Tesis sobre el tema "Asthma incidence"

Asthma represents the most common chronic disease in childhood. Children with asthma are at increased risk for developing long-term irreversible airway obstruction in adult life, the fourth leading cause of death in USA. Our aims were to: (1) Determine whether reduced IFNgamma production and plasma soluble CD14 (sCD14) levels in early life are significant risk factors for the development of wheezing in the first year of life; (2) Estimate rates of persistence and remission of childhood wheezing after puberty; (3) Study risk factors affecting persistence of childhood wheezing after puberty. We used data from the two large ongoing birth cohorts of the Tucson Infant Immune Study (IIS) and the Tucson Children's Respiratory Study (CRS). Among 238 children from IIS, we found the odds of developing recurrent wheezing in the first year of life to be 4.5 times higher for children in the lowest quartile of IFNgamma production at 3 months (p = .0005) and 3.2 times higher for children in the lowest quartile of sCD14 levels at birth (p = .004) as compared with children in the other 3 combined quartiles of IFNgamma and sCD14, respectively. We studied persistence and remission of wheezing after puberty among 732 children from the CRS cohort. We found that 29% of children with infrequent wheezing during childhood experienced persistent wheezing after contrast, the proportion of persistent wheezing was much higher (60%) among children meeting the for asthma during childhood. Frequency of wheezing during childhood, obesity, an early onset of puberty, bronchial hyperresponsiveness, and skin test sensitization were significant predictors of persistent asthma after puberty. By looking at genetic factors, we also found that the homozygous status for Gly in codon 16 of the beta2 Adrenoceptor doubled the risk for persistent wheezing after puberty among boys (RR 2.01, p = .0008) but not girls. Our findings from two population-based longitudinal cohorts provide the first evidence that altered immunological markers precede the onset of wheezing early in life, challenge the commonly held view that most asthma cases remit during adolescence, and provide a profile of risk.

IntroductionLes raisons de l’excès de risque d’asthme chez la femme ne sont pas établies. La réversion du sexe ratio autour de la puberté a fait évoquer le rôle des hormones sexuelles féminines dans l’asthme. Cependant l’histoire naturelle de l’asthme après 50 ans a été très peu étudiée. L’objectif général de cette thèse était d’apporter des nouveaux éléments de connaissance sur l’histoire naturelle de l’asthme de la femme. Les objectifs spécifiques étaient l’étude de l’incidence de l’asthme allergique et non-allergique de la femme et de son évolution avec le vieillissement (différences par rapport aux hommes après 50 ans, et association avec la ménopause) et l’étude de certains facteurs de risque associés à l’asthme de la femme.Matériels et méthodesL’incidence et l’évolution de l’asthme ont été étudiées chez 2 125 hommes et 2 298 femmes, initialement âgés de 20 à 44 ans et suivis pendant 20 ans dans la cohorte européenne sur la santé respiratoire « ECRHS ». Les associations entre la ménopause et l’asthme de la femme ont été étudiées dans un échantillon de 67 872 femmes, initialement âgées de 41 à 68 ans et suivies pendant 12 ans au sein de la cohorte E3N. Les données sur les expositions environnementales de l’Etude des facteurs Génétiques et Environnementaux de l’Asthme (EGEA) ont été utilisées pour étudier l’association entre l’usage domestique d’eau de Javel et l’asthme auprès de 607 femmes âgées de 44 ans en moyenne. L’asthme allergique est défini par la présence de tests cutanés positifs.RésultatsDans la cohorte ECRHS, les femmes étaient plus à risque que les hommes de développer de l’asthme non-allergique (Odds-Ratio (OR) ; Intervalle de confiance à IC95% : 4,0 [2,5-6,5]). Cette différence était moins marquée pour l’asthme allergique (OR 1,7 [1,0-2,7]), et on n’observait pas de différence dans la progression de l’asthme.L’analyse de la cohorte E3N ne montre pas de différence dans l’incidence de l’asthme entre les femmes pré-ménopausées et post-ménopausées de même âge, chez les femmes de corpulence normale (Hazard Ratio(HR) :1,1 [0,8-1,3]). Cependant, chez les femmes obèses, l’incidence de l’asthme augmentait lors de la transition vers la ménopause (aHR :1.9[1.0-3.7]) et en post-ménopause (HR :2,9 [1,1-4,1]). La ménopause chirurgicale était également associée à un plus grand risque d’asthme.Dans la cohorte EGEA, seuls 2% d’hommes contre 37% des femmes utilisaient hebdomadairement l’eau de Javel pour faire le ménage. Chez les femmes, l’usage fréquent d’eau de Javel était associé à un plus grand risque d’asthme non-allergique (OR :1,7 [IC :1,0-3,0]), mais il n’y a pas d’association avec l’asthme allergique. Chez les femmes asthmatiques, l’usage d’eau de javel était associé à une neutrophilie plus élevée.ConclusionA l’issue de ce travail, nous avons montré que le risque accru d’asthme chez la femme persistait au-delà de la période reproductive, et que la chute des hormones sexuelles féminines à la ménopause n’était pas indépendamment associée à l’incidence de l’asthme. D’autres facteurs, dont l’interaction entre les facteurs métaboliques et hormonaux, et les expositions genre-dépendantes pourraient expliquer l’excès de risque d’asthme non-allergique chez la femme
IntroductionThe reason for the higher asthma incidence in women during the reproductive years is still unknown. The gender switch in asthma incidence around puberty has been put forward to suggest a role of female sex hormones in asthma. However, there are limited findings in the natural history of asthma after age of 50 and whether the transition through menopause is associated with change in asthma incidence is unknown.The objective of this thesis was to investigate the natural history of allergic and non-allergic asthma in women in term of incidence, evolution with aging (menopause) and risk factors of asthma in women with a focus on the gender differences.Materials and methodsThe gender differences in allergic and non-allergic asthma was assess in 2.125 men and 2.298 women free of asthma at baseline (aged 20-44) followed for 20 years as a part of the European Community Respiratory Health Survey (ECRHS). The association between asthma incidence and menopausal status was assessed in 67,872 women free of asthma at baseline (aged 41-68 years) and regularly followed-up as a part of the French E3N cohort. Association between the domestic use of cleaning bleach and allergic and non-allergic asthma have been assess in 607 women (mean age 44 years) participating in the first follow-up of the Epidemiological Study on the Genetics and Environment of Asthma (EGEA). Allergy was define by a positive skin prick test.ResultsWith data from ECRHS we showed that the incidence of non-allergic asthma was higher in women as compared to men (Odds Ratio (OR): 4.0 [95% Confident Interval (CI95%): 2.5-6.5]. The female predominance was less marked for allergic asthma (OR :1.7 [IC :1.0-2.7]). However, in asthmatics there was no gender differences in the progression of asthma. With data from E3N we showed that among normal-weight women, there was no difference in asthma incidence between premenopausal and naturally postmenopausal women of the same age (Hazard Ratio(HR) :1,1 [0,8-1,3]). However, in obese women, the transition through menopause (HR: 1.9[1.0-3.7]) and the later period after menopause (HR:2.1 [1.1-4.1]) were associated with a higher asthma incidence. Surgically post-menopausal women were also at increased risk of developing asthma (HR:1.33[95%CI 1.01-1.75]).In EGEA, only 2% of men and 37% of women reported using bleach weekly for home cleaning. Women using bleach were at increased risk for non-allergic asthma (OR 3.3; 95%CI 1.5-7.1), and more particularly for non-allergic adult-onset asthma (OR 4.9; 95%CI 2.0-11.6). No association was observed for allergic asthma. Among women with asthma, frequent use of bleach was significantly associated with higher blood neutrophil cell counts.ConclusionGender differences in asthma incidence still persist in older adults however, changes in female sex hormones level occurring around natural menopause was not independently associated with change in asthma incidence in women. Our findings do not support the hypothesis that female sex hormones are independently associated with asthma incidence. The interaction between metabolic and hormonal factors and the gender difference in environment factor such as bleach use might explain the gender switch in asthma incidence around puberty and the female predominance in asthma more particularly for non-allergic asthma in adulthood

Contexte - Concernant l'histoire naturelle de l'asthme professionnel (AP), les évidences s'accumulent sur le fait que le processus inflammatoire menant à l'asthme clinique se développe tôt dans le cursus des travailleurs. L'étude ABCD - Asthme en Boulangerie et Coiffure Débutant - poursuit deux objectifs : 1) décrire l'évolution temporelle de l'incidence de l'AP au cours des premières années d'exposition de boulangers/pâtissiers (BP) et coiffeurs - secteurs reconnus à risque d'AP - et 2) identifier les facteurs de risque personnels, professionnels et nutritionnels influençant cette incidence. Méthode - L'étude ABCD repose sur deux facettes intriquées : (i) une cohorte longitudinale rétrospective d'anciens apprentis d'ancienneté croissante permettant l'estimation de l'incidence précoce de l'AP, et (ii) une étude de type cas-témoin nichée dans la cohorte explorant certains facteurs de risque de l'AP. Résultats - 866 sujets participèrent à l'étude qui mit en évidence une incidence cumulée de l'AP élevée lors des 4 premières années d'exposition chez les BP, et dans un moindre degré chez les coiffeurs. Le risque d'AP dépend du statut atopique chez les BP ; il est positivement associé, chez les coiffeurs, à l'intensité de l'exposition et, dans une moindre mesure, à l'indice de masse corporelle et à certains facteurs nutritionnels. Conclusions - Cette étude a permis de produire des données originales sur l'incidence précoce de l'asthme professionnel. Ces données constituent un support pour le développement de campagnes de prévention, notamment pour la détection précoce de la maladie dès les premières années d'exposition
Context - Regarding the natural history of occupational asthma (OA), there is increasing evidence that the inflammatory process leading to clinical asthma appears early after inception of exposure. The ABCD study (French acronym for early asthma in bakery and hairdressing) aims to answer two objectives: 1) describe the temporal evolution of the OA incidence in the early years of exposure of bakers/pastry-makers (BP) and hairdressers - occupations known at risk of OA - and 2) identify personal, occupational and nutritional risk factors. Method - The ABCD study has two intertwined facets: (i) a retrospective longitudinal cohort of past apprentices of increasing seniority allowing to estimate the early incidence of OA, and (ii) a nested case-control study allowing to explore some risk factors of OA. Results - 866 subjects participated to the study. The ABCD study shows a high cumulative incidence of OA during the first 4 years of exposure among BP, and in a lesser extent, among hairdressers. While the OA risk depends on atopic status for BP, it is positively associated, for hairdressers, with exposure intensity and, to a lesser extent, to body mass index and with a variety of nutritioal factors. Conclusions - This study produced original data on early incidence of OA. These data may provide support for the development of preventive action, in particular for the detection of OA in the early years of exposure

Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2007.
Title from electronic title page (viewed Sep. 16, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Economics." Discipline: Economics; Department/School: Economics.

Background In the past half-century, the prevalence of asthma among children and adolescents has risen and asthma has become an important public health challenge in Sweden as well as in many other countries, necessitating further studies on this complex disease and its risk factor pattern. The studies included in this thesis aimed to investigate the clinical expression of childhood asthma over time, to describe the determinants of new-onset and remission of asthma, and to evaluate possible environmental risk factors in northern Sweden. Methods As the result of a repeated questionnaire survey among primary school children aged 7-8 years in three municipalities in the north of Sweden, two pediatric cohorts were formed, one in 1996 (n=3430) and one in 2006 (n=2585). The cohort created in 1996 was followed annually until the age of 19 years. Skin prick testing was performed on children in both cohorts. Lung function and bronchial hyperreactivity testing were carried out in children with asthma in the first cohort. The study participation and retention rates were very high in both cohorts. Among children in the second cohort living in Luleå, the home addresses were assigned to coordinates in a geographical information system (GIS) to evaluate the impact on respiratory health of living near roads with much traffic, which was measured as the number of vehicles daily. We used a validated reported diagnosis of asthma and International Study of Asthma and Allergies in Childhood (ISAAC) questions were incorporated into the questionnaire. A cross-sectional study of children of the same age ten years apart, longitudinal studies on asthma incidence and remission as well as a cross-sectional study on vehicle traffic were performed. Results While children aged 7-8 years in 2006 more often had a physician-diagnosed asthma compared to children of the same age in 1996 (7.4% vs 5.7%, p<0.001), they had less asthma symptoms, especially severe symptoms. In parallel, a more beneficial environment and a more intense treatment with inhaled corticosteroids (ICS) were observed. The explanation for this change in clinical expression probably includes also an increased awareness and diagnosing of asthma. From age 12 years to age 19 years, the cumulative incidence of physician-diagnosed asthma was 7.2% and of current wheeze 22.0%. The risk of new-onset asthma in adolescence was increased among girls, sensitized and those with heredity for asthma. Smoking and home dampness increased the risk for incident wheeze. The risk for both incident asthma and wheeze was inversely related to number of siblings. Among children with current asthma at age 7-8 years, 21% were in remission, 38% had periodic asthma and 41% had persistent asthma at a follow-up at age 19 years. Subjects in remission and with periodic asthma had significantly less airway obstruction and showed less bronchial hyperreactivity compared to subjects with persistent asthma. The probability of asthma remission from childhood to early adulthood was significantly increased by absence of allergic sensitization, male gender and a low asthma severity scoring at age 7-8 years. Sensitization to furred animals was more important as a determinant of both incidence and remission than sensitization to pollen. Living close to roads with high traffic flows, especially with heavy vehicles, was associated with an increased risk for current wheeze. Stratified analyses showed that the effect of traffic on asthma and wheeze was restricted to non-sensitized subjects. Conclusion Asthma onset in adolescence was more common among girls and remission was more common among boys. Children sensitized to furred animals and children with a more severe asthma were risk groups for persistence of asthma. Environmental factors such as smoking and dampness were associated to onset of asthma symptoms during adolescence, and vehicle traffic was associated with asthma symptoms among children also in a small city with relatively low traffic flows. Preventive measures like smoking reduction programs, improvement of damp housing conditions and separation of areas where many children live from heavily trafficked roads could prove to be beneficial.
OLIN-studierna

This thesis represents an exploratory and iterative study into the relationships of Australian native plants from the family Myrtaceae, with respiratory symptoms, specifically asthma. This relationship is explored from a chemo-taxonomic stance and the connections with other plants with related chemotaxonomy are underlined. The research was performed against a background of geographical comparison between an urban coastal area and a rural mountainous area 90 kilometres just north of Brisbane, Queensland, Australia. The focus was the possible contribution of Melaleuca quinquenervia to the occurrence of autumn respiratory symptoms, especially asthma. The research challenges current beliefs that wind-pollinated plants are the only sources of allergens and the major botanical health threat for those who suffer with asthma. There is some critical analysis of the current understanding of world patterns of asthma, with particular reference to the Global Initiative for Asthma (GINA) geographic compilations. In this study 380 children were skin-tested with a battery of commercial allergens including Eucalyptus. Comparisons among children from three coastal schools and students from one mountain school were made with a view to testing the hypothesis that proximate vegetation would affect responses to allergens. As hypothesised, significant differences were detected between the coastal and range students in responses to Eucalyptus, which flowers prolifically on the coast. Coastal children, compared to the rural children from the mountain area exhibited a significantly greater percentage of skin-test responses (p≤.05) to Eucalyptus, when all responses greater than zero were measured. In the next phase more comparisons were undertaken with a smaller group of adults and adolescents in the coast and range communities. A range of terpenes and oxidized terpenes was applied during skin tests along with commercial allergens. Coastal and range reaction profiles revealed that coastal participants exhibit greater skin reactivity. When a 3mm wheal cut-off is employed alpha-pinene response in the range group is notable. During this second phase ambient air sampling was carried out at the same time as participants measured peak expiratory flow (PEF) and recorded respiratory symptoms. Chemicals trapped on Tenax over spring and autumn were analysed via GCMS and the results combined with symptom variables to ascertain significant predictors of symptom change. Using stepwise and general linear regression significant relationships were demonstrated between PEF and beta pinene and limonene in ambient air. In both types of modelling several terpenes were shown to be significant predictors of respiratory symptoms. In the coastal group the addition of alpha or beta pinene to a General Linear Regression model predicting standardized peak flow, accounted to an additional 20% of the variance in autumn. The model consisted of ozone, nitrogen dioxide and particulates less than 10 micron, all lagged three days. For spring, the additional variance explained was only 6 % and for spring an autumn combined it was 5%. Significant relationships were also demonstrated between linalool levels and preventer and reliever usage. The results support the hypotheses regarding the role of terpenes as having a possible role in the acquisition and exacerbation of asthma. Additionally a number of floral studies resulted in chemical profiles being elucidated for flowers from popular plants in Australia. Tenax collections of vapours from some household and lifestyle products resulted in chemical profiles for popular items. In conclusion, some observations about vegetation and patterns of asthma have been made and a new model of asthma acquisition proposed.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Public Health
Griffith Health
Full Text

The overall aims of our studies were to identify risk factors for respiratory symptoms and asthma in indoor environment but even to look at some personal risk factors such as body mass index and gastroesophageal reflux. The study population is based on participants of the European Community Respiratory Health Survey I and II.

In the first study, water damage and visible moulds were reported in 7.4% and 17% of the homes respectively. The combination of water damage and visible moulds was independently associated with attacks of breathlessness when resting and after activity and also to long term cough. In the second study, the prevalence of nocturnal GER increased with higher BMI and the same pattern could be seen for habitual snoring. Reported onset of asthma, wheeze and night-time symptoms increased in prevalence along with the BMI gradient. In the multivariable analysis, obesity and nocturnal GER were independent risk factors for onset of asthma, wheeze and night-time symptoms. Habitual snoring was an independent risk factor for onset of wheeze and night-time symptoms, but not for onset of asthma. In the third study, a total of 18% of the subjects reported indoor dampness in the last 12 months and 27% of the subjects reported indoor dampness since the previous survey. Respiratory symptoms and asthma were significantly more prevalent in individuals exposed to indoor dampness and indoor dampness was a risk factor for respiratory symptoms and asthma after adjusting for possible confounders. Indoor dampness was an independent risk factor for onset of respiratory symptoms but not for asthma onset. Remission of respiratory symptoms was less likely to occur if subjects reported indoor dampness. In the fourth study, the lowest prevalence of atopy and the lowest levels of all indoor allergens, bacteria and moulds were found in Iceland. A positive association was found, between cat allergen exposure and asthma symptoms and between bronchial hyperresponsiveness and the amount of viable mould in indoor air.

Aim: The aim of this project was to study the age and sex specific occurrence of atopic and non-atopic asthma and other atopic manifestations in a nationwide sample of Swedish pre-school children. Methods: All 70 allergen avoidance day-care centres (AADC) with 84 sections and 140 matched ordinary day-care centres with 440 sections in 62 municipalities across Sweden were sampled. In 2000 the staff at each section responded to a questionnaire on indoor and outdoor environment at the section. In 2002 parents of 5,886 children attending the AADCs and ODCs responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. In 2007, parents of 4255 children responded to an almost identical follow-up questionnaire. Results: The AADCs had far more strict rules than ODCs on furred pets and smoking at home and on perfume use, and the indoor environment was better, owing to better cleaning. The age specific asthma prevalence was curvilinear with a peak at age 3 of 11.4% among boys and 9.8% among girls. In addition the prevalence increased by municipality population density, a proxy for degree of urbanisation. There was a highly significant co-occurrence between all asthma-atopic manifestations, but there was no evidence of ordered sequence of manifestation onset. The asthma incidence was highly dependent on presence or absence of co-occurrence variables. Given the variable mix in the present study population, the annual asthma incidence ranged from 0.6% to 1.2%. Conclusions: AADCs had more strict rules and a better indoor environment than ODCs. The asthma prevalence was affected by age, sex and degree of urbanisation. There was close co-occurrence between all asthma and atopic manifestations but no evidence of ordered sequence of onsets. The annual asthma incidence was strongly dependent of co-occurrence conditions.

Dans ce travail, les concentrations d'aldéhydes dans l'air ont été quantifiées selon une méthode conventionnelle, couplant un prélèvement actif sur cartouche de DNPH à une analyse par HPLC/UV, et ceci dans divers environnements du Bas-Rhin : extérieur, intérieur et intermédiaires de type lieu public (galerie commerciale, bibliothèque, hall de gare, etc. ), habitacles de voitures et parking souterrain. Dans le cadre des mesures intérieures, une étude cas/témoin incluant une population asthmatique a été réalisée dans 162 logements. Enfin, une chambre d'exposition standardisée au formaldéhyde (FA) a été développée et utilisée lors d'un protocole de recherche biomédicale sur l'influence du FA sur la réponse bronchique aux allergènes d'acariens. Les résultats obtenus ont montré que le FA et l'acétaldéhyde (AA) sont les deux principaux aldéhydes présents en environnement extérieur et intermédiaire. En milieu intérieur, de l'hexanal a également été détecté. Les ratios des concentrations intérieur/extérieur pour le FA et l'AA (respectivement 13 et 8) ont confirmé l'existence de sources à l'intérieur même des logements. L'étude transversale chez les asthmatiques et les témoins a permis de constater que les taux de FA sont similaires pour les deux populations (respectivement 32. 6 et 31. 7µg m-3, p=0. 696). En revanche, les analyses statistiques réalisées sur les asthmatiques semblent montrer que ceux-ci sont particulièrement sensibles à l'exposition au FA à des taux supérieurs ou égaux à 50 µg m-3. Par ailleurs, la réalisation du protocole de recherche biomédicale a permis de montrer l’effet potentialisateur d'une pré-exposition au FA (100 µg m-3 pendant 30 minutes) sur la réponse bronchique, lors de l'exposition aux allergènes, chez des sujets présentant un asthme allergique. L'impact des taux d'aldéhydes mesurés a également été discuté en terme de dose potentielle d'exposition à ces composés pour différents 'scénarios' d'exposition et confronté aux réglementations en vigueur
In this work, gaseous aldehydes concentrations were quantified by a conventional DNHP-derivatization method, with active sampling, followed by liquid chromatography coupled to UV detection. Different environments in the Strasbourg area (east of France) were quantified: outdoor, indoor and intermediate environments such as public spaces (shopping centre, libraries, train station, etc. ), vehicle inside and underground parking garage. As part of indoor measurements, a case/control study, including asthmatics, was realised in 162 dwellings. Finally, a standardized human exposure chamber to formaldehyde (FA) was developped et used for a biomedical study on the effect of FA on allergen bronchial response in asthmatics sensitized to mites. The obtained results have shown that FA and acetaldehyde (AA) are the most abundant aldehydes in outdoor and intermediate environments. In homes, hexanal has been also detected. Indoor/outdoor ratios of both FA and AA (about 13 and 8 respectively) confirm the existence of indoor aldehyde sources in residential homes. The cross-sectional study by asthmatics and controls has underlined that FA levels are similar for asthmatics and controls (respectively 32. 6 and 31. 7µg m-3, p = 0. 696). However, statistical tests made on the asthmatic group have highlighted that allergic and asthmatic patients are particularly sensitive to levels of FA exposure higher than 50 µg m-3. Besides, the biomedical study has demonstrated that exposure to low levels of FA (100 µg m-3 for 30 minutes) enhances significantly the bronchial response to mite allergen in sensitised asthma patients. The effect of the measured gaseous aldehydes concentrations was also discussed in term of exposure potential dose to these compounds for different 'exposure cases' and the corresponding integrated exposures have been compared with the values given in the current guidelines

Les difficultés de la traduction médicale entre le français et l'allemand sont accrues par l'absence d'outils performants d'aide à la traduction entre ces langues. Pour pallier cette situation, nous présentons une analyse de textes médicaux en français et en allemand dans le domaine de l'asthme, qui aboutit à la description notionnelle du domaine, de son lexique et à la description des unités phraséologiques selon leur thématique d'emploi. L'approche notionnelle favorise le passage entre des langues. Les éléments de connaissances dégagés par notre analyse pourront servir à l'amélioration ou à la création d'outils de traduction pour la traduction médicale
The lack of effective translating tools between French and German increases the difficulties of medical translation. To find a solution we present an analysis of French and German medical texts in the field of asthma leading to a notional review of the field and its lexicon as well as to a description of the phraseological units through their thematic use. The notional approach improves the transfer between the languages. The knowledge acquired through such an analysis could be of use to improve or to create tools to help in the translation between these two languages

Les virus (Influenza virus équin (EIV), α-herpèsvirus (EHV-1 & EHV-4), Virus de la rhinite équine A et B (ERAV & ERBV), Adénovirus équin 1 et 2 (EAdV1 & EAdV2), γ-herpèsvirus (EHV-2 & EHV-5) et Coronavirus équin (ECoV)) n’ont actuellement pas tous été recherchés par qPCR dans le cadre de l’asthme équin modéré (AEM) chez les chevaux à l’entrainement. Les objectifs de ce projet sont :1) déterminer la prévalence et l'incidence de la détection et/ou quantification des génomes viraux dans les voies respiratoires des chevaux de course à l’entrainement ; 2) étudier la concordance entre deux compartiments des voies respiratoires; 3) préciser les relations entre la détection et/ou quantification virale et a) les signes cliniques d’AEM et b) les performances. Une étude prospective longitudinale a été conduite de Novembre 2012 à Janvier 2015, sur 52 Trotteurs Français différents ont été prélevés mensuellement : des écouvillons naso-pharyngés (ENP) et du liquide de lavage trachéal (LT). Les dix virus d’intérêt ont été systématiquement recherchés par qPCR dans les ENP et les LT. Les signes cliniques d’AEM (jetage nasal, toux) et le score de mucus trachéal ont été notés lors de chaque examen. Les génomes viraux les plus fréquemment détectés dans les ENP et LT sont EHV-5, EHV-2 et ERBV. Aucune association significative n'a été trouvée entre la détection/quantification virale dans les ENP et les signes cliniques. La détection d’EHV-2 dans le LT a été significativement associée à la toux (OR 3,1; P=0,01) et à l’excès de mucus trachéal (OR 2,1; P=0,02). La détection (OR 5,3; P < 0,001) et la quantification d’ERBV (OR 15,0; P < 0,001) dans le LT ont été significativement associés à la toux
Equine influenza virus (EIV), α-herpesvirus (EHV-1 & EHV-4), Equine rhinitis virus A and B (ERAV & ERBV), Equine adenovirus 1 and 2 (EAdV1 & EAdV2) Herpesvirus (EHV-2 & EHV-5) and Equine coronavirus (ECoV)) are not currently being investigated by qPCR for mild equine asthma (MEA) in training horses. The objectives of this project are to: 1) determine the prevalence and incidence of viral genome detection and / or quantification in the respiratory tract of racehorses during training; 2) to study the concordance between two compartments of the respiratory tract; 3) specify the relationship between detection and / or viral quantification and a) the clinical signs of MEA and b) performance. A longitudinal prospective study was conducted from November 2012 to January 2015, both nasopharyngeal swabs (NS) and tracheal washes (TW) were collected monthly on 52 Strandardbred racehorses at training. The ten viruses of interest were systematically investigated by qPCR in NS and TW. Clinical signs of MEA (nasal discharge, cough) and tracheal mucus score were noted during each examination. The viral genomes most frequently detected in NS and TW are EHV-5, EHV-2 and ERBV. No significant association was found between viral detection / quantification in NS and clinical signs. Detection of EHV-2 in TW was significantly associated with cough (OR 3. 1, P = 0. 01) and excess tracheal mucus (OR 2. 1, P = 0. 02). Detection (OR 5. 3; P <0. 001) and quantification of ERBV (OR 15. 0; P <0. 001) in LT were significantly associated with cough

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Background Few studies have examined the association between parenting quality and behavioral adjustment in children and asthma incidence. Medication non-adherence is a proposed mechanism for the association between caregiver stress and asthma morbidity, but research on the association is limited. Aims To examine the association between parent-child relationship and child’s behavioral adjustment and asthma incidence, and to explore the association between caregiver stress and medication non-adherence in children with asthma. Methods Secondary analyses were conducted in two study populations: a birth cohort study in the United Kingdom and an intervention trial of children with asthma in inner-city New Orleans. The first two analyses defined asthma by parent report and current asthma medication use at five or seven years. Mother-child relationship and child’s behavioral adjustment were measured with the Child-Parent Relationship Scale (CPRS) and the Strengths and Difficulties Questionnaire (SDQ), respectively, at three years. Caregiver stress and medication non-adherence were measured using Cohen’s Perceived Stress Scale (PSS-4) and caregiver self-report, respectively, at baseline and twelve months. Results Among families with the most major life events, children with mothers reporting poorest compared to best CPRS had an adjusted OR=2.8 (95% CI: 2.3-3.6) for asthma. Adjusted odds ratios for the association between abnormal versus normal SDQ at 3 years and asthma at 5 or 7 years was 1.2 (95% CI: 1.0-1.5). Adjusted odds ratios for non-adherence due to running out of medications were 6.8 (95% CI: 1.0-47.6) in high versus normal stress caregivers. Conclusions Increased risk of asthma was observed among those with the poorest mother-child relationships and the most major life events, and in children with abnormal behavioral adjustment. A statistically significant adjusted association between caregiver stress and overall medication non-adherence was not observed, but an association between increased caregiver stress and non-adherence due to running out of medications was suggested.
1
Fritha Morrison

Background: The causes of trends in asthma incidence are not fully understood. Objectives: This study examined trends in age and severity at asthma diagnosis for Ontario children. Methods: Multiple birth cohorts of Ontario children between 1992-2000 were created using health administrative data. Descriptive statistics and multivariable logistic regression examined changes in age and severity of asthma at diagnosis over time. Results: Age at asthma diagnosis decreased (p<0.0001) with a higher relative risk of asthma in children under age three (RR=1.5, 95% CI:1.47, 1.54). Predictors of asthma diagnosis before three included male sex, lower income quintile, and maternal asthma. ‘Severe onset asthma’ increased over time (p<0.0001), its predictors being male sex, lower income quintile, rural residence, comorbidity, low birth weight and age less than three. Conclusions: Observed trends in asthma incidence are not confined to mild disease and are secondary to variations in asthma rates in children under age three.

Thesis (Ph. D.)--University of Georgia, 2004.
Directed by Bradley C. Martin. Includes articles submitted to CHEST, The journal of allergy and clinical immunology, and Journal of asthma. Includes bibliographical references.

Not applicable
Smoking in Italy has been following a declining trend but still a primary cause of preventable death in the country. The primary purpose of the thesis was to investigate the bidirectional relationship between smoking habits and asthma using the data from a longitudinal study on responders to a cross–sectional prevalence study. It was aimed to study the predictors of smoking cessation as a function of asthma and the incidence of asthma as a function of smoking habits. The secondary aim of the study was to study predictors of smoking cessation and determinants of incidence of asthma. Indeed, it was not possible to prospectively investigate smoking initiation when the population under study is older than 20 years because in Italy, the age of start smoking is around 17 years old. The thesis was based on the analysis of three study cohorts, two from Verona (North of Italy) and one from Sassari (in Sardinia, one of the two main islands of Italy). The longitudinal data were collected at two periods of time, 1998–2000 (baseline study) and 2007–2009 (follow–up study). To build each cohort, 3000 subjects (1500 males:1500 females) were randomly selected from the general population aged 20–44 years to answer a screening questionnaire. Each subject was asked to respond to a postal screening questionnaire that contained questions on respiratory symptoms and smoking habits. Follow–up time was 9.1 ± 0.8 years. Of 5, 933 subjects who had participated in the baseline study, 3, 597 (60.6%) took part in the follow–up. The Cox proportional hazards regression was used to assess the association between study outcomes and baseline characteristics of participants. Smoking prevalence decreased in the population from 31.5% at baseline to 22.2% at follow–up (crude prevalence). At baseline, high smoking percentage was found in young people (20–30 years old), workmen and unemployed. During the follow–up, around 30% of smokers had stopped smoking for at least one month. Smoking cessation incidence rate was 42.1/1, 000 person–years. We found that having current asthma at baseline was one of factors that stimulate smoking cessation (Hazard ratio (HR) of quitting smoking = 1.57, 95% Confidence Interval (CI) 0.92–2.68: Heavy smokers had a tendency to quit smoking during the follow–up almost 40% lower than light smokers (HR= 0.58, 95%CI 0.45–0.74). The results suggest that the intensity of smoking significantly affected smoking cessation in the study population. The observed incidence rate of asthma was 5.2/1, 000 person–years. In terms of the relationship between incident asthma and smoking, we observed that16 abstract the HR of asthma onset was higher in ex-smokers compared with current and never smokers, although not significantly. Interestingly, there was an interaction between smoking habits and having asthma–like symptoms: the incidence of asthma was four times higher in ex–smokers with asthma–like symptoms than never smokers without asthma–like symptoms (HR = 4.12, 95%CI 2.12–7.99). The results were probably affected by a reverse causation which happened at baseline: when having asthma–like symptoms, smokers were liable to stop smoking. Besides, allergic rhinitis showed to be a risk factor for developing asthma: individuals with allergic rhinitis were prone to develop asthma with an adjusted HR of 3.85 (95%CI 2.71-5.46) compared with individuals without allergic rhinitis. In conclusion, smoking in Italy presents a declining trend. The rate of smoking cessation is high in people having current asthma at baseline. Between smoking and asthma there is a reverse causation that influences smoking habits: asthma is most likely a factor that causes smoking cessation while it is not possible to confirm the causal liaison of smoking to asthma. The fact that smoking intensity strongly affects smoking cessation requires that smoking cessation program should be tailored for light and heavy smokers separately. And lastly, individuals having allergic rhinitis and asthma-like symptoms should receive proper treatments and health consultants to control the diseases

碩士
國立臺灣大學
臨床醫學研究所
92
Asthma is the most common chronic disease in childhood and accounts for substantial morbidity and health care costs. During the last thirty years, an increase in the prevalence of asthma as been documented in many countries. As the human genotype would not have changed drastically over a relatively short time period, these phenomena are not easily ascribed to genetic changes in populations. Hence, environmental factors has become the focus of medical research. For a long time, allergen exposure early in life was considered to be a major risk factor for the development of asthma and other allergic diseases. No intervention studies, however, showed that reduced exposure to allergens has a significant impact on the development of asthma and allergic disease. Because of the consistent observations of an inverse association between family size and risk of atopy, allergic rhinitis, and eczema., the so-called “hygiene hypothesis” was proposed, suggesting changes in the type and degree of stimulation from the microbial environment associated with improvements in public health and hygiene may increase the predisposition to chronic allergic conditions during childhood. This hypothesis is explained by shifts in the pattern of infectious diseases in early life, affecting the maturation of the immune system. Thus, at birth the immune system is skewed towards a Th2 cytokine profile which is characteristic of allergic individuals, but during infancy and early childhood this profile is normally shifted towards a non-allergic Th1 profile, perhaps through exposure to infections and other environmental stimuli. Some epidemiological studies support the hypothesis by showing that exposure to measles, rubella, varicella, mumps, and environmental endotoxin in childhood may protect against the development of allergy, while for mycobacteria, measles and respiratory viruses, there are studies that demonstrate an enhancement rather than prevention of allergic disease. The available epidemiological evidence in supportive of hygiene hypothesis is thus controversial. Recently, it is increasingly apparent that asthma phenotype could probably programmed before birth. The interactions between mother, placenta and fetus in influencing the development of fetal and infant immune responses to allergens during gestation have emerged as a focus of intense research. Despite the laboratory work, few clinical studies on the effect of maternal infection on the development of childhood atopy have been inconsistent. Positive association between maternal use of antibiotics during pregnancy and childhood asthma and negative association between probiotics use during pregnancy advocate the hygiene hypothesis, while inverse relation between maternal vaginitis and febrile infection episodes during pregnancy defied the hypothesis. In this study, we retrospectively investigated the relationship between maternal and personal chronic hepatitis B virus (HBV) infection and its subsequent influence on the development of asthma of the child, because HBV is the most prevalent chronic maternal and neonatal infection in Taiwan before the implementation of universal neonatal HBV vaccination program. An estimated 15 to 20% of child-bearing age women are affected and approximately 40% to 50% of their children were infected perinatally. Besides, we hypothesized that chronic infection rather than episodic infection might play more roles in the maturation of the immune system. The carriage status between mother and child was also analyzed to see if there is any synergistic role on the development of asthma in later life. The study population consisted of randomly selected 2931 1980~1982 birth cohort in northern Taiwan, who participated in the national survey of asthma prevalence in 1995~1996. Asthma was defined by using International Study of Asthma and Allergies in Childhood (ISSAC) self-reported and video questionnaires and physician diagnosis. Detailed information on history of wheezing episodes, early age rural life and nursing status, pet-keeping, sibship size, and family history of allergy were acquired with standardized questionnaires. Maternal and personal Hepatitis B virus carrier status was obtained from self-reported questionnaires or telephone interview records and secondarily confirmed by reported hospital health records. An individual with a mother of HBV carrier was associated with a decreased cumulative incidence of asthma in the 20th ~21st year than with a mother of non-HBV carrier (OR 0.71, 95% CI 0.51 to 0.98). There was no association between asthma and personal HBV carrier status in the first 20th ~21st years of life, regardless of maternal carrier status. When maternal HBV carrier status was controlled, postnatally acquired HBV carrier was associated with an increased cumulative incidence of asthma at the age of 20 to 21 (OR 1.48, 95% CI 1.01 to 2.16). Our results showed that maternal carriage of HBV served as protective factors against the development of childhood asthma, and post-natally acquired HBV infection was positively associated with the incidence of asthma. The results may lend support to the view that that immune deviation as a critical factor against atopic disease may start before birth. Post-natally chronic HBV carrier state may reflect the Th2 nature of immunity and the propensity of asthma development. Further studies are required to clarify the underlying immunological mechanism. Studies on relationship between other maternal chronic infections on the risk of childhood atopy are also required.