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Background: A study was undertaken to investigate whether dietary intake predicted the prevalence of adult asthma among French women participating in the E3N study. Methods: of 68 535 women who completed a food frequency questionnaire in 1993 which included 238 food items, 2145 (3.1%) reported having asthma. The distribution of food intake was divided into quartiles (Q1-Q4) and the prevalence of asthma was compared between the different quartiles (lowest as reference) using logistic regression models on cross sectional data. Results: After adjusting for age, body mass index, menopausal status, smoking status, total caloric intake, physical activity, and use of dietary supplements, women who had a greater intake of tomatoes (ORQ1-Q4 0.85 95% CI 0.75 to 0.96, test for trend p=0.02), carrots (ORQ1-Q4 0.81 95% CI 0.72 to 0.92, test for trend p=0.0003), and leafy vegetables (ORQ1-Q4 0.82 95% CI 0.73 to 0.93, test for trend p=0.0009) had a lower prevalence of asthma. Apples were marginally related to the prevalence of asthma. No other fruits or vegetables were significantly associated with asthma prevalence. Conclusions: These results suggest that the intake of some vegetables may decrease the prevalence of adult asthma. [ABSTRACT FROM AUTHOR]

Summary: Objective: To estimate the prevalence of asthma among children in France. Methods: Data from 3 French national studies were analyzed: the Decennial Health Interview Survey conducted in 2003 among a representative sample of households and 2 surveys conducted among representative samples of schoolchildren from 9th grade in 2003–2004 and 5th grade in 2004–2005. In the Decennial Health Interview Survey, data on respiratory health were collected using a self-administered questionnaire that was filled in by 1675 children aged 11–14 years living in selected households. For the studies among schoolchildren, 7104 children from 5th grade and 7284 from 9th grade were interviewed by the school nurse or physician using a standardized questionnaire. Results: The cumulative prevalence of asthma varied from 12.3 to 13.4% depending on the survey and the prevalence of current wheeze (wheezing in the past year) varied from 8.3 to 10.1%. The prevalence of current asthma (current wheeze in a child having already had an asthma attack or treatment for wheezing or asthma in the past year) was nearly 9% in 5th-grade and 9th-grade schoolchildren. Asthma was not controlled (at least 4 attacks, 1 awakening per week, 1 severe attack, 4 unplanned medical visits, or 1 hospitalization in the past year) in 38.5% of the 598 asthmatic teenagers from 9th grade, and 29.2% did not declare any anti-inflammatory drug treatment in the past week in spite of the absence of asthma control. Conclusion: The prevalence of current asthma among children in France is estimated at 9%. Asthma control and treatment remain insufficient. Improving therapeutic and educational management of asthma among children and teenagers is necessary. [Copyright &y& Elsevier]

Background: The burden of undiagnosed obstructive lung disease (OLD) (mainly asthma and chronic obstructive pulmonary disease) is not fully established, and targets for corrective action are yet to be identified. We assessed the underdiagnosis of OLD and its determinants in France., Methods: CONSTANCES is a French population-based cohort of adults aged 18-69 years at inception. We analysed data collected at inclusion in 2013-2014. Undiagnosed OLD was defined as spirometry-confirmed airflow limitation (FEV 1 /FVC < lower limit of normal) without prior diagnosis of asthma, chronic obstructive pulmonary disease, or bronchiectasis. Multivariate analysis was performed with weighted robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of undiagnosed OLD., Results: Spirometry results were available for 19,398 participants. The prevalence of airflow limitation was 4.6%. Overall, 64.4% of adults with airflow limitation did not report a previous diagnosis of OLD. Individuals with high cumulative tobacco consumption (≥ 10 pack-years) (aPR: 1.72 [1.28-2.32]), without respiratory symptoms (aPR: 1.51 [1.28-1.78]), and with preserved lung function (aPR: 1.21 [1.04-1.41] for a 10-point increase in FEV 1 % predicted) had a higher risk of being undiagnosed. Half of symptomatic individuals with airflow limitation (45% of those with moderate to severe airflow limitation) were undiagnosed with OLD., Conclusion: Underdiagnosis of OLD is very common among French adults, even in patients with respiratory symptoms. Efforts should be made in France to raise awareness about OLD in the general population, improve the detection of respiratory symptoms, and increase the use of spirometry among primary care professionals., (© 2021. The Author(s).)

Introduction: The objectives of our study were to estimate the prevalence of asthma in adults in France and to study the effects of gender on the associations of asthma with the corpulence and socio-economic characteristics of individuals., Methods: We estimated the prevalence of current asthma (asthma attack in the past 12 months or current treatment for asthma) from data collected at inclusion in the Constances cohort study in 2013-2014. Analyses were performed separately in men and women, using robust Poisson regression for multivariate analysis., Results: Using data from 34,100 participants in the cohort (men: 47.7 %; mean age: 44.6 years), the prevalence of current asthma was estimated to be 5.8 % (5.1 % in men, 6.4 % in women). The risk of asthma was increased in women with high body mass index (BMI) or waist circumference. In men, only a high waist circumference was associated with an increased risk of asthma. An association with low socioeconomic status was observed only among women., Conclusion: The associations of asthma with corpulence and socioeconomic status differed between men and women. Additional analyses should provide a better understanding of the mechanisms responsible for these differences., (Copyright © 2021 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: The gender switch in asthma incidence around puberty has been put forward to suggest a role of sex hormones in asthma. However, there are limited and inconsistent findings on change in asthma incidence with menopause. We aimed to investigate the associations between menopause and asthma incidence, and interactions with overweight/obesity., Methods: Asthma incidence was assessed in 67,872 women free of asthma at baseline (aged 41-68 years) and regularly followed up as a part of the French E3N cohort. Adjusted hazard ratios (aHR) were derived from Cox models considering age as the time-scale, menopausal status as a time-varying covariate and taking into account menopausal treatment., Results: During 843,243 person-years of follow-up, 1205 new-onset asthma cases were identified. Compared with pre-menopause, surgical menopause was associated with an increased risk of asthma onset (aHR = 1.33 [95%CI 1.01-1.75]) but no association was observed for natural menopause (aHR = 1.05 [0.84-1.32]). In women with natural menopause, a further analysis separating the transition through menopause and the later post-menopausal period did not show any change in asthma incidence with menopause in the total sample or in normal-weight women alone. However, in overweight/obese women, peri-menopausal and post-menopausal women had an increased risk of developing asthma compared with pre-menopausal women of the same age (aHR = 1.91 [1.00-3.66] and aHR = 2.08 [1.07-4.06] respectively)., Conclusion: Surgical menopause was associated with an increased risk of asthma onset. For natural menopause, no change in asthma incidence was observed in normal-weight women. However, overweight/obese women had an increased risk of developing asthma after natural menopause., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: The aims were to assess 1) the relationship of asthma control assessed by combining epidemiological survey questions and lung function to Health-Related Quality of Life (HRQL) and 2) whether individuals with controlled asthma reach similar generic HRQL levels as individuals without asthma., Methods: The analysis included 584 individuals without asthma and 498 with asthma who participated in the follow-up of the Epidemiological study on Genetics and Environment of Asthma (EGEA). Asthma control was assessed from survey questions and lung function, closely adapted from the 2006-2009 Global Initiative for Asthma guidelines. The Asthma Quality of Life Questionnaire (AQLQ, scores range:1-7) and the generic SF-36 (scores range: 0-100) were used., Results: Adjusted mean total AQLQ score decreased by 0.5 points for each asthma control steps (6.4, 5.9 and 5.4 for controlled, partly-controlled and uncontrolled asthma respectively, p < 0.0001). The differences in SF-36 scores between individuals with controlled asthma and those without asthma were minor and not significant for the PCS (-1, p = 0.09), borderline significant for the MCS (-1.6, p = 0.05) and small for the 8 domains (<5.1) although statistically significant for 4 domains., Conclusion: These results support the discriminative properties of the proposed asthma control grading system and its use in epidemiology., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: Few data on regional variations in asthma prevalence are available in France., Methods: The study was carried out during the academic year 2005-2006 in a random sample of around 20,000 children in the last year of nursery school. The lifetime prevalence of asthma and the preceding year prevalences of asthma-like symptoms and treatment for wheezing or asthma attacks were estimated by region., Results: Overall, the lifetime prevalence of asthma was 9.8 % and the past-year prevalence of wheezing was 10.7 %. An increasing trend in prevalence was observed from Eastern to Western France and in overseas territories. The regional variations in past-year prevalence of wheezing remained when adjusting for gender, family structure and the number of siblings. Among children who had wheezed or received a treatment in the past year, 42 % had experienced frequent or severe symptoms., Conclusion: Large regional variations in asthma prevalence among young children in France exist., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Background: Various volatile organic compounds (VOCs) have been related to respiratory health effects, but have generally been assessed individually without taking into account the fact that such pollutants are highly correlated to one other., Aims: We investigated the effects of exposure to various VOC, and considered their combined effect on adult asthma and rhinitis., Method: A national cross-sectional representative survey conducted by the Indoor Air Quality Observatory objectively assessed 20 VOCs in 490 main dwellings in France. A standardized questionnaire determined the prevalence of asthma and rhinitis among 1012 inhabitants of the dwellings (≥ 15 years). Marginal models for binary outcome were used to relate VOCs exposure to asthma and rhinitis, controlling for potential confounders. A global score representing the number of VOCs in each dwelling with an elevated concentration (using the 3(rd) quartile value of the distribution as a threshold value) was then derived as a measure of the combined effect of VOCs. Specific scores were built using a similar approach, grouping VOCs by family., Results: Asthma (8.6%) was significantly associated with N-undecane and 1,2,4-trimethylbenzene and rhinitis (38.3%) with ethylbenzene, trichloroethylene, m/p- and o-xylene. The global VOC score was associated with a significant risk of asthma and rhinitis (odds ratio (OR) of 1.40 and 1.22, respectively, for 5 additional VOCs with high exposure level). Both specific scores for aromatic hydrocarbons and aliphatic hydrocarbons were associated with a significantly risk of asthma (OR=1.12; 95% confidence interval (CI): 1.01-1.24 and OR=1.41; 95% CI=1.03-1.93, respectively). The specific VOC score for halogenated hydrocarbons was associated with a significant risk of rhinitis (OR=1.28; 95% CI: 1.07-1.54)., Conclusion: We have shown that high concentrations of VOCs in homes were associated with an increasing prevalence of asthma and rhinitis in adults., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The aim of the present study was to determine dietary patterns and investigate their association with asthma incidence, current asthma and frequent asthma exacerbations. Dietary habits and asthma data were collected from the large E3N study (of French females, mostly teachers). Of the 54,672 females followed-up in 2003, 2,634 reported ever-adulthood asthma, 1,063 reported current asthma, 206 reported frequent asthma attacks (one or more a week), and 628 reported asthma onset between 1993 and 2003. Using principal component analysis, three dietary patterns were identified: the "prudent" pattern (fruits and vegetables); the "Western" pattern (pizza/salty pies, dessert and cured meats); and the "nuts and wine" pattern. Pattern scores were categorised into tertiles, and the incidence and prevalence of asthma was compared between tertiles. After adjustment for confounders, no association of dietary patterns was observed with asthma incidence, ever-asthma or current asthma. The Western pattern was associated with an increased risk of reporting frequent asthma attacks (highest versus lowest tertile odds ratio (OR) 1.79, 95% confidence interval (CI) 1.11-3.73). Increasing scores of the nuts and wine pattern were associated with a decreased risk of reporting frequent asthma attacks (highest versus lowest tertile OR 0.65, 95% CI 0.31-0.96). The results of the present study suggest that overall diet could be involved in frequent asthma exacerbations, one aspect of asthma severity.

Background: Endothelin-1 (EDN1) has been involved in the development of airway obstruction and inflammation in asthma. Several polymorphisms have been identified among the genes encoding for preproET1, an inactive precursor of ET-1, and for ETA (EDNRA) and ETB (EDNRB), the two receptors for EDN1. In the present work, we hypothesised that molecular variation in these genes could be a major determinant of the degree of bronchial obstruction. The purpose of this study was to investigate whether the genetic polymorphisms of preproET-1, EDNRA and EDNRB genes were associated with the degree of airway obstruction, assessed by FEV1., Methods: Polymorphisms of preproET-1, EDNRA and EDNRB were first studied in a population of adult asthmatic patients. Results were confirmed in a large population of adults from the general population from the ECRHS II study., Results: In our population of adult asthmatic patients, the EDNRB-30G>A (Leu277Leu) polymorphism (GG genotype) is strongly associated with a low FEV1 and with a higher percentage of patients with FEV1 < 80% of predicted value. No relationship was found between pulmonary function and EDNRA-1363C>T (His323His) or preproET-1-595G>T (Lys198Asp) polymorphism. In the adult population from the ECRHS II, we found a similar association between GG genotype and a low FEV1 or a higher percentage of subjects with FEV1 < 80% predicted, especially in the subgroups of asthmatics subjects (OR = 4.31 (95%CI 1.03 - 18.04)) and smokers (OR = 7.42 (95%CI 1.69 - 32.6))., Conclusion: the EDNRB-30G>A polymorphism could be a determinant of airway obstruction in humans with predisposing factors such as tobacco smoke exposure or asthma.

Reduced pulmonary function is an important predictor of cardiovascular morbidity and mortality. The mechanisms underlying this association are unknown but may involve systemic inflammation. We assessed the cross-sectional and longitudinal relationships between C-reactive protein (CRP) levels and forced expiratory volume in 1s (FEV1) and its decline in the general population, over a period of 8.5 years. The analyzes were based on 531 subjects (mean age at baseline: 37+/-7 years, 50% women and 42% non-smokers), recruited at two French centers participating in the European Community Respiratory Health Survey. Lung function was expressed as a percentage of predicted FEV1. CRP was measured centrally, by means of a highly sensitive assay. In cross-sectional analysis, FEV1 as a % of predicted values was negatively associated with serum CRP concentration (P=0.002). Multivariate adjustment did not alter these results (P=0.002). In longitudinal analysis, annual FEV1 decline tended to increase from the lower to the upper tertile for baseline CRP concentration but the association was borderline significant (P=0.14). Mean values of annual FEV1 decline were 26+/-32, 31+/-32, and 34+/-32 ml/year for the lower, middle and upper tertiles of baseline CRP concentration, respectively, after adjusting for potential confounders (P=0.09). Changes in CRP levels during follow-up were associated with annual FEV1 decline. The mean annual FEV1 declines in subjects with increasing CRP, in those with stable CRP and in those with decreasing CRP were 36+/-31, 30+/-31 and 24+/-31 ml/year, respectively (P<0.001). These findings were not affected by adjustment for potential confounders (P=0.002). In conclusion, increases in CRP levels over time were associated with a steeper FEV1 decline.

To evaluate the impact of body mass index (BMI) (weight (kg)/height (m)(2)) and change in body silhouette on asthma risk, the authors investigated a cohort of women participating in the E3N Cohort Study in France from 1990 to 1993. The authors identified 372 incident cases of asthma among 67229 women aged 40-65 years at baseline. Data were analyzed using proportional hazard models to determine the risk of asthma incidence in relation to BMI and body silhouette. Reported BMI at baseline was related to the incidence of asthma, with a significantly increased risk corresponding to increasing BMI quintiles (test for trend: p < 0.001). Compared with a BMI of 20-21.4 (second quintile), women with a BMI >or=27 had double the risk of incident asthma after adjustment for potentially confounding factors (multivariate relative risk = 2.02, 95% confidence interval: 1.38, 2.98). Increase in body mass between menarche and the start of the follow-up study was significantly related to asthma risk (for an increase of two silhouettes, relative risk = 1.66, 95% confidence interval: 1.18, 2.32). The authors conclude that a high BMI is significantly related to the risk of asthma incidence and that an increase in body silhouette between menarche and adulthood is related to the incidence of asthma later in life.

Recent studies of children suggest that factors encountered in a farm environment might protect against the development of allergy. However, it remains uncertain whether living on a farm in childhood is associated with a decreased risk of atopic diseases in adulthood. We analyzed data from 6,251 randomly selected adults 20 to 44 yr of age participating in the European Community Respiratory Health Survey (ECRHS). Subjects answered a detailed questionnaire and underwent specific IgE measurements to five allergens. After adjustment for potential confounders, including pet exposure in childhood, number of siblings, severe respiratory infection in childhood, and parental history of allergy, living on a farm in childhood was associated with a reduced risk of atopic sensitization in adulthood (OR = 0.76, CI 95% = 0.60-0.97). Compared with other adults, those who had lived on a farm as a child were less frequently sensitized to cat (OR = 0.63, CI 95% = 0.41-0.96) and to Timothy grass (OR = 0.68, CI 95% = 0.50-0.94), and were at lower risk of having nasal symptoms in the presence of pollen (OR = 0.80, CI 95% = 0.64-1.02). The protective effect of farming environment in childhood observed in this population-based sample of young adults provides evidence in favor of the hypothesis that environmental factors encountered in childhood may have a lifelong protective effect against the development of allergy.

Quality of life has been found to be impaired both in patients with asthma and in patients with allergic rhinitis, but the relative burden of these diseases has not been investigated. We analyzed answers to the SF-36 questionnaire from 850 subjects recruited in two French centers participating in the European Community Respiratory Health Survey, a population-based study of young adults. Both asthma and allergic rhinitis were associated with an impairment in quality of life. However, 78% of asthmatics also had allergic rhinitis. Subjects with allergic rhinitis but not asthma (n = 240) were more likely than subjects with neither asthma nor rhinitis (n = 349) to report problems with social activities, difficulties with daily activities as a result of emotional problems, and poorer mental well-being. Patients with both asthma and allergic rhinitis (n = 76) experienced more physical limitations than patients with allergic rhinitis alone, but no difference was found between these two groups for concepts related to social/mental health. As asthma was not found to further impair the quality of life in subjects with allergic rhinitis for concepts related to mental disability and well-being, and as subjects with asthma often also suffer from allergic rhinitis, further studies on quality of life in asthma should ensure that the impairment in quality of life attributed to asthma could not result from concomitant allergic rhinitis.

To test the hypothesis that a greater proportion of women than men react to methacholine challenge and investigate the possible reasons for any differences observed, we recruited 495 subjects 20 to 44 yr of age (50.9% male) in Paris and 304 subjects (51.3% male) in Montpellier (France), as part of the European Community Respiratory Health Survey. The proportion of responders (PD20 < or = 4 mg methacholine) was 33.7% in women and 11.9% in men (odds ratio = 3.8; 95% confidence interval = 2.4-6.0) in Paris and 43.2% in women and 29.5% in men (odds ratio = 1.8; 95% confidence interval = 1.1-2.9) in Montpellier. These differences could not be explained by asthma, respiratory symptoms, atopy, or lung function parameters. In stepwise logistic regressions including sex, asthma, and asthma-like symptoms, nasal allergies, atopy, baseline FEV1, FEV1%pred, FVC, and FEV1%FVC, the odds-ratios for the effect of female sex on PD20 < or = 4 mg methacholine were 5.2 (3.0-9.0) in Paris and 2.2 (1.2-3.8) in Montpellier. Reacting to low doses of methacholine (PD20 < or = 0.5 mg) was associated with asthma and atopy in both men and women. In contrast, reacting to doses between 0.5 and 4 mg was associated with asthma and atopy only in men and with heavy tobacco consumption only in women. We conclude that the excess of hyperresponsiveness in women is not due to their having smaller lung size or airway caliber than men and may be related to a greater susceptibility to smoking.