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Objectives: While asthma presents various clinical forms with different levels of severity, it is unclear whether asthma severities are a consequence of disease management or varied etiologies. We sought to investigate this question. Methods: This paper presents a cross-sectional study of 113,671 Israeli adolescents. Prevalence rates of mild and moderate-to-severe asthma over a 24-year period were calculated and multivariate regression models (outcomes: different asthma severity, reference: subjects without asthma) were performed to analyze associations with anthropometric indices and socio-demographic variables, in males and females separately. Results: The prevalence of mild asthma increased until birth years 1976-1980 and then steadily decreased. In contrast, the prevalence of moderate-to-severe asthma was relatively stable until birth years 1976-1980, then rose steeply until 1986-1990 and subsequently plateaued in the early 1990s. Obesity was positively associated with both mild and moderate-to-severe asthma in males (Odds Ratio (OR) [95%CIs]: 1.61 [1.37-1.89] and 1.63 [1.34-1.98], respectively) and females (1.54 [1.10-2.16] and 1.54 [1.20-1.98], respectively). Family size greater than three siblings was negatively associated with both mild and moderate-to-severe asthma in males (0.62 [0.56-0.68] and 0.59 [0.52-0.68]) and females (0.71 [0.60-0.83] and 0.73 [0.63-0.83]). In contrast, in males, underweight was only associated with mild asthma (1.54 [1.22-1.94]) but not with moderate-to-severe asthma. In females, overweight was only associated with moderate-to-severe asthma (1.21 [1.00-1.46]) and rural residence was only associated with mild asthma (1.26 [1.09-1.47]). Conclusions: The differences between mild and moderate-to-severe asthma enhance asthma phenotype characterization, with respect to secular trends and associated variables, and indicate varied etiologies. [ABSTRACT FROM AUTHOR]

Objective: To identify challenges that disadvantaged adults with asthma face in mitigating social and environmental factors associated with poor symptom control. Methods: Using a community-engaged approach, we partnered with a community health center in New Haven, CT to conduct in-person interviews and a written survey of asthmatic adults with poor symptom control. Using the constant comparative method, we analyzed participant interviews to establish emerging themes and identify common barriers to improved outcomes. Through a written survey utilizing clinically validated questions, we assessed information on access to medical care, asthma control, and selected social and environmental risk factors. Results: Twenty-one patients (mean age 47, 62% female, 71% Black, 95% insured by Medicaid) participated. The average Asthma Control Test (ACT) score was 11.6. Seventy-six percent of participants were currently employed and of those, 75% reported work-related symptoms. Among participants currently in housing, 59% reported exposure to domiciliary mice and 47% to mold. We identified three themes that summarize the challenges the study participants face: 1) Lack of knowledge about home and workplace asthma triggers; 2) Lack of awareness of legal rights or resources available to mitigate adverse conditions in the home or work environment; and 3) Fear of retaliation from landlords or employers, including threats of eviction, sexual assault, and job loss. Conclusion: Patients with poorly controlled asthma in a disadvantaged urban northeast community identified common barriers in both the domestic and work environments that impeded attainment of symptom control. These challenges may be best addressed through legal advocacy for those most at risk. [ABSTRACT FROM AUTHOR]

Perfluoroalkyl substances (PFASs) are highly persistent chemicals that might be associated with asthma and allergy, but the associations remain unclear. Therefore, this study examined whether pre- and postnatal PFAS exposure was associated with childhood asthma and allergy. Measles, mumps, and rubella (MMR) vaccination in early life may have a protective effect against asthma and allergy, and MMR vaccination is therefore taken into account when evaluating these associations. In a cohort of Faroese children whose mothers were recruited during pregnancy, serum concentrations of five PFASs – Perfluorohexane sulfonic acid (PFHxS), perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) – were measured at three timepoints (maternal serum in pregnancy week 34–36 and child serum at ages 5 and 13 years) and their association with immunoglobulin E (IgE) (cord blood and at age 7 years) and asthma/allergic diseases (questionnaires at ages 5 and 13 years and skin prick test at age 13 years) was determined. A total of 559 children were included in the analyses. Interactions with MMR vaccination were evaluated. Among 22 MMR-unvaccinated children, higher levels of the five PFASs at age 5 years were associated with increased odds of asthma at ages 5 and 13. The associations were reversed among MMR-vaccinated children. Prenatal PFAS exposure was not associated with childhood asthma or allergic diseases regardless of MMR vaccination status. In conclusion, PFAS exposure at age 5 was associated with increased risk of asthma among a small subgroup of MMR-unvaccinated children but not among MMR-vaccinated children. While PFAS exposure may impact immune system functions, this study suggests that MMR vaccination might be a potential effect-modifier. [ABSTRACT FROM AUTHOR]

There is a lack of reports focusing on the course of atopic dermatitis (AD) with respect to its evolution and association with other allergic diseases and parameters. This study gives the review of results concerning the evaluation of different parameters in patients suffering from AD older than 14 years of age. This study evaluates the occurrence of food allergy, food intolerance, inhalant allergy, occurrence of asthma bronchiale, allergic rhinitis, peripheral blood eosinophilia, family history of atopy, onset of AD and the severity of AD according to the SCORAD index. [ABSTRACT FROM AUTHOR]

Background: Interleukins (IL) 4 and 13 genes and their receptors (R) are the key cytokines which amplify inflammatory reactions in asthma. Objective: This study aimed to investigate the association ofIL 4, 4 R, 13and13 Rgenes polymorphism with asthma in Indian children. Methods: In this hospital-based case-control study, included were children aged 1–15 years recruited as diagnosed cases of bronchial asthma, according to EPR 2007 and excluded were subjects with other respiratory diseases. Children with no present or past history of asthma were enrolled as controls. Spirometry was done in cases age ≥ 6 years. Gene–gene interaction was evaluated using binary logistic regression. Results: From October 2010 to July 2013, 275 cases and 275 controls were recruited. Gene–gene interactions between C1112T inIL 13and Ile50Val inIL 4 R gene polymorphisms were found to be statistically significant (OR = 2.37, 95% CI = 1.04–5.42,p = 0.040). Individuals with CT and GG genotype of C1112T inIL 13and Ile50Val inIL 4 R were at twice the risk for the development of asthma compared to individuals with both non-risk genotypes. Conclusion: The data suggests that gene–gene interactions betweenIL 13andIL 4 R genes may play an important role in asthma among Indian children. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is an etiologically complex disease and develops by the interaction of multiple genes and environmental factors. Previous studies suggested a linkage between the interferon-gamma ( INFG) gene cluster in the chromosome 12q region and susceptibility to asthma. Methods: This meta-analysis was undertaken to examine the relationship between +874A/T and CA-repeat polymorphisms in INFG gene and asthma. Eligible articles were accumulated via online databases in October 2013. A total of nine articles were included that were associated with the +874A/T polymorphism, involving 470 cases and 574 controls, as well as articles involving CA-repeat polymorphisms, which included 365 cases and 517 controls. The meta-analysis was performed for heterogeneity and calculation of pooled odds ratio and evaluation of publication bias by Egger's linear regression test. Results: The differences between IFNG polymorphism and the susceptibility to asthma may vary across ethnicities and ages, and also that the allelic frequencies of the AA genotypes in IFNG at +874 is associated with an increased risk of asthma in the Chinese Han adult population; additionally, CA14 occurrence in the first intron can increase the risk of asthma in the Japanese population. Conclusion: Our findings suggested that some polymorphisms in the IFNG gene could act as high prevalence-susceptibility markers of asthma. Larger scale studies are warranted to address these associations among different ethnic populations, ages and the severity of asthma prognosis. [ABSTRACT FROM AUTHOR]

Background: Evaluation of the prevalence and incidence of asthma and research into its etiology often rely on self-reported information. We conducted this analysis to investigate reliability in reporting asthma history across categories of demographic and socio-economic characteristics. Methods: We analyzed data from 3109 participants in the Coronary Artery Risk Development in Young Adults study, a longitudinal study of African-American and white adults. Responses to self-administered questionnaires completed at 15- and 20-year follow-up exams were used to evaluate agreement in reporting asthma history and age at diagnosis and assess variation in agreement across categories of demographic and health-related characteristics. Results: A history of asthma was reported by 12% of participants at the 15-year exam and 11% of participants at the 20-year exam, with 97% agreement and an overall Kappa coefficient of 0.845 (95% confidence interval: 0.815-0.874). Kappa coefficients were higher among women than men and increased monotonically across categories of educational attainment. One-hundred eight participants (35%) reported exactly the same age at diagnosis at the two time points; for another 120 (39%), the difference in reported ages was ≤2 years. Age at asthma diagnosis reported at the 20-year exam was, on an average, 1 year (SD: 5.2) older than that reported at the 15-year exam. Conclusions: Five-year reliability in self-reported asthma history is high, and variation in reporting age at diagnosis is low across categories of participant characteristics. Nevertheless, agreement in responses at two times does not guarantee that self-administered questionnaires are sensitive tools for detecting a true asthma history. [ABSTRACT FROM AUTHOR]

This study was undertaken to determine whether there was a correlation between fine particles (PM2.5) levels and hospital admissions for asthma in Taipei, Taiwan. Hospital admissions for asthma and ambient air pollution data for Taipei were obtained for the period of 2006–2010. The relative risk of hospital admissions for asthma was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased asthma admissions were significantly associated with PM2.5levels both on warm days (>23°C) and cool days (<23°C), with an interquartile range rise associated with a 12% (95% CI = 6–18%) and 3% (95% CI = 0–8%) elevation in admissions for asthma, respectively. In the two-pollutant models, PM2.5levels remained significant for increased asthma admissions after inclusion of SO2or O3both on warm and cool days. This study provides evidence that higher levels of PM2.5elevate the risk of hospital admissions for asthma in Taiwan. [ABSTRACT FROM PUBLISHER]

Objective. Many fungi may cause allergic reactions and increase asthma symptoms prevalence and severity. One susceptible, vulnerable population subgroup of increasing size in industrialized countries and of public health concern who spends the majority of their time at home is older adults. Older adults diagnosed with chronic obstructive pulmonary disease (COPD) are at risk of exposure to fungi. Currently, species identification is based on observation of microscopic and macroscopic morphologies, which may underestimate concentrations compared to quantitative polymerase chain reaction (qPCR)-based measurements which are toxicologically more relevant to exposure science. Methods. This article analyzes quantitative indoor exposure data on fungi in floor dust (cells/cm2 floor) by real-time qPCR-based detection with quantitative outcome data via field spirometry in a pilot community-based study in Visalia, Tulare County, California, between July 2009 and January 2010. Subjects ( n = 9, five females, four males) were Caucasian, English-speaking, nonsmoking older adults with doctor-diagnosed asthma and/or COPD. Results. While certain results did not reach statistical significance ( p ≤ .10) due to sample size-overall and by gender-we found consistent trends and statistically significant associations for total fungal DNA (summer data) with forced vital capacity and forced expiratory volume in 1 second. Conclusions. The results of this pilot study are novel and suggest adverse effects of exposure inside homes to certain fungal species. This pilot study supports the need for larger prospective epidemiologic studies of older adults with asthma and/or chronic bronchitis based on quantitative environmental and clinical measures. [ABSTRACT FROM AUTHOR]