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Background: We studied the prevalence rate of exercise-induced bronchoconstriction (EIB) in Annaba schoolchildren. No previous assessment of this syndrome had ever been done in Algeria., Methods: EIB was evaluated using the 6 min free running test (6MFRT) on 286 children, 87.4% of whom were 10-12 years old. They performed the test in the morning, during the autumn-winter season. Peak expiratory flow rate (PEFR) was measured before, and then 5 and 10 min after the 6MFRT, a 15% or more decrease in post-exercise PEFR being defined as significant., Results: EIB was much more frequent in asthmatic than in nonasthmatic children (47.0% vs. 13.9%, p < .001) and the drop in PEFR was more marked among the former. EIB was observed more often in a cool temperature (<8°C). There were relatively more children who were either eutrophic or overweight among those presenting an EIB. Past histories of nocturnal wheezing and rhinoconjunctivitis presented respectively the best specificity (96.7%) and sensitivity (84.8%). Children of unemployed workers presented the highest occurrence of EIB. Passive smoking appeared as the only factor being related to EIB among the indoor pollutants. The prevalence rate of asthma (6.7%) was higher than in a previous cross-sectional epidemiological survey study performed in the Maghreb. The prevalence rate of EIB (13.9%) was situated in the upper range of the results given worldwide., Conclusions: These features of a fairly high bronchial hyperresponsiveness could be facilitated by the polluted environment of the city.

After exclusion of diverse pulmonary illnesses, the remaining explanations for chronic cough include medication with angiotensin-converting enzyme (ACE) inhibitor, gastroesophageal reflux disease (GERD), and post-nasal drip. Different clinics report shifting frequencies for both the causes of chronic cough and the success of treatment. However, after all evaluations, differential diagnosis still leaves a group of patients with unexplained cough. This unexplained cough is also known as chronic idiopathic cough (CIC), though there are widely varying opinions as to its existence. Among patients previously diagnosed with CIC, a subgroup has been identified with both upper and lower airway symptoms, including cough induced by odours and chemicals, and with increased cough sensitivity to inhaled capsaicin, which is known to stimulate the airway sensory nerves. A suggested explanation for this condition is a hyperreactivity of the sensory nerves of the entire airways, and hence the condition is known as sensory hyperreactivity (SHR). SHR affects more than 6% of the adult population in Sweden. It is a longstanding condition, and is clearly associated with significant social and psychological impacts., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Asthma diagnosis is a challenging condition, particularly in patients without obstructive pattern and reversibility on spirometry. Determination of airway hyperresponsiveness (AHR) may be helpful, but the procedure is time-consuming and not always practical., Objective: To determine the potential factors that may predict the presence of AHR in children with asthmalike symptoms but without obstructive pattern and reversibility on spirometry., Methods: All patients with asthmalike symptoms but without obstructive pattern and reversibility on spirometry were analyzed retrospectively between January 9, 2007, and December 30, 2009. The features of clinical history and laboratory results were analyzed with univariate and multivariate regression analysis., Results: A total of 111 children between 6 and 18 years of age, with a median age of 10.2 years, were analyzed, and AHR was detected in 67 patients (60.3%). Multivariate logistic regression analysis revealed coexistence of nocturnal cough and exercise-induced cough (odds ratio [OR], 22.1; 95% confidence interval [CI], 3.1-159.2; P = .004), eosinophilia (OR, 18.7; 95% CI, 1.9-178.7; P = .01), and borderline bronchodilator response in forced expiratory volume in 1 second (between 7% and 11%) (OR, 10.1; 95% CI, 2.1-49.1; P = .004) as significant risk factors for the presence of AHR, whereas exercise-induced dyspnea was found to be related to the absence of AHR (OR, 0.2; 95% CI, 0.1-0.8; P = .02)., Conclusion: In children with asthmalike symptoms but with normal spirometry, certain features of clinical history and laboratory results can strongly predict the presence of AHR and may help less frequent use of challenge tests., (Copyright © 2011 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: The health of workers in health care has been neglected in the past. There are few reports regarding occupational asthma (OA) in this group, and work-exacerbated asthma (WEA) has rarely been considered., Methods: We examined the frequency of claims for OA and WEA allowed by the compensation board in Ontario, Canada for which industry was coded as "health care" between 1998 and 2002, to determine the frequency of OA and WEA, causative agents, and occupations., Results: During this period, five claims were allowed for sensitizer OA, two for natural rubber latex (NRL), and three for glutaraldehyde/photographic chemicals. The two NRL cases occurred in nurses who had worked for >10 years prior to "date of accident." There were 115 allowed claims for WEA; health care was the most frequent industry for WEA. Compared to the rest of the province, claims in health care made up a significantly greater proportion of WEA claims (17.8%) than OA (5.1%) (odds ratio, 4.1, 95% CI 1.6-11.6; P = 0.002). The rate of WEA claims was 2.1 times greater than that in the rest of the workforce (P < 0.0001). WEA claims occurred in many jobs (e.g., clerk), other than "classic" health care jobs such as nurses, and were attributed to a variety of agents such as construction dust, secondhand smoke, and paint fumes., Conclusions: WEA occurs frequently in this industrial sector. Those affected and attributed agents include many not typically expected in health care. The incidence of OA claims in this sector in general was low; the continued low number of OA claims due to NRL is consistent with the successful interventions for prevention., (Copyright © 2011 Wiley-Liss, Inc.)

The forced oscillation technique (FOT) can be used to determine airway hyperresponsiveness, but the cut-points for changes in respiratory system conductance (Grs) and reactance (Xrs) that define a positive mannitol challenge are not known. Furthermore, the effects of changes in lung volume on these cut-points or on the repeatability of the test are unknown. In 15 non-asthmatic and 52 asthmatic subjects, response to mannitol challenge was measured by Grs and Xrs, using FOT, and by FEV(1). The FOT variables were adjusted for inspiratory capacity (IC) at each dose. Dose response slope (DRS) was used in receiver operator characteristic (ROC) analysis to compare the ability of adjusted and unadjusted DRSGrs and DRSXrs to detect a positive challenge, defined as PD(15)FEV(1) ≤635 mg mannitol. Mannitol challenges were positive in 32 asthmatic and 2 non-asthmatic subjects. Both DRSGrs and DRSXrs detected positive challenges (p < 0.0001 for both), and this was not altered by adjustment for IC for either DRSGrs (p = 0.21) or DRSXrs (p = 0.90). FOT cut-points for a positive challenge were 27% fall in Grs or 0.93 cm H(2)O/L/s decrease in Xrs at 635 mg. Repeatability of DRSGrs (±2.01 doubling doses) and DRSXrs (±1.95dd) was comparable with DRSFEV(1) (±1.67dd) and was not improved by adjustment for IC. Grs and Xrs, measured by FOT, provide a sensitive, repeatable measure of response to mannitol challenge. Adjusting for lung volume does not alter the ability of these variables to detect a positive response or the repeatability of the measurement., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Background: Airway hyperresponsiveness is highly prevalent in competitive swimmers, but it is unknown whether this is transient or persistent., Objectives: To document changes in airway responsiveness and airway inflammation in elite swimmers during intense training and rest., Methods: Nineteen swimmers and 16 healthy controls completed a standardized questionnaire, allergy skin prick tests, exhaled nitric oxide measurement, eucapnic voluntary hyperpnea testing, methacholine challenge, and induced sputum analysis. Testing was performed during intense swimming and after at least 2 weeks of rest., Results: Sixteen swimmers and 13 controls were atopic. Airway responsiveness to methacholine and eucapnic voluntary hyperpnea was significantly higher in swimmers than in controls (P < .0001). A significant decrease in airway responsiveness was observed from training to rest in swimmers only (P < .005). This occurred with both methacholine challenge--with PC(20) values of 6.0 mg/mL and 12.8 mg/mL, respectively--and eucapnic voluntary hyperpnea testing--with a maximum fall in FEV(1) after voluntary testing of 14.1 L and 10.1 L, respectively. Eight of 12 swimmers with airway hyperresponsiveness during intense training had normal airway responsiveness during rest. No airway inflammation occurred, and no significant change in this parameter was observed from training to rest., Conclusion: Training may contribute to the development of airway hyperresponsiveness in elite swimmers, but this seems reversible in many athletes after training cessation for at least 2 weeks., (Copyright © 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)

Background: Symptoms of obstructive lung disease in domestic cleaning staff have been related to the use of bleach and other irritant cleaning products., Material and Methods: Included in the study were thirteen cleaning employees with work-related asthma-like symptoms, three asthmatic controls and three atopic subjects without bronchial hyperresponsiveness (BHR) who had no exposure to cleaning products. The study protocol consisted of a methacholine test, sputum induction and fraction of exhaled nitric oxide measurement (FENO) both at baseline and 24 hr after a 1-hr inhalation challenge with either placebo or bleach at a concentration of 0.4 ppm of chlorine., Results: The inhalation of the placebo caused no bronchial reactions. Mean maximum fall in FEV(1) during challenge testing with bleach was significantly higher than the values obtained during the placebo challenge. Inhalation challenge with bleach elicited two isolated late asthmatic reactions and one dual asthmatic reaction. Of all the patients who underwent challenge testing with bleach, only one had a ≥2-fold decrease in methacholine PC(20) 24 hr after the challenge. No significant correlation was found between maximum fall in FEV(1) and PC(20) methacholine. Following challenge testing with bleach, no clinically significant changes in sputum cell counts or FENO were detected., Conclusions: These results suggest that bleach inhalation at a concentration of 0.4 ppm-a concentration below 8-hr permissible occupational exposure level-brings about a substantial decrease in FEV1 in subjects with and without BHR. Some subjects have a positive challenge response to bleach inhalation., (Copyright © 2010 Wiley-Liss, Inc.)

Objective: To evaluate the prevalence of and risk factors for asthma and related conditions in the Canaries, Spain., Methods: From a randomised sample of 9506 adults aged 20-44 years who answered a short questionnaire, a random sample corresponding to 20% of the original was taken. Subjects classified as symptomatic in the previous survey and who were not included in the random sample were also invited to participate. The subjects completed a respiratory questionnaire, and underwent spirometry, bronchial hyperresponsiveness (BHR) test, skin tests and immunoglobulin E (IgE) measurements., Results: The random sample included 593 subjects. The prevalence of skin sensitisation to mites was 30.3% (95%CI 26.7-34.2) and the prevalence of IgE to mites 30.5% (95%CI 26.2-35.2). A prevalence of 40.6% (95%CI 35.9-45.5) was found for atopy, 14.1% (95%CI 11.1-17.1) for BHR and 4.2% (95%CI, 2.5-5.9) for asthma. The risk factors most strongly associated with asthma were atopy (OR 4.89, 95%CI 3.07-7.78) and respiratory infection before the age of 5 years (OR 2.78, 95%CI 1.66-4.67)., Conclusion: This study shows a high prevalence of sensitisation to mites, atopy, BHR and asthma in the Canaries, similar to that observed in English-speaking countries. We suggest that these findings could partially result from climatic conditions.

Rationale: Few studies have investigated the factors associated with the early inception of chronic obstructive pulmonary disease (COPD)., Objectives: We investigated COPD risk factors in an international cohort of young adults using different spirometric definitions of the disease., Methods: We studied 4,636 subjects without asthma who had prebronchodilator FEV(1)/FVC measured in the European Community Respiratory Health Survey both in 1991 to 1993 (when they were 20-44 yr old) and in 1999 to 2002. COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease fixed cut-off criterion (FEV(1)/FVC < 0.70), and two criteria based on the Quanjer and LuftiBus reference equations (FEV(1)/FVC less than lower limit of normal). COPD determinants were studied using two-level Poisson regression models., Measurements and Main Results: COPD incidence ranged from 1.85 (lower limit of normal [Quanjer]) to 2.88 (Global Initiative for Chronic Obstructive Lung Disease) cases/1,000/yr. Although about half of the cases had smoked less than 20 pack-years, smoking was the main risk factor for COPD, and it accounted for 29 to 39% of the new cases during the follow-up. Airway hyperresponsiveness was the second strongest risk factor (15-17% of new cases). Other determinants were respiratory infections in childhood and a family history of asthma, whereas the role of sex, age, and of being underweight largely depended on the definition of COPD used., Conclusions: COPD may start early in life. Smoking prevention should be given the highest priority to reduce COPD occurrence. Airway hyperresponsiveness, a family history of asthma, and respiratory infections in childhood are other important determinants of COPD. We suggest the need for a definition of COPD that is not exclusively based on spirometry.

Objective: We attempted to investigate the relationship between migraine without aura (MwoA) and bronchial hyper-reactivity to postulate inflammation as an underlying mechanism in migraine., Background: Comorbidity of migraine and atopic diseases such as asthma has been an argument for suspected immune system dysfunction in migraineurs., Methods: Twenty patients with MwoA and 5 control subjects without history of atophy and asthma were included in study. Subjects with abnormal physical examination and chest radiographs were excluded. After a normal spirometry, methacholine bronchoprovocation test was performed in all subjects and controls according to 5 breath dosimeter methods., Results: Sixteen of 20 patients and 2 of 5 control subjects were women. Mean ages were 37.5 (19-56) and 33.8 (26-43) years, respectively. Methacholine bronchoprovocation test was positive in 3 patients (15%) but was normal in all controls (0%)., Conclusions: The relationship between MwoA and bronchial hyper-reactivity may help to postulate the inflammation in migraine as an underlying mechanism., (© 2010 American Headache Society.)

Purpose: A high prevalence of bronchial hyperresponsiveness (BHR) and respiratory symptoms has been reported among competitive swimmers. From the 2002 Winter Olympics, BHR measurements or bronchodilator reversibility have been required for approved use of β2-agonists in sports. The first aim of this study was to evaluate the relationship among respiratory symptoms in young elite swimmers, eucapnic voluntary hyperpnea (EVH), and the inhaled dose of methacholine, causing a 20% decrease in forced expiratory volume in 1 s (FEV1; PD(20 methacholine)). The second aim of this study was to assess the repeatability of the EVH test., Methods: For this study, 15 male and 9 female adolescent elite swimmers, aged 15 to 25 yr, performed one PD(20 methacholine) test and two EVH tests in a randomized order. Dry air containing 5% CO2 was inhaled for 6 min with a target ventilation of ≥85% of maximum voluntary ventilation (minimum = 65%). PD(20 methacholine) ≤2 μmol and EVH with FEV1 reduction ≥10% were considered positive. Respiratory symptoms and medication were reported in the modified AQUA2008 questionnaire., Results: Twenty swimmers (83%) reported respiratory symptoms, 13 (65%) of them had a positive provocation test. Fourteen (58%) had at least one positive test to either EVH or PD(20 methacholine); three had only one positive EVH test. One athlete had BHR without symptoms. The sensitivity of PD(20 methacholine) ≤2 μmol for respiratory symptoms was 50% versus 60% and 47.37% for the two EVH tests, respectively, and 75% for PD(20 methacholine) ≤4 μmol. The Bland-Altman plot of the two EVH tests showed a consistent distribution, with only one subject outside the limits of agreement., Conclusions: BHR was frequently found among adolescent competitive swimmers. PD(20 methacholine) ≤2 μmol and EVH ≥ 10% compared well, but PD(20 methacholine) ≤4 μmol had the highest sensitivity for respiratory symptoms. The EVH test has high repeatability but is very expensive and uncomfortable to perform.

Aim: To describe the point prevalence of current physician-diagnosed asthma and bronchial hyperreactivity (BHR) in 2001 among unselected Danish schoolchildren aged 6-17 years, compared with the prevalence from a similar study from 1990 to 1991., Methods: Cross-sectional study using parental questionnaire on asthma and respiratory symptoms combined with a 6-min free running test with peak expiratory flow rate (PEFR) measurement (n = 1051, response rate 89.3%). Results were compared with those of a similar study in the same area from 1990 to 1991. Main outcome measures were current physician-diagnosed asthma or BHR in children without physician-diagnosed asthma measured by either a decrease in lung function after standardized running test and/or variability in PEFR on home monitoring., Results: The prevalence of current physician-diagnosed asthma was 4.0% [95% confidence interval (CI) 2.7-5.3%] in 1990-1991 and 3.6% (95% CI 2.4-4.8%) in 2001. The prevalence of BHR was 3.2% (95% CI 2.0-4.4%) in 1990-1991 and 2.0% (95% CI 1.1-2.9%) in 2001. The combined prevalence was 7.2% (95% CI 5.4-8.9%) in 1990-1991 and 5.6% (95% CI 4.2-7.1%) in 2001., Conclusion: The point prevalence of current physician-diagnosed asthma and BHR among unselected Danish schoolchildren aged 6-17 years was unchanged over 10 years between 1990-1991 and 2001., (© 2010 The Author(s)/Acta Paediatrica © 2010 Foundation Acta Paediatrica.)

Assessment of problematic severe asthma in children should be performed in a step-wise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessment is performed to identify issues that may need attention, including comorbidities. Thirdly, the pattern of inflammation is assessed, and finally steroid responsiveness is documented. Based upon these four steps an optimal individualised treatment plan is developed. In this article the many gaps in our current knowledge in all these steps are highlighted, and recommendations for current clinical practice and future research are made. The lack of good data and the heterogeneity of problematic severe asthma still limit our ability to optimise the management on an individual basis in this small, but challenging group of patients.

The impact of single exposures on asthma development is better understood than the effect of multiple exposures. The objective of the present study was to evaluate the effect of combined early exposure to dog allergen (Can-f1) plus indoor nitrogen dioxide (NO₂) or environmental tobacco smoke (ETS) on asthma and bronchial hyperreactivity (BHR) in a high-risk birth cohort. We also aimed to assess atopy's impact on the effects of these exposures. Peri-birth ETS exposure was measured using cord blood cotinine (CCot). During year 1, atopy, NO₂, Can-f1, and urinary cotinine (UCot) were measured. At 7 yrs of age, 380 children were assessed for asthma and BHR. Exposure effects were determined using stepwise multiple linear regression. Co-exposure to elevated Can-f1 and NO₂, or Can-f1 and ETS (CCot), increased risk for asthma, relative to having neither such exposure (OR 4.8 (95% CI 1.1-21.5) and 2.7 (1.1-7.1), respectively); similar risks resulted when substituting dog ownership for allergen. Atopy increased asthma and BHR risk associated with several exposures; notably, atopy with elevated UCot, relative to atopy without such exposure, increased risk of BHR (OR 3.1 (95% CI 1.1-8.6)). In a high-risk birth cohort, early co-exposure to Can-f1 and NO₂ or ETS increased the risk of incident asthma. Atopy increased the risk of asthma and BHR associated with ETS.

Background: There is a paucity of data regarding respiratory health in restorers of cultural heritage or similar occupations, such as visual artists or museum workers, although they are exposed to a complex mixture of various respiratory hazards., Aims: To evaluate atopy and respiratory health parameters, including bronchial and nasal non-specific reactivity, in restorers and conservators of cultural heritage (restorers)., Methods: Fifty-six restorers and 62 controls provided general data and data on ever experienced rhinitic or asthma-like symptoms, spirometry, non-specific bronchial and nasal responsiveness to histamine, skin prick testing to common inhalational allergens and serum total IgE levels., Results: Spirometry values were in the range of normal values in 55 of 56 restorers and did not differ significantly from those in control subjects. However, restorers had more than two times higher prevalence of nasal hyper-responsiveness (NHR), with 2.3 times higher risk of NHR compared to controls [95% confidence interval (CI): 1.4-3.6, P < 0.001]. The risk of NHR was slightly reduced by increasing age (odds ratio 0.95, 95% CI: 0.91-0.99, P < 0.05). NHR was not associated with gender, smoking status, bronchial hyperresponsiveness (BHR), upper or lower respiratory symptoms or atopy status., Conclusions: Compared with controls, the studied group of workers occupationally exposed to respiratory hazards during restoration/conservation activities had no deterioration of lung function but had an increased non-specific nasal responsiveness that was not correlated with upper and lower respiratory symptoms, BHR or atopy. The relationship of this finding to future clinical outcome should be investigated in a longitudinal study.

Background: Although several mechanisms underlying the asthma-obesity connection have been proposed, debates still remain. This study was to determine whether overweight is associated with a higher prevalence of atopy, asthma symptoms, airway obstruction, bronchial hyperresponsiveness (BHR) or biomarkers of inflammation in a sample of Korean adolescents., Methods: We conducted a cross-sectional survey involving questionnaires, skin tests, spirometry and methacholine challenge tests among 717 adolescents from Seoul (South Korea). Overweight status was defined as a BMI greater than the local age- and gender-specific 85th percentile., Results: Overweight subjects more frequently reported ever having wheezing (24.6 vs. 14.0%, p = 0.001) and wheezing in the previous 12 months (11.5 vs. 6.3%, p = 0.02) than normal-weight subjects, especially in boys. Atopy was more common among overweight adolescents than among those of normal weight (61.5 vs. 49.2%, p = 0.002), especially in boys (65.0 vs. 52.8%, p = 0.005). Overweight subjects had higher total WBC counts and eosinophil counts, especially boys. The presence of BHR was more common only among overweight girls (32.8 vs. 18.0%, p = 0.028). Overweight status was a significant risk factor for the presence of atopy (odds ratio = 1.49; 95% CI 1.06-2.10), after adjusting for various confounders by logistic regression analysis., Conclusions: An association was found between overweight status and both atopy and an increased prevalence of wheezing in adolescent Korean boys. These findings suggest that being overweight in puberty may be one of several risk factors responsible for atopy, BHR, and asthma symptoms., (Copyright © 2010 S. Karger AG, Basel.)

More then 25 years after the Chernobyl accident, a higher prevalence of bronchial hyperreactivity, reduced lung function, and increased levels of free radicals in exhaled breath condensates (EBC) were observed in children residing in radioactive contaminated territories. Comparing children with different residential radiation background, this study investigated fatty acids of EBC using gas liquid chromatography, counts of B-lymphocyte antigen CD19 in T-cell (CD3) and phagocytotic activity of neutrophils in blood samples. Regarding EBC, we demonstrate that lipid peroxidation was activated, antioxidant properties of pulmonary surfactant were decreased, were detected metabolic disorders of essential fatty acids at the stage of bioregulators-eicosanoids formation. Regarding the immune function of blood cells, we found a decrease of the proportions of CD3+ 19- and CD3- 19+ lymphocyte subpopulations and an unbalance of their numbers. Also the phagocytotic activity of neutrophils was reduced in higher exposed children. Children living in the radioactive contaminated territories have more alterations of surfactant properties and immune activities, which may contribute to an increased risk of respiratory problems. This research was supported by grants from the U.S. Civilian Research and Development Foundation (UKB1-2929-KV-08).

Although after oesophageal atresia (OA) repair in infancy, respiratory problems are common, their natural history remains unclear. We assessed morbidity, pulmonary function (PF), and bronchial hyperresponsiveness (BHR) in adults with repaired OA respiratory. 588 patients who underwent surgery for OA during 1947-1985 were identified and those 262 who were alive and had their native oesophagus were included. Respiratory symptoms and respiratory symptom-related quality of life (RSRQoL) were assessed by questionnaire and interview, and the patients underwent spirometry, a histamine challenge test, and an exhaled nitric oxide test. For the questionnaires, we added 287 carefully matched general population-derived controls. Among the 101 (58 male) patients, median age 36 yrs (range 22-56 yrs), respiratory morbidity was significantly increased compared to controls. Patients had more respiratory symptoms and infections, as well as asthma and allergies, and more often impaired RSRQoL (p<0.001 for all). PF tests revealed restrictive ventilatory defect in 21 (21%) patients, obstructive ventilatory defect in 21 (21%) patients, and both in 36 (36%) patients. A total of 41 (41%) had BHR, and in 15 (15%), it was consistent with asthma. The most significant risk factors for restrictive ventilatory defect were thoracotomy-induced rib fusions (OR 3.4, 95% CI 1.3-8.7; p = 0.01) and oesophageal epithelial metaplasia (OR 3.0, 95% CI 1.0-8.9; p = 0.05). After repair of OA, respiratory-related morbidity, restrictive ventilatory defect and BHR extended into adulthood. Nearly half the patients had BHR and over half had a restrictive ventilatory defect. Thoracotomy-induced rib fusions and gastro-oesophageal reflux-associated oesophageal epithelial metaplasia were the strongest risk factors for restrictive ventilatory defect.

Glutathione-S-transferases (GSTM1 and GSTP1) and nicotinamide quinone oxidoreductase (NQO1) genes play an important role in cellular protection against oxidative stress which has been linked to asthma pathogenesis. We investigated whether common, functional polymorphisms in GSTM1, GSTP1 and NQO1 influence airway hyperreactivity (AHR) and atopy among schoolchildren in South Africa. Genomic DNA was extracted from 317 primary schoolchildren, aged 9-11 years, from urban, low socioeconomic communities of Durban, South Africa. GSTM1 (null vs. present genotype), GSTP1 (Ile105Val; AA → AG + GG), and NQO1 (Pro/187Ser; CC → CT/TT) genotypes were determined using polymerase chain reaction (PCR) methods. Atopy was defined as a positive skin-prick test to any of several common allergens. Airway hyperreactivity (AHR) was evaluated by pulmonary function testing before and after methacholine challenge. Among the children, 30% were GSTM1 null, 65% carried the G allele for GSTP1, and 36% carried the C allele for NQO1. The frequency of GSTM1, GSTP1, and NQO1 variants among our South African sample was similar to frequencies found in similar ethnic groups worldwide. Marked airway reactivity (PC(20) ≤ 2 mg/ml) was found in 10.3% of children and approximately 40% of them were atopic. No significant associations for GSTM1 and NQO1 with either AHR or atopy were identified. A significant protective effect against atopy was found among children with one or two copies of the GSTP1 G allele.

Rationale: Airway inflammation is a hallmark of asthma. Several studies have validated the use of the fractional concentration of exhaled nitric oxide (Fe(NO)) as a surrogate marker of airway inflammation in asthma., Objectives: We examined how the change in Fe(NO) levels, since the beginning of occupational exposure, could be associated with the incidence of bronchial hyperresponsiveness (BHR) among baker, pastry maker, and hairdresser apprentices during their 2-year training., Methods: A standardized questionnaire was administered; skin prick tests for common and specific occupational allergens were done; methacholine challenge and measurement of Fe(NO) were performed 6, 12, and 15 months after the first examination., Measurements and Main Results: Of 441 apprentices initially included, 351 completed the study. The increase in Fe(NO), since the beginning of exposure, was associated with the incidence of BHR (odds ratio, 2.00 [95% confidence interval, 1.21-3.32] per unit increase in log parts per billion) both in atopic and nonatopic subjects. The average increase in Fe(NO) was similar in atopic and nonatopic subjects and was unrelated to past or current smoking habits, sex, or training track. Atopy in bakers/pastry makers and sensitization to alkaline persulfates in hairdressers were also independently associated with the incidence of BHR. BHR occurred sooner among bakers/pastry makers than among hairdressers, but its incidence leveled off later., Conclusions: Our results suggest that measurement of Fe(NO), a simple and reproducible test, could be useful in the screening of BHR in workers newly exposed to agents known to cause occupational asthma.

Rationale: Bronchial responsiveness is an objectively measurable trait related to asthma. Its prevalence and association with asthma symptoms among children in many countries are unknown., Objectives: To investigate international variations in bronchial responsiveness (BR) and their associations with asthma symptoms and atopic sensitization., Methods: Bronchial challenge tests were conducted in 6,826 schoolchildren (aged 8-12 years) in 16 countries using hypertonic (4.5%) saline. FEV(1) was measured at baseline and after inhalation for 0.5, 1, 2, 4, and 8 min. BR was analyzed both as a dichotomous (bronchial hyperreactivity, BHR, at least 15% decline in FEV(1)) and as a continuous variable (time-response slope, BR slope, individual decline in FEV(1) per log(min))., Results: Prevalence of wheeze last year ranged from 4.4% in Tirana (Albania) to 21.9% in Hawkes Bay (New Zealand) and of BHR from 2.1% in Tirana to 48% in Mumbai (India). The geometric mean BR slope varied between 3.4%/log(min) in Tirana and 12.8%/log(min) in Mumbai and Rome (Italy). At the individual level, BHR was positively associated with wheeze during the past 12 months both in affluent countries (OR = 3.6; 95% CI: 2.7-5.0) and non-affluent countries (OR = 3.0; 1.6-5.5). This association was more pronounced in atopic children. There was a correlation (rho = 0.64, P = 0.002) between center-specific mean BR slope and wheeze prevalence in atopic, but not in non-atopic children., Conclusions: BR to saline in children varied considerably between countries. High rates of BR were not confined to affluent countries nor to centers with high prevalences of asthma symptoms. The association between wheeze and BHR at the individual level differed across centers and this heterogeneity can be largely explained by effect modification by atopy. Pediatr. Pulmonol. 2010; 45:796-806. (c) 2010 Wiley-Liss, Inc., (Copyright 2010 Wiley-Liss, Inc.)

Background: The occurrence of new-onset asthma during adulthood is common, but there is insufficient understanding of its determinants including the role of atopy., Objective: To assess the risk factors for the development of new-onset asthma in middle-aged adults and to compare them according to atopy., Methods: A longitudinal analysis of 9175 young adults who participated in two surveys of the European Community Respiratory Health Survey (ECRHS) conducted 9 years apart., Findings: We observed 179 cases of new-onset asthma among 4588 participants who were free of asthma and reported at the beginning of the follow-up that they had never had asthma (4.5 per 1000 person-years). In a logistic regression, the following risk factors were found to increase the risk of new-onset asthma: female gender (OR: 1.97; 95% confidence interval (CI): 1.38, 2.81), bronchial hyperresponsiveness (3.25; 2.19, 4.83), atopy (1.55; 1.08, 2.21), FEV(1) < 100 % predicted (1.87; 1.34, 2.62), nasal allergy (1.98;1.39,2.84) and maternal asthma (1.91; 1.13; 3.21). Obesity, respiratory infections in early life and high-risk occupations increased the risk of new-onset asthma although we had limited power to confirm their role. Among the atopics, total IgE and sensitization to cat were independently related to the risk of new-onset asthma. The proportion of new-onset asthma attributable to atopy varied from 12% to 21%., Conclusion: Adults reporting that they had never had asthma were at a substantial risk of new-onset asthma as a result of multiple independent risk factors including lung function. Atopy explains a small proportion of new-onset adult asthma.

Rationale: The long-term respiratory sequelae of infants born extremely preterm (EP) and now graduating from neonatal intensive care remains uncertain., Objectives: To assess the degree of respiratory morbidity and functional impairment at 11 years in children born EP (i.e., at or less than 25 completed weeks of gestation) in relation to neonatal determinants and current clinical status., Methods: Pre- and postbronchodilator spirometry were undertaken at school in children born EP and classroom control subjects. Physical examination and respiratory health questionnaires were completed. Multivariable regression was used to estimate the predictive power of potential determinants of lung function., Measurements and Main Results: Spirometry was obtained in 182 of 219 children born EP (129 with prior bronchopulmonary dysplasia [BPD]) and 161 of 169 classmates, matched for age, sex, and ethnic group. Children born EP had significantly more chest deformities and respiratory symptoms than classmates, with twice as many (25 vs. 13%; P < 0.01) having a current diagnosis of asthma. Baseline spirometry was significantly reduced (P < 0.001) and bronchodilator responsiveness was increased in those born EP, the changes being most marked in those with prior BPD. EP birth, BPD, current symptoms, and treatment with beta-agonists are each associated independently with lung function z-scores (adjusted for age, sex, and height) at 11 years. Fifty-six percent of children born EP had abnormal baseline spirometry and 27% had a positive bronchodilator response, but less than half of those with impaired lung function were receiving any medication., Conclusions: After extremely preterm birth, impaired lung function and increased respiratory morbidity persist into middle childhood, especially among those with BPD. Many of these children may not be receiving appropriate treatment.

Background: Bronchial Hyperresponsiveness (BHR) is considered a hallmark of asthma. Other methods are helpful in epidemiological respiratory health studies including Fractional Exhaled Nitric Oxide (FENO) and Eosinophils Percentage (EP) in nasal lavage fluid measuring markers for airway inflammation along with the Forced Oscillatory Technique measuring Airway resistance (AR). Can their outcomes discriminate profiles of respiratory health in healthy subjects starting apprenticeship in occupations with a risk of asthma?, Methods: Rhinoconjunctivitis, asthma-like symptoms, FEV1 and AR post-Methacholine Bronchial Challenge (MBC) test results, FENO measurements and EP were all investigated in apprentice bakers, pastry-makers and hairdressers not suffering from asthma. Multiple Correspondence Analysis (MCA) was simultaneously conducted in relation to these groups and this generated a synthetic partition (EI). Associations between groups of subjects based on BHR and EI respectively, as well as risk factors, symptoms and investigations were also assessed., Results: Among the 441 apprentice subjects, 45 (10%) declared rhinoconjunctivitis-like symptoms, 18 (4%) declared asthma-like symptoms and 26 (6%) suffered from BHR. The mean increase in AR post-MBC test was 21% (sd = 20.8%). The median of FENO values was 12.6 ppb (2.6-132 range). Twenty-six subjects (6.7%) had EP exceeding 14%. BHR was associated with atopy (p < 0.01) and highest FENO values (p = 0.09). EI identified 39 subjects with eosinophilic inflammation (highest values of FENO and eosinophils), which was associated with BHR and atopy., Conclusions: Are any of the identified markers predictive of increased inflammatory responsiveness or of development of symptoms caused by occupational exposures? Analysis of population follow-up will attempt to answer this question.

Background: The hygiene hypothesis suggests that infectious diseases in early life reduce the risk of allergic diseases., Objective: To investigate the association between measles infection during early childhood and the prevalence of allergic diseases, lung function, bronchial hyperresponsiveness (BHR), and sensitization in later childhood., Methods: A survey was conducted 5 years after a nationwide measles outbreak in Korea. From September 1 through November 30, 2006, we obtained information on history of measles and allergic diseases but not of measles vaccination through a questionnaire completed by 1004 schoolchildren aged 6 to 7 years. Furthermore, we measured measles antibody titers and performed skin prick tests, pulmonary function tests, and methacholine challenge tests. Children were divided into groups based on their history of measles infection and antibody titers., Results: Prevalence of measles infection was 8.2%. Children with both a positive measles history and a positive antimeasles antibody had significantly higher antimeasles antibody levels than those without a measles history. The prevalence of current rhinitis (adjusted odds ratio [aOR], 1.86; 95% confidence interval [CI], 1.02-3.40), rhinitis ever (aOR, 2.17; 95% CI, 1.19-3.94), and current BHR (aOR, 1.98; 95% CI, 1.04-3.78) was significantly higher in the group with a positive measles history compared with the group with a negative measles antibody. No differences were found among groups in the prevalence of asthma, lung function, provocation concentration that caused a decrease in forced expiratory volume of 1 second of 20%, or sensitization., Conclusion: Early measles infection was associated with increased prevalence of rhinitis and BHR at the age of 7 years but has no effect on the development of asthma and allergy at the age of 7 years. This study indicates that common childhood infections such as measles in early age do not protect against later development of allergic diseases.

Background: Food allergy (FA) is associated with an increased risk of asthma., Objective: To evaluate whether bronchial hyperreactivity (BHR) occurs in children with FA depending on the presence of respiratory symptoms., Methods: Fifty-four children with FA and 62 without FA were studied for BHR, defined as a provocation concentration of methacholine that caused a decrease in forced expiratory volume in 1 second of 20% (PC20). The diagnosis of FA was established using questionnaires, clinical criteria, skin prick tests, serum specific IgE antibodies, and a double-blind placebo-controlled food challenge., Results: Among nonasthmatic children, BHR was diagnosed in 15 (47%) with FA and in 7 (17%) without FA (P < .005); BHR was demonstrated in 7 children (41%) with FA alone. All the patients with asthma with or without FA had BHR. The mean (SD) PC20 in children with FA alone was 2.8 [1.38] mg/mL and was significantly higher than that in children with asthma alone (0.88 [1.01] mg/mL) or with asthma and FA (0.96 [0.83] mg/mL) (P < .001). BHR was detected in 5 children (36%) with a mild anaphylactic reaction provoked by food, in 23 (74%) with a moderate reaction, and in all the children with a severe reaction., Conclusions: Children with FA had increased BHR independent of respiratory symptoms. Although BHR occurs in asymptomatic children with FA, its course is milder than that in children with FA and asthma. Factors that determine BHR prevalence in children with FA are similar to those in children without FA.

Background: Cobalt has been shown to induce mainly asthma, allergic contact dermatitis and hard metal disease. The data on cobalt asthma are mainly based on case reports., Aims: To characterize all the cases of occupational cobalt asthma encountered in a cobalt plant at the time of diagnosis and 6 months later. We also evaluated the incidence of cobalt asthma in different departments on the basis of data on occupational exposures., Methods: We identified cases of cobalt asthma confirmed with specific bronchial challenge tests in the Kokkola cobalt plant in Finland where exposure levels have been regularly monitored., Results: Between 1967 and 2003, a total of 22 cases of cobalt asthma were diagnosed in the cobalt plant. On challenge tests, mostly late or dual asthmatic reactions were observed. The incidence of cobalt asthma was the highest in the departments with the highest cobalt exposure levels. All cases of cobalt asthma were encountered in departments where irritant gases were present in the ambient air in addition to cobalt. At the time of the follow-up examination 6 months later, non-specific hyperreactivity had mostly remained at the same level or increased., Conclusions: The incidence of cobalt asthma correlated with the exposure levels of cobalt in corresponding departments. An irritating effect of gaseous compounds may enhance the risk of cobalt asthma and even the smallest amounts of cobalt may be harmful to susceptible workers. Symptoms of asthma may continue despite the fact that occupational exposure to cobalt has ceased.

Objective: Cellular defenses against allergens and reactive oxygen species (ROS) exposure are critical in the pathogenesis of asthma. CD14 is a receptor for various bacterial products, such as lipopolysaccharides (LPS), and is also a mediator of inflammatory processes. Manganese superoxide dismutase (MnSOD) is an ROS scavenger, and myeloperoxidase (MPO) can convert hydrogen peroxide into hypochlorous acid; thus, they are considered to be involved in inflammatory defense. The authors conducted a case-control study to evaluate the susceptibility to childhood asthma based on CD14, MnSOD, and MPO genes., Methods: The CD14 -260, MnSOD -9, and MPO -463 genotypes were identified by polymerase chain reactions for 116 asthmatic children and 232 healthy controls. Questionnaires were administered to obtain demographic characteristics. Allergen testing used common Taiwanese aeroallergens., Results: A higher level of parental education, family history of asthma, incense burning at home, allergen-test positive, and the MnSOD Val-Ala/Ala-Ala genotypes (matched relative risk = 2.0; 95% confidence interval = 1.0-4.2) were significantly associated with childhood asthma. Interactions between CD14, MnSOD, MPO genotypes and allergy status were significantly associated with asthma risk in these children (all p <.001). Furthermore, atopic cases with MnSOD Val-Ala/Ala-Ala (log eosinophil 2.66/mm(3), log total serum immunoglobulin E [IgE] 2.48 IU/ml) or Val-Val (log eosinophil 2.61/mm(3), log total serum IgE 2.63 IU/ml) genotypes had elevated eosinophil counts and total serum IgE levels as compared to nonatopic cases with MnSOD Val-Val genotype (log eosinophil 2.27/mm(3), log total serum IgE 1.83 IU/ml)., Conclusions: Susceptible MnSOD genotypes might modulate the development of asthma in Taiwanese children.

Background: Home environmental exposures may aggravate asthma. Few population-based studies have investigated the relationship between asthma control in children and home environmental exposures., Objective: Identify home environmental exposures associated with poor control of asthma among asthmatic children less than 12 years of age in Montreal (Quebec, Canada)., Methods: This cross-sectional population-based study used data from a respiratory health survey of Montreal children aged 6 months to 12 years conducted in 2006 (n = 7980). Asthma control was assessed (n = 980) using an adaptation of the Canadian asthma consensus report clinical parameters. Using log-binomial regression models, prevalence ratios (PRs) with 95% confidence intervals (95% CIs) were estimated to explore the relationship between inadequate control of asthma and environmental home exposures, including allergens, irritants, mold, and dampness indicators. Subjects with acceptable asthma control were compared with those with inadequate disease control., Results: Of 980 children with active asthma in the year prior to the survey, 36% met at least one of the five criteria as to poor control of their disease. The population's characteristics found to be related with a lack of asthma control were younger age, history of parental atopy, low maternal education level, foreign-born mothers, and tenant occupancy. After adjustments, children living along high-traffic density streets (PR, 1.35; 95% CI, 1.00-1.81) and those with their bedroom or residence at the basement level (PR, 1.30; 95% CI, 1.01-1.66) were found to be at increased risk of poor asthma control., Conclusions: Suboptimal asthma control appears to be mostly associated with traffic, along with mold and moisture conditions, the latter being a more frequent exposure and therefore having a greater public health impact.

Background: Studies on perimenstrual asthma are inconsistent, and different methodologies limit comparisons., Objective: To investigate cyclic variations in bronchial hyperreactivity (BHR) to methacholine in premenopausal women in a population-based cohort and assess effect modification by oral contraceptives (OCs)., Methods: Day of menstruation cycle at the time of methacholine challenge was calculated in 571 menstruating women without hormonal treatment, age 28 to 58 years, on the basis of questionnaire data from the Swiss cohort study on Air Pollution And Lung Disease In Adults (SAPALDIA) cohort 2001/2002. A window of risk was defined 3 days before and after the first day of menstruation. Logistic and linear regression analyses were performed adjusting for main predictors of BHR and stratifying for asthma status. The impact of OCs was studied in the same sample enlarged by 130 women taking OCs., Results: The prevalence of BHR was 13% (fall of > or =20% in FEV(1) up to a maximal cumulative dose of 2 mg), and 6% had asthma. A total of 143 women had undergone methacholine challenge within the risk window. We observed a significant increase in BHR within the window of risk (odds ratio [OR], 2.3; 95% CI, 1.27-4.29). A cyclic association pattern was confirmed by trigonometric functions. Effect modification by asthma status and oral contraceptive use was found, with lower OR in subjects without asthma and OR <1 in women using OCs., Conclusion: The data provide evidence of a systematic variation in BHR during the menstruation cycle, supporting the hypothesis of a hormonal influence. OCs appear to have a protective effect. Cyclicity of BHR could be of clinical importance in view of future medication recommendations and timing of respiratory function tests in women., (Copyright (c) 2010 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)

This study was designed to measure hyperreactivity of bronchi in patients aged from 7-8 to 13-14 years presenting with allergic rhinitis. The efficiency of the bronchoprovocative test with physical exercises was shown to be higher than the study of external respiratory function at rest.

Chronic obstructive pulmonary disease and asthma are both highly prevalent inflammatory diseases characterized by airway obstruction with distinct pathogenic mechanisms and different degrees of response to antiinflammatory therapy. However, forms of presentation that show overlap between both diseases and which are not clearly represented in clinical trials are frequently encountered in clinical practice. These patients may show accelerated loss of pulmonary function and have a worse prognosis. Therefore their early identification is essential. Biomarkers such as bronchial hyperreactivity or nitric oxide in exhaled air have yielded discrepant results. Phenotypic characterization will allow treatment with inhaled corticosteroids to be individually tailored and optimized., (Copyright © 2010 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.)

Background: Microbial exposures in both childhood and adult life are protective against atopy, allergic rhinitis and atopic asthma. In adults, this protective effect is paralleled by an increased prevalence of non-atopic asthma. This study was undertaken to investigate associations between occupational endotoxin exposure and atopic sensitization and bronchial hyperresponsiveness to methacholine (BHR) in agricultural workers. In addition, the role of atopy in endotoxin-related respiratory effects was studied., Methods: Data were available for 427 farmers and agricultural industry workers, for whom airborne endotoxin exposure levels were estimated by 249 personal exposure measurements. Atopy was assessed as specific serum IgE to common inhalant allergens, and respiratory symptoms and personal characteristics by standardized questionnaires. BHR was determined in a subset of 113 subjects. Associations were adjusted for age, sex, smoking and living on a farm during childhood., Results: Endotoxin exposure was positively associated with BHR and wheeze (p < 0.05). In contrast, endotoxin exposure was inversely associated with atopy and IgE to grass pollen (p < 0.001). The proportions of wheeze and BHR that were attributable to atopy were only 16.6 and 32.8%, respectively., Conclusions: High endotoxin exposure is a risk factor for BHR and wheeze, which were characterized by a predominantly non-atopic phenotype. At the same time, endotoxin exposure is related to a reduced risk of atopy and IgE to grass pollen in adults. It is unlikely that this is entirely a result of healthy worker selection, as significant inverse associations between endotoxin and IgE to grass pollen were found regardless of reported allergic symptoms., (Copyright 2009 S. Karger AG, Basel.)

Some myths and unsupported beliefs about asthma are very popular and enjoy general public acceptance and fairly strong support on the Internet. Onions for cough; dairy products avoidance for asthma; and some other popular myths are reviewed, along with some other medical and mixed (popular and medical) myths comparing their popular and scientific support. Classifying medical statements as realities or unsupported beliefs is a hard and serious work nowadays addressed by Evidence Based Medicine methods, which are not devoid of the influence of medical fashion: the medical community is more prone to accept fashionable statements compared to non-fashionable or old-fashioned statements.

Background: Since the intensity of some variables that influence bronchial hyper-responsiveness (BHR) varies across different seasons of the year, the percentage of positive metacholine challenge test (MCT) is theoretically subjected to seasonal variation. This study has looked at the seasonal variability of MCT among young adults with suspected asthma., Methods: The number of MCT performed and its corresponding proportion of positive results were retrospectively evaluated and compared for different seasons over a 5-year period., Results: Overall 645 subjects (mean age 21.4 +/- 2.3 yr) underwent MCT during the study period. Two-hundred nine MCTs (34.2%) were performed in the winter, significantly higher when compared to any other season of the year. Positive MCT (defined as PC(20) < 16 mg/mL) was noted in 163 patients (25.2%). The proportion of positive MCTs has shown significant seasonal trend, (p < 0.0001, chi-square test for trend), it was significantly higher in the winter and in the spring (32.2% and 32.4%, respectively) when compared with the summer (13.4%)., Conclusions: This study showed a significant seasonal variability for both pattern of referral to MCT and the seasonal prevalence of BHR young adults. These findings probably reflect seasonal variation in the intensity of external stimuli that involve in the pathogenesis of BHR, such as allergens burden and respiratory tract infections across the year. We suggest that interpretation of a positive MCT as predictive of BHR and of asthma should take into account the observed seasonal variability of the test.

Introduction: The prevalence of bronchial hyperreactivity (BHR) or the effect of anti-reflux treatment on BHR in children with asthma and gastroesophageal reflux disease (GERD) is not known., Methods: Thirty non-atopic children with persistent asthma were studied. Extended esophageal pH monitoring was used to diagnose GERD and methacholine challenge test (MCT) was used as a marker of BHR and performed before and 2 years after anti-GERD treatment., Results: Of the 21 patients positive for GERD (group A), 15 had positive MCT suggesting BHR. Of the 9 patients negative for GERD (group B), 5 had positive MCT. On repeat testing 2 years later, 11/15 group A patients and 3/5 group B patients tested negative for BHR. Group A patients were receiving fewer asthma medications and experienced fewer exacerbations than Group B patients., Conclusions: BHR is prevalent in children with asthma and GERD and improves with anti-GERD treatment.

Background: Active smoking is known to increase asthma symptoms and bronchial hyper-responsiveness (BHR) while decreasing pulmonary function in adults, but few studies have addressed these issues in adolescents., Methods: We conducted a cross-sectional survey involving questionnaires and assessment of urinary cotinine levels among 1,492 adolescents from three urban areas of South Korea. Current smoking was defined as having smoked more than 1 day in the prior 30 days or having urine cotinine levels >or=100 ng/ml. Spirometry, skin tests, and methacholine challenge tests were performed on adolescents in Seoul (n = 724)., Results: The prevalence of current smoking was 8.2% in boys and 2.4% in girls. Reports of wheeze and exercise-induced wheeze in the previous 12 months were more frequent in smokers than nonsmokers (15.2% vs. 8.5%, P = 0.024, and 20.4% vs. 10.7%, P = 0.004, respectively). In multiple logistic regression analysis, current smoking was found to be a significant risk factor for having wheezed in previous 12 months (OR = 4.5, 95% CI 1.5-13.2) and having exercise-induced wheezing in previous 12 months (OR = 8.7, 95% CI, 3.7-20.9). The subgroup analysis revealed that the FEV(1)/FVC was lower in smokers than nonsmokers (mean +/- SD, 105.1 +/- 8.6% vs. 107.8 +/- 7.8%, P = 0.019). In contrast, there was no significant difference in BHR. The effect of smoking on asthma symptoms were more pronounced in non-atopic compared with atopic adolescents., Conclusion: Current smoking was significantly associated with symptoms of asthma, such as having recent wheezing and recent exercise-induced wheezing, especially for non-atopics, in Korean adolescent population. Current smoking was further associated with lower pulmonary function, but not BHR.

Background: Bronchial asthma (A) is frequently diagnosed in patients with chronic cough. The study was conducted to determine whether an evaluation of fractional exhaled nitric oxide (FeNO) concentration can be used as a screening test for asthma in young adults with chronic cough (CCP)., Methods: The study was performed on 540 (mean age 26.5; range 18-45 years), nonsmoking young CCP. All patients had resting spirometry within normal limits and no abnormalities on chest radiographs. Skin prick tests with common aeroallergens, bronchial provocation challenge with histamine, and evaluation of FeNO concentration were performed in all patients. One hundred healthy, nonsmoking, nonatopic subjects were used as control subjects (HC)., Results: Asthma (A) was diagnosed in 178 CCP (32.96%). Other frequent diagnoses included rhinitis/sinusitis (R) and gastroesophageal reflux (GERD). The median FeNO concentration in A (86 ppb; 95% CI 72 to 94,5 ppb) was significantly greater than in R (37 ppb; 95% CI 35,6 to 42,9 ppb; p < 0.0001), GERD (14,8 ppb; 95%CI 13.3 to 16.2 ppb; p < 0.0001), or in HC (13 ppb; 95%CI 11 to 15 ppb; p < 0.0001). Significant correlation was found between log(FeNO) and bronchial reactivity expressed as log(PC20) (r = -0.529; 95%CI -0.616 to -0.429; p < 0.0001), but even stronger correlation was demonstrated between log(FeNO) and peripheral blood eosinophilia (r = 0.757; 95%CI 0.717 to 0.792). Receiver Operator Characteristic (ROC) curve analysis revealed that CCP can be screened for A by measuring FeNO concentration. Using 40 ppb as a cut-off value for the FeNO concentration, the specificity 82.6% and sensitivity 88.3% can be achieved., Conclusion: In clinical practice, assessment of FeNO concentration can be used as a screening test for asthma in young adults who have chronic cough.

Although it is generally agreed that sensitization is an important risk factor for allergic diseases, the extent to which sensitization accounts for allergic symptoms in children is controversial. As part of the Aalst Allergy Study, this cross-sectional study investigated the prevalence of allergic symptoms and their association with sensitization in an unselected population of Flemish children aged 3.4-14.8 yr. Skin prick testing with the most common aeroallergens was performed and allergic symptoms were documented by a parental questionnaire. In the children older than 6 yr, a significant association of current wheezing, current dyspnea, airway hyperreactivity, rhinoconjunctivitis, and current eczema with sensitization was found, while in the pre-school children these associations were less pronounced. The association with sensitization was strongest for rhinoconjunctivitis and current respiratory symptoms - the association was less striking for children with current eczema. The impact of a positive family history of allergy on the association with sensitization was more important for eczema than for the other analyzed allergic symptoms. Persistent and late-onset wheezers were significantly more likely than non-wheezers and transient early wheezers to be associated with sensitization and a personal history of rhinoconjunctivitis. Late-onset wheezing was associated with a positive family history of allergy, while transient early wheezing was associated with day-care attendance. An association with eczema was found for all three childhood wheezing phenotypes. The association of allergic symptoms with sensitization is significant in the older but less pronounced in pre-school children and is more pronounced for current allergic symptoms. Diagnosis and disease definition of allergy symptoms remains difficult at pre-school age. The influence of a positive family history of allergy on the association of the respective allergic symptoms with sensitization was most important for eczema. Our data confirm the atopic characteristics of the different wheeze phenotypes.

Objective: This study assessed current health risks due to occupational exposure to coffee dust., Methods: We performed a cross-sectional study in a coffee haulage company (n = 24), a coffee silo (n = 19), and a decaffeinating company (n = 17). Cross-shift and cross-week case histories of these employees as well as lung function values were recorded. During the handling of green coffee, measurements of airborne dust were conducted., Results: The employees in these workplaces were mainly affected by erythematous and rhinoconjunctival symptoms. They occurred especially in subjects exposed to a high dust load (> 10 mg of inhalable dust per cubic meter of air; n = 28) [Pearson chi(2) test, p = 0.020 and p = 0.023]. IgE antibodies to green coffee and castor beans were detected in 3 workers and 10 workers, respectively. The majority of them (two employees and six employees, respectively) had shown respiratory symptoms during the past 12 months. The preshift lung function values were below average but were not dependent on the level of the inhalable coffee dust exposure. Employees with a coffee dust load > 10 mg/m(3) of air showed higher unspecific bronchial responsiveness more frequently than those with lower exposures., Conclusion: During the transshipment (especially during unloading) of green coffee, a high and clinically relevant exposure to irritative and sensitizing dust occurs. Therefore, efforts to reduce these dust exposures are generally recommended.

Study Objectives: Pulmonary involvement is a major cause of morbidity and mortality in patients with sickle cell disease (SCD). Although a high prevalence of airway hyperresponsiveness (AHR) has been reported, there are no studies demonstrating the relationship between AHR and acute chest syndrome (ACS) in adults with SCD. We investigated AHR prevalence, lung function abnormalities, and the relationships of these variables with ACS in SCD patients., Method: Thirty-one adult patients without asthmatic symptoms were compared with 31 matched controls. Expiratory flow rates, lung volumes, carbon monoxide diffusion capacity (DLCO), and methacholine provocation test (MPT) results were assessed., Results: Forced vital capacity (FVC), forced expiratory volume in one second, forced expiratory flow rate at 25% to 75% of FVC (FEF(25%-75%)), peak expiratory flow rate, total lung capacity, and DLCO values were significantly lower in the patient group than in the controls. No significant difference in pulmonary function test results was found between patients with and without a history of ACS. Fifteen patients with SCD (48%) and only 5 controls (16%) had AHR (p = 0.007). A significant correlation was found between the number of ACS episodes and MPT positivity (r = 0.379, p = 0.035). The FEF(25%-75%) values were significantly lower in patients with positive MPT results than in patients with negative MPT results (p = 0.027)., Conclusion: The prevalence of AHR was high in adult patients with SCD. A significant correlation was found between AHR and recurrent ACS episodes. Anti-inflammatory controller agents can be used routinely to decrease pulmonary morbidity associated with SCD, even in the absence of asthmatic symptoms.

Background: Cholinergic urticaria is occasionally associated with bronchospasm, even in patients without a history of asthma; the underlying mechanism has not been elucidated., Objective: To evaluate bronchial hyperresponsiveness (BHR) in patients with cholinergic urticaria compared with healthy adults and patients with chronic urticaria., Methods: Patients with a history of cholinergic urticaria and a positive ergometric test result constitute the study group. History was reviewed and physical examination and spirometry were performed to exclude exercise-induced anaphylaxis and exercise-induced asthma. Patients with chronic urticaria and healthy volunteers were used as positive and negative controls, respectively. All 3 groups were evaluated for BHR using a methacholine challenge test., Results: Fifty-nine adults participated in the study: 30 patients with cholinergic urticaria, 15 with chronic urticaria, and 14 healthy volunteers. BHR was demonstrated in 13 of 30 patients (43%) in the study group, 1 of 15 patients with chronic urticaria (7%), and 1 of 14 healthy volunteers (7%); the observed difference was statistically significant. Further analysis of the study group demonstrated the existence of 2 subpopulations of patients with cholinergic urticaria, which were discriminated on the basis of intensity and duration of symptoms, with 96.7% accuracy. In addition, a statistically significant correlation was found between patient age and disease duration and between intensity and frequency of symptoms., Conclusions: Evaluation of patients with cholinergic urticaria should probably include BHR. A formula based on duration and intensity of cholinergic urticaria symptoms is provided as a tool for the prediction of BHR.

Rationale: Bronchoconstriction after deep inhalation is associated with increased severity of asthma and is also a predictor of length of hospital stay in individuals admitted with asthma exacerbations. We hypothesized that this effect may represent a new non-invasive method to assess bronchial reactivity and other measures of asthma control., Methods: We used a cross-sectional study design recruiting participants 18 to 65 years of age with a physician diagnosis of asthma. All participants were asked to provide three serial peak expiratory flow rate (PEFR) measurements in the morning, and bronchial reactivity was measured up to a maximum inhaled dose of 24.5 micromoL methacholine on the same day. Participants also recorded their asthma symptoms score and bronchodilator use during the 7 days before measuring bronchial reactivity., Results: A total of 127 people provided data for analysis. There was no significant relationship between bronchoconstriction after deep inhalation (as measured by three serial PEFR measurements) and either bronchial reactivity to methacholine, asthma symptoms, or bronchodilator use., Conclusions: Bronchoconstriction induced by deep inspiration does not appear to be a valid marker of airway hyperresponsiveness or asthma severity in adults with mild to moderate asthma.

The direct effect of gastro-esophageal reflux (GER) on lung function is still debated. Objective. To investigate the role of esophageal acidification in affecting airway response to MCh in GER-related versus atopic asthmatics and to assess specificity and sensitivity of events. Subjects. A total of 56 never-smoking, mild asthmatics: 27 non-atopic asthmatics and acid GER (GER+ve) and 29 atopic asthmatics without any GER (GER-ve). Methods. Each subject performed an MCh challenge in baseline (MCh(b)), and 30 minutes after an acid drink (125 mL at pH = 2; MCh(ac)), one day apart. PD(20)FEV(1) MCh(b) and MCh(ac) were compared by estimating the area under the ROC curve (AU-ROC). Results. GER+ve and GER-ve subjects (well matched in baseline) had a different duration of esophageal acid contact (24-hour monitoring; pH-24h AU(4)), and PD(20)FEV(1) MCh(ac) (both p < 0.001). AU-ROC was 86.3% (76% to 97%, 95%CI). Sensitivity and specificity of changes were 82.8% (72.9% to 92.7%, 95%CI) and 85.2% (75.9% to 94.5%, 95%CI), respectively. The difference in MCh threshold that maximized both the sensitivity and specificity level was 100 mu g. Conclusions. The esophageal acidification identified GER-related asthma with a good level of both sensitivity and specificity by enhancing the MCh response only in the presence of acid GER. Data are supporting the effectiveness of this procedure for clinical purposes.

Oxidative stress is an important causative factor in the onset and progression of smoking-related lung diseases, such as chronic obstructive pulmonary disease (COPD). Superoxide dismutases (SODs) can prevent an increase in oxidative burden. A total of 1,390 subjects from the prospective Vlagtwedde-Vlaardingen cohort were genotyped for two single nucleotide polymorphisms (SNPs) in SOD2 and four SNPs in SOD3, which were further analysed for associations with the presence of bronchial hyperresponsiveness (BHR; provocative concentration causing a 10% fall in the forced expiratory volume in one second (FEV(1); PC(10)

Objectives: To identify occupational exposure risk factors associated with the development of new-onset asthma in nurses., Methods: A cross-sectional survey was administered to a sample of licensed Texas nurses (response rate 70%) and compared to three other healthcare professional groups. Nursing professionals were defined based on self-reported longest held job. Outcome variables were physician-diagnosed new-onset asthma after entry into the healthcare profession and symptoms associated with bronchial hyper-responsiveness (BHR). Occupational exposures were ascertained through a job-exposure matrix, grouped into four categories: cleaning-related tasks, use of powdered latex gloves, administration of aerosolised medications, and tasks involving adhesive compounds, glues and/or solvents., Results: After adjustment for age, sex, ethnicity, atopy, smoking, body mass index and seniority, reported asthma was significantly greater among nursing professionals involved in medical instrument cleaning (OR = 1.67, 95% CI 1.06 to 2.62) and exposure to general cleaning products and disinfectants (OR = 1.72, 95% CI 1.00 to 2.94). Use of powdered latex gloves during 1992-2000 was associated with 1.6 times (95% CI 1.01 to 2.50) the odds of reported asthma. In univariate analysis, exposure to adhesives, glues and/or solvents was associated with a twofold increase in the odds of reported asthma, but not after adjustment for covariates. Similarly, the odds of BHR-related symptoms were significantly greater among nursing professionals exposed to general cleaning products and disinfectants (OR = 1.57, 95% CI 1.11 to 2.21) and adhesives, glues and/or solvents used in patient care (OR = 1.51, 95% CI 1.08 to 2.12)., Conclusion: Among nursing professionals, workplace exposures to cleaning products and disinfectants increase the risk of new-onset asthma.

Background: Exposure to microbes may result in the polarization of the immune system and a decrease in the risk of asthma and associated allergic disease, whilst exposure to Helicobacter pylori has been hypothesized to increase the risk of obstructive airways disease. We tested the hypotheses that exposure to H. pylori reduces the risk of asthma and allergic disease and is associated with a decrease in lung function., Methods: Data were collected on allergic disease symptoms, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), bronchial reactivity, allergen skin sensitization, serum IgE and H. pylori serological status in 2437 randomly selected adults., Results: Individuals with serological evidence of exposure to H. pylori had lower lung function, FEV1 being lower by 53 ml (95% CI 1-106) and FVC 83 ml (95% CI 20-145) lower in the cross-sectional analysis. These differences ceased to be statistically significant after adjustment for height or socio-economic status. There was no association between H. pylori serological status and measures of asthma or atopy in the cross-sectional analysis, and there was no significant association between H. pylori serological status and decline in FEV1 and FVC over 9 years., Conclusion: Although H. pylori exposure may be associated with lower cross-sectional FEV1 and FVC, this association was not independent of height or socio-economic status. There was no association between H. pylori exposure and either chronic obstructive pulmonary disease (COPD), measures of allergic disease or decline in lung function.

Introduction: Asthma is frequent in elite athletes and the high prevalence of asthma might be associated with specific types of sport. It has been suggested that chronic endurance training might increase the number of neutrophils in the airways, and this may reflect airway injury. The use of anti-asthmatic medication in elite athletes is also currently under scrutiny in order to reduce the risk of under-treatment or over treatment., Objectives: Determine the use of anti-asthmatic medication and the prevalence of asthma-like symptoms and asthma in Danish elite athletes. Further, to determine whether elite athletes with asthma-like symptoms have asthma and investigate the airway inflammation and airway reactivity to mannitol., Materials and Methods: Three cross-sectional studies: (i) Applications for Abbreviated Therapeutic Use Exemption (ATUE) certificates in 2005 were studied (N = 694); (ii) a questionnaire survey of elite athletes (N = 418); and (iii) a clinical study of elite athletes. A total of 54 elite athletes (19 with physician-diagnosed asthma) participated together with two control groups: (i) 22 non-athletes with physician-diagnosed asthma (steroid naïve for 4 weeks before the examination) and (ii) 35 non-athletes without asthma., Examinations: questionnaires, exhaled nitric oxide (eNO), spirometry, skin prick test, mannitol test and blood samples. Induced sputum was done in subjects with asthma., Results: (i) Anti-asthmatic medication was included in 445 (64%) of all ATUE certificates. A total of 308 (69%) elite athletes applied for inhaled corticosteroids (ICS), and most ATUE certificates were handled by general practitioners (GP) (78%). (ii) A total of 329 (79%) elite athletes completed the questionnaire; 181 (55%) reported asthma-like symptoms and 46 (14%) had asthma. Anti-asthmatic medication was currently taken by 24 (7%) elite athletes. Elite athletes participating in endurance sports had higher prevalences of asthma-like symptoms (74%), use of anti-asthmatic medication (15%) and current asthma (24%) than all other athletes (P < 0.01). (iii) No difference in lung function, eNO, airway reactivity (AR) to mannitol and atopy between elite athletes with and without asthma-like symptoms was found. Elite athletes with physician-diagnosed asthma had less AR [Response Dose Ratio (RDR) 0.02 (0.004) vs 0.08 (0.018) P < 0.01], and fewer sputum eosinophils [0.8% (0-4.8) vs 6.0% (0-18.5), P < 0.01] than non-athletes with physician-diagnosed asthma., Conclusion: Most applications for ATUE certificates were handled by GPs, and the majority concerned anti-asthmatic medication. We found signs of under-treatment of elite athletes with asthma, and endurance athletes had the highest prevalence of asthma-like symptoms and asthma. The prevalence of asthma-like symptoms was higher than the prevalence of asthma, and we showed that symptoms alone should not be used to diagnose asthma. We demonstrated that asthma-like symptoms are independent of lung function, eNO, RDR and atopy in elite athletes. Elite athletes with physician-diagnosed asthma seem to have less airway reactivity and fewer sputum eosinophils than non-athletes with physician-diagnosed asthma, but more studies are needed to further investigate if and how the asthma phenotype of elite athletes differs from that of classical asthma.