Associations of Exposure to Nitrogen Oxides with Prevalent Asthma and Other Atopic Diseases in Israel

Childhood exposure to nitrogen oxides (NOx) is considered a risk factor for the onset of asthma. However, associations of this exposure with other atopic diseases and factors that modify this association are less clear. We aimed to study associations between exposure to NOx and the prevalence of atopic diseases in Israeli adolescents using a cross-sectional design. The study population comprised all Israeli-born adolescents whose medical status was evaluated for mandatory military recruitment during 1967–2017 (n = 2,523,745), of whom 5.9% had prevalent asthma. We based the exposure assessments on a land-use regression model and estimated associations using multivariable logistic regression models. Across all periods, mean exposure to NOx from birth to adolescence was associated with prevalent asthma at the examination in a dose-response manner, with an odds ratio for the upper quintile of 1.61 (95% CI: 1.56–1.67), in comparison to the lowest quintile. Associations were stronger in males and in lower socioeconomic strata. We found the strongest associations for asthma with comorbid rhinitis, with an almost twofold increase in the odds of upper versus lower quintile of exposure (odds ratio = 1.96, 95% CI: 1.82–2.11). Rhino-conjunctivitis and allergic atopic dermatitis suggested a possible threshold level with NOx. Capsule Summary: Research indicates that half of the global population will suffer from an allergic condition at some point in life. Childhood exposure to nitrogen oxides is a risk factor for the onset of asthma. The association between exposure and allergic diseases other than asthma is unclear. We demonstrate a strong, dose-response relationship between exposure and a group of allergic outcomes, using data comprising 2.5 million subjects over 50 years. The large health benefits from clean air should motivate governments to prioritize mitigation measures.

Associations between Exposure to Industrial Air Pollution and Prevalence of Asthma and Atopic Diseases in Haifa Bay Area

Haifa Bay Area (HBA) contains Israel’s principal industrial area, and there are substantial public concerns about health effects from its emissions. We aimed to examine associations between exposure to air pollution from HBA industrial area with prevalent asthma and other atopic diseases at age 17. This is a cross-sectional study. The study population included all adolescents born in Israel and whose medical status was evaluated for mandatory military recruitment by the Israeli medical corps during 1967–2017. We analyzed prevalent asthma, allergic rhinitis, atopic dermatitis, and rhinoconjunctivitis. We estimated exposure to industrial air pollution by a kriging interpolation of historical SO2 observations and adjusted the associations to the year of birth, SES, school orientation, and traffic pollution. The study population included n = 2,523,745 adolescents, among which 5.9% had prevalent asthma and 4.6% had allergic rhinitis. Residency in HBA was associated with a higher adjusted risk of asthma, compared with non-HBA residency. Still, this association was limited to the three lowest exposure categories, while the highest exposure group had the lowest adjusted risk. Sensitivity analyses and other atopic diseases presented similar results. These results do not provide support for causal relationships between HBA industry-related emissions and prevalent atopic diseases.

The systematic use of metabolomic epidemiology, biobanks, and electronic medical records for precision medicine initiatives in asthma: findings suggest new guidelines to optimize treatment

The application of large-scale metabolomic profiling provides new opportunities to realize the potential of omics-based precision medicine with regard to asthma. We leveraged over 14,000 individuals from four distinct epidemiological studies. We identified and independently replicated seventeen steroid metabolites that were significantly reduced in individuals with prevalent asthma. Importantly steroid levels were reduced among all individuals with asthma regardless of medication use; however, the largest reduction was associated with inhaled corticosteroids use (ICS) that was further confirmed in a four-year ICS clinical trial. Cortisol levels extracted from electronic medical records confirmed that cortisol is reduced among asthmatics taking ICS over the entire 24-hour period, compared with all other groups. Clinical-grade adrenal suppression in asthmatics on ICS, resulting from substantial reductions in steroid metabolites, represents a larger public health problem than previously recognized. Regular cortisol testing may identify at-risk individuals, enabling personalized treatment modifications and improving overall patient care.

Night Shift Work Increases the Risk of Asthma

Shift work causes misalignment between our internal clock and daily behavioural cycles and is associated with metabolic disorders and cancer. Here, we describe the relationship between shift work and prevalent asthma in >280,000 UK Biobank participants. Compared to day workers, ‘permanent’ night shift workers had a higher likelihood of moderate/severe asthma (odds ratio (OR) 1.36 (1.03-1.8)) and all asthma (OR 1.23 (1.03-1.46) after adjustment for known major confounders). The public health implications of this finding are far-reaching due to the high prevalence and co-occurrence of both asthma and shift work.

061 Training in headache in australia, new zealand and asia

IntroductionMigraine is the leading cause of age-adjusted neurological disability in Australia, but little is known about headache training in our region. We aimed to assess the quantity of teaching in headache subjects during undergraduate and postgraduate years.MethodThis is a cross-sectional survey study where questionnaires were sent to 137 delegates from Australia, New Zealand and Asia, prior to the Headache Master School in Sydney in August 2018. The Main outcome measured are recalled number of hours of teaching in undergraduate year and postgraduate years in: 1) Migraine; 2) Trigeminal autonomic cephalalgias (TACs); 3) Asthma; 4) Myasthenia gravis (MG).ResultsThe questionnaire response rate was 73% (100 of 137), of which 29 delegates were within 10 years of completing their undergraduate degree and 98 were neurologists. In undergraduate training, there was much greater quantity of teaching in asthma than migraine (Z=5.007, p<0.000) despite both being high-prevalent (asthma 11%, migraine 15–20%) conditions. Similarly, for diseases of medium-to-low prevalence, there was less training in TACs (1/1000), compared to MG (1.2/10,000) (Z=6.196, p<0.000). These major differences in training were also seen in postgraduate years even though overall headache teaching was greater in postgraduate than undergraduate training (p<0.000).ConclusionsDespite the high prevalence and morbidity of headache disorders, they receive less attention in training than conditions with similar prevalence. We propose that headache training opportunities should be improved in our region, particularly in the undergraduate course and preceptorships or fellowships in postgraduate years.

P.2.38 Occupational exposure and incidence of asthma based on prescription of drugs

Prescription of drugs for obstructive lung diseases (ATC code R03) has previously been shown to be an indicator of actual asthma. In this cohort study, we have combined occupational information with data from redeemed prescriptions between 2000 and 2013 extracted from the National Danish Prescription register.In 2003 a total of 7255 persons aged 20 and 44 years fulfilled a questionnaire, which among other things, included information on their longest held job. The jobs of 6470 were coded according to ISCO-88 and an asthma Job Exposure Matrix (JEM) was applied. Prevalent asthma was defined as at least two redeemed prescriptions of a R03 drug within 2 years. Incident asthma between 2003 and 2013 was defined as not having redeemed a R03 prescription in the previous years. Data was analyzed separately for each gender using multivariate logistic regression and presented as odds ratios (OR) with 95% confidence intervals (CI).Among those having a job 327 (5.1%) were identified as incident cases and 467 (7.2%) as prevalent cases. In females increased incidences were seen in exposures to reactive low molecular weight (LMW) substances (OR1.47 (95% CI 1.04–2.07)), cleaning agents (OR 1.52 (1.05–2.18)), metals (OR 3.31 (1.63–6.64)), while increased prevalence was seen with mite exposure (OR 4.41 (1.74–11.2)) and irritant gases (OR 1.76 (1.16–2.69)). In males no increased incidences were seen and only an increased prevalence with mixed environments (OR 2.24 (1.13–4.43)).In jobs increased prevalence and incidence were seen in female cleaners and drivers. Increased prevalence was seen in male printing workers.Meaningful associations with well-known asthmagenic exposures in young adults with asthma can be identified in administrative register data, and implementing the analyses of register data from larger populations will have the power to detect potential increased risks due to rare exposures or changes in risk over time.

Indoor bacteria and asthma in adults: a multicentre case–control study within ECRHS II

Both protective and adverse effects of indoor microbial exposure on asthma have been reported, but mostly in children. To date, no study in adults has used non-targeted methods for detection of indoor bacteria followed by quantitative confirmation.A cross-sectional study of 198 asthmatic and 199 controls was conducted within the European Community Respiratory Health Survey (ECRHS) II. DNA was extracted from mattress dust for bacterial analysis using denaturing gradient gel electrophoresis (DGGE). Selected bands were sequenced and associations with asthma confirmed with four quantitative PCR (qPCR) assays.15 out of 37 bands detected with DGGE, which had at least a suggestive association (p<0.25) with asthma, were sequenced. Of the four targeted qPCRs,Clostridiumcluster XI confirmed the protective association with asthma. The association was dose dependent (aOR 0.43 (95% CI 0.22–0.84) for the fourthversusfirst quartile, p for trend 0.009) and independent of other microbial markers. Few significant associations were observed for the three other qPCRs used.In this large international study, the level ofClostridiumcluster XI was independently associated with a lower risk of prevalent asthma. Results suggest the importance of environmental bacteria also in adult asthma, but need to be confirmed in future studies.

Prevalence of asthma-like symptoms with ageing

BackgroundChange in the prevalence of asthma-like symptoms in populations of ageing adults is likely to be influenced by smoking, asthma treatment and atopy.MethodsThe European Community Respiratory Health Survey collected information on prevalent asthma-like symptoms from representative samples of adults aged 20–44 years (29 centres in 13 European countries and Australia) at baseline and 10 and 20 years later (n=7844). Net changes in symptom prevalence were determined using generalised estimating equations (accounting for non-response through inverse probability weighting), followed by meta-analysis of centre level estimates.FindingsOver 20 years the prevalence of ‘wheeze’ and ‘wheeze in the absence of a cold’ decreased (−2.4%, 95% CI −3.5 to −1.3%; −1.5%, 95% CI −2.4 to −0.6%, respectively) but the prevalence of asthma attacks, use of asthma medication and hay fever/nasal allergies increased (0.6%, 95% CI 0.1 to 1.11; 3.6%, 95% CI 3.0 to 4.2; 2.7%, 95% CI 1.7 to 3.7). Changes were similar in the first 10 years compared with the second 10 years, except for hay fever/nasal allergies (increase seen in the first 10 years only). Decreases in these wheeze-related symptoms were largely seen in the group who gave up smoking, and were seen in those who reported hay fever/nasal allergies at baseline.InterpretationEuropean adults born between 1946 and 1970 have, over the last 20 years, experienced less wheeze, although they were more likely to report asthma attacks, use of asthma medication and hay fever. Decrease in wheeze is largely attributable to smoking cessation, rather than improved treatment of asthma. It may also be influenced by reductions in atopy with ageing.