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1. Are Environmental Factors for Atopic Eczema in ISAAC Phase Three due to Reverse Causation?

Author

Aït-Khaled, N., Anderson, H.R., Asher, M.I., Beasley, R., Björkstén, B., Brunekreef, B., Crane, J., Ellwood, P., Flohr, C., Foliaki, S., Forastiere, F., García-Marcos, L., Keil, U., Lai, C.K.W., Mallol, J., Mitchell, E.A., Montefort, S., Odhiambo, J., Pearce, N., Robertson, C.F., Stewart, A.W., Strachan, D., von Mutius, E., Weiland, S.K., Weinmayr, G., Williams, H.C., Wong, G., Clayton, T.O., Ellwood, E., Baena-Cagnani, C.E., Gómez, M., Howitt, M.E., Weyler, J., Pinto-Vargas, R., Petrolera de Salud, Caja, Cunha, A.J. D.A., de Freitas Souza, L., Kuaban, C., Ferguson, A., Rennie, D., Standring, P., Aguilar, P., Amarales, L., Benavides, L.A., Contreras, A., Chen, Y.-Z., Kunii, O., Pan, Q. Li, Zhong, N.-S., Aristizábal, G., Cepeda, A.M., Ordoñez, G.A., Bustos, C., Riikjärv, M.-A., Melaku, K., Sa’aga-Banuve, R., Pekkanen, J., Hypolite, I.E., Novák, Z., Zsigmond, G., Awasthi, S., Bhave, S., Hanumante, N.M., Jain, K.C., Joshi, M.K., Mantri, S.N., Pherwani, A.V., Rego, S., Sabir, M., Salvi, S., Setty, G., Sharma, S.K., Singh, V., Sukumaran, T., Suresh Babu, P.S., Kartasasmita, C.B., Konthen, P., Suprihati, W., Masjedi, M.R., Steriu, A., Koffi, B.N., Odajima, H., al-Momen, J.A., Imanalieva, C., Kudzyte, J., Quah, B.S., Teh, K.H., Baeza-Bacab, M., Barragán-Meijueiro, M., Del-Río-Navarro, B.E., García-Almaráz, R., González-Díaz, S.N., Linares-Zapién, F.J., Merida-Palacio, J.V., Ramírez-Chanona, N., Romero-Tapia, S., Romieu, I., Bouayad, Z., MacKay, R., Moyes, C., Pattemore, P., Onadeko, B.O., Cukier, G., Chiarella, P., Cua-Lim, F., Brêborowicz, A., Solé, D., Sears, M., Aguirre, V., Barba, S., Shah, J., Baratawidjaja, K., Nishima, S., de Bruyne, J., Tuuau-Potoi, N., Lai, C.K., Lee, B.W., El Sony, A., Anderson, R., Rutter, Charlotte E., Silverwood, Richard J., Williams, Hywel C., Ellwood, Philippa, Asher, Innes, Garcia-Marcos, Luis, Strachan, David P., Pearce, Neil, and Langan, Sinéad M.

Published
2019
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4. Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Author

Weinmayr, G., Jaensch, A., Ruelius, A. -K., Forastiere, F., Strachan, D. P., Weiland, S. K., Buchele, G., Dentler, C., Rzehak, P., Priftanji, A., Shkurti, A., Simenati, J., Grabocka, E., Shyti, K., Agolli, S., Gurakuqi, A., Stein, R. T., de Pereira, M. U., Jones, M. H., Pitrez, P. M., Cooper, P. J., Chico, M., Chen, Y. Z., Zhong, N. S., Lai, C. K. W., Wong, G. W. K., Riikjarv, M. -A., Annus, T., Annesi-Maesano, I., Gotua, M., Rukhadze, M., Abramidze, T., Kvachadze, I., Karsanidze, L., Kiladze, M., Dolidze, N., Leupold, W., Keil, U., von Mutius, E., Arthur, P., Addo-Yobo, E., Gratziou, C., Priftis, K., Papadopoulou, A., Katsardis, C., Tsanakas, J., Hatziagorou, E., Kirvassilis, F., Clausen, M., Shah, J. R., Mathur, R. S., Khubchandani, R. P., Mantri, S., Di Domenicantonio, R., De Sario, M., Sammarro, S., Pistelli, Riccardo, Serra, M. G., Corbo, Giuseppe Maria, Perucci, C. A., Svabe, V., Sebre, D., Casno, G., Novikova, I., Bagrade, L., Brunekreef, B., Schram, D., Doekes, G., Jansen-van Vliet, P. H. N., Janssen, N. A. H., Aarts, F. J. H., de Meer, G., Crane, J., Wickens, K., Barry, D., Nystad, W., Bolle, R., Lund, E., Batlles Garrido, J., Rubi Ruiz, T., Bonillo Perales, A., Gonzalez Jimenez, Y., Aguirre Rodriguez, J., Momblan deCabo, J., Losilla Maldonado, A., Daza Torres, M., Garcia-Marcos, L., Martinez Torres, A., Guillen Perez, J. J., Pinana Lopez, A., Castejon Robles, S., Garcia Hernandez, G., Martinez Gimeno, A., Moro Rodriguez, A. L., Luna Paredes, C., Gonzalez Gil, I., Morales Suarez-Varela, M. M., Llopis Gonzalez, A., Escribano Montaner, A., Tallon Guerola, M., Braback, L., Kjellman, M., Nilsson, L., Mai, X. -M., Sandin, A., Saraclar, Y., Kuyucu, S., Tuncer, A., Sackesen, C., Sumbuloglu, V., Geyik, P., Kocabas, C., Kaur, B., El-Sharif, N., Nemery, B., Barghuthy, F., Abu Huij, S., Qlebo, M., van Hage, M., Ait-Khaled, N., Anderson, H. R., Flohr, C., Williams, John Harford, Asher, I., Ellwood, P., Stewart, A., Mitchell, E., Pearce, N., Beasley, R., Bjorksten, B., Foliaki, S., Mallol, J., Montefort, S., Odhiambo, J., and Robertson, C.

Subjects
International variation, medicine.medical_specialty, Allergy, Epidemiology, Settore MED/10 - MALATTIE DELL'APPARATO RESPIRATORIO, Environment, 030204 cardiovascular system & hematology, Global Health, medicine.disease_cause, Atopy, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Surveys and Questionnaires, Wheeze, Hypersensitivity, Prevalence, Humans, Medicine, Environmental risk factors, 030212 general & internal medicine, Risk factor, Child, Asthma, business.industry, Public health, Aeroallergen, medicine.disease, medicine.symptom, business, Demography
Abstract

Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8-12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother's smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence.

Published
2018
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5. Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three

Author

Ellwood, Philippa, Asher, M Innes, García-Marcos, Luis, Williams, Hywel, Keil, Ulrich, Robertson, Colin, Nagel, Gabriele, Aït-Khaled, N, Anderson, H R, Asher, M I, Beasley, R, Björkstén, B, Brunekreef, B, Crane, J, Ellwood, P, Flohr, C, Foliaki, S, Forastiere, F, García-Marcos, L, Keil, U, Lai, C K W, Mallol, J, Mitchell, E A, Montefort, S, Odhiambo, J, Pearce, N, Robertson, C F, Stewart, A W, Strachan, D, von Mutius, E, Weiland, S K, Weinmayr, G, Williams, H, Wong, G, Asher, M I, Clayton, T O, Ellwood, E, Ellwood, P, Mitchell, E A, Stewart, A W, Baena-Cagnani, C E, Gómez, M, Howitt, M E, Weyler, J, Pinto-Vargas, R, Cunha, A J L A, de Freitas Souza, L, Kuaban, C, Ferguson, A, Rennie, D, Aguilar, P, Amarales, L, Benavides, L A V, Contreras, A, Chen, Y-Z, Kunii, O, Li Pan, Q, Zhong, N-S, Aristizábal, G, Cepeda, A M, Ordoñez, G A, Koffi, B N, Bustos, C, Riikjärv, M-A, Melaku, K, Saʼaga-Banuve, R, Pekkanen, J, Vlaski, E, Hypolite, I E, Wong, G, Novák, Z, Zsigmond, G, Awasthi, S, Sabir, M, Sharma, S K, Singh, V, Suresh Babu, P S, Kartasasmita, C B, Konthen, P, Suprihati, W, Masjedi, M-R, Steriu, A, Odajima, H, al-Momen, J A, Imanalieva, C, Kudzyte, J, Quah, B S, Teh, K H, Baeza-Bacab, M, Barragán-Meijueiro, M, Del-Río-Navarro, B E, García-Almaráz, R, González-Díaz, S N, Linares-Zapién, F J, Merida-Palacio, J V, Ramírez-Chanona, N, Romero-Tapia, S, Romieu, I, Bouayad, Z, Asher, M I, MacKay, R, Moyes, C, Pattemore, P, Pearce, N, Onadeko, B O, Cukier, G, Chiarella, P, Cua-Lim, F, Brêborowicz, A, Lis, G, Câmara, R, Lopes dos Santos, J M, Nunes, C, Rosado Pinto, J, Fuimaono, P, Goh, D Y T, Zar, H J, Lee, H-B, Blanco-Quirós, A, Busquets, R M, Carvajal-Urueña, I, García-Hernández, G, García-Marcos, L, González Díaz, C, López-Silvarrey Varela, A, Morales Suárez-Varela, M M, Pérez-Yarza, E G, Al-Rawas, O, Mohammad, S, Mohammad, Y, Tabbah, K, Huang, J-L, Kao, C-C, Trakultivakorn, M, Vichyanond, P, Iosefa, T, Windom, H H, Burr, M, Strachan, D, Holgado, D, Lapides, M C, Aldrey, O, Sears, M, Aguirre, V, Mallol, J, Lai, C K W, Shah, J, Baratawidjaja, K, Anderson, H R, Nishima, S, and Lee, B-W

Published
2013
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14. How well do questionnaires perform compared with physical examination in detecting flexural eczema? Findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two

Author

Flohr, C., Weinmayr, G., Weiland (deceased), S. K., Addo-Yobo, E., Annesi-Maesano, I., Björkstén, B., Bråbäck, L., Büchele, G., Chico, M., Cooper, P., Clausen, M., El Sharif, N., Martinez Gimeno, A., Mathur, R. S., von Mutius, E., Morales Suarez-Varela, M., Pearce, N., Svabe, V., Wong, G. W.K., Yu, M., Zhong, N. S., and Williams, H. C.

Published
2009
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17. Are environmental factors for atopic eczema in ISAAC phase three due to reverse causation?

Author

Rutter, Charlotte E., Silverwood, Richard J., Williams, Hywel C., Ellwood, Philippa, Asher, Innes, Garcia-Marcos, Luis, Strachan, David P., Pearce, Neil, Langan, Sinead M., Ait-Khaled, N., Anderson, H. R., Asher, M., I, Beasley, R., Bjorksten, B., Brunekreef, B., Crane, J., Ellwood, P., Flohr, C., Foliaki, S., Forastiere, F., Garcia-Marcos, L., Keil, U., Lai, C. K. W., Mallol, J., Mitchell, E. A., Montefort, S., Odhiambo, J., Pearce, N., Robertson, C. F., Stewart, A. W., Strachan, D., von Mutius, E., Weiland, S. K., Weinmayr, G., Williams, H. C., Wong, G., Clayton, T. O., Ellwood, E., Baena-Cagnani, C. E., Gomez, M., Howitt, M. E., Weyler, Joost J., Pinto-Vargas, R., da Cunha, A. J., de Freitas Souza, L., Kuaban, C., Ferguson, A., Rennie, D., Standring, P., Aguilar, P., Amarales, L., Benavides, L. A., Contreras, A., Chen, Y-Z, Kunii, O., Pan, Q. Li, Zhong, N. S., Aristizabal, G., Cepeda, A. M., Ordonez, G. A., Bustos, C., Riikjarv, M-A, Melaku, K., Sa'aga-Banuve, R., Pekkanen, J., Hypolite, I. E., Novak, Z., Zsigmond, G., Awasthi, S., Bhave, S., Hanumante, N. M., Jain, K. C., Joshi, M. K., Khatav, V. A., Mantri, S. N., Pherwani, A., V, Rego, S., Sabir, M., Salvi, S., Setty, G., Sharma, S. K., Singh, V, Sukumaran, T., Babu, P. S. Suresh, Kartasasmita, C. B., Konthen, P., Suprihati, W., Masjedi, M. R., Steriu, A., Koffi, B. N., Odajima, H., al-Momen, J. A., Imanalieva, C., Kudzyte, J., Quah, B. S., Teh, K. H., Baeza-Bacab, M., Barragan-Meijueiro, M., Del-Rio-Navarro, B. E., Garcia-Almaraz, R., Gonzalez-Diaz, S. N., Linares-Zapien, F. J., Merida-Palacio, J., V, Ramirez-Chanona, N., Romero-Tapia, S., Romieu, I, Bouayad, Z., MacKay, R., Moyes, C., Pattemore, P., Onadeko, B. O., Cukier, G., Chiarella, P., Cua-Lim, F., Breborowicz, A., Sole, D., Sears, M., Aguirre, V, Barba, S., Shah, J., Baratawidjaja, K., Nishima, S., de Bruyne, J., Tuuau-Potoi, N., Lai, C. K., Lee, B. W., El Sony, A., Anderson, R., and ISAAC Phase Three Study Grp

Subjects
Human medicine
Abstract

Some previously described environmental associations for atopic eczema may be due to reverse causation. We explored the role of reverse causation by comparing individual-and school-level results for multiple atopic eczema risk factors. The International Study of Asthma and Allergies in Childhood (i.e, ISAAC) Phase Three surveyed children in schools (the sampling unit) regarding atopic eczema symptoms and potential risk factors. We assessed the effect of these risk factors on atopic eczema symptoms using mixed-effect logistic regression models, first with individual-level exposure data and second with school-level exposure prevalence. Overall, 546,348 children from 53 countries were included. At ages 6-7 years, the strongest individual-level associations were with current paracetamol use (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.37-1.54), which persisted at school-level (OR = 1.55, 95% CI = 1.10-2.21), early-life antibiotics (OR = 1.41, 95% CI = 1.34-1.48), and early-life paracetamol use (OR = 1.28, 95% CI = 1.21-1.36), with the former persisting at the school level, whereas the latter was no longer observed (OR = 1.35, 95% CI = 1.00-1.82 and OR = 0.94, 95% CI = 0.69-1.28, respectively). At ages 13-14 years, the strongest associations at the individual level were with current paracetamol use (OR = 1.57, 95% CI = 1.51-1.63) and open-fire cooking (OR = 1.46, 95% CI = 1.33-1.62); both were stronger at the school level (OR = 2.57, 95% CI = 1.84-3.59 and OR = 2.38, 95% CI = 1.52-3.73, respectively). Association with exposure to heavy traffic (OR = 1.31, 95% CI = 1.27-1.36) also persisted at the school level (OR = 1.40, 95% CI = 1.07-1.82). Most individual-and school-level effects were consistent, tending to exclude reverse causation.

Published
2019

18. Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation?

Author

Silverwood, Richard J., Rutter, Charlotte E., Mitchell, Edwin A., Asher, M. Innes, Garcia-Marcos, Luis, Strachan, David P., Pearce, Neil, Ait-Khaled, N., Anderson, H. R., Asher, M. I., Beasley, R., Bjorksten, B., Brunekreef, B., Crane, J., Ellwood, P., Flohr, C., Foliaki, S., Forastiere, F., Garcia-Marcos, L., Keil, U., Lai, C. K. W., Mallol, J., Mitchell, E. A., Montefort, S., Odhiambo, J., Pearce, N., Robertson, C. F., Stewart, A. W., Strachan, D., von Mutius, E., Weiland, S. K., Weinmayr, G., Williams, H. C., Wong, G., Clayton, T. O., Baena-Cagnani, C. E., Gomez, M., Howitt, M. E., Weyler, Joost J., Pinto-Vargas, R., da Cunha, A. J., de Freitas Souza, L., Kuaban, C., Ferguson, A., Rennie, D., Standring, P., Aguilar, P., Amarales, L., Benavides, L. A., Contreras, A., Chen, Y-Z, Kunii, O., Pan, Li, Zhong, N. S., Aristizabal, G., Cepeda, A. M., Ordonez, G. A., Bustos, C., Riikjarv, M-A, Melaku, K., Sa'aga-Banuve, R., Pekkanen, J., Hypolite, I. E., Novak, Z., Zsigmond, G., Awasthi, S., Bhave, S., Hanumante, N. M., Jain, K. C., Joshi, M. K., Khatav, V. A., Mantri, S. N., Pherwani, A. V., Rego, S., Sabir, M., Salvi, S., Setty, G., Sharma, S. K., Singh, V., Sukumaran, T., Babu, P. S. Suresh, Kartasasmita, C. B., Konthen, P., Suprihati, W., Masjedi, M. R., Steriu, A., Koffi, B. N., Odajima, H., al-Momen, J. A., Imanalieva, C., Kudzyte, J., Quah, B. S., Teh, K. H., Baeza-Bacab, M., Barragan-Meijueiro, M., Del-Rio-Navarro, B. E., Garcia-Almaraz, R., Gonzalez-Diaz, S. N., Linares-Zapien, F. J., Merida-Palacio, J. V., Ramirez-Chanona, N., Romero-Tapia, S., Romieu, I., Bouayad, Z., MacKay, R., Moyes, C., Pattemore, P., Onadeko, B. O., Cukier, G., Chiarella, P., Cua-Lim, F., Breborowicz, A., Lis, G., Camara, R., Chiera, M. L., Lopes dos Santos, J. M., Nunes, C., Pinto, J. Rosado, Vlaski, E., Fuimaono, P., Pisi, V., Goh, D. Y., Zar, H. J., Lee, H. B., Blanco-Quiros, A., Busquets, R. M., Carvajal-Uruena, I., Garcia-Hernandez, G., Gonzalez Diaz, C., Lopez-Silvarrey, A., Morales-Suarez-Varela, M., Perez-Yarza, E. G., Musa, O. A., Al-Rawas, O., Mohammad, S., Mohammad, Y., Tabbah, K., Huang, J. L., Kao, C. C., Trakultivakorn, M., Vichyanond, P., Iosefa, T., Burr, M., Holgado, D., Lapides, M. C., Windom, H. H., Aldrey, O., Sole, D., Sears, M., Aguirre, V., Barba, S., Shah, J., Baratawidjaja, K., Nishima, S., de Bruyne, J., Tuuau-Potoi, N., Lai, C. K., Lee, B. W., El Sony, A., Anderson, R., ISAAC Phase Three Study Grp, ISAAC Int Data Ctr, ISAAC Principal Investigators, and ISAAC Natl Coordinators Not

Subjects
Human medicine
Abstract

Background: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence of symptoms of asthma in children. We undertook comprehensive analyses addressing risk factors for asthma symptoms in combination, at both the individual and the school level, to explore the potential role of reverse causation due to selective avoidance or confounding by indication. Objective: To explore the role of reverse causation in risk factors of asthma symptoms. Methods: We compared two sets of multilevel logistic regression analyses, using (a) individual level exposure data and (b) school level average exposure (ie prevalence), in two different age groups. In individual level analyses, reverse causation is a possible concern if individual level exposure statuses were changed as a result of asthma symptoms or diagnosis. School level analyses may suffer from ecologic confounding, but reverse causation is less of a concern because individual changes in exposure status as a result of asthma symptoms would only have a small effect on overall school exposure levels. Results: There were 131 924 children aged 6-7 years (2428 schools, 25 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (odds ratio = 2.06; 95% confidence interval 1.97-2.16), early life antibiotic use (1.65; 1.58-1.73) and open fire cooking (1.44; 1.26-1.65). In school level analyses, these risk factors again showed increased risks. There were 238 586 adolescents aged 13-14 years (2072 schools, 42 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (1.80; 1.75-1.86), cooking on an open fire (1.32; 1.22-1.43) and maternal tobacco use (1.23; 1.18-1.27). In school level analyses, these risk factors again showed increased risks. Conclusions & clinical relevance: These analyses strengthen the potentially causal interpretation of previously reported individual level findings, by providing evidence against reverse causation.

Published
2019

21. Can environment or allergy explain international variation in prevalence of wheeze in childhood?

Author

Weinmayr, G., Jaensch, A., Ruelius, A. -K., Forastiere, F., Strachan, D. P., Weiland, S. K., Buchele, G., Dentler, C., Rzehak, P., Priftanji, A., Shkurti, A., Simenati, J., Grabocka, E., Shyti, K., Agolli, S., Gurakuqi, A., Stein, R. T., de Pereira, M. U., Jones, M. H., Pitrez, P. M., Cooper, P. J., Chico, M., Chen, Y. Z., Zhong, N. S., Lai, C. K. W., Wong, G. W. K., Riikjarv, M. -A., Annus, T., Annesi-Maesano, I., Gotua, M., Rukhadze, M., Abramidze, T., Kvachadze, I., Karsanidze, L., Kiladze, M., Dolidze, N., Leupold, W., Keil, U., von Mutius, E., Arthur, P., Addo-Yobo, E., Gratziou, C., Priftis, K., Papadopoulou, A., Katsardis, C., Tsanakas, J., Hatziagorou, E., Kirvassilis, F., Clausen, M., Shah, J. R., Mathur, R. S., Khubchandani, R. P., Mantri, S., Di Domenicantonio, R., De Sario, M., Sammarro, S., Pistelli, R., Serra, M. G., Corbo, G., Perucci, C. A., Svabe, V., Sebre, D., Casno, G., Novikova, I., Bagrade, L., Brunekreef, B., Schram, D., Doekes, G., Jansen-van Vliet, P. H. N., Janssen, N. A. H., Aarts, F. J. H., de Meer, G., Crane, J., Wickens, K., Barry, D., Nystad, W., Bolle, R., Lund, E., Batlles Garrido, J., Rubi Ruiz, T., Bonillo Perales, A., Gonzalez Jimenez, Y., Aguirre Rodriguez, J., Momblan deCabo, J., Losilla Maldonado, A., Daza Torres, M., Garcia-Marcos, L., Martinez Torres, A., Guillen Perez, J. J., Pinana Lopez, A., Castejon Robles, S., Garcia Hernandez, G., Martinez Gimeno, A., Moro Rodriguez, A. L., Luna Paredes, C., Gonzalez Gil, I., Morales Suarez-Varela, M. M., Llopis Gonzalez, A., Escribano Montaner, A., Tallon Guerola, M., Braback, L., Kjellman, M., Nilsson, L., Mai, X. -M., Sandin, A., Saraclar, Y., Kuyucu, S., Tuncer, A., Sackesen, C., Sumbuloglu, V., Geyik, P., Kocabas, C., Kaur, B., El-Sharif, N., Nemery, B., Barghuthy, F., Abu Huij, S., Qlebo, M., van Hage, M., Ait-Khaled, N., Anderson, H. R., Flohr, C., Williams, H., Asher, I., Ellwood, P., Stewart, A., Mitchell, E., Pearce, N., Beasley, R., Bjorksten, B., Foliaki, S., Mallol, J., Montefort, S., Odhiambo, J., Robertson, C., Pistelli R. (ORCID:0000-0003-3776-2482), Corbo G. (ORCID:0000-0002-8104-4659), Williams H., Weinmayr, G., Jaensch, A., Ruelius, A. -K., Forastiere, F., Strachan, D. P., Weiland, S. K., Buchele, G., Dentler, C., Rzehak, P., Priftanji, A., Shkurti, A., Simenati, J., Grabocka, E., Shyti, K., Agolli, S., Gurakuqi, A., Stein, R. T., de Pereira, M. U., Jones, M. H., Pitrez, P. M., Cooper, P. J., Chico, M., Chen, Y. Z., Zhong, N. S., Lai, C. K. W., Wong, G. W. K., Riikjarv, M. -A., Annus, T., Annesi-Maesano, I., Gotua, M., Rukhadze, M., Abramidze, T., Kvachadze, I., Karsanidze, L., Kiladze, M., Dolidze, N., Leupold, W., Keil, U., von Mutius, E., Arthur, P., Addo-Yobo, E., Gratziou, C., Priftis, K., Papadopoulou, A., Katsardis, C., Tsanakas, J., Hatziagorou, E., Kirvassilis, F., Clausen, M., Shah, J. R., Mathur, R. S., Khubchandani, R. P., Mantri, S., Di Domenicantonio, R., De Sario, M., Sammarro, S., Pistelli, R., Serra, M. G., Corbo, G., Perucci, C. A., Svabe, V., Sebre, D., Casno, G., Novikova, I., Bagrade, L., Brunekreef, B., Schram, D., Doekes, G., Jansen-van Vliet, P. H. N., Janssen, N. A. H., Aarts, F. J. H., de Meer, G., Crane, J., Wickens, K., Barry, D., Nystad, W., Bolle, R., Lund, E., Batlles Garrido, J., Rubi Ruiz, T., Bonillo Perales, A., Gonzalez Jimenez, Y., Aguirre Rodriguez, J., Momblan deCabo, J., Losilla Maldonado, A., Daza Torres, M., Garcia-Marcos, L., Martinez Torres, A., Guillen Perez, J. J., Pinana Lopez, A., Castejon Robles, S., Garcia Hernandez, G., Martinez Gimeno, A., Moro Rodriguez, A. L., Luna Paredes, C., Gonzalez Gil, I., Morales Suarez-Varela, M. M., Llopis Gonzalez, A., Escribano Montaner, A., Tallon Guerola, M., Braback, L., Kjellman, M., Nilsson, L., Mai, X. -M., Sandin, A., Saraclar, Y., Kuyucu, S., Tuncer, A., Sackesen, C., Sumbuloglu, V., Geyik, P., Kocabas, C., Kaur, B., El-Sharif, N., Nemery, B., Barghuthy, F., Abu Huij, S., Qlebo, M., van Hage, M., Ait-Khaled, N., Anderson, H. R., Flohr, C., Williams, H., Asher, I., Ellwood, P., Stewart, A., Mitchell, E., Pearce, N., Beasley, R., Bjorksten, B., Foliaki, S., Mallol, J., Montefort, S., Odhiambo, J., Robertson, C., Pistelli R. (ORCID:0000-0003-3776-2482), Corbo G. (ORCID:0000-0002-8104-4659), and Williams H.

Abstract

Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8–12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother’s smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence.

Published
2019

24. Tai-Chi and pulmonary rehabilitation compared for treatment-naïve patients with COPD; A Randomized Controlled Trial

Author

Polkey, MI, Qiu, Z-H, Zhou, L, Zhu, M-D, Wu, Y-X, Chen, Y-Y, He, Y-S, Jiang, M, He, B-T, Mehta, B, Zhong, N-S, and Luo, Y-M

Subjects
indacaterol, Respiratory System, COPD, 1103 Clinical Sciences, Tai Chi, pulmonary rehabilitation, respiratory tract diseases
Abstract

Background In COPD, functional status is improved by pulmonary rehabilitation (PR) but requires specific facilities. Tai Chi, which combines psychological treatment and physical exercise and requires no special equipment, is widely practiced in China and is becoming increasingly popular in the rest of the world. We hypothesized that Tai Chi is equivalent (ie, difference less than ±4 St. George’s Respiratory Questionnaire [SGRQ] points) to PR. Methods A total of 120 patients (mean FEV1, 1.11 ± 0.42 L; 43.6% predicted) bronchodilator-naive patients were studied. Two weeks after starting indacaterol 150 μg once daily, they randomly received either standard PR thrice weekly or group Tai Chi five times weekly, for 12 weeks. The primary end point was change in SGRQ prior to and following the exercise intervention; measurements were also made 12 weeks after the end of the intervention. Results The between-group difference for SGRQ at the end of the exercise interventions was –0.48 (95% CI PR vs Tai Chi, –3.6 to 2.6; P = .76), excluding a difference exceeding the minimal clinically important difference. Twelve weeks later, the between-group difference for SGRQ was 4.5 (95% CI, 1.9 to 7.0; P < .001), favoring Tai Chi. Similar trends were observed for 6-min walk distance; no change in FEV1 was observed. Conclusions Tai Chi is equivalent to PR for improving SGRQ in COPD. Twelve weeks after exercise cessation, a clinically significant difference in SGRQ emerged favoring Tai Chi. Tai Chi is an appropriate substitute for PR.

Published
2018

32. World Allergy Organization guidelines for prevention of allergy and allergic asthma: Condensed version

Author

Asher, I, Baena-Cagnani, C, Boner, A, Canonica, GW, Chuchalin, A, Custovic, A, Dagli, E, Haahtela, T, Haus, M, Hemmo-Loten, M, Holgate, S, Holloway, J, Holt, P, Host, A, Iikura, Y, Johansson, SGO, Kaplan, A, Kowalski, ML, Lockey, RF, Naspitz, C, Odhiambo, J, Ring, J, Sastre, J, Venables, K, Vichyanond, P, Volovitz, B, Wahn, U, Warner, J, Weiss, K, Zhong, N-S, and Davies, KH

Published
2004

34. Development and validation of a chronic obstructive pulmonary disease screening questionnaire in China

Author

Zhou, Y-M., primary, Chen, S-Y., additional, Tian, J., additional, Cui, J-Y., additional, Li, X-C., additional, Hong, W., additional, Zhao, Z-X., additional, Hu, G-P., additional, He, F., additional, Qiu, R., additional, Wang, X-P., additional, Wang, D-L., additional, Zheng, J-P., additional, Zhong, N-S., additional, and Ran, P-X., additional

Published
2013
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35. Impulse Oscillometry for Leukotriene D4 Inhalation Challenge in Asthma

Author

Guan, W. J., primary, Zheng, J. P., additional, Gao, Y., additional, Jiang, C. Y., additional, Shi, X., additional, Xie, Y. Q., additional, Liu, Q. X., additional, Jiang, M., additional, An, J. Y., additional, Yu, X. X., additional, Liu, W. T., additional, Zhong, L. P., additional, Wu, Z. P., additional, and Zhong, N. S., additional

Published
2013
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43. Prior SO2 exposure promotes airway inflammation and subepithelial fibrosis following repeated ovalbumin challenge.

Author

Cai, C., Xu, J., Zhang, M., Chen, X-D., Li, L., Wu, J., Lai, H-W., and Zhong, N-S.

Subjects
AIRWAY (Anatomy), GROWTH factors, POLLUTANTS, SULFUR dioxide, ENVIRONMENTAL toxicology
Abstract

Background Exposure to allergens or air pollutants often leads to asthma exacerbations associated with aggravation of airway inflammation. Although, repeated allergen challenge often induces chronic allergic airway inflammation (CAAI) and airway remodelling, yet, the effects of brief exposure to air pollutants such as SO2 on development of CAAI and airway remodelling remain to be clarified. Objective The aim of the experiment was to investigate the effects of acute neutrophilic airway inflammation induced by brief exposure to SO2 on development of CAAI and subepithelial fibrosis (SEF) in a murine model of asthma. Methods Acute airway inflammation was induced by brief exposure to 50 p.p.m. SO2 (1 h/d, 3 days). CAAI and SEF in BALB/c mice were induced by repeated challenge with ovalbumin (OVA) for 5 or 9 weeks with or without prior exposure to SO2. Bronchoalveolar lavage fluid (BALF) eosinophilia as index of CAAI, BALF endothelin-1 (ET-1) and TGF-β1 levels, morphometric evaluation of fibrotic area beneath subbasement membrane and lung hydroxyproline content (Hyp) as indexes of SEF were monitored. Results Exposure to SO2 led to acute neutrophilic inflammation and epithelial sloughing with profound elevation of BALF ET-1. Repeated OVA challenge resulted in CAAI and SEF along with elevation of Hyp, increase of fibrotic area beneath subbasement membrane and elevation of BALF TGF-β1. Preceding SO2 exposure exaggerated BALF eosinophilia, facilitated and enhanced SEF with more significant elevation of BALF ET-1 and TGF-β1 levels compared with OVA-challenged mice without prior exposure to SO2. The increase of Hyp was positively correlated with elevation of BALF TGF-β1 during CAAI ( r=0.842, P<0.01). Conclusion This data demonstrated that SEF developed in parallel with severity and time course of CAAI following repeated OVA challenge. SO2-induced acute epithelial injury and neutrophilic inflammation could enhance CAAI and promote SEF, probably through overexpression of ET-1 and TGF-β1. [ABSTRACT FROM AUTHOR]

Published
2008
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45. Epidemiology and cause of severe acute respiratory syndrome (SARS) in Guangdong, People's Republic of China, in February, 2003.

Author

Zhong, N S, Zheng, B J, Li, Y M, Poon, Xie, Z H, Chan, K H, Li, P H, Tan, S Y, Chang, Q, Xie, J P, Liu, X Q, Xu, J, Li, D X, Yuen, K Y, Peiris, and Guan, Y

Abstract

Background An epidemic of severe acute respiratory syndrome (SARS) has been associated with an outbreak of atypical pneumonia originating in Guangdong Province, People''s Republic of China. We aimed to identify the causative agent in the Guangdong outbreak and describe the emergence and spread of the disease within the province.Methods We analysed epidemiological information and collected serum and nasopharyngeal aspirates from patients with SARS in Guangdong in mid-February, 2003. We did virus isolation, serological tests, and molecular assays to identify the causative agent.Findings SARS had been circulating in other cities of Guangdong Province for about 2 months before causing a major outbreak in Guangzhou, the province''s capital. A novel coronavirus, SARS coronavirus (CoV), was isolated from specimens from three patients with SARS. Viral antigens were also directly detected in nasopharyngeal aspirates from these patients. 48 of 55 (87%) patients had antibodies to SARS CoV in their convalescent sera. Genetic analysis showed that the SARS CoV isolates from Guangzhou shared the same origin with those in other countries, and had a phylogenetic pathway that matched the spread of SARS to the other parts of the world.Interpretation SARS CoV is the infectious agent responsible for the epidemic outbreak of SARS in Guangdong. The virus isolated from patients in Guangdong is the prototype of the SARS CoV in other regions and countries. [Copyright &y& Elsevier]

Published
2003
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46. Are Environmental Factors for Atopic Eczema in ISAAC Phase Three due to Reverse Causation?

Author

Rutter, Charlotte E., Silverwood, Richard J., Williams, Hywel C., Ellwood, Philippa, Asher, Innes, Garcia-Marcos, Luis, Strachan, David P., Pearce, Neil, Langan, Sinéad M., Aït-Khaled, N., Anderson, H.R., Asher, M.I., Beasley, R., Björkstén, B., Brunekreef, B., Crane, J., Ellwood, P., Flohr, C., Foliaki, S., Forastiere, F., García-Marcos, L., Keil, U., Lai, C.K.W., Mallol, J., Mitchell, E.A., Montefort, S., Odhiambo, J., Pearce, N., Robertson, C.F., Stewart, A.W., Strachan, D., von Mutius, E., Weiland, S.K., Weinmayr, G., Williams, H.C., Wong, G., Clayton, T.O., Ellwood, E., Baena-Cagnani, C.E., Gómez, M., Howitt, M.E., Weyler, J., Pinto-Vargas, R., Petrolera de Salud, Caja, Cunha, A.J. D.A., de Freitas Souza, L., Kuaban, C., Ferguson, A., Rennie, D., Standring, P., Aguilar, P., Amarales, L., Benavides, L.A., Contreras, A., Chen, Y.-Z., Kunii, O., Pan, Q. Li, Zhong, N.-S., Aristizábal, G., Cepeda, A.M., Ordoñez, G.A., Bustos, C., Riikjärv, M.-A., Melaku, K., Sa’aga-Banuve, R., Pekkanen, J., Hypolite, I.E., Novák, Z., Zsigmond, G., Awasthi, S., Bhave, S., Hanumante, N.M., Jain, K.C., Joshi, M.K., Mantri, S.N., Pherwani, A.V., Rego, S., Sabir, M., Salvi, S., Setty, G., Sharma, S.K., Singh, V., Sukumaran, T., Suresh Babu, P.S., Kartasasmita, C.B., Konthen, P., Suprihati, W., Masjedi, M.R., Steriu, A., Koffi, B.N., Odajima, H., al-Momen, J.A., Imanalieva, C., Kudzyte, J., Quah, B.S., Teh, K.H., Baeza-Bacab, M., Barragán-Meijueiro, M., Del-Río-Navarro, B.E., García-Almaráz, R., González-Díaz, S.N., Linares-Zapién, F.J., Merida-Palacio, J.V., Ramírez-Chanona, N., Romero-Tapia, S., Romieu, I., Bouayad, Z., MacKay, R., Moyes, C., Pattemore, P., Onadeko, B.O., Cukier, G., Chiarella, P., Cua-Lim, F., Brêborowicz, A., Solé, D., Sears, M., Aguirre, V., Barba, S., Shah, J., Baratawidjaja, K., Nishima, S., de Bruyne, J., Tuuau-Potoi, N., Lai, C.K., Lee, B.W., El Sony, A., and Anderson, R.

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48. The impact of the method of consent on response rates in the ISAAC time trends study

Author

Ellwood, P., Asher, M. I., Stewart, A. W., Aït-Khaled, N., Anderson, H. R., Beasley, R., Björkstén, B., Brunekreef, B., Crane, J., Flohr, C., Foliaki, S., Forastiere, F., García-Marcos, L., Keil, U., Lai, C. K. W., Mallol, J., Mitchell, E. A., Montefort, S., Odhiambo, J., Pearce, N., Robertson, C. F., Strachan, D., Mutius, E., Weiland, S. K., Weinmayr, G., Williams, H., Wong, G., Clayton, T. O., Benhabylès, B., Esamai, F. O., Ng Ang A, L., Bouayad, Z., Onadeko, B. O., Heather Zar, Jerray, M., Chen, Y. Z., Zhong, N. -S, Lau, Y. L., Kartasasmita, C. B., Odajima, H., Teh, K. H., Bruyne, J., Quah, B. S., Cua-Lim, F., Goh, D. Y. T., Lee, H. -B, Huang, J. -L, Vichyanond, P., Trakultivakom, M., Masjedi, M. -R, Al-Momen, J. A., Mahmood, N., Al-Rawas, O., Khatav, V. A., Kumar, L., Setty, G., Jain, K. C., Sukumaran, T. U., Joshi, M. K., Pherwani, A. V., Sharma, S. K., Hanumante, N. M., Guimaraes, I. M. E., Baena-Cagnani, C. E., Rosário, N., Fischer, G. B., Britto, M., Freitas Souza, L., Solé, D., Amarales, L., Aguilar, P., Calvo, M. A., Soto-Quirós, M. E., Romieu, I., Cukier, G., Guggiari-Chase, J. A., Chiarella, P., Holgado, D., Howitt, M. E., Sears, M., Rennie, D., Yeatts, K., Redding, G. J., Priftanji, A., Riikjärv, M. -A, Pekkanen, J., Gotua, M., Svabe, V., Kudzyte, J., Lis, G., Breborowicz, A., Deleanu, D., Kondiourina, E. G., Vogt, H., Ognev, V., Marks, G., Moyes, C., Pattemore, P., Mackay, R., Haidinger, G., Weyler, J., Standring, P., Goulding, R., Steriu, A., Bonci, E., Galassi, C., Petronio, M. G., Chellini, E., Bisanti, L., Sestini, P., Ciccone, G., Piffer, S., Camâra, R., Rosado Pinto, J. E., Nunes, C., Dos Santos, J. M. L., Clancy, L., Busquets, R. M., González Díaz, C., Arnedo-Pena, A., Garcia Hernández, G., Guillén-Grima, F., Morales-Suarez-Varela, M. M., Blanco Quirós, A., Thames, N., Austin, J. B., Shamssain, M. H., Burr, M., Shah, J., Baratawidjaja, K., Nishima, S., Baeza-Bacab, M., Manning, P., Khaitov, R. M., Lee, B., and Nilsson, L.

Subjects
Consent, Pulmonary and Respiratory Medicine, Infectious Diseases, Epidemiology, Medicine (all), ISAAC, Children, Asthma

50. PULMONARY PUZZLE: Prolonged fever, dyspnoea and diffuse pleural thickening in a 20-year-old man.

Author

Cai, C., Li, D. R., Zeng, Q. S., Zhong, S. Q., and Zhong, N. S.

Subjects
RESPIRATORY diseases, PLEURA diseases, ANEMIA, CHEST X rays
Abstract

The article presents the case study of a 20 year old man who reported high fever, night sweat, loss of body weight for 6 months and developed progressive exerional dyspnoea 4 weeks before his admission to hospital. Laboratory examination of the patient showed mild microcytic hypochromic anaemia and chest radiography showed bilateral pleural thickening without prenchymal abnormality.

Published
2007
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