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Objective: Different phenotypes of wheezing have been described to date but not in early life. We aim to describe wheezing phenotypes between the ages of two months and one year, and assess risk factors associated with these wheezing phenotypes in a large birth cohort. Methods: We studied 18,041 infants from the ELFE (French Longitudinal Study of Children) birth cohort. Parents reported wheezing and respiratory symptoms at two and 12 months, and answered a complete questionnaire (exposure during pregnancy, parental allergy). Results: Children with no symptoms (controls) accounted for 77.2%, 2.1% had had wheezing at two months but no wheezing at one year (intermittent), 2.4% had persistent wheezing, while 18.3% had incident wheezing at one year. Comparing persistent wheezing to controls showed that having one sibling (ORa = 2.19) or 2 siblings (ORa = 2.23) compared to none, nocturnal cough (OR = 5.2), respiratory distress (OR = 4.1) and excess bronchial secretions (OR = 3.47) at two months, reflux in the child at 2 months (OR = 1.55), maternal history of asthma (OR = 1.46) and maternal smoking during pregnancy (OR = 1.57) were significantly associated with persistent wheezing. These same factors, along with cutaneous rash in the child at 2 months (OR = 1.13) and paternal history of asthma (OR = 1.32) were significantly associated with increased odds of incident wheezing. Having one sibling (ORa = 1.9) compared to none, nocturnal cough at 2 months (OR = 1.76) and excess bronchial secretions at 2 months (OR = 1.65) were significantly associated with persistent compared to intermittent wheezing. Conclusion: Respiratory symptoms (cough, respiratory distress, and excessive bronchial secretion) were significantly associated with a high risk of persistent wheezing at one year. Smoking exposure during pregnancy was also a risk factor for persistent and incident wheezing. [ABSTRACT FROM AUTHOR]

Background: The results of international epidemiological surveys show large geographical variations in skin test reactivity but do not provide a rationale for such variations. Objective: To assess the relationship between climate and allergic sensitization in schoolchildren. Methods: In the present study, we analyzed data from a multicenter, epidemiological survey that included 6,461 schoolchildren, aged 9-11 years, living in 6 French cities scattered around France. The protocol also included a battery of skin prick tests to common airborne allergens. The crude prevalence of sensitization to each allergen was estimated for each city and then adjusted for potential confounding factors. This analysis was repeated for monosensitization and for allergens grouped into 2 categories: indoor allergens, i.e., house dust mite (HDM), cat, and cockroach allergens, and outdoor allergens, i.e., birch pollen, grass pollen, and Alternaria . We also grouped cities according to their location on the coast, i.e., Marseille and Bordeaux, or inland, i.e., Créteil, Clermont-Ferrand, Reims, and Strasbourg. Results: A difference in prevalence of sensitization to each airborne allergen or al-lergens grouped into indoor and outdoor categories was found between cities, even after adjusting for potential confounding factors. Also, a higher prevalence of sensitization to HDM, cat dander, and, broadly speaking, indoor allergens, was found in children living on the coast than in those living inland, whereas they showed a lower prevalence of sensitization to birch pollen. Between-city differences in the prevalence of monosensitization were also statistically significant. Children living in coastal cities had a higher rate of monosensitization to indoor allergens and a lower prevalence of sensitization to birch pollen. The higher prevalence of allergic sensitization in children from coastal cities is most likely due to climatic conditions, such as proximity from sea and humidity. Differences in sensitization to birch allergens could be due to differential exposure to these pollen. Conclusion: These results indicate a role of environmental exposure in sensitization to perennial as well as seasonal allergens. [ABSTRACT FROM AUTHOR]

Summary: Background: Our aim was to explore the association between respiratory health and proximity air quality in elderly. Methods: The prevalence of respiratory conditions was linked in 2104 individuals aged ≥65 years recruited in Bordeaux (3C Study) to home address concentrations of NO2, CO, SO2, fine particles (PM10), VOCs and benzene, estimated through a dispersion model combining data on background air pollution, traffic characteristics, and conditions of topographical and meteorological dispersion of air pollutants. Results: Mean [minimum; maximum] values of the annual concentrations (μg/m3) of proximity air pollutants were respectively: 28 [18; 72.2] for NO2, 420 [350; 1337] for CO, 7.5[5; 13.7] for SO2, 23.1 [19; 51] for PM10, 8.1 [0.01; 116.6] for VOCs and 1.8 [1.5; 6.9] for benzene. Using a binary logistic regression model, PM10 were significantly associated with usual cough (Odds-Ratio=1.33 (95% confidence interval: 1.00–1.77) for exposed compared to non-exposed) and SO2 with usual cough (1.55 (1.16–2.08)) and phlegm (1.45 (1.04–2.01)). We found a 10% and a 23% increase in usual cough for a 10μg/m3 increment in PM10 and a 1μg/m3 increment in SO2 respectively, and a 23% increase in usual phlegm for a 1μg/m3 increase in SO2. A sensitivity analysis showed similar results when considering 3-year proximity pollution. A more pronounced effect of SO2 and PM10 on usual cough and phlegm was observed in woman. Conclusions: Our assessment of exposure to proximity air pollution has shown an increased prevalence of bronchitis-like symptoms in elderly living in areas polluted by SO2 and PM10. [Copyright &y& Elsevier]

Objective . To evaluate the prevalence of nocturnal symptoms in a large sample of asthmatic patients, and to assess the agreement between patients' complaints and general practitioners' (GPs') reports in primary care. Design . Cross-sectional survey involved 3,526 GPs and 751 specialists (pulmonologists and allergists) and included 13,493 patients with persistent asthma. Symptoms, treatment, and social and medical data were collected in real time by the patients and their GPs. Setting . France. Results . Prevalence of nocturnal symptoms was 60%. A total of 7,989 patients with nocturnal symptoms had complete data for both patients and GPs; 3,849 (48.1%) had perfect agreement between GP and their complaints for nocturnal symptoms (agreement group; [kappa = 1]); 3,376(42.2%) declared having no symptoms during the night, but these were detected by the GP during the visit (underestimated by patients and detected by GPs); 773(9.6%) declared having nocturnal symptoms, but these were not detected by GPs. Patients with a good agreement with their GP's opinion were significantly more frequently followed-up by a specialist than other patients ( p = 0.002). Conclusions . Nocturnal symptoms appear to be underdeclared by patients. GPs should therefore systematically ask their patients about nocturnal symptoms to increase control of asthma and to adequately manage its treatment. [ABSTRACT FROM AUTHOR]

Background: The space and time distribution of risk factors for allergic diseases may provide insights into disease mechanisms. Allergy is believed to vary by month of birth, but multinational studies taking into account latitude have not been conducted. Methods and Findings: A questionnaire was distributed in 54 centres to a representative sample of 20- to 44-y-old men and women mainly in Europe but also including regions in North Africa, India, North America, Australia, and New Zealand. Data from 200,682 participants were analyzed. The median prevalence of allergic rhinitis was 22%, with a substantial variation across centres. Overall, allergic rhinitis decreased with geographical latitude, but there were many exceptions. No increase in prevalence during certain winters could be observed. Also, no altered risk by birth month was found, except borderline reduced risks in September and October. Effect estimates obtained by a multivariate analysis of total and specific IgE values in 18,085 individuals also excluded major birth month effects and confirmed the independent effect of language grouping. Conclusion: Neither time point of first exposure to certain allergens nor early infections during winter months seems to be a major factor for adult allergy. Although there might be effects of climate or environmental UV exposure by latitude, influences within language groups seem to be more important, reflecting so far unknown genetic or cultural risk factors. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding a study which analysed the relationship between protease inhibitors (Pi) genotype and chronic obstructive pulmonary disease (COPD) in patients more than 65 years old.

Abstract: Introduction: Fine particles (PM2.5) are an important component of air pollution. Epidemiological studies have shown health effects due to ambient air particles, particularly allergies in children. Since the main difficulty is to determine exposure to such pollution, traffic air pollutant (TAP) dispersions models have been developed to improve the estimation of individual exposure levels. One such model, the ExTra index, has been validated for nitrogen oxide concentrations but not for other pollutants. The purpose of this study was to assess the validity of the ExTra index to assess PM2.5 exposure. Methods: We compared PM2.5 concentrations calculated by the ExTra index to reference measures (passive samplers situated under the covered part of the playground), in 15 schools in Bordeaux, in 2000. First, we collected the input data required by the ExTra index: background and local pollution depending on traffic, meteorology and topography. Second, the ExTra index was calculated for each school. Statistical analysis consisted of a graphic description; then, we calculated an intraclass correlation coefficient. Results: Concentrations calculated with the ExTra index and the reference method were similar. The ExTra index underestimated exposure by 2.2μgm−3 on average compared to the reference method. The intraclass correlation coefficient was 0.85 and its 95% confidence interval was [0.62; 0.95]. Conclusions: The results suggest that the ExTra index provides an assessment of PM2.5 exposure similar to that of the reference method. Although caution is required in interpreting these results owing to the small number of sites, the ExTra index could be a useful epidemiological tool for reconstructing individual exposure, an important challenge in epidemiology. [Copyright &y& Elsevier]

Abstract: Epidemiological studies have reported an increased risk of respiratory diseases in agricultural population, but a protective “farm-effect” has also been reported for asthma. In the AGRICAN cohort, self-reported doctor-diagnosed asthma was analyzed according to allergy, in relation with history of life-time exposure to 13 crops and 5 livestock, pesticide exposure and early life on a farm, taking into account sex, age, education and body mass index. Among the 1246 asthmatics (8.0%), 505 were allergic (3.3%) and 719 non-allergic (4.6%). In multivariate analysis, a significant excess was observed, only for allergic asthma, in vine-growing (OR=1.43, p =0.002), fruit-growing (OR=1.58, p =0.001), greenhouses (OR=1.66, p =0.02), grasslands (OR=1.35, p =0.009), beets (OR=1.52, p =0.003) and horses (OR=1.35, p =0.04). Pesticide use and history of pesticide poisoning were significantly associated with allergic asthma in grassland, vineyards and fruit-growing and with non-allergic asthma in beets. Living on a farm in the first year of life tended to be protective for childhood allergic asthma in farms with livestock (OR=0.72, p =0.07) but deleterious in farms with vineyards, fruit or vegetables (OR=1.44, p =0.07). In AGRICAN, an increased risk of allergic asthma was observed with crop exposure, pesticide use and early life on a farm, especially in vine-growing, grassland, beets, fruit and vegetable-growing. [Copyright &y& Elsevier]

Abstract: Purpose: This study examined the hypothesis that emotion and conduct problems (ECPs) may modify the relationships between ambient air pollutants and childhood asthma and eczema. Methods: In the cross-sectional study, 4209 French schoolchildren (aged 10–12 years) were investigated between March 1999 and October 2000. Ambient air pollutants exposures were estimated with dispersion modeling. Health outcomes and ECPs were evaluated by validated questionnaires, completed by the parents. Marginal models were used to analyze the relationships of exposures to ambient air pollutants and/or ECPs to asthma phenotypes and current eczema, adjusting for potential confounders. Results: In our population, interactions were found between ECPs and exposures to ambient air pollutants (benzene, carbon monoxide, nitrogen dioxide, nitrogen oxides, particulate matter with an aerodynamic diameter below 10 μm, volatile organic compounds) (P < .20). In addition, ECPs were related to current wheezing (adjusted prevalence odds ratio [aOR], 2.35; 95% confidence interval [CI], 1.59–3.47), current doctor-diagnosed asthma (aOR, 1.82; 95% CI, 1.25–2.66), and current eczema (aOR, 2.21; 95% CI, 1.61–3.02). Children with ECPs had 1.17–1.51 times higher aORs for the associations between ambient air pollutants and asthma phenotypes and current eczema than those without ECPs. Conclusions: ECPs may modify the relationships between ambient air pollutants and childhood asthma and eczema. [Copyright &y& Elsevier]