A lung nodule like no other Chaptal, M; Gaumond, S; Raherison Semjen, C
Revue des maladies respiratoires,
05/2023, Letnik:
40, Številka:
5
Journal Article
Les études récentes rapportent une augmentation de la prévalence de l’asthme et de l’obésité, avec un retentissement important en termes de morbidité et de recours aux soins. L’obésité serait un ...facteur d’asthme incident à l’âge adulte, et l’asthme chez les patients obèses serait plus difficile à contrôler. Une diminution de réponse aux corticoïdes inhalés pourrait constituer un des facteurs explicatifs de mauvais contrôle de l’asthme, mais il ne faut oublier les autres comorbidités associées tel que le RGO et le SAOS. L’asthme chez l’obèse pourrait constituer un phénotype d’asthme sévère. La réduction de la surcharge pondérale chez les patients obèses améliore les symptômes, la qualité de vie et la fonction ventilatoire, à court terme et à long terme.
Recent studies report an increase in the prevalence of both asthma and obesity, with an important impact in terms of morbidity and frequency of hospitalization. Obesity can be a triggering factor for asthma in adults, and asthma in obese adults can be more difficult to control. A decreased response to inhaled corticosteroids may be one of the reasons for poor control of asthma in such patients, but it is also important to take into account other co-morbidities, such as GERD and OSA. Asthma in the obese may be a phenotype of severe asthma. Weight reduction in obese asthmatics improves their symptoms, quality of life and pulmonary function, both short term and long term.
Epidemiology of COPD Raherison, C; Girodet, P-O
European respiratory review,
12/2009, Letnik:
18, Številka:
114
Journal Article
Recenzirano
Odprti dostop
* Dept of Respiratory Diseases, CHU Bordeaux, Institute of Public Health, Epidemiology and Development, University of Bordeaux 2, and # Dept of Pharmacology, CHU Bordeaux, University of Bordeaux 2, ...Bordeaux, France.
CORRESPONDENCE: C. Raherison, Dept of Respiratory Diseases, Haut-Lévèque, CHU Bordeaux, EA 3672, Institute of Public Health, Epidemiology and Development, University of Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux, France. E-mail: chantal.raherison{at}chu-bordeaux.fr
Received: June 2, 2009
Accepted September 9, 2009
ABSTRACT
Chronic obstructive pulmonary disease (COPD) is responsible for early mortality, high death rates and significant cost to health systems. The projection for 2020 indicates that COPD will be the third leading cause of death worldwide (from sixth in 1990) and fifth leading cause of years lost through early mortality or handicap (disability-adjusted life years) (12th in 1990). Active smoking remains the main risk factor, but other factors are becoming better known, such as occupational factors, infections and the role of air pollution. Prevalence of COPD varies according to country, age and sex. This disease is also associated with significant comorbidities. COPD is a disorder that includes various phenotypes, the continuum of which remains under debate. The major challenge in the coming years will be to prevent onset of smoking along with early detection of the disease in the general population.
KEYWORDS: Chronic obstructive pulmonary disease, epidemiology, morbidity, mortality, (cigarette) smoking
Asthma, frequently associated with rhinitis, is the most common chronic disease in children, and a significant role is played by a range of environmental exposures. Among them, air pollution is of ...foremost concern. However, little is known about the impact of airborne pesticide exposure on children's respiratory health in rural areas. The objective of this study was to analyze the association between airborne pesticide exposure and asthma and rhinitis in children.
In a French vineyard rural area, children (3–10 years old) from 4 selected schools were invited to participate in this study over two periods: winter, with no or low air pesticide levels, and summer when fields are frequently treated with pesticides. Two health outcomes were considered: asthma and rhinitis symptoms (ISAAC questionnaire), and peak expiratory flow (PEF). A quantitative score of symptoms was built. Exposure to pesticides was evaluated 1) by measuring 56 pesticides in the ambient outdoor air around schools in the two periods and building a cumulative exposure index, and 2) by measuring ethylenethiourea (ETU) concentrations in urine in a subsample of children (n = 96), ETU being a urine biomarker of exposure to dithiocarbamates fungicides. Next, the association between pesticide exposure and respiratory health was studied using a logistic regression model, adjusted for confounders and respiratory status at baseline.
281 children participated in the study (47% girls, mean age: 7.5 yrs). 25% of the children were living on a farm. 22% had experienced wheezing at least once. 15.8% had asthma diagnosed by a doctor, 12% had current asthma and 35% had allergic rhinitis.
The main pesticides detected in the ambient outdoor air around schools were fungicides (89,3%; mainly folpet and dithiocarbamates) and insecticides (10.6%).
No association was found between the symptom score and pesticides in the outdoor air around schools during summer, when pesticides were applied to vineyards. However, an association was found between ETU urinary concentration (>0.974 μg/g creatinine) and asthma and rhinitis symptoms (OR=3.56; IC 95% 1.04–12.12). This result could be explained by extracurricular exposure, which was not considered in our air measurements in the schools. No association was found between peak expiratory flow and exposure to pesticides in the air.
Children living in vineyard rural areas are at a higher risk of airborne dithiocarbamates exposure during the summer period. Despite the limited size of our sample, our results suggest possible links between some pesticide measurements and respiratory and allergic symptoms such as rhinitis.
The aim of this study was to evaluate the impact of urban air pollution, assessed through reliable indicators of exposure, on asthma and allergies in schoolchildren. A validated dispersion model ...combining data on traffic conditions, topography, meteorology and background pollution was used to relate 3-yrs averaged concentrations of major urban pollutants at the sites of schools to skin prick tests, exercise-induced asthma and reported asthma and allergies in 6,683 children (9-11 yrs) attending 108 schools randomly selected in six French communities. For the 4,907 children who had resided at their current address for the past 3 yrs, asthma (exercise induced, past year and lifetime) was significantly positively associated with benzene, SO(2), particles with a 50% cut-off aerodynamic diameter of 10 microm (PM(10)), nitrogen oxides (NO(x)) and CO. In the same children, eczema (lifetime and past year) was significantly positively associated with benzene, PM(10), NO(2), NO(x) and CO, lifetime allergic rhinitis with PM(10) and sensitisation to pollens with benzene and PM(10). Among the 2,213 children residing at their current address since birth, the associations persisted for lifetime asthma with benzene (adjusted OR per interquartile range (95% CI) 1.3 (1.0-1.9)) and PM(10 )(1.4 (1.0-2.0)), and for sensitisation to pollens with volatile organic compounds (1.3 (1.0-1.9)) and PM(10) (1.2 (1.0-1.9)). Accurately modelled urban air pollution was associated with some measures of childhood asthma and allergies.
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