Poor adherence to treatment is a cause of inadequate asthma control and increased exacerbations. Better understanding of the factors associated with adherence could lead to recognition of appropriate ...solutions.
An online, quantitative, self-completed questionnaire-based survey was conducted among 1024 French adults with asthma (aged 18-50years). Data were collected on socio-demographic characteristics, asthma control, patient perception of the disease and adherence.
Only 11% of asthma patients considered that their asthma is uncontrolled while 48% were uncontrolled according to the GINA criteria. More than half (56%) of respondents admitted not taking their maintenance therapy every day. The perception that asthma was well controlled and lack of impact of the disease on daily activities were the most common reasons cited (46% of respondents) for not taking maintenance therapy. The other main reasons cited were forgetting and use only during symptomatic periods (21% and 14% of respondents, respectively).
Adult asthma patients tend to overestimate their level of asthma control. Improving the management of asthma requires systematic detection of respiratory symptoms, awareness of the patient that asthma is a chronic disease and improved physician assessment of patients' expectations and perception of their disease.
Smoking remains common, with an exposure that begins early during pregnancy. It induces epigenetic changes, with a trans-generational transmission. Smoking increases the risk of uncontrolled asthma ...during childhood and adult life. Asthma is also associated with increased risk of a decline of lung function and chronic obstructive pulmonary disease (COPD). Women are more at risk of developing early and severe COPD. The mechanisms are currently poorly known.
Data on physical activity in severe asthma are scarce. From May 2016 to June 2017, 1502 adult patients with severe asthma visiting a pulmonologist practicing in one of the 104 non-academic hospitals ...participating in the study were included in this prospective, cross-sectional, multicenter study, provided they gave consent. Physical activity was classified according to 4 levels: 1 (no activity), 2 (occasional), 3 (regular), or 4 (frequent). Clinical and therapeutic parameters were described according to these levels.
Respectively, 440, 528, 323, and 99 patients had physical activity of level 1, 2, 3, and 4. The percentage of patients with controlled asthma increased with physical activity. Treatment adherence did not differ with physical activity. Percentages of obese patients, patients with FEV1 <60%, and patients with anxiety, depressive syndrome, gastro-esophageal reflux disease, arterial hypertension, diabetes, obstructive sleep apnoea-hypopnoea syndrome, and osteoporosis decreased with physical activity. Respiratory rehabilitation was offered to only 5% of patients.
In this large study, physical activity is associated with disease control in severe asthma and with less comorbidity. Its practice should be encouraged and respiratory rehabilitation offered more often.
Summary
Background
Mice models suggest epigenetic inheritance induced by parental allergic disease activity. However, we know little of how parental disease activity before conception influences ...offspring's asthma and allergy in humans.
Objective
We aimed to assess the associations of parental asthma severity, bronchial hyperresponsiveness (BHR), and total and specific IgEs, measured before conception vs. after birth, with offspring asthma and hayfever.
Methods
The study included 4293 participants (mean age 34, 47% men) from the European Community Respiratory Health Survey (ECRHS) with information on asthma symptom severity, BHR, total and specific IgEs from 1991 to 1993, and data on 9100 offspring born 1972–2012. Adjusted relative risk ratios (aRRR) for associations of parental clinical outcome with offspring allergic disease were estimated with multinomial logistic regressions.
Results
Offspring asthma with hayfever was more strongly associated with parental BHR and specific IgE measured before conception than after birth BHR: aRRR = 2.96 (95% CI: 1.92, 4.57) and 1.40 (1.03, 1.91), respectively; specific IgEs: 3.08 (2.13, 4.45) and 1.83 (1.45, 2.31), respectively. This was confirmed in a sensitivity analysis of a subgroup of offspring aged 11–22 years with information on parental disease activity both before and after birth.
Conclusion & Clinical Relevance
Parental BHR and specific IgE were associated with offspring asthma and hayfever, with the strongest associations observed with clinical assessment before conception as compared to after birth of the child. If the hypothesis is confirmed in other studies, parental disease activity assessed before conception may prove useful for identifying children at risk for developing asthma with hayfever.
Si l’allaitement semble avoir un effet protecteur vis-à-vis des allergies notamment chez les enfants à risque, les études portant sur le lien entre l’allaitement et les allergies ont souvent ...considéré les enfants non allaités comme un groupe homogène. Pourtant, la composition des préparations infantiles (PI) est très diverse notamment sur le traitement des protéines qui peut influencer le risque allergique. Notre objectif est d’étudier le lien entre l’alimentation lactée à 2 mois et l’incidence des allergies à 1 et 2 ans dans une cohorte récente.
Les analyses ont porté sur 8962 enfants de l’étude ELFE. Le mode d’alimentation a été collecté par entretien téléphonique à 2 mois. Les PI ont été classées en fonction du degré d’hydrolyse des protéines (non hydrolysées, hydrolysat partiel non labellisé hypoallergénique (HA), hydrolysat partiel labellisé HA, hydrolysat poussé) et comparées à un allaitement maternel exclusif à 2 mois. Les parents ont rapporté un diagnostic médical d’allergie alimentaire à 2 mois et 2 ans, des manifestations d’eczéma ou de sifflements à 2 mois, 1 et 2 ans et le nombre d’épisodes de bronchiolite à 1 et 2 ans. Des régressions logistiques, ajustées sur les facteurs de risque d’allergie et sur les caractéristiques familiales, ont été utilisées. Les enfants avec au moins un symptôme allergique rapporté à 2 mois ont été exclus des analyses, de même que ceux qui recevaient un hydrolysat poussé à 2 mois.
L’allaitement maternel exclusif à 2 mois est associé à un risque plus faible d’avoir eu plusieurs épisodes de bronchiolite dans la 1re année. À l’inverse, les enfants recevant des PI hydrolysées (labellisées HA ou non) à 2 mois ont un risque accru d’avoir eu plusieurs épisodes de bronchiolite dans la 1re année. Ces associations ne sont pas retrouvées à 2 ans. Le degré d’hydrolyse des PI à 2 mois n’est associé ni au risque d’eczéma ni au risque de sifflements à 1 et 2 ans. Enfin, les enfants recevant des PI labellisées HA à 2 mois ont un risque accru d’allergie alimentaire à 2 ans.
L’interaction entre les antécédents d’allergie (ATCD) dans la fratrie et l’alimentation à 2 mois est non significative (p>0,2) quelle que soit l’allergie considérée. L’interaction entre les ATCD des parents et l’alimentation à 2 mois est significative pour les sifflements à 1 an (p=0,01) et pour les épisodes de bronchiolite à 2 ans (p=0,02). Chez les enfants avec des ATCD, ceux recevant des PI hydrolysées à 2 mois ont un risque accru de sifflements et d’épisodes de bronchiolites à 1 an. Chez les enfants sans ATCD, ceux recevant une PI labellisée HA à 2 mois ont un risque accru de bronchiolite et d’allergie alimentaire à 2 ans.
Les associations entre l’alimentation lactée à 2 mois et les sifflements ou épisodes de bronchiolite, malgré l’exclusion des cas potentiels ou avérés d’allergie précoce, devront être interprétées après une analyse détaillée des facteurs associés à la consommation de PI hydrolysées chez des enfants ne manifestant aucun symptôme allergique à 2 mois.
Abstract Alpha-1-antitrypsin deficiency (A1ATD) is a genetic condition caused by SERPINA1 mutations, which results into decreased protease inhibitor activity in the serum and predisposes to emphysema ...and/or to liver disease due to accumulation of the abnormal protein in the hepatic cells. In most cases the clinical manifestations of A1ATD are associated with PIZZ (p.Glu366Lys; p.Glu366Lys (p.Glu342Lys; p.Glu342Lys)) or PISZ (p.Glu288Val; p.Glu366Lys (p.Glu264Val; p.Glu342Lys)) genotype, less frequently, deficient or null alleles may be present in compound heterozygous or homozygous A1AT deficient patients. We report the identification of a novel alpha1-antitrypsin variant in a 64-year old woman presenting with dyspnea on exertion. Imaging revealed bilateral bronchiectasis associated with moderate panacinar emphysema. The pulmonary function tests (PFTs) were subnormal but hypoxemia was noticed and A1AT quantitative analysis revealed a severe deficiency. DNA sequencing showed compound heterozygosity for the PIZ variant and a novel missense variant p.Phe232Leu (p.Phe208Leu). No specific treatment was proposed since PFTs were within the normal range at this stage of the disease. Close follow-up of pulmonary and hepatic parameters was recommended.
To cite this article: Randriamanantany ZA, Annesi-Maesano I, Moreau D, Raherison C, Charpin D, Kopferschmitt C, Lavaud F, Taytard A, De Blay F, Caillaud D. Alternaria sensitization and allergic ...rhinitis with or without asthma in the French Six Cities study. Allergy 2010; 65: 368-375. Allergic sensitization to Alternaria has been related to asthma in various studies, but its association with allergic rhinitis is still controversial. The aim of this study was to assess at the population level the relationships in childhood between Alternaria sensitization and 'past-year rhinoconjunctivitis' (PYRC), 'ever hay fever' (EHF) and 'ever allergic rhinitis caused by allergens other than pollens' (EAR) according to the presence or the absence of asthma. This study is part of the Six Cities Study, the French contribution to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II. Children underwent skin prick test (SPT) to Alternaria and parents filled a standardized medical questionnaire. Some 6726 children with a mean age of 10 years were examined. The overall prevalence of Alternaria sensitization was 2.8%, 0.8% for monosensitization. Prevalences of symptoms in sensitized children were 27.7% for PYRC, 27.0% for EHF and 30.4% for EAR. Adjusted Odds Ratios (OR) between Alternaria sensitization and allergic rhinitis phenotypes were 2.34 (95% confidence interval: 1.51-3.63) for PYRC, 2.40 (1.65-3.50) for EHF and 2.95 (2.05-4.23) for EAR. The relationship still remained in the case of monosensitization to Alternaria for both PYRC and EAR when excluding the asthmatic children OR = 3.87 (1.54-9.78) and 2.88 (1.10-7.55) respectively. In our population-based sample of children, we found a link between Alternaria sensitization and allergic rhinitis, independently of asthma, which is compatible with the mechanisms of deposition of Alternaria in the upper airways.
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