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Background: Asthma is a prevalent chronic respiratory disease among children, influenced by various climate and environmental factors. Despite its prevalence, the specific effects of these factors on asthma remain unclear. This study aims to systematically assess the epidemiological evidence using spatial and temporal methods on the impact of climate and environmental factors on childhood asthma., Methods: A systematic review was conducted to analyse the impact of climate and environmental factors on childhood asthma and wheezing, focusing on spatial and temporal trends. Searches were carried out in PubMed, Embase, and CINAHL databases for studies published from January 2000 to April 2024, using key search terms 'asthma/wheezing', 'extreme weather, 'green space', 'air pollution' and 'spatial or temporal analyses"., Results: The systematic review analysed 28 studies, with six employing spatial and 22 using temporal analysis methods; however, none incorporated spatio-temporal analysis in their models. The findings reveal that extreme weather events, including heatwaves and heavy rainfall, elevate childhood asthma risks across various climates, with significant effects observed during summer and winter months. Dust storms in arid and subtropical regions are linked to immediate spikes in hospital admissions due to asthma exacerbations. The effects of green spaces on childhood asthma are mixed, with some studies indicating protective effects while others suggest increased risks, influenced by local environmental factors. Air pollutants such as PM 2.5 , NO 2 , and ozone can exacerbate asthma symptoms and along with other environmental factors, contribute to seasonal effects. High temperatures generally correlate with increased asthma risks, though the effects vary by age, sex, and climate., Conclusion: Future research should integrate spatial and temporal methods to better understand the effects of environmental and climate changes on childhood asthma., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Alkylphenols can originate from numerous products containing alkylphenol ethoxylates, including cleaning products, household items, and cosmetics. Some phenols, such as nonylphenol, are known to be endocrine disruptors, and exposure to them is thought to have contributed to the recent increase in allergic diseases such as asthma. However, the impacts of prenatal phenol exposure on asthma development in children are still unclear., Methods: We analyzed the association between maternal urinary phenol concentrations during early pregnancy and the development of asthma in children at the age of 4, using data from the Japan Environment and Children's Study (JECS), a large-scale nationwide birth cohort study., Results: We recruited 3,513 pairs of mothers and children participating in the Sub-Cohort Study of JECS. We measured 24 phenols, including nitrophenol, parabens, bisphenol, octylphenol, and nonylphenol, in urine samples taken during the first trimester of pregnancy. The urinary levels of these phenols differed markedly, and some showed a broad spectrum of distribution. Methylparaben was detected at high levels in almost every participant (267.7 ng/ml, standard deviation 433.78). Logistic regression analysis revealed that the odds ratio of asthma onset for high exposure to butylparaben was 1.54 (95% confidence interval: 1.11-2.15). Additionally, logistic regression analysis by gender revealed an asthma development odds ratio of 2.09 (95% confidence interval: 1.20-3.65) for males and 0.65 (95% confidence interval: 0.25-1.70) for females born to mothers in whom 4-nonylphenol was detected, suggesting a gender difference., Conclusion: Our current analysis using large cohort data suggests that high exposure to butylparaben and low exposure to 4-nonylphenol during pregnancy are risk factors for asthma development in children. These findings establish a valuable foundation for formulating recommendations about prenatal phenol exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Atopic eczema may be related to multiple subsequent adverse health outcomes. Here, we provide evidence to judge and compare associations between eczema and a comprehensive set of outcomes. We conducted 71 cohort studies (age, sex, general practice-matched) using Clinical Practice Research Datalink Aurum primary care records (1997-2023), comparing up to 3.6 million people with eczema to 16.8 million without. Eczema was associated with subsequent diagnosis of outcomes with adjusted hazard ratios (99% confidence intervals) from Cox regression of up to 4.02(3.95-4.10) for food allergy (rate difference [RD] per 1,000 person-years of 1.5). Besides strong associations with atopic and allergic conditions (e.g., asthma 1.87[1.39-1.82], RD5.4) and skin infections (e.g., molluscum contagiosum 1.81[1.64-1.96], RD1.8), the strongest associations were with Hodgkin's lymphoma (1.85[1.66-2.06], RD0.02), Alopecia Areata (1.77[1.71-1.83], RD0.2), Crohn's disease (1.62[1.54-1.69], RD0.1), Urticaria (1.58[1.57-1.60], RD1.9), Coeliac disease (1.42[1.37-1.47], RD0.1), Ulcerative colitis (1.40[1.34-1.46], RD0.1), Autoimmune liver disease (1.32[1.21-1.43], RD0.01), and Irritable bowel syndrome (1.31[1.29-1.32], RD0.7). Sensitivity analyses revealed the impact of consultation bias or choice of cohort age cut-off on findings. Comparatively large HRs in severe eczema were seen for some liver, gastrointestinal and cardiovascular conditions, osteoporosis, and fractures. Most cancers and neurological conditions were not associated with eczema., (© 2024. The Author(s).)

Background: Asthma and allergic diseases (such as allergic rhinitis) are multifactorial chronic respiratory diseases, and have many common pathogenic mechanisms. This study aimed to assess the joint effects of breastfeeding and genetic susceptibility on asthma, allergic disease in children and adolescents and sought to examine whether the effect of breastfeeding was consistent under distinct levels of genetic risk., Methods: A total of 351,931 UK Biobank participants were analyzed. Firstly, Cox proportional hazards model was used to evaluate the relation between breastfeeding and asthma, allergic disease and their comorbidity. Next, we incorporated the polygenic risk score as an additional covariate into the model. Then, we explored the role of breastfeeding at each stage of asthma and allergic disease through a multi-state model. Meanwhile, several sensitivity analyses were conducted to evaluate the robustness of our results. Finally, we calculated the attributable protection and population attributable protection of breastfeeding., Results: Breastfeeding was related to a reduced risk of occurring asthma (adjusted hazard ratio [HR] = 0.89, 95% confidence interval [CI] 0.86 ~ 0.93), allergic disease (HR = 0.89, 95%CI 0.87 ~ 0.91) and comorbidity (HR = 0.89, 95%CI 0.83 ~ 0.94). The effect of breastfeeding was almost unchanged after considering PRS and did not substantially differ across distinct genetic risk levels. Breastfeeding showed a stronger risk-decreased impact on individuals who developed from allergic rhinitis to comorbidity (HR = 0.83, 95%CI 0.73 ~ 0.93). Further, the influence of breastfeeding was robust against covariates considered and the confounding influence of adolescent smoking. Finally, due to breastfeeding, 12.0%, 13.0% or 13.0% of the exposed population would not suffer from asthma, allergic diseases and the comorbidity, while 7.1%, 7.6% or 7.6% of the general population would not suffer from these diseases., Conclusions: This study provided supportive evidence for the risk-reduced effect of breastfeeding on asthma, allergic diseases, and the comorbidity in children and adolescents, and further revealed that such an influence was consistent across distinct genetic risk levels., (© 2024. The Author(s).)

School racial segregation significantly affects racial disparities in US children's health. Recently, school segregation has been increasing, partially due to Supreme Court decisions since 1991 that have made it easier for school districts to be released from court-ordered desegregation. We investigated the association of the end of court-ordered desegregation with child health, using the 1997-2018 waves of the National Health Interview Survey (n = 8182 Black children; n = 16 930 White children). We exploited quasi-random variation in the timing of school districts' releases from court orders to estimate effects on general health, body weight, mental health, and asthma, using difference-in-differences and event-study methods (including traditional and heterogeneity-robust estimators). Heterogeneity-robust difference-in-differences analyses show that release was associated with increased school segregation, improved mental health among Black children, and better self-reported health among White children. For heterogeneity-robust event-study analyses, school segregation increased steadily over time after release, with worse self-reported health and higher risk of asthma episodes among Black children aged 18 years or older after release. Black children's mental health temporarily improved in the short term. In contrast, White children had improved self-reported health, mental health, and risk of asthma episodes in some years. Interventions to address the harms of school segregation are important for reducing racial health inequities., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The A2 score is an eight-question patient-reported outcome measure that has been validated for ruling in (score ≥4) and ruling out (score 0-1) asthma. However, this screening tool has been validated in a cohort similar to the derivation cohort used. This study aims to validate the predictive accuracy of the A2 score in a primary care population against general practitioner (GP) clinical assessment and to determine whether the proposed cut-offs are the most appropriate., Design: This accuracy study is a secondary analysis of the EPI-ASTHMA population-based study., Setting: Primary care centres in Portugal., Participants: Random adult participants answered the A2 score by phone interview., Outcomes: Those with an A2 score ≥1 (plus 5% with an A2 score of 0) were invited to a diagnostic visit carried out by a GP to confirm or not a diagnosis of asthma. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves., Results: A total of 1283 participants (median 54 (p25-p75 43-66) years; 60% women) were analysed. The A2 score showed high discriminatory power in identifying asthma, with an area under the ROC curve of 82.9% (95% CI 80.4% to 85.4%). The proposed cut-off ≥4 was the most appropriate to rule in asthma (specificity 83.1%, positive predictive value 62.4%, accuracy 78%). Similarly, the proposed cut-off<2 was the most suitable for excluding asthma (sensitivity 92.7%, negative predictive value 93.7%, accuracy 60.5%)., Conclusions: The A2 score is a useful tool to identify patients with asthma in a primary care population., Trial Registration Number: NCT0516961., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Asthma is a chronic inflammatory condition leading to intermittent airway narrowing and obstruction. Although millions suffer from asthma globally, there is limited data from African countries, particularly Sudan. This study addresses the gap in research on asthma knowledge, attitudes, and practices among the adults in Shendi locality, Northern Sudan. This cross-sectional, community-based study was conducted in Kabushiya village, Shendi, Sudan, involving 148 participants selected through multistage random sampling. Data were collected via face-to-face interviews using a validated, structured questionnaire. Statistical analyses included Mann-Whitney, Kruskal-Wallis, Chi-square, Fisher exact tests, and multiple linear regression. Participants demonstrated high levels of knowledge, positive attitudes, and good practices regarding asthma. Knowledge scores were significantly associated with marital status, education, occupation, and income (P values: .040, .003, .000, and .006, respectively), with the highest medians among divorced individuals, those with higher education, professional workers, and people earning <50,000 SDGs (medians: 17, 16, 17, and 16, respectively). Attitude scores varied significantly by marital status, education, occupation, and family asthma history (P values: .001, .000, .003, and .016, respectively), with highest scores among divorced individuals, those with high school or higher education, professionals, and those with a first-degree relative with asthma (medians: 6, 5, 5, and 5, respectively). Patient practice scores differed by marital status and income (P values: .026 and .006, respectively), with higher scores among singles and those earning <50,000 SDGs. Co-patient practice scores were significantly influenced by occupation, personal or familial asthma experience, and family asthma status (P values: .026, .003, and .000, respectively). No significant differences were observed in co-patient practice scores between groups. The study highlights a generally good level of asthma knowledge and positive attitudes among participants, with some variability in practices based on socio-demographic factors. These findings emphasize the need for targeted education and intervention programs to improve asthma management in rural Sudan., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Ambient air pollution has become a challenging global health issue since industrialization, especially affecting respiratory diseases. However, the causal link between air pollution and allergic respiratory diseases (ARDs) remains unclear due to confounding factors in conventional epidemiological studies across different populations. Thus, we aimed to clarify the causal associations between air pollution and ARDs in European and East Asian populations using Mendelian randomization (MR)., Methods: MR utilizes genetic variants and provides a satisfactory level of causal evidence. Genetic data for exposures (PM 2.5 , PM 2.5 absorbance, PM 10 , PM coarse , NO 2 and NO x ) and outcomes (allergic rhinitis, chronic rhinosinusitis, asthma, and obesity related asthma) were obtained from genome-wide association studies. Instrumental variables were strictly filtered based on core assumptions. Two-sample MR and sensitivity analyses were conducted separately for European and East Asian populations., Results: PM coarse was causally associated with an increased risk of chronic rhinosinusitis (OR = 1.588 [1.002-2.518]; p = 0.049) and obesity related asthma (OR = 1.956 [1.012-3.780]; p = 0.046) in European population, and PM 10 was associated with a decreased risk of allergic rhinitis in East Asian population (OR = 0.882 [0.798-0.974]; p = 0.013). No heterogeneity or pleiotropy was detected in any significant causal association., Conclusion: Our findings indicate that ambient air pollution has opposite impacts on the etiology of ARDs in European and East Asian populations, which provides evidence for decisions on public policies and suggests that different responses to environmental factors such as air pollution may contribute to racial heterogeneity of ARDs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Severe bronchiolitis (i.e., bronchiolitis requiring hospitalization) is linked to childhood asthma development. Despite a growing understanding of risk factors for developing post-bronchiolitis asthma, protective factors remain unclear. In this study, we aimed to investigate whether exposure to residential greenness between birth and bronchiolitis hospitalization is associated with asthma and atopic asthma development by age 6 years., Methods: We analyzed a US severe bronchiolitis cohort from hospitalization to age 6 years, investigating how the normalized difference vegetation index (NDVI) and chlorophyll index green (CI green), measured in small (100 m) and large (500 m) radiuses around homes, relate to asthma and atopic asthma by age 6 years. We also explored whether maternal antibiotic use, daycare attendance, and respiratory virus type during hospitalization act as effect modifiers., Results: The study cohort included 861 infants, with 239 (28%) developing asthma by age 6 years-152 atopic, 17 nonatopic, and 70 unclassified. Early life residential exposure to high NDVI and CI green levels was associated with lower odds of asthma (OR Adj for NDVI within a 100 m radius, 0.18; 95% CI, 0.05-0.78; and OR Adj for CI green levels within a 100 m radius, 0.53; 95% CI, 0.31-0.90). Associations also were significant for the development of atopic asthma (OR Adj 0.16; 95% CI, 0.03-0.96; and OR Adj 0.46; 95% CI, 0.25-0.92; respectively). Results were similar for the 500 m radius exposures. No effect modification was noted., Conclusion: In a U.S. bronchiolitis cohort, exposure to residential greenness between birth and bronchiolitis hospitalization is linked to lower asthma and atopic asthma risk by age 6 years., (© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Identification of therapeutic targets other than asthma can guide the choice of biologics in cases of severe asthma. Some of the allergic diseases (atopic dermatitis, food allergies, allergic rhinoconjunctivitis) that may be associated with asthma can be treated with biologics. In this review, we aim to assess the effectiveness of these biologic therapies on the allergic comorbidities of asthma. In the treatment of atopic dermatitis, only Dupilumab, an anti-IL4Rα, has proven its effectiveness and has received reimbursement authorization for this indication. In patients presenting with allergic rhinoconjunctivitis, Omalizumab has shown effectiveness, but has not been approved for this indication. Data from post-hoc analyses of studies on severe asthma likewise suggest the effectiveness of Dupilumab regarding allergic rhinitis. While these two biologic therapies have shown positive signals, inducing oral food tolerance, the relevant data are not robust. Biologic therapies targeting IL-5 or its receptor (Mepolizumab, Benralizumab) have seldom been evaluated in allergic comorbidities, excepting atopic dermatitis, for which their effectiveness has not been proven. Lastly, there are interesting data on the combination of biologic therapy and allergen immunotherapy in cases of allergic rhinitis and food allergies, but they need to be confirmed by randomized studies., (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Asthma is a major health issue with an extensive burden to family and health systems. Different measures were used previously to assess disease burden, including prevalence, school performance, parental perceptions, and cost among others., Aim: The purpose of this study was to assess the burden of asthma among schoolchildren using parental and child reports and metered-dose inhaler (MDI) demonstration., Methods: A descriptive exploratory design based on parent and child self-reports was employed. Parents of children with asthma completed a questionnaire about asthma management and burden including symptoms and health services use. A sample of children with asthma completed a questionnaire measuring their perception of asthma management at school. An assessment of children's proper use of MDI inhalers was also conducted., Results: The burden of asthma was high in the current sample with the majority of children experiencing symptoms, asthma exacerbations, emergency department (ED) visits, and admission because of their asthma. The majority of participating children also performed incorrect inhaler technique, which reflects uncontrolled asthma and poor management. Parental perception of their child's health compared well with their burden of asthma., Conclusion: The outcomes of this study and previous reports show an alarmingly high burden of asthma. This calls for collaboration between professionals and stakeholders with children and caregivers in planning and implementing care, including improving the school environment., (© 2024 Wiley Periodicals LLC.)

Background: Pediatric asthma remains one of the most prominent chronic health conditions among US youth. Geographic determinants such as air pollutants have been identified as playing a role in asthma development and exacerbation. The purpose of this study was to determine geospatial predictors of pediatric asthma exacerbation events and to prioritize housing remediation resources., Methods: Electronic medical records were abstracted from a health plan in Southern California. The inclusion criteria that created a sample of 51 557 members were those aged 21 years and younger, who had at least 1 asthma-related encounter between January 2019 and December 2021. Diagnoses, age, number of clinic and emergency department visits, and home addresses were included. The air quality index from the closest monitoring station during the study period, residential distance from a primary roadway, and residential distance from manufacturing sites were included in the spatial analysis., Results: The average number of asthma-related clinic visits was 2 across the sample. Individuals with more asthma-related clinic visits residing in public housing were more likely to live within 4 km of industrial manufacturing locations ( P < .001), reside closer to a major roadway ( P < .001), and experience a higher number of poor air quality days ( P < .001). Modeling results show these factors were also significantly predictive of an increase of asthma-related health care encounters., Conclusions: The findings of this study were consistent with previous studies linking asthma and poor air quality and further highlighted some of the additive and potentially exponential challenges that public housing, major roadways, and manufacturing sites provide communities in their proximity. This research can guide environmental interventions, including the frequency of public housing inspections, community outreach, and the development of communication strategies, to reduce asthma-related experiences across neighborhoods., Competing Interests: None of the authors have conflicts of interest or financial disclosure statements to report., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The aim was to evaluate asthma and health-related quality of life (HRQoL) outcomes in adolescents, after hospital-treated bronchiolitis experienced in less than 6 months of age. A prospective cohort study started in 2001-2004 and followed up 166 children hospitalised for bronchiolitis in early infancy. At 16-20 years of age, 76 cases and 41 population-based controls without a history of bronchiolitis participated in the current study. Clinical asthma, presumptive symptoms and HRQoL data were collected with a structured questionnaire and the St. Georges Respiratory Questionnaire (SGRQ). Flow-volume spirometry was measured before and after bronchodilator administration. Asthma was present in 21.1% of cases in the post-bronchiolitis cohort compared to 9.8% in the control group (p = 0.21). Also, 35.5% of cases and 19.5% of controls reported dyspnea during the last 12 months (p = 0.04). In addition, total SGRQ scores were higher in the bronchiolitis group (4.26) than in the control group (1.67, p < 0.001) referring to a reduced health-related quality of life., Conclusion: Viral bronchiolitis in early infancy was associated with increased respiratory symptoms and lower health-related quality of life at age 16-20 years., What Is Known: • The prevalence of asthma at the school age and adolescence is increased after hospitalisation required bronchiolitis in infancy compared to those without hospitalisation due to bronchiolitis., What Is New: • Viral bronchiolitis requiring hospitalisation in early infancy was associated with increased respiratory symptoms, such as dyspnoea, and lower health-related quality of life at age 16-20 years in a prospectively followed post-bronchiolitis cohort., (© 2024. The Author(s).)

Background: Given their antioxidative stress, anti-allergic, anti-inflammatory, and immune-modulating effects, flavonoids are hypothesized to play a role in preventing chronic obstructive pulmonary disease (COPD) and asthma., Objectives: This cohort study aimed to examine associations between flavonoid intake and COPD, asthma, and lung function., Methods: Among 119,466 participants of the UK Biobank, median [interquartile range] age of 60 [53, 65] y, we estimated intakes of flavonoids, flavonoid-rich foods, and a flavodiet score from 24-h diet assessments. Prospective associations with both incident COPD and asthma and cross-sectional associations with measures of lung function [%predicted forced expiratory volume in 1s (FEV 1 ); and FEV 1 /forced vital capacity (FVC)] were examined using multivariable-adjusted Cox proportional hazards and linear regression models, respectively. We investigated mediation by inflammation--represented by the INFLA score--and stratified analyses by smoking status., Results: Compared with low intakes, moderate intakes of total flavonoids, flavonols, theaflavins + thearubigins, and flavanones, and moderate-to-high intakes of flavanol monomers, proanthocyanidins, anthocyanins, flavones, and the flavodiet score were associated with up to an 18% lower risk of incident COPD {e.g., [hazard ratio (95% confidence interval) for total flavonoids: 0.83 (0.75, 0.92)]} but not incident asthma. Furthermore, compared with low intakes, higher intakes of all flavonoid subclasses (except theaflavins + thearubigins), and the flavodiet score were associated with better percent predicted FEV 1 baseline. Associations were most apparent in ever (current or former) smokers. Flavonoid intakes were inversely associated with the INFLA score, which appeared to mediate 11%-14% of the association between intakes of proanthocyanidins and flavones and incident COPD., Conclusions: Moderate-to-high flavonoid intakes were associated with a lower risk of COPD and better lung function, particularly among ever smokers. Promoting intakes of healthy flavonoid-rich foods, namely, tea, apples, and berries, may improve respiratory health and lower COPD risk, particularly in individuals with a smoking history., Competing Interests: Conflict of interest AC acts as an advisor to the United States Highbush Blueberry Council (USHBC) grant committee and has received funding from them for a randomized controlled trial and population-based work. BHP consults for MaxBiocare, a company engaged in micronutrient research and related commercial activities. All other authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of competing interest The authors have no competing interests to declare.

Background: The Asthma Impairment and Risk Questionnaire (AIRQ), a 10-item, equally weighted, yes/no tool assessing symptom impairment and risk of exacerbations in patients with asthma aged ≥12 years, was developed and validated in a US patient population to evaluate varying levels of asthma control. This study aimed to validate the German language version of the AIRQ in patients aged ≥12 years with different levels of asthma control., Methods: A cross-sectional, observational, multi-centre study comprising a single visit was conducted in multiple specialised asthma centres and general practices in Germany. A total of 300 patients completed the following measures: 1) Patient Sociodemographic and Clinical Questionnaire, 2) AIRQ, 3) Asthma Control Test (ACT), and 4) Asthma Control Questionnaire (ACQ-6). Logistic regression analyses were conducted to assess the AIRQ score cut points with the greatest predictive validity in discriminating between different control levels relative to a standard of ACT plus prior-year exacerbations or ACQ-6 plus prior-year exacerbations., Results: The German version of the AIRQ demonstrated a robust capability to correctly identify well-controlled versus not well- or very poorly controlled (AUC values of 0.90 or higher) and well- or not well-controlled versus very poorly controlled asthma (AUC values of 0.89 or higher)., Conclusions: The German version of the AIRQ is a suitable tool to identify adults with varying levels of asthma control, which in turn can help to accurately identify patients with uncontrolled asthma in clinical practice., Competing Interests: F. Kanniess has served as a speaker and on advisory boards from AstraZeneca, Mundipharma, Novartis, GSK and Teva. M. Lommatzsch has served as a speaker and on advisory boards for ALK, Allergopharma, AstraZeneca, Bencard Allergie, Berlin-Chemie, Boehringer Ingelheim, Bosch, Chiesi, Circassia, GSK, HAL Allergy, Janssen-Cilag, MSD, Mundipharma, Novartis, Nycomed/Takeda, Sanofi, Teva, and UCB. T. Schultz has served as a speaker and on advisory boards and has received research support from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, Esanum, GSK, Meda, Mundipharma, Novartis, Omniamed, TEVA, UCB and various professional associations. H. Timmermann has served as a speaker and lecturer and received consultant fees and/or research grants from AstraZeneca, Almirall, Astellas Pharma, Bayer, Boehringer Ingelheim, Berlin-Chemie, GSK, Leti Pharma, Meda, Mundipharma, Novartis, Nycomed, Pfizer, Sanofi, Takeda, and TEVA. O. Schmidt received fees for lectures or consulting from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis, and Sanofi. S. Heindl has served as speaker and received consultation fees from AstraZeneca, GSK, Sanofi and Klosterfrau Melissengeist. H.J. Baumann has served as a speaker and lecturer and received consultant fees and/or research grants from AstraZeneca, Boehringer Ingelheim, Berlin-Chemie, Chiesi, GSK, Novartis, Orion Pharma and Pfizer. R. Buhl has received grants from Boehringer Ingelheim, GSK, Novartis, and Roche, as well as personal fees from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, Cipla, GSK, Novartis, Sanofi, Roche and Teva. S. Korn has served as a speaker received consultation fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GSK, Novartis, and Sanofi. K. Defosse and F. Höing are employees of AstraZeneca. C. Taube has no competing interests to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: The aim of our study was to investigate the prevalence of coexisting conditions and exposures in children with nodular tracheobronchitis diagnosed by flexible bronchoscopy., Methods: We conducted a single-center retrospective review of 100 children diagnosed with nodular tracheobronchitis by flexible bronchoscopy between 2012 and 2023., Results: Common coexisting diagnoses included gastroesophageal reflux disease (GERD, 50%), dysphagia/aspiration (40%), asthma (30%), recurrent croup (30%), tracheostomy dependence (19%) and eosinophilic esophagitis (EOE) (12%). Bronchoalveolar lavage (BAL) demonstrated cellular inflammation with elevated proportions of neutrophils in 63%, and lymphocytes in 24%. Among 88 patients in whom bacterial cultures were performed, 52% were positive, with Moraxella, Haemophilus, Streptococcal and Pseudomonas species predominating. Among 30 patients who underwent viral testing, 57% were positive, with rhinovirus (82%) and adenovirus (29%) predominating. Patients with neutrophilic inflammation were more likely to have a positive respiratory bacterial culture and/or viral polymerase chain reaction (p = 0.003, 0.005). Evaluation of the gastrointestinal tract included 79 patients with a history of esophagogastroduodenoscopy, 45 patients with a videofluoroscopic swallow study (VFSS), and 45 patients with multi-channel intraluminal impedance and pH testing. The majority of VFSS were abnormal (60%) demonstrating either laryngeal penetration (33%) or intratracheal aspiration (27%). Median pH reflux and impedance proximal reflux indices were 3.8% and 0.5% respectively., Conclusion: Potential contributing factors in the pathophysiology of nodular tracheobronchitis include bacterial and viral infections, GERD, dysphagia/aspiration, and EOE. When nodular tracheobronchitis is observed during bronchoscopy, further evaluation to assess for these conditions should be considered., (© 2024 Wiley Periodicals LLC.)

Background and Objectives: Different factors (etiotypes) can lead to persistent airflow obstruction (PAO) across the lifetime, including genetic factors, abnormal lung development, cigarette smoking, traffic pollution exposure, respiratory infections and asthma. Here we explore the prevalence of PAO and associated etiotypes in the general population in different age bins., Methods: We studied 664 individuals with PAO (FEV1/FVC post bronchodilation (post-BD) below the lower limit of normal (LLN)) and 11,522 with normal lung function (FEV1/FVC, FEV1 and FVC ≥ LLN and ≤ upper limit of normal (ULN) post-BD) included in the LEAD Study (NCT01727518), a general population cohort in Vienna (Austria). For analysis, participants were stratified in three age bins (<25, 25-<50 and ≥ 50 years of age)., Results: PAO occurred in 3.8 % in females and 5.6 % in males of the cohort, and it increased with age. Most participants with PAO (57.5 %) reported respiratory symptoms, indicating a high burden of disease. PAO was associated with male sex (25-<50 years), ever smoking (>50 years), increased number of pack years (25-<50 years, >50 years), not being breastfed (<25 years) and ever diagnosis of asthma (in all age bins). Etiotypes varied by age bins with cigarette smoking being the most prevalent one, often in combination with traffic pollution exposure., Conclusion: In the general population PAO occurs in about 5 % of participants with a higher prevalence in older individuals. Etiotypes and associated factors for PAO accumulate with age., Competing Interests: Declaration of competing interest Grasl M.T. has, within the last 3 years, received an unrestricted Grant for The Ludwig Boltzmann Institute for Lung Health for this study; support for attending meetings by Vivisol, Habel and AstraZeneca. She is a member of advisory boards for Boehringer Ingelheim.Agusti A. is a chairman of the Board of directors of GOLD. He received grants from AstraZeneca, GSK and Menarini. He received honoraria for lectures and presentations from AstraZeneca, GSK, Chiesi, Menarini, Sanofi and Zambon.Hartl S. received honoraria for lectures and presentations from AstraZeneca and GSK. She is a member of advisory boards for AstraZeneca, GSK and Menarini. She also received unrestricted scientific grants from AstraZeneca, GSK and Menarini Pharma for the Austrian LEAD Study.Breyer-Kohansal R. received consulting fees AstraZeneca, Boehringer Ingelheim, Glaxo Smith Kline, Menarini, Novartis Pharma and Sanofi. She is a member of advisory boards for AstraZeneca, Sanofi and Menarini.Karimi A., Breyer M.-K. and Azizzadeh M. have no declaration of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The daily lives of adolescents have changed significantly because of COVID-19 pandemic. We investigated the effects of changes in daily life attributed to COVID-19 on allergic diseases among Korean adolescents., Methods: Data from the 2021 Korea Youth Risk Behavior Survey were used. In total, 54,848 survey participants were included in the analysis. Allergic diseases included allergic rhinitis, atopic dermatitis, and asthma. Changes attributed to COVID-19 included family economic difficulties, physical activity, breakfast skipping frequency, alcohol consumption, smoking, and depressive moods. Chi-square tests and multiple logistic regression analyses were conducted to examine the impact of changes in daily life attributed to COVID-19 on allergic diseases., Results: Among the Korean adolescents surveyed, 29.8% experienced a deterioration in their economic status due to COVID-19, 49.1% reported decreased physical activity, 2.8% reported increased alcohol consumption, 1.0% reported an increase in their smoking behavior, and 36.9% reported an increase in depressive moods. Those diagnosed with atopic dermatitis, allergic rhinitis, or asthma within the previous 12 months accounted for 17.1%, 6.2%, and 1.0% of the population, respectively. Adolescents who were significantly affected by COVID-19 in their daily lives were frequently diagnosed with allergic diseases within the last 12 months., Conclusion: Changes in daily life due to COVID-19, including decreased physical activity and increased depressive mood, were common in adolescents and were associated with an increased prevalence of allergic diseases. Since changes in daily life due to the pandemic may increase the burden of allergic disease, additional interventions for disease management should be considered.

Background: Social determinants of health have a significant impact on asthma outcomes, and factors such as income level and neighborhood environment have crucial roles., Objective: This study aimed to assess the impact of the Neighborhood Deprivation Index (NDI) and Total Crime Index (TCI) on acute asthma exacerbation (AAE) and asthma-related emergency department and urgent care (ED/UC) visits in adults with mild asthma., Methods: This retrospective cohort study used administrative data from Kaiser Permanente Southern California among 198,873 adult patients with mild asthma between January 1, 2013 and December 31, 2018. We employed robust Poisson regression models, adjusted for age and sex, to investigate the associations of NDI and TCI with AAE and asthma-related ED/UC visits. Data analysis included subgroup assessments by race and ethnicity and body mass index categories to explore potential disparities in asthma outcomes., Results: Among the cohort, 12,906 patients (6.5%) experienced AAE in 1 year, and Black patients had the highest AAE percentage (7.1%). Higher NDI quintiles were associated with increased AAE risk (adjusted risk ratio = 1.11-1.27), with similar trends across body mass index categories and race or ethnicity, except for Black patients. The TCI showed weaker associations with AAE. Regarding ED/UC visits, 5.0% had such visits within 1 year. Higher NDI quintiles were associated with higher ED/UC visit risk (adjusted risk ratio = 1.23-1.75) whereas TCI associations were weaker., Conclusion: Addressing socioeconomic disparities, as indicated by NDI, may be crucial in mitigating asthma exacerbations and reducing health care use, highlighting the importance of incorporating social determinants into asthma management strategies even in patients with mild asthma., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Prior studies reported excess rates (ERs) of cardiorespiratory events associated with short-term increases in PM 2.5 concentrations, despite implementation of pollution-control policies. In 2017, Federal Tier 3 light-duty vehicle regulations began, and to-date there have been no assessments of population health effects of the policy. Using the NYS Statewide Planning and Research Cooperative System (SPARCS) database, we obtained hospitalizations and ED visits with a principal diagnosis of asthma or chronic obstructive pulmonary disease (COPD) for residents living within 15 miles of six urban PM 2.5 monitoring sites in NYS (2014-2019). We used a time-stratified case-crossover design and conditional logistic regression (adjusting for ambient temperature, relative humidity, and weekday) to estimate associations between PM 2.5 , POC (primary organic carbon), SOC (secondary organic carbon), and rates of respiratory disease hospitalizations and emergency department (ED) visits from 2014 to 2019. We evaluated demographic disparities in these relative rates and compared changes in ERs before (2014-2016) and after Tier 3 implementation (2017-2019). Each interquartile range increase in PM 2.5 was associated with increased ERs of asthma or COPD hospitalizations and ED visits in the previous 7 days (ERs ranged from 1.1%-3.1%). Interquartile range increases in POC were associated with increased rates of asthma ED visits (lag days 0-6: ER = 2.1%, 95% CI = 0.7%, 3.6%). Unexpectedly, the ERs of asthma admission and ED visits associated with PM 2.5 , POC, and SOC were higher during 2017-2019 (after Tier 3) than 2014-2016 (before Tier-3). Chronic obstructive pulmonary disease analyses showed similar patterns. Excess Rates were higher in children (<18 years; asthma) and seniors (≥65 years; COPD), and Black, Hispanic, and NYC residents. In summary, unanticipated increases in asthma and COPD ERs after Tier-3 implementation were observed, and demographic disparities in asthma/COPD and PM2.5, POC, and SOC associations were also observed. Future work should confirm findings and investigate triggering of respiratory events by source-specific PM., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objective: Uncontrolled asthma in patients treated for mild/moderate disease could be caused by non-pulmonary treatable traits (TTs) that affect asthma control negatively. We aimed to identify demographic characteristics, behavioural (smoking) and extrapulmonary (obesity, comorbidities) TTs and the risk for future exacerbations among patients with uncontrolled asthma prescribed step 1-3 treatment according to the Global Initiative for Asthma (GINA)., Methods: Twenty-eight thousand five hundred eighty-four asthma patients (≥18 y) with a registration in the Swedish National Airway Register between 2017 and 2019 were included (index-date). The database was linked to other national registers to obtain information on prescribed drugs 2-years pre-index and exacerbations 1-year post-index. Asthma treatment was classified into step 1-3 or 4-5, and uncontrolled asthma was defined based on symptom control, exacerbations and lung function., Results: GINA step 1-3 included 17,318 patients, of which 9586 (55%) were uncontrolled (UCA 1-3). In adjusted analyses, UCA 1-3 was associated with female sex (OR 1.34, 95% CI 1.27-1.41), older age (1.00, 1.00-1.00), primary education (1.30, 1.20-1.40) and secondary education (1.19, 1.12-1.26), and TTs such as smoking (1.25, 1.15-1.36), obesity (1.23, 1.15-1.32), cardiovascular disease (1.12, 1.06-1.20) and depression/anxiety (1.13, 1.06-1.21). Furthermore, UCA 1-3 was associated with future exacerbations; oral corticosteroids (1.90, 1.74-2.09) and asthma hospitalization (2.55, 2.17-3.00), respectively, also when adjusted for treatment step 4-5., Conclusion: Over 50% of patients treated for mild/moderate asthma had an uncontrolled disease. Assessing and managing of TTs such as smoking, obesity and comorbidities should be conducted in a holistic manner, as these patients have an increased risk for future exacerbations., (© 2024 The Author(s). Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

Background: The discriminatory and racist policy of historical redlining in the United States during the 1930s played a role in perpetuating contemporary environmental health disparities., Objective: Our objectives were to determine associations between home and school pollutant exposure (fine particulate matter [PM 2.5 ], NO 2 ) and respiratory outcomes (Composite Asthma Severity Index, lung function) among school-aged children with asthma and examine whether associations differed between children who resided and/or attended school in historically redlined compared to non-redlined neighborhoods., Methods: Children ages 6 to 17 with moderate-to-severe asthma (N = 240) from 9 US cities were included. Combined home and school exposure to PM 2.5 and NO 2 was calculated based on geospatially assessed monthly averaged outdoor pollutant concentrations. Repeated measures of Composite Asthma Severity Index and lung function were collected., Results: Overall, 37.5% of children resided and/or attended schools in historically redlined neighborhoods. Children in historically redlined neighborhoods had greater exposure to NO 2 (median: 15.4 vs 12.1 parts per billion) and closer distance to a highway (median: 0.86 vs 1.23 km), compared to those in non-redlined neighborhoods (P < .01). Overall, PM 2.5 was not associated with asthma severity or lung function. However, among children in redlined neighborhoods, higher PM 2.5 was associated with worse asthma severity (P < .005). No association was observed between pollutants and lung function or asthma severity among children in non-redlined neighborhoods (P > .005)., Conclusions: Our findings highlight the significance of historical redlining and current environmental health disparities among school-aged children with asthma, specifically, the environmental injustice of PM 2.5 exposure and its associations with respiratory health., Competing Interests: Disclosure statement Supported by the National Institutes of Health (NIH-K01HL140216), Robert Wood Johnson Foundation, and Amos Medical Faculty Development Award. This project has been funded in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), National Center for Advancing Translational Sciences (NCATS), and Department of Health and Human Services under contract numbers 1UM1AI114271-01, UM2AI117870, 5UM1AI114271, NCATS/NIH UL1TR001079, NCATS/NIH 1UL1TR001430, NCATS/NIH UL1TR001873, NCATS/NIH UL1TR002345, UL1TRG01422, NIH/NCATS Colorado CTSA UL1 TR002535, NCATS/NIH UL1TR001876, and NIH/CTSA 5UL1TR001425-03. Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. All rights reserved.)

Background: Epidemiologic studies have reported conflicting findings for cat or dog exposure and childhood asthma. No study has evaluated whether persistent pet exposure from early life to school age is associated with asthma or allergic sensitization in youth., Objective: To evaluate whether persistent ownership of a cat or a dog throughout childhood is associated with asthma in Puerto Rican youth, a group disproportionately affected with asthma., Methods: Prospective study of 384 youth who completed a baseline visit at ages 6 to 14 years and a second visit at ages 9 to 20 years. Persistent cat or dog ownership was defined as ownership of a cat or a dog in early life (during pregnancy or the first year of life) at either study visit (at school age). An allergen-specific IgE result was considered positive if more than or equal to 0.35 IU/mL. Logistic regression was used for the multivariable analysis of asthma and allergic sensitization., Results: In an analysis adjusting for household income, family history of atopy, persistent overweight or obesity, a persistent unhealthy diet, the time interval between study visits, and other covariates, persistent cat ownership was significantly associated with 68% reduced odds of asthma (95% CI for odds ratio = 0.11-0.92) but not with any allergic sensitization or sensitization to cat allergen. In contrast, persistent dog ownership was not significantly associated with asthma or allergic sensitization., Conclusion: Among school-aged Puerto Rican youth followed for an average of 5 years, persistent cat ownership from early life to school age was inversely associated with asthma., (Copyright © 2024 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Studies have shown an association between chronic rhinosinusitis (CRS) and non-cystic fibrosis (CF) bronchiectasis., Objective: We aimed to determine whether CRS increases the risk of developing non-CF bronchiectasis., Methods: A retrospective analysis was conducted utilizing electronic medical records from an academic center. Patients with CRS without bronchiectasis, with at least 1 chest computed tomography (CT) scan performed after the diagnosis of CRS, were identified between January 2006 and December 2015. Charts were reviewed until May 2022. The control group was age-, sex-, and race-matched, and included patients without CRS, asthma, or chronic obstructive pulmonary disease (COPD) who had at least 1 chest CT scan. Bronchiectasis was identified by chest CT radiology reports. The odds of developing bronchiectasis were analyzed in patients with CRS without asthma or COPD (cohort 1) and patients with CRS with asthma or COPD (cohort 2)., Results: The odds of developing bronchiectasis were significantly higher in patients with CRS (139 of 1,594; 8.7%) than in patients in the control group (443 of 7,992; 5.5%; odds ratio OR 1.63; 95% confidence interval [95% CI] 1.34-1.99). Furthermore, the odds of developing bronchiectasis were higher in cohort 1 (63 of 863; 7.3%; OR 1.34; 05% CI 1.02-1.76) and cohort 2 (76/ of 731; 10.4%; OR 1.98; 95% CI 1.53-2.55) versus the control group. After adjusting for confounding diseases, the association was attenuated in cohort 1 (OR 1.22; 95% CI 0.92-1.61) but remained significant in cohort 2 (OR 1.78; 95% CI 1.37-2.31)., Conclusions: The CRS is associated with the future development of non-CF bronchiectasis. Patients with CRS, especially those with asthma or COPD, have a higher likelihood of developing bronchiectasis than patients without CRS., (Copyright © 2024. Published by Elsevier Inc.)

Background: Non-pharmaceutical interventions have been implemented globally to control the COVID-19 pandemic and have been shown to alleviate both allergies and respiratory infections. Although mask-wearing is an accepted non-pharmaceutical intervention, the effects of social distancing have not been thoroughly evaluated., Objectives: To evaluate the effects of social distancing on asthma trends in Seoul, South Korea., Methods: This study included data from the National Health Insurance Service of South Korea, covering approximately 10 million people in Seoul. Daily and monthly data of patients with asthma from 2018 to 2021 were examined, and the degree of social distancing performance was measured using the number of subway users as an index. Pearson's correlation coefficient was used to determine the relationship between the two indices. The change-point detection technique, cross-correlation, and Granger causality method were used to assess the temporal causality between social distancing and asthma., Results: The number of patients with asthma decreased by 42.4 % from 2019 to 2020, while that of subway users decreased by 26.3 % during this period. Pearson's correlation analysis revealed significant positive correlations. Asthma and subway users showed a significant change in incidence following the implementation of social distancing; subway users showed a causal relationship with patients with asthma., Conclusion: Our results showed that the number of subway users decreased after the implementation of strict social distancing, coinciding with a decrease in the number of patients with asthma. These findings suggest that social distancing measures implemented to control COVID-19 may reduce the incidence and exacerbation of asthma., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: We review the prevalence of allergic diseases in children across prenatal exposures to heavy metals., Methods: This systematic review and meta-analysis is registered in the PROSPERO database (CRD42023478471). A comprehensive search of PubMed, Web of Science, Medline and Cochrane library was conducted from the database inception until 31 October 2023. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to assess the quality of included studies. We used a random-effects model to summarize the effects from the studies., Results: A total of 16 studies were included, 120,065 mother-child pairs enrolled. The NOS scores indicated that the quality of the literature included in the study was of a high standard., Conclusion: The final results indicate that prenatal exposure to Pb increased the incidence of wheeze and Eczema in infants, and exposure to Ni and CD increased the incidence of AD in infants.

Background: Although evidence has documented the associations of ambient air pollution with chronic respiratory diseases (CRDs) and lung function, the underlying metabolic mechanisms remain largely unclear., Research Question: How does the metabolomic signature for air pollution relate to CRD risk, respiratory symptoms, and lung function?, Study Design and Methods: We retrieved 171,132 participants free of COPD and asthma at baseline from the UK Biobank, who had data on air pollution and metabolomics. Exposures to air pollutants (particulate matter with diameter ≤ 2.5 μm [PM 2.5 ], particulate matter with a diameter ≤ 10 μm, nitrogen oxide [NO X ], and NO 2 ) were assessed for 4 years before baseline considering residential address histories. We used 10-fold cross-validation elastic net regression to identify air pollution-associated metabolites. Multivariable Cox models were used to assess the associations between metabolomic signatures and CRD risk. Mediation and pathway analysis were conducted to explore the metabolic mechanism underlying the associations., Results: During a median follow-up of 12.51 years, 8,951 and 5,980 incident COPD and asthma cases were recorded. In multivariable Cox regressions, air pollution was positively associated with CRD risk (eg, hazard ratio per interquartile range increment in PM 2.5 , 1.09; 95% CI, 1.06-1.13). We identified 103, 86, 85, and 90 metabolites in response to PM 2.5 , particulate matter with a diameter ≤ 10 μm, NO X , and NO 2 exposure, respectively. The metabolomic signatures showed significant associations with CRD risk (hazard ratio per SD increment in PM 2.5 metabolomic signature, 1.11; 95% CI, 1.09-1.14). Mediation analysis showed that peripheral inflammatory and erythrocyte-related markers mediated the effects of metabolomic signatures on CRD risk. We identified 14 and 12 perturbed metabolic pathways (energy metabolism and amino acid metabolism pathways, etc) for PM 2.5 and NO X metabolomic signatures., Interpretation: Our study identifies metabolomic signatures for air pollution exposure. The metabolomic signatures showed significant associations with CRD risk, and inflammatory- and erythrocyte-related markers partly mediated the metabolomic signatures-CRD links., Competing Interests: Financial/Nonfinancial Disclosures None declared., (Copyright © 2024 American College of Chest Physicians. All rights reserved.)

Background: Hidradenitis suppurativa (HS) is a systemic disorder associated with various metabolic and inflammatory comorbidities. Although HS shares risk factors and pathogenic pathways with various respiratory conditions, few studies have explored the relationship between HS and respiratory disease., Methods: This is a cross-sectional, case-control, population-based study that examined the United States National Inpatient Sample database from January 1, 2002, to December 31, 2012. HS was identified using ICD-9-CM codes during hospital admissions. Multivariable logistic regression was used to evaluate for adjusted associations between HS and respiratory diagnoses as compared to matched controls., Results: Twenty-three thousand seven hundred and sixty-seven hospital admissions for HS were compared with 95,068 age- and sex-matched controls. HS patients had significantly higher adjusted odds of asthma (OR: 1.233; 95% CI: [1.170-1.299]; P < 0.001), chronic airway obstruction (OR: 1.532; 95% CI: [1.419-1.651]; P < 0.001), sarcoidosis (OR: 1.601; 95% CI: [1.157-2.214]; P < 0.001), and sleep apnea (OR: 1.274; 95% CI: [1.182-1.374]; P < 0.001)., Conclusion: HS is associated with several common forms of respiratory disease. Knowledge of these associations may allow for better recognition of respiratory disease in HS patients., (© 2024 The Authors. International Journal of Dermatology published by Wiley Periodicals LLC on behalf of the International Society of Dermatology.)

Background: This study aimed to analyze the probabilities of transitioning between controlled, uncontrolled, and partially controlled states of asthma patients and investigate the influence of age, smoking, dust allergy, and obesity on these probabilities., Methods: This study aimed to analyze the probabilities of transitioning between controlled, uncontrolled, and partially controlled states of asthma patients and investigate the influence of age, smoking, dust allergy, and obesity on these probabilities., Results: Results showed that controlled patients were more likely to remain in that state, with approximately 79 out of 100 patients expected to stay in optimal control in the long term. A discrete nonhomogeneous time Markov Model with the stationarity criterion was used to examine the factors affecting patient states and transitions. Patients seen during the spring and summer seasons were more likely to move into a controlled state compared with those seen in the fall and winter seasons. Patients with dust allergies and obesity significantly impacted asthma exacerbation, with overweight patients more likely to transition into a controlled state. The study estimated the transition intensities matrix under certain conditions, assuming the regularity of patients. In the long term, the probability of an asthmatic patient being in a controlled state was approximately 0.8., Conclusion: This study provided insights into the probabilities and factors influencing asthma progression in Morocco. Dust allergy and obesity were identified as significant contributors to asthma exacerbation, emphasizing the need for effective management strategies.

Objective: Our objective was to identify the hospital- and community-related factors associated with the hospital-level rate of potentially unnecessary interfacility transfers (IFTs) for pediatric patients with asthma exacerbations., Methods: We analyzed California Emergency Department (ED) data from 2016 to 2019 to capture ED visits where a pediatric patient (age, 2-17 years) presented with an asthma exacerbation and was transferred to another ED or acute care hospital. The primary outcome was hospital-level rate of potentially unnecessary IFTs, defined as a visit where length of stay after transfer was <24 hours and no advanced services (eg, critical care) were used. Hospital- and community-related characteristics included urbanicity, teaching hospital status, availability of pediatric resources in the sending facility and patient's community, pediatric patient volume, and Social Vulnerability Index. We described and compared hospitals in the top quartile of potentially unnecessary IFT rate versus all others and used a multivariable modified Poisson model to identify factors associated with potentially unnecessary IFT., Results: A total of 325 sending hospitals were included, with a median 573 pediatric asthma visits (interquartile range, 183-1309) per hospital annually. Nearly half of the hospitals (145/325, 45%) sent a potentially unnecessary IFT. Most (90%) hospitals were urban, 9% were teaching hospitals, 5% had >500 beds, and 22% had a pediatric ED on-site. Factors associated with higher adjusted prevalence of potentially unnecessary IFT included availability of pediatric telehealth (prevalence ratio [PR], 1.5; 95% confidence interval [CI], 1.2-2.0), increased pediatric volume (eg, <1800 vs ≥10,000 visits: PR, 2.6; 95% CI, 1.4-4.7), and higher community Social Vulnerability Index (PR, 1.5; 95% CI, 1.1-1.9)., Conclusions: Several hospital- and community-related factors were associated with potentially unnecessary IFTs among pediatric patients presenting to the ED with asthma exacerbations. These findings provide insight into disparities in potentially unnecessary IFT across communities and can guide the development of future interventions., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: This study aimed to document adverse health effects among office, copy, and print shop workers using the Nano-Control, International Foundation Survey., Methods: Self-reported information on 16 health outcomes and three surrogate exposure variables were collected from 1998 individuals between 1999 and 2010. Logistic regression models, adjusted for age, gender, and smoking status, assessed the association between printer exposure and health symptoms., Results: Among the participants, 61.9% were office workers, 5.5% were technicians, and 23.3% held other professions. Technicians had a higher risk for cancer compared to office workers (odds ratio [OR], 2.5; P < 0.01). Visible toner dust exposure was associated with chronic fatigue (OR, 9.6; P < 0.01), bronchial hyperresponsiveness (OR, 5.1; P < 0.01), cardiovascular diseases (OR, 3.6; P < 0.01), asthma, allergies, and other diseases (OR range, 1.4-3.2; P < 0.01)., Conclusions: The increased chronic and acute health risks among these workers warrant further investigations of causal associations., Competing Interests: Ethical considerations and disclosures: Data for all participants involved in this study were de-identified. As such, this work was exempt from the UML IRB. Authors A. Ojo, D. Bello, K. Heavner, K. Lucas, and A. Bello have no relationships/conditions/circumstances that present potential conflict of interest. Conflict of interest: None declared., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Occupational and Environmental Medicine.)

Introduction: The emergence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the subsequent coronavirus disease 2019 (COVID-19) pandemic has raised questions about its impact on pediatric asthma. This review analyzes the latest research to offer a comprehensive understanding of the dynamics between COVID-19 and pediatric asthma., Areas Covered: This narrative review examines the effects of COVID-19 on pediatric asthma, exploring clinical outcomes, immune responses, recommended treatments, the impact of SARS-CoV-2 strains, and COVID-19 vaccination. Data were sourced from databases (PubMed, Embase, and BioRxiv/MedRxiv) from January 2020 to November 2023., Expert Opinion: In response to the COVID-19 pandemic, the international scientific community rapidly developed extensive knowledge, demonstrating unprecedented cooperation. Despite these advances, questions remain about SARS-CoV-2 infection and pediatric asthma. Most research consists of epidemiological studies with varying methods, sometimes yielding contradictory results. While asthma generally did not increase the risk of severe COVID-19 in children, uncontrolled asthma was a risk factor, highlighting the importance of maintaining asthma management. Telemedicine has proven effective for asthma control and will continue to grow, despite its limitations. Notably, allergic asthma may have a protective role against severe COVID-19. We recommend COVID-19 vaccination in the pediatric age group, including those with asthma.

Objective: To assess the associations of asthma status or age at asthma diagnosis with cognition using the Telephone Survey of Cognitive Status from a large population-based sample. Further, we investigated the possibility that asthma treatment mediates these associations., Methods: This is a cross-sectional study from the Indonesian Family Life Survey Fifth Wave (IFLS-5) collected in 2014-2015. A weighted linear regression model was used to examine the associations between asthma and cognitive functioning scores in adults aged 50 years or older. Of the 6660 total samples included in this study, 176 participants had asthma (2.6%). We controlled for age, sex, and urbanicity with further adjustments for adult covariates or childhood covariates, as appropriate., Results: There was no association between overall asthma status and cognitive functioning scores. However, asthma diagnosed at 0-19 years was associated with significantly higher cognitive functioning scores (Beta coefficient = 2.24, 95% CI: 0.62 - 0.87), compared to those without asthma. In the analysis involving current treatment status (restricted analysis), the significant association disappeared among those under current asthma treatment status, indicating that asthma treatment may mediate the association., Conclusion: Asthma might not be a risk factor for cognitive impairment. Observations of a significant association of pediatric asthma with higher cognitive scores need further investigation. Understanding cognitive functioning among older adults with asthma may improve the surveillance of cognitive decline inthis age group.

Background: Asthma is an inflammatory disease. The potential of omega-6 fatty acids to alleviate asthma symptoms through their anti-inflammatory and immunomodulatory effects has been investigated. However, the association of dietary omega-6 fatty acids in childhood and adolescent asthma remains controversial., Objective: The aim of this study was to evaluate the association between dietary intake of omega-6 fatty acids and asthma in children and adolescents in the United States., Methods: We conducted a cross-sectional analysis of 5045 children and adolescents from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2020. Covariates were adjusted, and multivariate logistic regression, restricted cubic splines, threshold effects, and subgroup analyses were used., Results: Of the 5045 participants, 1000 (19.8%) were identified as having asthma. After adjustment for potential confounders, individuals in the second group (T2, 215.3-377.7 mg/kg/day) had an adjusted odds ratio (OR) of 0.70 (95% CI: 0.57-0.86, P = 0.001) for asthma compared with those in the lowest omega-6 fatty acid intake group (T1, < 215.3 mg/kg/day). Similarly, individuals in the third group (T3, > 377.7 mg/kg/day) had an adjusted OR of 0.59 (95% CI: 0.45-0.78, P < 0.001) for asthma. Furthermore, a non-linear (L-shaped) relationship between omega-6 intake and asthma was observed (P = 0.001), with subgroup analyses confirming the stability of the results. In the threshold analysis, a critical turning point was observed at around 384.2 mg/kg/day (OR = 0.996, 95% CI: 0.995-0.998, P < 0.001)., Conclusion: The consumption of omega-6 fatty acids in the diet showed an L-shaped association with asthma among children and adolescents in the United States. A critical turning point was noted at approximately 384.2 mg/kg/day., (© 2024. The Author(s).)

Background: Abnormalities in lipid metabolism are common among adult asthmatics. However, the precise directionality linking asthma to blood lipid levels remains controversial. Our study aimed to evaluate the association between the Non-HDL to HDL Ratio (NHHR), a lipid composite index, and asthma prevalence among the adult population in the United States., Methods: Utilizing adult participants' data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2009 to 2018, the study employed a multivariable logistic regression model, adjusting for covariables, to establish the relationship between NHHR levels and the prevalence of asthma. Furthermore, smoothing curve fitting and subgroup analyses were conducted to investigate the robustness of this association., Results: This study included 26,023 adult individuals (mean age = 49.63 ± 17.66). In the fully adjusted model, a significant inverse association was observed between log-transformed NHHR values and asthma prevalence (OR = 0.85, 95% CI: 0.79-0.93). Subgroup analysis revealed that gender served as a modulator, altering the association between NHHR levels and asthma prevalence. A more pronounced negative association between lnNHHR and asthma prevalence was noted among male participants [(Male: OR = 0.78, 95% CI: 0.69-0.88) vs. (Female: OR = 0.92, 95% CI: 0.83-1.03), P for interaction = 0.0313]., Conclusions: Our study revealed an inverse association between NHHR levels and the prevalence of asthma in the US adult population, which is influenced by gender. NHHR measurement may be a potential tool for early identification and prediction of adult asthmatics in specific populations., (© 2024. The Author(s).)

Background: With a diverse geographic and sociocultural landscape, Vancouver Coastal Health (VCH) Authority (British Columbia, Canada) encompasses both urban and rural regions, providing a case study to examine the delivery of care services for asthma and chronic obstructive pulmonary disease (COPD). To better understand the landscape of care services within VCH, we aimed to (1) identify asthma and COPD care services availability in urban and rural communities and (2) identify where asthma and COPD quality improvement (QI) initiatives were implemented and their implementation-related characteristics. Methods: An environmental scan was conducted to identify asthma and COPD care services provided in VCH communities. A literature review was conducted to determine where VCH asthma and COPD QI initiatives were implemented and identify their implementation-related characteristics. This case study was analysed descriptively and summarised in tables and figures. Results: The environmental scan analysis revealed that specialty outpatient care, pulmonary rehabilitation, respiratory education and clinical smoking cessation services were limited in urban and unavailable in rural VCH communities. Spirometry services were limited in urban and rural VCH communities. Cross-referencing recommendations from asthma and COPD clinical practice guidelines against prevalence data, we estimated that rural VCH communities could provide 0%-23% of required spirometry while urban could provide 40%-75%. Further, of the 16 asthma and COPD QI initiatives identified within 21 papers, none were conducted at rural VCH healthcare sites. Conclusion: Our findings suggest rural VCH communities have lower access to asthma and COPD care services and the limited urban care services were insufficient to make up for this difference. Past asthma and COPD QI initiatives have not apparently translated to care service improvements in rural regions. Future QI initiatives should focus on overcoming barriers to conducting and participating in QI to improve urban and rural regions' access to asthma and COPD care services., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Amelia Choy et al.)

With China's aging population, the incidence of eye diseases is increasing, leading to urgent concerns about visual impairment and blindness. The cause-and-effect relationship between asthma and eye diseases in the Chinese population remains unclear. This study aimed to investigate the link between asthma and eye-related diseases, including cataracts and glaucoma, among Chinese adults. This study utilized data from the 4th wave of the China Health and Retirement Longitudinal Survey conducted in 2018, involving 19,816 Chinese participants. We first described baseline characteristics, then constructed 5 logistic regression models to study the relationship between asthma and eye diseases in the Chinese context. Additionally, subgroup analyses were performed with selected variables. Across 5 models adjusting for covariates, we found that asthma was significantly associated with cataracts (odds ratios [95% confidence intervals]: 1.36 [1.01-1.79], P = .034) and glaucoma (odds ratios [95% confidence intervals]: 1.92 [1.46-2.49], P < .001). Subgroup analyses revealed that Chinese women, former smokers, or drinkers were at higher risk of developing cataracts (all P < .001), while those aged ≤ 60 years were at higher risk of developing glaucoma (P < .001). Our study provides possible observational evidence linking asthma to cataracts, glaucoma, and visual impairment in the Chinese population. These findings are crucial for disease prevention strategies in China's healthcare system., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Asthma is an airway inflammatory disease driven by multiple factors with a high incidence in children and adolescents. Environmental tobacco smoke exposure (TSE) and diet are inducing factors for asthma. The potential of omega-3 polyunsaturated fatty acids (PUFAs) to alleviate asthma symptoms by their anti-inflammatory effects has been explored. However, to date, no studies have explored the effect of dietary PUFAs intake on the asthma in children and adolescents exposed to tobacco smoke., Objective: We aimed to examine the effect of dietary PUFAs intake on the current asthma in children and adolescents exposed to tobacco smoke., Methods: Data of this cross-sectional were extracted from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Children and adolescents with serum cotinine concentration ≥ 0.05 ng/mL were defined to exposed to tobacco smoke. Dietary PUFAs intake information were obtained from 24 h recall interview. The weighted univariate and multivariate were utilized to explore the effect of PUFAs on the association of asthma and TSE, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs). These moderating effects were further explored based on the age, gender and body mass index (BMI) and sedentary time., Results: Totally, 7981 eligible children and adolescents were included, with the mean age of 11.96 ± 0.06 years old. Of whom, 1.024 (12.83%) had current asthma. After adjusted all covariates, we found children and adolescents with TSE had high occurrence of current asthma (AOR = 1.2, 95% CI 1.03-1.63); We also found omega-3 PUFAs intake (P for interaction = 0.010), not omega-6 PUFAs (P for interaction = 0.546), has a moderating effect on the association of TSE and current asthma. Moreover, we further observed that children and adolescents with TSE and low omega-3 PUFAs intake had high occurrence of current asthma (AOR = 1.58, 95% CI 1.19-2.10), while no significant association was found in children and adolescents with high omega-3 PUFAs intake (all P > 0.05). This moderating effect was more prominent in children and adolescents aged ≤ 12 years old (AOR = 1.62, 95% CI 1.06-2.47), girls (AOR = 2.14, 95% CI 1.15-3.98), overweight (AOR = 1.87, 95% CI 1.01-3.47) and sedentary time > 6 h (AOR = 1.96, 95% CI 1.00-3.86)., Conclusion: We found dietary omega-3 PUFAs plays a moderating effect on the association of asthma and TSE in children and adolescents, especially in children and adolescents aged ≤ 12 years, girls, overweight or sedentary time > 6 h. This moderating effect suggested higher omega-3 intake has potential benefits in decreasing the occurrence of asthma in children and adolescents who exposed to tobacco smoke., (© 2024. The Author(s).)

Asthma is one of the most common chronic illnesses affecting children. Long-term asthma control medications (LTACMs) are an important aspect of asthma management, with under-prescription associated with poor asthma control and increased asthma deaths. This study aimed to document temporal trends in the prescribing of LTACMs for paediatric patients for asthma-related presentations to Australian general practice registrars (trainees). Longitudinal analyses of data from 2010 to 2022 from the Registrars Clinical Encounters in Training study were undertaken. Proportions of paediatric presentations where LTACMs were prescribed were calculated, and temporal trends analysed and graphed. There was no change over time in registrar prescribing of LTACMs for paediatric asthma, although temporal changes were seen in the types of LTACMs prescribed. The lack of temporal increase in overall LTACMs prescription, despite evidence showing their importance in preventing asthma morbidity and mortality, has significant educational, clinical, and policy implications., (© 2024. The Author(s).)

Objective: To explore the relationship between dietary flavonoids and bronchitis, emphysema and asthma., Method: A total of 11743 United States adults were extracted from the National Health and Nutrition Examination Survey (NHANES) in 2007-2008, 2009-2010 and 2017-2018. Of these, 47.7% were male and 52.3% female. Dietary flavonoid intake assessed using FDNNS and 24-hour dietary recall data. Inclusion of demographics (gender, age, education, family income), behavioral factors (BMI, smoking, drinking status, diet), chronic disease information (diabetes, hypertension) as covariates to eliminate confounding. Stepwise logistic regression was used to analyze the association between total dietary flavonoid intake and the risk of chronic respiratory disease. Weighted quantile sum regression (WQS) was used to analyze the association between 29 dietary flavonoids and the risk of chronic respiratory disease. Restricted cubic spline was used to analyze the dose-response relationship between dietary flavonoid intake and risk of chronic respiratory disease., Results: Stepwise logistic regression results showed that higher flavonoid intake in men was associated with a lower risk of CB and asthma (OR of CB: 0.55(0.31-0.97); OR of asthma: 0.72(0.52-0.99)), and WQS results showed a mixed health effect for total flavonoids and chronic respiratory tract in response to the 29 flavonoid fractions (OR of asthma: 0.97(0.94-0.99); OR of emphysema: 0.95(0.90-0.99)). Glycitein had the highest health contribution of 26.2% for emphysema; Eriodictyol had the highest health contribution of 32.13% for asthma, respectively. The RCS showed a dose-response relationship between flavonoids and respiratory tract health. The maximum dose for ingesting flavonoids to gain respiratory health benefits is 1500 mg/d., Conclusion: Higher dietary flavonoid intake was associated with lower chronic respiratory risk in adult U.S. men. Also 29 dietary flavonoid components have an overall health effect on respiratory health. Glycitein and Eriodictyol may have potential health effects on the respiratory system. 1500 mg/day may be the Tolerable Upper Intake Level of dietary flavonoids for respiratory health in U.S. adults., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sun, Ding. 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.)

Background: The indoor home environment plays a crucial role in determining the outcome of respiratory diseases, including asthma. Researchers, clinicians, and patients would benefit from self-reported questionnaires to assess indoor home environmental exposures that may impact on respiratory health., Objective: To review self-reported instruments for assessing indoor home environmental exposures in asthma patients and to characterise their content, development, and psychometric properties., Design: A scoping review was conducted with content assessment., Methods: A literature search was conducted in Embase and PubMed using the key words housing quality, questionnaire and asthma and their index terms, covering articles published in English between January 2000 to July 2023. Articles in which questionnaires or single item questions were used to assess indoor home environmental exposures in asthma patients in middle- and high-income countries were included. We excluded articles in which the questionnaire required an interviewer or onsite observations and those conducted in low-income countries., Results: We screened 1584 articles to identify 44 studies containing self-reported questionnaires measuring indoor home environmental exposures. 36 studies (82%) were cross sectional, 35 (80%) had a sample size of greater than 1000 participants, and 29 (66%) were conducted in children. Most studies (86%, n = 38) had binary (yes/no) or multiple-choice responses. 25 studies (57%) included a recall period of 12 months. 32 studies (73%) had a response rate of greater than 50%. Dampness, biological exposures (e.g. mould), and second-hand tobacco smoke were the most assessed indoor home environmental exposures. Childhood asthma (54%, n = 24) and asthma symptoms (36%, n = 16) were the most examined asthma related outcomes. The exposure most associated with adverse asthma outcomes was exposure to damp (79%, n = 35). 13 studies (29%) had developed a self-reported instrument by adapting questions from previous studies and almost all instruments (n = 42 studies, 95%) had not been validated., Conclusions: The scoping review did not identify a comprehensive, validated self-reported questionnaire for assessing indoor home environmental exposures in patients with asthma. There is need to develop and validate a robust but pragmatic self-reported instrument, incorporating the findings from this review., (© 2024. The Author(s).)

Background: Reliable estimates of asthma prevalence are essential for developing effective public health policies. However, discrepancies in published results have posed challenges for public health planning in China. To address this issue, we conducted this study to provide a comprehensive assessment of the epidemiology of asthma prevalence in China., Methods: We conducted a thorough systematic review across multiple databases including PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Weipu database. The search was limited to studies published in either Chinese or English up to August 31, 2023, that reported on asthma prevalence in China. We extracted relevant study characteristics and performed meta-analyses. The study protocol was registered with PROSPERO (CRD42023397949)., Results: A literature search yielded 192 studies that met the inclusion criteria out of 17,152 articles. The overall prevalence of asthma in Mainland China was found to be 2.20% (95% confidence interval, CI: 1.96-2.47%; I 2  = 99.8%), with the prevalence of ever asthma at 2.21%, current asthma at 2.16%, ever asthma-like symptoms at 14.36%, and current asthma-like symptoms at 3.01%. Using a random-effects model, the prediction interval ranged from 0.44 to 10.27%. Meta-analysis subgroups indicated that men or children and the elderly generally have a higher prevalence of asthma. In addition, the prevalence of asthma is higher in urban areas and in the East China. The prevalence of asthma has been on the rise over the past three decades, from 0.69% in 1984 to 5.30% in 2021. Projections suggest that the prevalence could reach 9.76% by 2050 for the Chinese population., Conclusions: Asthma remains less prevalent in China than in western countries, however its prevalence has been gradually increasing over the past thirty years. The disease burden shows notable variations based on sex, age, and geographic regions, indicating significant demographic and regional disparities. To guide decision-making priorities and direct future research, conducting high-quality epidemiological studies on asthma is crucial., (© 2024. The Author(s).)

Observational studies have reported associations between atopic diseases, including allergic rhinitis (AR), asthma, atopic dermatitis (AD), and inflammatory bowel disease (IBD), but the causal relationship remains unknown. We utilized pooled data from genome-wide association studies, qualified instrumental variables were screened according to the 3 hypotheses of MR, and bidirectional causality between atopic diseases and IBD was assessed using 2-sample Mendelian randomization analysis (2SMR). The results of our study suggest that AR increased the risk of Crohn disease (CD) (IVW OR = 1.19, 95% CI = 1.02-1.39, P = .026), ulcerative colitis (UC) (IVW OR = 1.14, 95% CI = 1.01-1.29, P = .031) and overall IBD (IVW OR = 1.15, 95% CI = 1.03-1.28, P = .015); Asthma increased the risk of CD (IVW OR = 7.66, 95% CI = 1.58-37.20, P = .012), UC (IVW OR = 3.81, 95% CI = 1.09-13.32, P = .036) and overall IBD (IVW OR = 5.13, 95% CI = 1.48-17.70, P = .010); AD increased the risk of CD (IVW OR = 1.19, 95% CI = 1.02-1.39, P = .023) and overall IBD (IVW OR = 1.14, 95% CI = 1.03-1.28, P = .015) risk. In reverse causality, only CD increased the risk of AR (IVW OR = 1.02, 95% CI = 1.00-1.05, P = .031). This study shows that atopic diseases of AR and asthma are causally related to IBD and its subtypes, and AD is causally related to IBD (which may be attributed to CD). Of the reverse causality, only CD was causally related to AR., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: The existence of an association between physical activity (PA) and asthma and chronic obstructive pulmonary disease (COPD) has been confirmed in observational studies. Therefore, it is necessary to reveal whether there is a risk-effect relationship between physical activity and asthma and COPD through Mendelian randomization (MR) analysis., Materials and Methods: Univariate Mendelian randomization (UVMR) analyses were performed to examine the associations between moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA), accelerometer-assessed physical activity (AA), and strenuous exercise or other exercise (SSOE) with asthma and COPD. The methods of analysis were dominated by Inverse Variance-Weighted (IVW), Weighted median (WM), and MR-Egger methods. In addition, multivariate Mendelian randomization (MVMR) analyses were performed to correct the effects of four types of physical activity on asthma and COPD. Finally, potential mediating effect relationships were identified through mediation analyses., Results: The results of Univariate Mendelian randomization analysis showed that SSOE could reduce the risk of asthma and COPD(asthma: OR =0.15,95% CI=0.04-0.58, P =0.006; COPD: OR =0.05, 95% CI=0.01-0.33, P =0.002). The results of the Multivariate Mendelian randomization analysis showed that SSOE was still able to reduce the risk of asthma and COPD after adjusting for the effects of different types of physical activity(asthma: 95% CI=-2.77--0.31, P =0.014; COPD: 95% CI=-4.00--0.50, P =0.012). Mediation analyses showed that frailty intervened in the causal relationship between physical activity and asthma and chronic obstructive pulmonary disease., Conclusion: SSOE is a protective factor for asthma and COPD in the European population, while frailty plays a mediating role., Competing Interests: The authors declare that there is no conflict of interest in this study., (© 2024 Chen et al.)

Background: Preschool-aged children have among the highest burden of acute wheeze. We investigated differences in healthcare use, treatment and outcomes for recurrent wheeze/asthma in preschoolers from different ethno-socioeconomic backgrounds., Methods: Retrospective cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics in England. We reported number of acute presentations and hospitalisations stratified by index of multiple deprivation (IMD) and ethnicity; and factors associated with treatment non-escalation, and hospitalisation rates using multivariable logistic and Poisson regression models., Results: 194 291 preschool children were included. In children not trialled on asthma preventer medications, children from the most deprived IMD quintile (adjusted OR 1.67; 95% CI 1.53 to 1.83) and South Asian (1.77; 1.64 to 1.91) children were more likely to have high reliever usage and where specialist referral had not occurred, the odds of referral being indicated was higher in the most deprived quintile (1.39; 1.28 to 1.52) and South Asian (1.86; 1.72 to 2.01) children compared with the least deprived quintile and white children, respectively.Hospitalisation rates for wheeze/asthma were significantly higher in children from the most deprived quintile (adjusted IRR 1.20; 95% CI 1.13 to 1.27) compared with the least, and in South Asian (1.57; 1.44 to 1.70) and black (1.32; 1.22 to 1.42) compared with white children., Conclusions: We identified inequalities in wheeze/asthma treatment and morbidity in preschool children from more deprived, and non-white backgrounds. A multifaceted approach to tackle health inequality at both the national and local levels, which includes a more integrated and standardised approach to treatment, is needed to improve health outcomes in children with preschool wheeze/asthma., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare the following: DL and CL receive support from the National Institute for Health and Care Research (NIHR). DL has also received an institutional research grant from the Midlands Asthma and Allergy Research Association (MAARA). HP holds institutional research grants from NIHR and Asthma UK unrelated to this publication and has received personal fees from Teva Pharmaceuticals and Sandoz UK. Additionally, HP has received travel expense payments from the European Respiratory Society (ERS). JKQ has received institutional grants from the Industrial Strategy Challenge Fund, the Medical Research Council, Health Data Research, GlaxoSmithKline (GSK), Boehringer Ingelheim (BI), Asthma+Lung UK, and Astra Zeneca (AZ); and personal fees from GSK, Evidera, Chiesi, AZ, and Insmed. EAG has received institutional grants from Gilead, Circassia, Chiesi, Propellar Health, Helicon Health, Adherium Ltd, and AZ; and personal fees from Circassia and Sanofi. SS and CG had no competing interests to declare., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Identified as a critical risk factor for childhood asthma, environmental pollution plays a pivotal role. However, research on the effects and mechanisms of phthalates mixture and their interactions in relation to childhood asthma is still lacking. In the National Health and Nutrition Examination Survey (NHANES) conducted from 2009 to 2018, our research explored the link between phthalates in urine and the prevalence of childhood asthma. In this study, which involved 810 participants, we used four different statistical analysis methods to investigate the association between urinary phthalate levels and childhood asthma. Additionally, we conducted a mediation analysis to explore whether the impact mechanism of phthalate exposure on childhood asthma operates through the glycolysis. Among the participants, 525 (64.81 %) individuals were diagnosed with asthma, with 330 (40.74 %) individuals undergoing testing for glycolytic markers. Through Spearman correlation analysis and weighted principal component analysis (W-PCA), it was found that mono-2-ethyl-5-carboxypentyl phthalate (MECPP), mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl)-hexyl phthalate (MEHP) and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) are the four most highly correlated phthalates. In addition, comprehensive analysis by the weighted generalized linear models (W-GLM), weighted quantile sum (WQS) and Bayesian kernel machine regression (BKMR) models showed that phthalates mixture were positively associated with the prevalence of childhood asthma, especially MECPP, MEHHP and MEOHP. More importantly, glycolysis participated as a mediator in the relationship between MECPP, MEHHP and MEOHP exposure and the prevalence of childhood asthma, explaining 41.194 %, 38.322 % and 39.871 % of the effects respectively. Therefore, our study revealed that phthalate exposure is a risk factor for asthma in children, and glycolysis may be involved as a potential mediator in this process. This conclusion will be verified through more prospective studies in the future., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Exposure to 1-bromopropane (1-BP) is an emerging environmental and health concern due to its increasing environmental prevalence. Although the health effects of 1-BP exposure have been under-recognized, current evidence suggests the possibility of adverse pulmonary health effects due to 1-BP exposure. However, the association between 1-BP exposure and asthma prevalence remains unclear. Thus, we aimed to examine the association between 1-BP exposure and asthma prevalence in the general population. Using nationally representative data, we explored the potential impacts of indoor air quality (IAQ)-related behavioral factors on the level of 1-BP exposure. This study included 1506 adults from the 2020-2021 Korea National Health and Nutrition Examination Survey. The prevalence of asthma was based on self-reported physician-diagnosed asthma. Urinary N-acetyl-S-(n-propyl)-L-cysteine (BPMA) levels were measured as a biomarker of 1-BP exposure, using high-performance liquid chromatography-mass spectrometry. Multiple logistic regression models were performed to investigate the associations between urinary BPMA metabolite and asthma prevalence after adjusting for potential confounders. Log-linear multiple regression models were used to examine the association between IAQ-related behavior and urinary BPMA concentration. Forty-seven individuals with asthma and 1459 without asthma were included. Individuals in the highest quartile of urinary BPMA concentration had a 2.9 times higher risk of asthma than those in the lowest quartile (odds ratio [OR]: 2.85, 95% confidence interval [CI]: 1.02-7.98). The combination of natural and mechanical ventilation was associated with a reduced urinary BPMA concentration. Our findings suggest that 1-BP exposure is associated with the prevalence of asthma in adults and revealed higher urinary levels of BPMA in our study population compared to those in other countries. Given the emerging importance of IAQ, actively managing and modifying behavioral patterns to reduce 1-BP exposure in indoor environments could substantially attenuate the risk of asthma-related to 1-BP exposure., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Rationale: Few studies have examined the effects of long-term childhood air pollution exposure on adult respiratory health, including whether childhood respiratory effects underlie this relation. Objectives: To evaluate associations between childhood air pollution exposure and self-reported adult bronchitic symptoms while considering child respiratory health in the Southern California Children's Health Study. Methods: Exposures to nitrogen dioxide (NO 2 ), ozone, and particulate matter <2.5 μm and <10 μm in diameter (PM 10 ) assessed using inverse-distance-squared spatial interpolation based on childhood (birth to age 17 yr) residential histories. Bronchitic symptoms (bronchitis, cough, or phlegm in the past 12 mo) were ascertained via a questionnaire in adulthood. Associations between mean air pollution exposure across childhood and self-reported adult bronchitic symptoms were estimated using logistic regression. We further adjusted for childhood bronchitic symptoms and asthma to understand whether associations operated beyond childhood respiratory health impacts. Effect modification was assessed for family history of asthma, childhood asthma, and adult allergies. Measurements and Main Results: A total of 1,308 participants were included (mostly non-Hispanic White [56%] or Hispanic [32%]). At adult assessment (mean age, 32.0 yr; standard deviation [SD], 4.7), 25% reported bronchitic symptoms. Adult bronchitic symptoms were associated with NO 2 and PM 10 childhood exposures. Odds ratios per 1-SD increase were 1.69 (95% confidence interval, 1.14-2.49) for NO 2 (SD, 11.1 ppb) and 1.51 (95% confidence interval, 1.00-2.27) for PM 10 (SD, 14.2 μg/m 3 ). Adjusting for childhood bronchitic symptoms or asthma produced similar results. NO 2 and PM 10 associations were modified by childhood asthma, with greater associations among asthmatic individuals. Conclusions: Childhood NO 2 and PM 10 exposures were associated with adult bronchitic symptoms. Associations were not explained by childhood respiratory health impacts; however, participants with childhood asthma had stronger associations.