- Email: [email protected]
Effect Of Early Exposure To Traffic Related Air Pollution On The Asthma Predictive Index and Asthma At Age 7
Abstracts AB239
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
824
High Traffic Pollution Exposure Is Significantly Associated With Poorer Asthma-Related Quality Of Life In Older Asthmatics Dr. Jennifer A. Kannan1, Dr. David I. Bernstein, MD, FAAAAI2, Ms. Cheryl Koff Bernstein, RN, BSN, CCRC3, Dr. Patrick Ryan, PhD1,4, Dr. Jonathan A. Bernstein, MD, FAAAAI5, Dr. Manuel S. Villareal, MD, FAAAAI1, Dr. Andrew M. Smith, MD, FAAAAI6, Dr. Peter Lenz1, Dr. Tolly Epstein, MD, MS7; 1University of Cincinnati Medical Center, Cincinnati, OH, 2Bernstein Allergy Group, Cincinnati, OH, 3Bernstein Clinical Research Center, LLC, Cincinnati, OH, 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 5Division of Immunology Allergy & Rheumatology, University of Cincinnati Medical Center, Cincinnati, OH, 63255 Eden Ave., HPB 350, University of Cincinnati Medical Center, Cincinnati, OH, 7Allergy Partners of Central Indiana, Indianapolis, IN. RATIONALE: Morbidity and mortality from asthma is highest in older adults and quality of life (QOL) may be lower, although standardized measures of QOL have not been validated in this population. Predictors of asthma-related QOL in this population also have not been determined. METHODS: Allergy and Pulmonary outpatients (n5164) age 65 years and older with an objective diagnosis of asthma completed the miniAsthma Quality of Life Questionnaire (AQLQ). Demographics, medical history, and Elemental Carbon Attributable to Traffic (ECAT), a surrogate for diesel exposure, were determined. Regression was used to determine predictors of AQLQ scores. RESULTS: Total AQLQ (mean 6 SD5 5.4 6 1.1), and symptom, emotional, and activity domain scores were similar to younger populations, while environmental domain scores (4.4 6 1.7) appeared poorer. Poorer AQLQ scores were significantly associated with ED visits (adjusted [a] b5-1.3;p<0.0001) and with poorer scores on the Asthma Control Questionnaire (ab5-0.7; p<0.0001). Higher ECAT exposure (ab5-1.6; _ 30 kg/m2(ab5 -0.4; p<0.02), female gender (ab 5-0.4; p<0.006), BMI > p<0.01), GERD (ab5-0.4; p<0.01), non-atopic status (ab5-0.5; p<0.002), and asthma onset before age 40 years (ab5-0.5; p<0.004) were significantly associated with poorer AQLQ scores. CONCLUSIONS: AQLQ scores in stable, older asthmatics were similar to those in younger populations and were predictive of other measures of asthma control, verifying that the AQLQ is an appropriate tool in older asthmatics. Traffic pollution exposure was the strongest predictor of poorer asthma-related QOL in older asthmatics.
7.0-25.2; p <0.0001). Allergic persistent wheezing was associated with a significantly higher risk of asthma than non-allergic persistent wheezing (aOR 5 10.4 vs. 5.3; 95% CI 4.1-26.0; p <0.0001). ECAT exposure was not significantly associated with asthma despite a positive API or persistent wheezing. CONCLUSIONS: Both persistent wheezing and a positive API at age 3 significantly predict asthma at age 7 in a high-risk prospective birth cohort. This relationship is not modified by exposure to traffic pollution at age 3.
826
Twins' Increased Risk Of Asthma Compared To Singletons Is Mediated By Gestational Age Vilhelmina Ullemar1, Cecilia Lundholm, MSc1, Prof. Catarina Almqvist, MD, PhD1,2; 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 2Department of Women’s and Children’s Health, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden. RATIONALE: There is an association between low birth weight or premature birth and an increased risk of asthma. Twins are on average smaller at birth compared to singletons and twin gestations are shorter. It has been hypothesized that twins could comprise a high risk population for asthma, although previous studies show conflicting results. This population-based study aims to explore the association between twinship and childhood asthma and to identify potential mediators. METHODS: The study population consisted of all twins and singletons born in Sweden from January 1st 1993 to June 1st 2001 (n5756,363 singletons and n522,548 twins). The Medical Birth Register was used to identify the individuals and their exposure status. Asthma diagnosis was defined as having an ICD-9 diagnosis 493 or ICD-10 diagnosis J45 or J46 registered in the National Patient Register before 18 years of age. Statistical analysis was performed using logistic regression. RESULTS: The crude OR of asthma diagnosis in twins compared to singletons was 1.21 (95% CI 1.15-1.27). Adjusting for gestational age resulted in a protective effect of twinship on childhood asthma diagnosis (OR 0.90, 95% CI 0.85-0.94). CONCLUSIONS: In crude analyses twins were at significantly higher risk of asthma. However the association is mediated by gestational age. When compared to singletons born at the same gestational age, twins are at lower risk of developing asthma in childhood.
Effect Of Early Exposure To Traffic Related Air Pollution On The Asthma Predictive Index and Asthma At Age 7 Dr. Priyal Amin, DO1, Prof. Linda Levin, PhD2, Dr. Tolly Epstein, MD, MS3, Dr. Patrick Ryan, PhD4, Dr. David I. Bernstein, MD, FAAAAI5; 1 University of Cincinnati, College of Medicine, Cincinnati, OH, Afghanistan, 2University of Cincinnati, Cincinnati, OH, 3Allergy Partners of Central Indiana, Indianapolis, IN, 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 5Bernstein Allergy Group, Cincinnati, OH. RATIONALE: The Asthma Predictive Index (API) and wheezing phenotypes identify children at risk for childhood asthma. The impact of traffic pollution on the relationship between the API and asthma is unclear. This is the first study to prospectively determine if the API and/or wheezing phenotypes at age 3 predict asthma at age 7 in a high risk birth cohort, and if exposure to traffic pollution modifies this relationship. METHODS: Data from the Cincinnati Children’s Allergy and Air Pollution Study (CCAAPS) – a high risk prospective birth cohort-was used. Parent-reported or physician-diagnosed asthma was confirmed by _ 4 mg/ml or > _ 20% FEV1 reversibility postmethacholine challenge (PC20 < challenge), or prior controller treatment for asthma. API and persistent wheezing were assessed at age 3. Average daily exposure to elemental carbon attributable to traffic (ECAT) was determined at age 3. Multivariate logistic regression with adjustment for potential confounders was performed. RESULTS: At age 7, 103 of 589 children had asthma. A positive API at age 3 was associated with asthma at age 7 (adjusted [a]OR513.3; 95% CI
TUESDAY
825
J ALLERGY CLIN IMMUNOL VOLUME 133, NUMBER 2
824
High Traffic Pollution Exposure Is Significantly Associated With Poorer Asthma-Related Quality Of Life In Older Asthmatics Dr. Jennifer A. Kannan1, Dr. David I. Bernstein, MD, FAAAAI2, Ms. Cheryl Koff Bernstein, RN, BSN, CCRC3, Dr. Patrick Ryan, PhD1,4, Dr. Jonathan A. Bernstein, MD, FAAAAI5, Dr. Manuel S. Villareal, MD, FAAAAI1, Dr. Andrew M. Smith, MD, FAAAAI6, Dr. Peter Lenz1, Dr. Tolly Epstein, MD, MS7; 1University of Cincinnati Medical Center, Cincinnati, OH, 2Bernstein Allergy Group, Cincinnati, OH, 3Bernstein Clinical Research Center, LLC, Cincinnati, OH, 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 5Division of Immunology Allergy & Rheumatology, University of Cincinnati Medical Center, Cincinnati, OH, 63255 Eden Ave., HPB 350, University of Cincinnati Medical Center, Cincinnati, OH, 7Allergy Partners of Central Indiana, Indianapolis, IN. RATIONALE: Morbidity and mortality from asthma is highest in older adults and quality of life (QOL) may be lower, although standardized measures of QOL have not been validated in this population. Predictors of asthma-related QOL in this population also have not been determined. METHODS: Allergy and Pulmonary outpatients (n5164) age 65 years and older with an objective diagnosis of asthma completed the miniAsthma Quality of Life Questionnaire (AQLQ). Demographics, medical history, and Elemental Carbon Attributable to Traffic (ECAT), a surrogate for diesel exposure, were determined. Regression was used to determine predictors of AQLQ scores. RESULTS: Total AQLQ (mean 6 SD5 5.4 6 1.1), and symptom, emotional, and activity domain scores were similar to younger populations, while environmental domain scores (4.4 6 1.7) appeared poorer. Poorer AQLQ scores were significantly associated with ED visits (adjusted [a] b5-1.3;p<0.0001) and with poorer scores on the Asthma Control Questionnaire (ab5-0.7; p<0.0001). Higher ECAT exposure (ab5-1.6; _ 30 kg/m2(ab5 -0.4; p<0.02), female gender (ab 5-0.4; p<0.006), BMI > p<0.01), GERD (ab5-0.4; p<0.01), non-atopic status (ab5-0.5; p<0.002), and asthma onset before age 40 years (ab5-0.5; p<0.004) were significantly associated with poorer AQLQ scores. CONCLUSIONS: AQLQ scores in stable, older asthmatics were similar to those in younger populations and were predictive of other measures of asthma control, verifying that the AQLQ is an appropriate tool in older asthmatics. Traffic pollution exposure was the strongest predictor of poorer asthma-related QOL in older asthmatics.
7.0-25.2; p <0.0001). Allergic persistent wheezing was associated with a significantly higher risk of asthma than non-allergic persistent wheezing (aOR 5 10.4 vs. 5.3; 95% CI 4.1-26.0; p <0.0001). ECAT exposure was not significantly associated with asthma despite a positive API or persistent wheezing. CONCLUSIONS: Both persistent wheezing and a positive API at age 3 significantly predict asthma at age 7 in a high-risk prospective birth cohort. This relationship is not modified by exposure to traffic pollution at age 3.
826
Twins' Increased Risk Of Asthma Compared To Singletons Is Mediated By Gestational Age Vilhelmina Ullemar1, Cecilia Lundholm, MSc1, Prof. Catarina Almqvist, MD, PhD1,2; 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 2Department of Women’s and Children’s Health, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden. RATIONALE: There is an association between low birth weight or premature birth and an increased risk of asthma. Twins are on average smaller at birth compared to singletons and twin gestations are shorter. It has been hypothesized that twins could comprise a high risk population for asthma, although previous studies show conflicting results. This population-based study aims to explore the association between twinship and childhood asthma and to identify potential mediators. METHODS: The study population consisted of all twins and singletons born in Sweden from January 1st 1993 to June 1st 2001 (n5756,363 singletons and n522,548 twins). The Medical Birth Register was used to identify the individuals and their exposure status. Asthma diagnosis was defined as having an ICD-9 diagnosis 493 or ICD-10 diagnosis J45 or J46 registered in the National Patient Register before 18 years of age. Statistical analysis was performed using logistic regression. RESULTS: The crude OR of asthma diagnosis in twins compared to singletons was 1.21 (95% CI 1.15-1.27). Adjusting for gestational age resulted in a protective effect of twinship on childhood asthma diagnosis (OR 0.90, 95% CI 0.85-0.94). CONCLUSIONS: In crude analyses twins were at significantly higher risk of asthma. However the association is mediated by gestational age. When compared to singletons born at the same gestational age, twins are at lower risk of developing asthma in childhood.
Effect Of Early Exposure To Traffic Related Air Pollution On The Asthma Predictive Index and Asthma At Age 7 Dr. Priyal Amin, DO1, Prof. Linda Levin, PhD2, Dr. Tolly Epstein, MD, MS3, Dr. Patrick Ryan, PhD4, Dr. David I. Bernstein, MD, FAAAAI5; 1 University of Cincinnati, College of Medicine, Cincinnati, OH, Afghanistan, 2University of Cincinnati, Cincinnati, OH, 3Allergy Partners of Central Indiana, Indianapolis, IN, 4Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 5Bernstein Allergy Group, Cincinnati, OH. RATIONALE: The Asthma Predictive Index (API) and wheezing phenotypes identify children at risk for childhood asthma. The impact of traffic pollution on the relationship between the API and asthma is unclear. This is the first study to prospectively determine if the API and/or wheezing phenotypes at age 3 predict asthma at age 7 in a high risk birth cohort, and if exposure to traffic pollution modifies this relationship. METHODS: Data from the Cincinnati Children’s Allergy and Air Pollution Study (CCAAPS) – a high risk prospective birth cohort-was used. Parent-reported or physician-diagnosed asthma was confirmed by _ 4 mg/ml or > _ 20% FEV1 reversibility postmethacholine challenge (PC20 < challenge), or prior controller treatment for asthma. API and persistent wheezing were assessed at age 3. Average daily exposure to elemental carbon attributable to traffic (ECAT) was determined at age 3. Multivariate logistic regression with adjustment for potential confounders was performed. RESULTS: At age 7, 103 of 589 children had asthma. A positive API at age 3 was associated with asthma at age 7 (adjusted [a]OR513.3; 95% CI
TUESDAY
825