,

Lennart Bråbäck,

Kristiina Rajaleid,

Bertil Forsberg,

Anders Hjern

Abstract

Background

It has been proposed that maternal obesity during pregnancy may increase the risk that the child develops allergic disease and asthma, although the mechanisms underpinning this relationship are currently unclear. We sought to assess if this association may be due to confounding by genetic or environmental risk factors that are common to maternal obesity and childhood asthma, using a sibling pair analysis.

Methods

The study population comprised a Swedish national cohort of term children born between 1992 and 2008 to native Swedish parents. Maternal body mass index (BMI) was measured at 8–10 weeks gestation. Unconditional logistic regression models were used to determine if maternal obesity was associated with increased risk of inhaled corticosteroid (ICS) in 431,718 first-born children, while adjusting for potential confounders. An age-matched discordant sib-pair analysis was performed, taking into account shared genetic and environmental risk factors.

Results

Maternal over-weight and obesity were associated with increased risk that the child would require ICS (for BMI≥35 kg/m2, aOR = 1.30, 95%CI = 1.10–1.52 compared with normal weight mothers) in children aged 6–12 years. Similar effects were seen in younger children, but in children aged 13–16 years, maternal obesity (BMI≥30) was related to increased risk of ICS use in girls (aOR = 1.28, 95%CI = 1.07–1.53) but not boys (OR = 1.05, 95%CI = 0.87–1.26). The sib-pair analysis, which included 2,034 sib-pairs older than six years who were discordant for both ICS use and maternal BMI category, failed to find any evidence that increasing maternal weight was related to increased risk of ICS use.

Conclusion

Maternal obesity is associated with increased risk of childhood ICS use up to approximately 12 years of age, but only in girls after this age. These effects could not be confirmed in a sib pair analysis, suggesting either limited statistical power, or the effects of maternal BMI may be due to shared genetic or environmental risk factors.

Citation: Lowe AJ, Ekeus C, Bråbäck L, Rajaleid K, Forsberg B, et al. (2013) Impact of Maternal Obesity on Inhaled Corticosteroid Use in Childhood: A Registry Based Analysis of First Born Children and a Sibling Pair Analysis. PLoS ONE 8(6): e67368. doi:10.1371/journal.pone.0067368

Editor: Amanda Bruce, University of Missouri-Kansas City, United States of America

Received: December 17, 2012; Accepted: May 17, 2013; Published: June 28, 2013

Copyright: © 2013 Lowe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This project was supported by Swedish Research Council through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) network, grant no. 2008-7491, who provided financial support to A.L. and L.B. to undertake this project. Also, A.L. was supported by the Australian National Health and Medical Research Council, C.E. was supported with grants from the Swedish Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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Interleukin-13 +1923C/T Polymorphism Is Associated with Asthma Risk: A Meta-Analysis

BioMed Research International
Volume 2013 (2013), Article ID 394316, 9 pages
http://dx.doi.org/10.1155/2013/394316

Review Article

Interleukin-13 +1923C/T Polymorphism Is Associated with Asthma Risk: A Meta-Analysis

Yongan Liu,^1,2 Tao Liu,² Wei Nie,² Guoxiang Lai,³ and Qingyu Xiu²

¹Department of Intensive Care Medicine, No. 411 Hospital of PLA, Shanghai 200080, China
²Department of Respiratory Disease, Shanghai Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai 200003, China
³Department of Respiratory Disease, Fuzhou Military General Hospital, Fuzhou, Fujian 350025, China

Received 12 March 2013; Accepted 22 May 2013

Academic Editor: Koji Kawakami

Copyright © 2013 Yongan Liu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

There are controversies on the association between interleukin-13 (IL-13) +1923C/T polymorphism (rs1295686) and the risk of asthma. We performed this study to assess the association by the method of meta-analysis. A systematic search current to October 16, 2012, was conducted using PubMed, EMBASE, and China National Knowledge Infrastructure (CNKI) and identified ten studies comprising 13698 cases and 38209 controls. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. There was a significant association between IL-13 +1923C/T polymorphism and asthma risk in codominant model. When stratified by ethnicity, IL-13 +1923C/T polymorphism remained significantly associated with higher asthma risk in Asians and Caucasians. In the subgroup analysis by study quality, a significantly increased asthma risk was observed in high quality studies. Sensitivity analysis and cumulative analysis further strengthened the validity of the results. No publication bias was found in this meta-analysis. In conclusion, results from this meta-analysis suggested that IL-13+1923C/T polymorphism was a risk factor of asthma.

Asthma, Chronic Obstructive Pulmonary Disease (COPD), and the Overlap Syndrome

Asthma, Chronic Obstructive Pulmonary Disease

(COPD), and the Overlap Syndrome

+Author Affiliations

From Department of Family Medicine, San Jacinto Methodist Hospital, Baytown, TX.

Corresponding author: Mohammad Obadah Nakawah, MD, San Jacinto Methodist Hospital, 4301 Garth Road, Suite 300, Baytown, Texas 77521 (E-mail: Jdomon@tmhs.org).

Abstract

Asthma and chronic obstructive pulmonary disease (COPD) are highly prevalent chronic diseases in the general population. Both are characterized by heterogeneous chronic airway inflammation and airway obstruction. In both conditions, chronic inflammation affects the whole respiratory tract, from central to peripheral airways, with different inflammatory cells recruited, different mediators produced, and thus differing responses to therapy. Airway obstruction is typically intermittent and reversible in asthma but is progressive and largely irreversible in COPD. However, there is a considerable pathologic and functional overlap between these 2 heterogeneous disorders, particularly among the elderly, who may have components of both diseases (asthma-COPD overlap syndrome). The definitions for asthma and COPD recommended by current guidelines are useful but limited because they do not illustrate the full spectrum of obstructive airway diseases that is encountered in clinical practice. Defining asthma and COPD as separate entities neglects a considerable proportion of patients with overlapping features and is largely based on expert opinion rather than on the best current evidence. The presence of different phenotypes or components of obstructive airway diseases, therefore, needs to be addressed to individualize and optimize treatment to achieve the best effect with the fewest side effects for the patient. Although specific interventions vary by disease, the treatment goals of obstructive airway diseases are similar and driven primarily by the need to control symptoms, optimize health status, and prevent exacerbations.

This Article
1. doi:10.3122/jabfm.2013.04.120256J Am Board Fam Med July-August 2013 vol. 26 no. 4470-477
1. » Abstract
2. Full Text
3. Full Text (PDF)

Pharmacogenomic Investigation of Adverse Drug Reactions(ADRs): The ADR Prioritization Tool, APT

2013;20(2):e110-27. Epub 2013 May 3.

Pharmacogenomic Investigation of Adverse Drug Reactions(ADRs): The ADR Prioritization Tool, APT.

Shaw K, Amstutz U, Castro-Pastrana L, Loo TT, Ross CJ, Ito S, Reider MJ, Maher M, Macleod S, Koren G, Hayden MR, Carleton BC.

Abstract

Background

The impact of genetic factors on the risk of adverse drug reactions (ADRs) is being increasingly recognized as clinically important. ADR Prioritization Tool (APT) was developed to facilitate the prioritization of drugs and their associated ADRs for future pharmacogenomic studies.ObjectivesTo describe a novel tool developed for the prioritization of pharmacogenomic investigation of ADRs and discuss the impact of specific scoring criteria.

Methods

APT scores were based on 25 key scientific and feasibility criteria relevant for clinical research evaluating the genetic basis of ADRs, with a maximum possible score of 60 points. The tool was independently applied to five ADRs (warfarin-induced bleeding/thrombosis, cisplatin-induced ototoxicity, methotrexate-induced neutropenia, carbamazepine-induced Stevens-Johnson syndrome, and abacavir-induced hypersensitivity) by two researchers. Scores were compared using the intraclass correlation coefficient (ICC) to determine level of agreement.

Results

Overall scores for target ADRs ranged from 19.5 to 44 points (33-73% of maximum possible score). Cisplatin-induced ototoxicity, a frequent and severe ADR, received the highest score (44). Lower scores were obtained for abacavir-induced hypersensitivity (19.5) and methotrexate-induced neutropenia (28). High agreement was observed between the scientific, feasibility, and total scores from two reviewers (ICC values = 0.895, 0.980, and 0.983, respectively).

Conclusion

Application of APT enables simple and direct comparison of potential study targets for research groups embarking on pharmacogenomic investigation of ADRs. Research teams will be able to identify which study targets are best suited for their research environment and discern how to optimize resource allocation for successful discovery and replication of clinically relevant biomarkers.

PMID:: 23824325; [PubMed - in process]

Free full text pdf

http://www.jptcp.com/jptcp_13130_e110_e127_carleton-pdf-r193063

Clinical and follow up assessment of children in a program directed at the use of formulas for cow's milk protein allergy

Revista Paulista de Pediatria

Print version ISSN 0103-0582

Rev. paul. pediatr. vol.31 no.2 São Paulo June 2013

http://dx.doi.org/10.1590/S0103-05822013000200004

ORIGINAL ARTICLE

Clinical and follow up assessment of children in a program directed at the use of formulas for cow's milk protein allergy

Ana Laissa O. Aguiar^I; Clarissa Marques Maranhão^I; Lívia Carvalho Spinelli^I; Roberta Marinho de Figueiredo^I; Jussara Melo C. Maia^II; Rosane Costa Gomes^III; Hélcio de Sousa Maranhão^IV

^IBolsista de Iniciação Científica da Faculdade de Medicina da UFRN, Natal, RN, Brasil
^IIDoutora em Ciências da Saúde pelo Programa de Pós-graduação em Ciências da Saúde da UFRN; Professora Adjunta do Departamento de Pediatria da UFRN, Natal, RN, Brasil
^IIIPós-Graduanda de Doutorado do Programa de Pós-graduação em Ciências da Saúde da UFRN; Professora – Assistente do Departamento de Pediatria da UFRN, Natal, RN, Brasil
^IVDoutor em Ciências pelo Programa de Pós-graduação em Pediatria da Universidade Federal de São Paulo (Unifesp); Professor Associado do Departamento de Pediatria da UFRN, Natal, RN, Brasil

Endereço para correspondência