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Abstract Background Imbalance in l-arginine and nitric oxide (NO) metabolism has been implicated in the pathophysiology of asthma and obstructive sleep apnea (OSA), and both diseases impact the other’s morbidity. We sought to determine whether l-arginine/NO metabolism differs between adults with asthma with or without comorbid OSA, and its association with asthma morbidity. Methods This is a cross-sectional study of 322 adults with asthma recruited in Denver, CO and New York City, NY. Data were collected on OSA status, spirometry, and metrics of asthma control and morbidity. l-Arginine metabolites were quantified in patient serum. Bivariate analyses and multiple regression were performed to determine differences between l-arginine metabolism, OSA and association with asthma morbidity. Results Among the 322 participants, 92 (28.5%) had OSA. The cohort was 81.6% female, 23.4% identified as Black and 30.6% as Latino. Patients with asthma and OSA had significantly higher serum concentrations of NO synthase inhibitor asymmetric dimethylarginine (ADMA) (p-value = 0.019), lower L-arginine to ornithine ratios (p-value = 0.003), and increased ornithine (p-value = 0.001) and proline levels (p-value

Olufemi O Desalu,1 Adekunle O Adeoti,2 Olutobi B Ojuawo,1 Adeniyi O Aladesanmi,1 Micheal S Oguntoye,3 Oluwafemi J Afolayan,4 Matthew O Bojuwoye,1 Ademola E Fawibe1 1Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria; 2Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria; 3Department of Epidemiology, Kwara State Ministry of Health, Ilorin, Nigeria; 4Department of Medicine, Goulburn Valley Health, Shepparton, VIC, AustraliaCorrespondence: Olufemi O DesaluDepartment of Medicine, University of Ilorin/University of Ilorin, Teaching Hospital, Ilorin, NigeriaEmail femuy1967@yahoo.co.ukPurpose: Urbanization is associated with the risk of developing allergic conditions. Few studies have evaluated the urban–rural disparity of allergic diseases in sub-Saharan Africa.Objective: To compare the epidemiology of adult asthma and allergies in urban and rural Nigeria.Subjects and Methods: A population-based cross-sectional study was performed among 910 subjects in Kwara State, North Central Nigeria, comprising 635 urban and 275 rural adults who were randomly selected. We used standardized questionnaires for data collection.Results: The age-adjusted prevalence of adults reporting a previous “asthma attack” or “currently taking asthma medication” within the preceding 12 months (ECRHS asthma definition) was 3.4% urban, 0.5% rural, current allergic rhinoconjunctivitis (26.2% urban, 22.2% rural), and current skin allergy (13.9% urban, 10.5% rural). The age-adjusted prevalence of “physician-diagnosed allergic conditions”: asthma (3.3% urban, 1.5% rural), allergic rhinoconjunctivitis (4.9% urban, 3.2% rural), and skin allergy (4.8% urban, 4.6% rural) were higher in urban areas than in rural areas. Urban areas recorded a higher age-adjusted 12 months prevalence of wheezing, night waking by breathlessness, night waking by chest tightness, asthma attack (p=0.042), and current use of asthma medication (p=0.031) than the rural areas. In the urban areas, 81% of those with asthma significantly had current allergic rhinoconjunctivitis, and 40.5% had current skin allergy, whereas in the rural areas, all subjects with asthma had current allergic rhinoconjunctivitis and 12.5% had current skin allergy (p=0.482). The most common trigger for asthma attack/respiratory symptoms among the urban household was exposure to environmental smoke (17.2%), and among the rural household, it was dust exposure (18.2%). Living in urban areas significantly increased the odds of having asthma [aOR: 5.6 (95% CI:1.6– 19.6)] and allergic rhinoconjunctivitis [aOR: 1.7 (95% CI: 1.2– 2.4)].Conclusion: This study shows that urban residents frequently reported more allergic and respiratory symptoms and were at risk of having asthma and allergic rhinitis compared to rural residents. The findings would assist the physicians in understanding the urban–rural differences in the occurrence of allergic conditions, symptom triggers, and comorbidity, which are relevant in patient’s clinical evaluation, treatment, and disease prevention.Keywords: urbanization, rural areas, asthma epidemiology, allergy, Nigeria

Lina Rönnebjerg,1 Malin Axelsson,2 Hannu Kankaanranta,1,3,4 Helena Backman,5 Madeleine Rådinger,1 Bo Lundbäck,1 Linda Ekerljung1 1Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; 2Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden; 3Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; 4Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland; 5Department of Public Health and Clinical Medicine, Umeå University, Umeå, SwedenCorrespondence: Lina RönnebjergKrefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Box 424, 405 30, Gothenburg, SwedenTel +46 31 786 67 09Email lina.ronnebjerg@gu.sePurpose: Current guidelines primarily use medication levels to distinguish severe asthma from other types of asthma. In addition, severe asthma must also be uncontrolled at high-intensity treatment or become uncontrolled if treatment level is decreased. To date, only a few studies have used this definition to investigate the prevalence and clinical characteristics of severe asthma in population-based samples. Therefore, the aim of this study was to evaluate the prevalence and clinical characteristics of individuals with severe asthma in the population-representative West Sweden Asthma Study.Materials and Methods: In this cross-sectional population-based study, a randomly selected sample (n=1172) and a separate asthma sample (n=744) underwent clinical examinations, completed a structured interview and responded to questionnaires. Severe asthma was defined as at least one feature of uncontrolled asthma despite treatment in line with the Global Initiative for Asthma (GINA) steps 4/5. This treatment level required a minimum medium dose of inhaled corticosteroids (ICS) plus a second controller or oral corticosteroids.Results: The prevalence of severe asthma was 1.1% in the adult random sample and 9.5% within the asthma sample. Individuals with severe asthma were older and had more symptoms, activity limitations, heart disease and blood neutrophils compared to those with other asthma. They also had lower lung function and despite these impairments, 32% did not have annual contact with a healthcare provider.Conclusion: The prevalence of severe asthma was higher compared to previous studies, and many individuals with severe asthma did not have regular contact with healthcare providers. Due to the high burden of symptoms and impairments for individuals with severe asthma, it is important that the healthcare system implement strategies to improve follow-up and evaluate these patients according to existing guidelines.Keywords: asthma epidemiology, asthma control, asthma-medication, asthma severity symptoms, lung function

BACKGROUND: Severe asthma is a major burden on health-economic resources; hence, knoing the epidemiology of these patients is important in planning and provision of asthma care. In addition, identifying and managing the comorbidities helps improve symptoms and reduce associated morbidity and mortality. OBJECTIVES: Epidemiology of difficult asthma has not been ell studied in the Middle East, so in this study, e present the demographic and clinical characteristics of severe asthma in the United Arab Emirates (UAE). METHODS: We retrospectively revieed the notes of severe asthma patients attending three tertiary care hospitals beteen May 2015 and December 2019. Data on baseline demographics, asthma characteristics, treatment, and comorbidities ere collected. RESULTS: We revieed the notes of 458 patients (271 females and 187 males) that fulfilled the 2019 Global Initiative for Asthma guidelines for the diagnosis of severe asthma. The mean age as 47.7 (standard deviation 17.2) years. Males had significantly higher asthma control test scores (17.9 vs. 16, P = 0.01) and mean blood eosinophils (0.401 vs. 0.294, P

Abstract Wildfires are a growing threat in the United States. At a population level, exposure to ambient wildfire smoke is known to be associated with severe asthma outcomes such as hospitalizations. However, little work has been done on subacute clinical asthma outcomes, especially in sensitive populations. This study retrospectively investigated associations between ambient wildfire smoke exposure and measures of lung function and asthma control, Forced Expiratory Volume in 1 Second (FEV1) and the Asthma Control Test (ACT) and Children's Asthma Control Test (CACT) test scores, during nonurgent clinic visits. The study population consisted of pediatric asthma patients (ages 4–21; n = 1,404 for FEV1 and n = 395 for ACT/CACT) at National Jewish Health, a respiratory referral hospital in Denver, Colorado, and therefore represents a more severe asthma phenotype than the general pediatric asthma population. Wildfire smoke‐related PM2.5 at patients' residential ZIP codes was characterized using satellite‐derived smoke polygons from NOAA's Hazard Mapping System combined with kriging of ground‐based U.S. EPA monitors. Mixed effect models were used to estimate associations between clinical outcomes and smoke PM2.5 exposure, controlling for known risk factors and confounders. Among older children aged 12–21 we found that wildfire PM2.5 was associated with lower FEV1 the next day but higher FEV1 the day after. We found no associations between wildfire PM2.5 and FEV1 in younger children or between wildfire PM2.5 and asthma control measured by the ACT/CACT in all ages. We speculate that rescue medication usage by older children may decrease respiratory symptoms caused by wildfire smoke.

Asthma is a globally significant non-communicable disease with major public health consequences for both children and adults, including high morbidity, and mortality in severe cases. We have summarized the evidence on asthma trends, environmental determinants, and long-term impacts while comparing these epidemiological features across childhood asthma and adult asthma. While asthma incidence and prevalence are higher in children, morbidity, and mortality are higher in adults. Childhood asthma is more common in boys while adult asthma is more common in women, and the reversal of this sex difference in prevalence occurs around puberty suggesting sex hormones may play a role in the etiology of asthma. The global epidemic of asthma that has been observed in both children and adults is still continuing, especially in low to middle income countries, although it has subsided in some developed countries. As a heterogeneous disease, distinct asthma phenotypes, and endotypes need to be adequately characterized to develop more accurate and meaningful definitions for use in research and clinical settings. This may be facilitated by new clustering techniques such as latent class analysis, and computational phenotyping methods are being developed to retrieve information from electronic health records using natural language processing (NLP) algorithms to assist in the early diagnosis of asthma. While some important environmental determinants that trigger asthma are well-established, more work is needed to define the role of environmental exposures in the development of asthma in both children and adults. There is increasing evidence that investigation into possible gene-by-environment and environment-by-environment interactions may help to better uncover the determinants of asthma. Therefore, there is an urgent need to further investigate the interrelationship between environmental and genetic determinants to identify high risk groups and key modifiable exposures. For children, asthma may impair airway development and reduce maximally attained lung function, and these lung function deficits may persist into adulthood without additional progressive loss. Adult asthma may accelerate lung function decline and increase the risk of fixed airflow obstruction, with the effect of early onset asthma being greater than late onset asthma. Therefore, in managing asthma, our focus going forward should be firmly on improving not only short-term symptoms, but also the long-term respiratory and other health outcomes.

Objetivos: Entre 2007 y 2008 se descargaron 215.000 toneladas de cascarilla de soja en el puerto de Tarragona. En la cascarilla se encuentra la proteína causante de las epidemias de asma bronquial. Los objetivos de este estudio fueron estudiar las características de las descargas, la dispersión del alergeno y el riesgo para la población. Métodos: Se recogió información sobre el proceso de descarga, transporte y almacenaje, la meteorología y los casos de asma atendidos en urgencias hospitalarias. Se midió la concentración de alergeno en los filtros de PM10 de las estaciones de vigilancia de la contaminación atmosférica. En los pacientes sensibilizados se realizó un estudio clínico consistente en pruebas cutáneas, IgE sérica total y específica para soja, e inmunoblotting. Resultados: Se encontraron concentraciones moderadas de alergeno a un kilómetro del punto de descarga (3 días por encima de 300U/m³, máximo 441U/m³). El perfil proteico de los extractos de cascarilla es similar al de las muestras de las epidemias de Barcelona. El 92% de los pacientes estudiados son sensibles a los extractos de cascarilla. No hubo ninguna epidemia de asma durante los días de descarga. Además de las proteínas de bajo peso molecular identificadas en estudios anteriores (6 y 14-17kDa), se han encontrado proteínas de mayor peso molecular (14-49kDa). Conclusiones: Existe dispersión del alergeno a corta distancia del lugar de la descarga y riesgo para la población que continúa sensibilizada. Han de adoptarse medidas durante las descargas para reducir al mínimo la emisión de partículas.Objectives: From 2007 to 2008, 215,000 tons of soybean hull were unloaded in the Port of Tarragona. Soybean hull was identified as the etiologic agent causing bronchial asthma outbreaks. The aim of the present study was to identify the characteristics of soybean unloading, soybean allergen dispersion, and the population risk. Methods: Data on soybean hull unloading, carriage and storage, meteorological conditions and the number of emergency room admissions for asthma were recorded. Allergen concentrations were obtained by sampling PM10 filters retaining particles of less than 10 microns for 24 hours in the atmospheric contamination surveillance stations. Sensitized patients underwent clinical examination consisting of skin prick test, total and specific IgE and immunoblotting to soybean extracts. Results: Allergen emissions were moderate at one kilometer from the unloading source (above 300U/m³ on 3 days, maximum 441U/m³). The protein pattern of hull soybean extracts was similar to that found in asthma epidemics in Barcelona. Ninety-two percent of the patients were sensitized to soybean hull extracts. No asthma epidemic was detected during unloading days. In addition to the low molecular weight soybean proteins identified in previous studies (6 and 14-17kDa), high molecular weight proteins were found (14-49kDa). Conclusions: There is allergen dispersion at a short distance from the unloading source, posing a risk to sensitized patients. Technical measures are required during soybean hull operations to reduce particle emissions.

Abstract Background The morbidity and mortality from asthma have markedly increased since the late 1970s. The hospitalization rate, an important marker of asthma severity, remains substantial. Methods In adults with health care access, we prospectively studied 242 with asthma, aged 18–50 years, recruited from a random sample of allergy and pulmonary physician practices in Northern California to identify risk factors for subsequent hospitalization. Results Thirty-nine subjects (16%) reported hospitalization for asthma during the 18-month follow-up period. On controlling for asthma severity in multiple logistic regression analysis, non-white race (odds ratio [OR], 3.1; 95% confidence interval [CI], 1.1–8.8) and lower income (OR, 1.1 per $10,000 decrement; 95% CI, 0.9–1.3) were associated with a higher risk of asthma hospitalization. The severity-of-asthma score (OR, 3.4 per 5 points; 95%, CI 1.7–6.8) and recent asthma hospitalization (OR, 8.3; 95%, CI, 2.1–33.4) were also related to higher risk, after adjusting for demographic characteristics. Reliance on emergency department services for urgent asthma care was also associated with a greater likelihood of hospitalization (OR, 3.2; 95% CI, 1.0–9.8). In multivariate analysis not controlling for asthma severity, low income was even more strongly related to hospitalization (OR, 1.2 per $10,000 decrement; 95% CI, 1.02–1.4). Conclusion In adult asthmatics with access to health care, non-white race, low income, and greater asthma severity were associated with a higher risk of hospitalization. Targeted interventions applied to high-risk asthma patients may reduce asthma morbidity and mortality.