In this study, the introduction of guidelines-based therapy in all children decreased the number of days per fortnight that children had asthma symptoms. Treatment with omalizumab resulted in fewer ...days with asthma symptoms than placebo.
Studies of inner-city children, adolescents, and young adults with asthma show that symptom control is improved and exacerbations are decreased when there is either a reduction in household exposure to allergens
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or aggressive implementation of guidelines-based therapy.
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Nonetheless, achieving disease control remains difficult, necessitating a need for additional treatment.
For patients with allergies who have asthma that is not controlled with implementation of the higher treatment steps of the most recent guidelines from the National Asthma Education and Prevention Program (NAEPP) (Expert Panel Report 3), omalizumab, a humanized monoclonal anti-IgE antibody, is recommended.
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Anti-IgE treatment reduces exacerbations, symptoms and, . . .
Summary Background Together with smoking, the lung function attained in early adulthood is one of the strongest predictors of chronic obstructive pulmonary disease. We aimed to investigate whether ...lung function in early adulthood is, in turn, affected by airway function measured shortly after birth. Methods Non-selected infants were enrolled at birth in the Tucson Children's Respiratory Study between 1980 and 1984. We measured maximal expiratory flows at functional residual capacity (VmaxFRC ) in 169 of these infants by the chest compression technique at a mean of 2·3 months (SD 1·9). We also obtained measurements of lung function for 123 of these participants at least once at ages 11, 16, and 22 years. Indices were forced expiratory volume in 1 s (FEV1 ), forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of FVC (FEF25–75 ), both before and after treatment with a bronchodilator (180 μg of albuterol). Findings Participants who had infant VmaxFRC in the lowest quartile also had lower values for the FEV1 /FVC ratio (−5·2%, p<0·0001), FEF25–75 (−663 mL/s, p<0·0001), and FEV1 (−233 mL, p=0·001) up to age 22, after adjustment for height, weight, age, and sex, than those in the upper three quartiles combined. The magnitude and significance of this effect did not change after additional adjustment for wheeze, smoking, atopy, or parental asthma. Interpretation Poor airway function shortly after birth should be recognised as a risk factor for airflow obstruction in young adults. Prevention of chronic obstructive pulmonary disease might need to start in fetal life.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Summary Background Incidence of asthma increases during early adulthood. We aimed to estimate the contributions of sex and early life factors to asthma diagnosed in young adults. Methods 1246 healthy ...newborn babies were enrolled in the Tucson Children's Respiratory Study. Parental characteristics, early-life wheezing phenotypes, airway function, and bronchial hyper-responsiveness to cold dry air and sensitisation to Alternaria alternata were determined before age 6 years. Physician-diagnosed asthma, both chronic and newly diagnosed, and airway function were recorded at age 22 years. Findings Of 1246 babies enrolled, 849 had follow-up data at 22 years. Average incidence of asthma at age 16–22 years was 12·6 per thousand person-years. 49 (27%) of all 181 cases of active asthma at 22 years were newly diagnosed, of which 35 (71%) were women. Asthma remittance by 22 years was higher in men than in women (multinomial odds ratio M-OR 2·0, 95% CI 1·2–3·2, p=0·008). Age at diagnosis was linearly associated with the ratio of forced expiratory volume at 1 s to forced vital capacity at age 22 years. Factors independently associated with chronic asthma at 22 years included onset at 6 years (7·4, 3·9–14·0) and persistent wheezing (14·0, 6·8–28·0) in early life, sensitisation to A alternata (3·6, 2·1–6·4), low airway function at age 6 years (2·1, 1·1–3·9), and bronchial hyper-responsiveness at 6 years (4·5, 1·9–10·0). Bronchial hyper-responsiveness (6·9, 2·3–21·0), low airway function at 6 years (2·8, 1·1–6·9), and late-onset (4·6, 1·7–12·0) and persistent wheezing (4·0, 1·2–14·0) predicted newly diagnosed asthma at age 22 years. Interpretation Asthma with onset in early adulthood has its origins in early childhood. Funding National Heart Lung and Blood Institute.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Evidence from longitudinal cohort studies demonstrates that wheezing that begins in early life and continues into the school years generally persists into adulthood. This persistent wheezing is ...associated with lung function deficits and airways hyperresponsiveness that appear to be established in the first few years of life. Allergic sensitization early in life, early-life infection with rhinovirus, or colonization with any of a number of bacteria have been associated with increased risk of persistent wheeze. Early life, whether in utero or in the first few years of life, presents a window of vulnerability during which airway injury results in persistent airways dysfunction. Available data further suggest that a second such window of vulnerability might be present in the preadolescent and adolescent years. Lung function growth patterns established by age 6 years generally continue into early adulthood to middle adulthood, typically leaving groups of subjects with wheezing that persists into or relapses during adulthood with a mean FEV1 of about 10% of predicted value less than their peers who do not wheeze. Subgroups of patients with persistent asthma, however, can have progressive decreases in lung function and enter adulthood with even lower lung function. The concern exists that these deficits in lung function apparent in early adulthood might put subjects at risk for the later development of chronic obstructive pulmonary disease.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Low maximally attained lung function increases the risk of chronic obstructive pulmonary disease irrespective of the subsequent rate of lung function decline.
We aimed to determine if there were ...individuals with a distinct, persistently low lung function trajectory in the CRS (Tucson Children's Respiratory Study).
The CRS, an ongoing birth cohort study, enrolled 1,246 participants between 1980 and 1984. Latent class linear mixed effects modeling of the ratio of FEV1 to FVC was used to identify distinct lung function trajectories among participants with two or more spirometry measurements between ages 11 and 32 years.
Among 599 participants with 2,142 observations, a model with two distinct trajectories (a low trajectory n = 56; 9.3% and a normal trajectory) fit the data significantly better than a model with only one trajectory (P = 0.0007). As compared with those with a normal trajectory, participants with a persistently low trajectory were more likely to have a history of maternal asthma (20.0% vs. 9.9%; P = 0.02); early life lower respiratory illness caused by respiratory syncytial virus (41.2% vs. 21.4%; P = 0.001); and physician-diagnosed active asthma at age 32 years (43.9% vs. 16.2%; P < 0.001). Individuals with a persistently low trajectory also demonstrated lower lung function as measured by average maximal expiratory flow at functional residual capacity during infancy and at age 6 years.
A distinct group of individuals in a nonselected population demonstrates a persistently low lung function trajectory that may be partly established at birth and predisposes them to chronic obstructive pulmonary disease later in life.
The ripple effect WAYNE, SANDY J.; LEMMON, GRACE; HOOBLER, JENNY M. ...
Journal of organizational behavior,
July 2017, Volume:
38, Issue:
6
Journal Article
Peer reviewed
Open access
Exploring the role of both the employee and supervisor, we tested a model of how cognition-based work-to-family conflict manifests itself in the workplace, impacting employee job success. Based on ...conservation of resources theory and the concept of loss spirals, we hypothesized that when an employee’s work interferes with family demands, the resulting work-to-family conflict spills over to the work domain via employee emotional exhaustion. We further argued that the behavioral manifestation of employee emotional exhaustion in the workplace is low employee engagement, as assessed by the supervisor. Drawing on signaling theory, we proposed that supervisor assessments of employee engagement are related to promotability, performance ratings, and salary. Work scheduling autonomy, as a boundary condition, is examined as a resource that attenuates these relationships. Data collected from 192 employee–supervisor dyads of a Fortune 1000 company, as well as performance ratings and salary obtained from company records 9 months later, indicated support for our conceptual model. Future research examining employee work–family conflict and job outcomes is discussed.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NMLJ, NUK, OILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Diminished lung function and increased prevalence of asthma have been reported in children with a history of early lower respiratory illnesses (LRIs), including pneumonia. Whether these associations ...persist up to adulthood has not been established.
As part of the prospective Tucson Children's Respiratory Study, LRIs during the first 3 years of life were ascertained by pediatricians. Spirometry was performed at ages 11, 16, 22, and 26 years. The occurrence of asthma/wheeze during the previous year was ascertained at ages 11, 13, 16, 18, 22, 24, 26, and 29 years. Longitudinal random effects models and generalized estimating equations were used to assess the relation of LRIs to lung function and asthma.
Compared with participants without early-life LRIs, those with pneumonia had the most severe subsequent lung function impairment, with mean ± SE deficits of -3.9% ± 0.9% (P < .001) and -2.5% ± 0.8% (P = .001) for pre- and post-bronchodilator FEV1:FVC ratio from age 11 to 26 years, respectively. Pneumonia was associated with increased risk for asthma (odds ratio OR: 1.95; 95% confidence interval CI: 1.11-3.44) and wheeze (OR: 1.94; 95% CI: 1.28-2.95) over the same age range. Early non-pneumonia LRIs were associated with mildly impaired pre-bronchodilator FEV1 (-62.8 ± 27.9 mL, P = .024) and FEV1:FVC ratio (-1.1 ± 0.5%, P = .018), and wheeze (OR: 1.37; 95% CI: 1.09-1.72).
Early pneumonia is associated with asthma and impaired airway function, which is partially reversible with bronchodilators and persists into adulthood. Early pneumonia may be a major risk factor for adult chronic obstructive pulmonary disease.
Background Asthma severity is reflected in many aspects of the disease, including impairment and future risks, particularly for exacerbations. According to the Expert Panel Report 3: Guidelines for ...the Diagnosis and Management of Asthma, however, to assess more comprehensively the severity of asthma the level of current treatment needed to maintain a level of control should be included. Objective Development and validation of a new instrument, the Composite Asthma Severity Index (CASI), which can quantify disease severity by taking into account impairment, risk, and the amount of medication needed to maintain control. At present, there is no instrument available to measure and assess the multidimensional nature of asthma. Methods Twenty-six established asthma investigators, who are part of the National Institutes of Health–supported Inner City Asthma Consortium, participated in a modified Delphi consensus process to identify and weight the dimensions of asthma. Factor analysis was performed to identify independent domains of asthma by using the Asthma Control Evaluation trial. CASI was validated by using the Inner City Anti-IgE Therapy for Asthma trial. Results CASI scores include 5 domains: day symptoms and albuterol use, night symptoms and albuterol use, controller treatment, lung function measures, and exacerbations. At Asthma Control Evaluation trial enrollment, CASI ranged from 0 to 17, with a mean of 6.2. CASI was stable, with minimal change in variance after 1 year of treatment. In external validation, CASI detected a 32% larger improvement than did symptoms alone. Conclusion CASI retained its discriminatory ability even with low levels of symptoms reported after months of guidelines-directed care. Thus, CASI has the ability to determine the level of asthma severity and provide a composite clinical characterization of asthma.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Additional Thoughts on Intrinsic Dysanapsis Tepper, Robert S; Morgan, Wayne J; Taussig, Lynn M
American journal of respiratory and critical care medicine,
2024-Apr-15, 2024-04-15, 20240415, Volume:
209, Issue:
8
Journal Article
Background There is an association between adiposity and asthma prevalence, but the relationship to asthma control is unclear. Objectives We sought to understand the relationships among adiposity, ...sex, and asthma control in inner-city adolescents with asthma. Methods We prospectively followed 368 adolescents with moderate-to-severe asthma (ages 12-20 years) living in 10 urban areas for 1 year. Asthma symptoms and exacerbations were recorded, and pulmonary function and exhaled nitric oxide levels were measured every 6 weeks. Adiposity measures (body mass index BMI and dual-energy X-ray absorptiometric scans) were made, and blood was collected for measurement of allergy markers, adiponectin, leptin, TNF-α, IL-6, and C-reactive protein levels. Results More than 60% of female subjects and 50% of male subjects were above the 85th percentile of BMI for age. Higher BMI was associated with more symptom days ( R = 0.18, P = .02) and exacerbations ( R = 0.18, P = .06) among female subjects only. Adiponectin was inversely related to asthma symptoms ( R = −0.18, P < .05) and exacerbations ( R = −0.20, P < .05) and positively with FEV1 /forced vital capacity ratio ( R = 0.15, P < .05) in male subjects only independent of body size. There was no relationship between adiposity or adipokines and total IgE levels, blood eosinophil counts, and exhaled nitric oxide levels. Dual-energy X-ray absorptiometry provided little additional value in relating adiposity to asthma outcome in this population of adolescents. Conclusion Adiposity is associated with poorer asthma control in female subjects. Adiponectin is associated with improved asthma control in male subjects.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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