| 41. |
- Blanc, Paul D., et al.
(författare)
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The prevalence and predictors of respiratory-related work limitation and occupational disability in an international study
- 2003
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Ingår i: Chest. ; 124:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Work-related symptoms and disability due to respiratory disease are common and costly among working-age adults. To investigate this problem, we analyzed data on respiratory symptoms related to the workplace and occupational disability from the European Community Respiratory Health Survey (ECRHS). METHODS: The ECRHS is a population-based sample of adults aged 20 to 44, with oversampling of subjects with symptoms that are consistent with respiratory disease. We analyzed structured interviews from 17,567 subjects, of whom 15,039 were from a general random population sample and 2,528 were from the respiratory symptom oversample. We defined work-related respiratory symptoms as self-reported wheeze or chest tightness at work, and work-related respiratory disability as reported job change due to breathing difficulties at work. We used binary generalized linear modeling with a log link to estimate the risk of symptoms and disability. FINDINGS: Wheeze at work was reported in the general population sample by 1,552 subject (10%), ranging from 4 to 15% among the 16 countries analyzed. Work-related respiratory disability was reported by 540 subjects (4%), ranging from 1 to 8%. Reported workplace exposure to vapors, gases, dust, or fumes was associated with increased risk of respiratory symptoms at work (prevalence ratio [PR], 2.1; 95% CI 1.8-2.4) and work-related respiratory disability (PR, 3.4; 95% confidence interval [CI], 2.0 to 5.1). Workplace environmental tobacco smoke exposure was associated with symptoms (PR, 1.3; 95% CI, 1.2 to 1.5) but not with disability (PR, 1.1; 95% CI, 0.9 to 1.4). INTERPRETATION: These data indicated that work-related respiratory symptoms and disability vary widely in this international sample but, nonetheless, are associated with workplace exposures that could be addressed through preventive measures.
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| 42. |
- Bousquet, Philippe-Jean, et al.
(författare)
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Geographical distribution of atopic rhinitis in the European Community Respiratory Health Survey I
- 2008
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Ingår i: Allergy. European Journal of Allergy and Clinical Immunology. - : Wiley. - 0105-4538 .- 1398-9995. ; 63:10, s. 1301-1309
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: No large studies in adults has examined geographical variation in the prevalence of nasal allergy/allergic rhinitis in adults or considered the proportion of reported nasal symptoms on exposure to allergen attributable to atopy. The aim of this report was to describe the geographic distribution of subjects with nasal symptoms who are sensitized as determined by skin prick tests, using data from the European Community Respiratory Health Survey I. METHODS: Information on the presence of nasal allergy, nasal symptoms on exposure to allergen and atopy using skin prick tests was collected from 15,394 adults aged 20-44 years living in 35 centres in 15 countries. Age sex standardized prevalence of symptoms and the attributable fraction of IgE sensitization for nasal symptoms on exposure to allergen were determined. RESULTS: The age-sex standardized prevalence of nasal allergy ranged from 11.8% in Oviedo (Spain) to 46.0% in Melbourne (Australia). The prevalence of atopic nasal allergy ranged from 4.6% in Oviedo to 31.8% in Melbourne (analysis limited on 12,566 subjects). The median attributable fraction for atopy on nasal symptoms on exposure ranged between 12.8% and 65.9% (median 27.2%). CONCLUSION: In the general population there is a wide variation in the prevalence of nasal allergy in young adults. Many subjects complaining from nasal symptoms on exposure to allergen are not atopic.
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| 43. |
- Castro-Giner, F., et al.
(författare)
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Joint effect of obesity and TNFA variability on asthma : two international cohort studies
- 2009
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Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 33:5, s. 1003-1009
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Tidskriftsartikel (refereegranskat)abstract
- Obesity is a risk factor for asthma. Adipose tissue expresses pro-inflammatory molecules including tumour necrosis factor (TNF), and levels of TNF are also related to polymorphisms in the TNF-alpha (TNFA) gene. The current authors examined the joint effect of obesity and TNFA variability on asthma in adults by combining two population-based studies. The European Community Respiratory Health Survey and the Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults used comparable protocols, questionnaires and measures of lung function and atopy. DNA samples from 9,167 participants were genotyped for TNFA -308 and lymphotoxin-alpha (LTA) +252 gene variants. Obesity and TNFA were associated with asthma when mutually adjusting for their independent effects (odds ratio (OR) for obesity 2.4, 95% confidence interval (CI) 1.7-3.2; OR for TNFA -308 polymorphism 1.3, 95% CI 1.1-1.6). The association of obesity with asthma was stronger for subjects carrying the G/A and A/A TNFA -308 genotypes compared with the more common G/G genotype, particularly among nonatopics (OR for G/A and A/A genotypes 6.1, 95% CI 2.5-14.4; OR for G/G genotype 1.7, 95% CI 0.8-3.3). The present findings provide, for the first time, evidence for a complex pattern of interaction between obesity, a pro-inflammatory genetic factor and asthma.
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| 44. |
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| 45. |
- Castro-Giner, F, et al.
(författare)
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TNFA -308G>A in two international population-based cohorts and risk of asthma
- 2008
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Ingår i: European Respiratory Journal. - Sheffield : European respiratory society journals. - 0903-1936 .- 1399-3003. ; 32:2, s. 350-361
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Tidskriftsartikel (refereegranskat)abstract
- Genetic association studies have related the tumour necrosis factor-alpha gene (TNFA) guanine to adenine substitution of nucleotide -308 (-308G>A) polymorphism to increased risk of asthma, but results are inconsistent. The aim of the present study was to test whether two single-nucleotide polymorphisms, of TNFA and of the lymphotoxin-alpha gene (LTA), are associated with asthma, bronchial hyperresponsiveness and atopy in adults, by combining the results of two large population-based multicentric studies and conducting a meta-analysis of previously published studies. The European Community Respiratory Health Survey (ECRHS) and Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) used comparable protocols, including questionnaires for respiratory symptoms and measures of lung function and atopy. DNA samples from 11,136 participants were genotyped at TNFA -308 and LTA 252. Logistic regression employing fixed and random effects models and nonparametric techniques were used. The prevalence of asthma was 6%. The TNFA -308G>A polymorphism was associated with increased asthma prevalence and with bronchial hyperresponsiveness. No consistent association was found for atopy. The LTA 252A>G polymorphism was not associated with any of the outcomes. A meta-analysis of 17 studies showed an increased asthma risk for the TNFA -308 adenine allele. The tumour necrosis factor-alpha gene nucleotide -308 polymorphism is associated with a moderately increased risk of asthma and bronchial hyperresponsiveness, but not with atopy. These results are supported by a meta-analysis of previously published studies.
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| 46. |
- Cerveri, Isa, et al.
(författare)
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Underestimation of airflow obstruction among young adults using FEV1/FVC<70% as a fixed cut-off : a longitudinal evaluation of clinical and functional outcomes
- 2008
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Ingår i: Thorax. - : BMJ. - 0040-6376 .- 1468-3296. ; 63:12, s. 1040-1045
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early detection of airflow obstruction is particularly important among young adults because they are more likely to benefit from intervention. Using the forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) (FEV1/FVC) <70% fixed ratio, airflow obstruction may be underdiagnosed. The lower limit of normal (LLN), which is statistically defined by the lower fifth percentile of a reference population, is physiologically appropriate but it still needs a clinical validation.Methods: To evaluate the characteristics and longitudinal outcomes of subjects misidentified as normal by the fixed ratio with respect to the LLN, 6249 participants (aged 20-44 years) in the European Community Respiratory Health Survey were examined and divided into three groups (absence of airflow obstruction by the LLN and the fixed ratio; presence of airflow obstruction only by the LLN; presence of airflow obstruction by the two criteria) for 1991-1993. LLN equations were obtained from normal non-smoking participants. A set of clinical and functional outcomes was evaluated in 1999-2002.Results: The misidentified subjects were 318 (5.1%); only 45.6% of the subjects with airflow obstruction by the LLN were also identified by the fixed cut-off. At baseline, FEV1 (107%, 97%, 85%) progressively decreased and bronchial hyperresponsiveness (slope 7.84, 6.32, 5.57) progressively increased across the three groups. During follow-up, misidentified subjects had a significantly higher risk of developing chronic obstructive pulmonary disease and a significantly higher use of health resources (medicines, emergency department visits/hospital admissions) because of breathing problems than subjects without airflow obstruction (p<0.001).Conclusions: Our findings show the importance of using statistically derived spirometric criteria to identify airflow obstruction.
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| 47. |
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| 48. |
- Chinn, S., et al.
(författare)
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Incidence of asthma and net change in symptoms in relation to changes in obesity
- 2006
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Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 28:4, s. 763-771
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Tidskriftsartikel (refereegranskat)abstract
- The incidence of asthma has been reported to be associated with obesity. An alternative analysis, of net change in prevalence, does not require exclusion of those with asthma at baseline. Follow-up data were obtained from 9,552 participants in the European Community Respiratory Health Survey and the Swiss cohort Study on Air Pollution and Lung Disease in Adults. Incidence of asthma was analysed by proportional hazards regression, and net changes in symptoms and asthma status by generalised estimating equations, by obesity group. Incidence and net change in ever having had asthma were greater in females than in males, and in participants who remained obese compared with those who were never obese (hazard ratio 2.00, 95% confidence interval 1.25-3.20; excess net change 2.8%, 0.4-5.3% per 10 yrs). The effect of being obese on net change in diagnosed asthma was greater in females than in males, but for net change in wheeze without a cold it was greater in males. The present results are consistent with asthma being more frequently diagnosed in females, especially obese females. These findings may help to explain the reports of a stronger association between asthma and obesity in females than in males.
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| 49. |
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| 50. |
- Coton, Sonia, et al.
(författare)
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Severity of Airflow Obstruction in Chronic Obstructive Pulmonary Disease (COPD) : Proposal for a New Classification
- 2017
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Ingår i: COPD. - : Informa UK Limited. - 1541-2555 .- 1541-2563. ; 14:5, s. 469-475
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Tidskriftsartikel (refereegranskat)abstract
- Current classifications of Chronic Obstructive Pulmonary Disease (COPD) severity are complex and do not grade levels of obstruction. Obstruction is a simpler construct and independent of ethnicity. We constructed an index of obstruction severity based on the FEV1/FVC ratio, with cut-points dividing the Burden of Obstructive Lung Disease (BOLD) study population into four similarly sized strata to those created by the GOLD criteria that uses FEV1. Wemeasured the agreement between classifications and the validity of the FEV1-based classification in identifying the level of obstruction as defined by the new groupings. We compared the strengths of association of each classification with quality of life (QoL), MRC dyspnoea score and the self-reported exacerbation rate. Agreement between classifications was only fair. FEV1-based criteria for moderate COPD identified only 79% of those with moderate obstruction and misclassified half of the participants with mild obstruction as having more severe COPD. Both scales were equally strongly associated with QoL, exertional dyspnoea and respiratory exacerbations. Severity assessed using the FEV1/FVC ratio is only in moderate agreement with the severity assessed using FEV1 but is equally strongly associated with other outcomes. Severity assessed using the FEV1/FVC ratio is likely to be independent of ethnicity.
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