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Background: Although several studies have investigated the influence of diet on asthma in schoolchildren, none of them has evaluated how obesity can modify this effect. A study was undertaken to evaluate the association of various foods and a Mediterranean diet with the prevalence of asthma and rhinoconjunctivitis, adjusting for obesity and exercise. Methods: A cross-sectional study was performed in 20 106 schoolchildren aged 6–7 years from eight Spanish cities. Using the ISAAC phase III questionnaire, parents reported chest and nose symptoms, food intake, weight, height and other factors, including exercise. A Mediterranean diet score was developed. A distinction was made between current occasional asthma (COA) and current severe asthma (CSA). Results: Independent of the amount of exercise, each Mediterranean score unit had a small but protective effect on CSA in girls (adjusted OR 0.90, 95% CI 0.82 to 0.98). Exercise was a protective factor for COA and rhinoconjunctivitis in girls and boys (the more exercise, the more protection). Obesity was a risk factor for CSA in girls (adjusted OR 2.35, 95% CI 1.51 to 3.64). Individually, a more frequent intake (1–2 times/week and ⩾3 times/week vs never/occasionally) of seafood (adjusted ORs 0.63 (95% CI 0.44 to 0.91) and 0.53 (95% CI 0.35 to 0.80)) and cereals (adjusted OR 0.56 (95% CI 0.30 to 1.02) and 0.39 (95% CI 0.23 to 0.68)) were protective factors for CSA, while fast food was a risk factor (adjusted ORs 1.64 (95% CI 1.28 to 2.10) and 2.26 (95% CI 1.09 to 4.68)). Seafood (adjusted ORs 0.74 (95% CI 0.60 to 0.92) and 0.67 (95% CI 0.53 to 0.85)) and fruit (adjusted ORs 0.76 (95% CI 0.60 to 0.97) and 0.71 (95% CI 0.57 to 0.88)) were protective factors for rhinoconjunctivitis. Conclusions: A Mediterranean diet has a potentially protective effect in girls aged 6–7 years with CSA. Obesity is a risk factor for this type of asthma only in girls.

Background Asthma is an airway inflammatory disease driven by multiple factors with a high incidence in children and adolescents. Environmental tobacco smoke exposure (TSE) and diet are inducing factors for asthma. The potential of omega-3 polyunsaturated fatty acids (PUFAs) to alleviate asthma symptoms by their anti-inflammatory effects has been explored. However, to date, no studies have explored the effect of dietary PUFAs intake on the asthma in children and adolescents exposed to tobacco smoke. Objective We aimed to examine the effect of dietary PUFAs intake on the current asthma in children and adolescents exposed to tobacco smoke. Methods Data of this cross-sectional were extracted from the National Health and Nutrition Examination Survey (NHANES) 2007–2018. Children and adolescents with serum cotinine concentration ≥ 0.05 ng/mL were defined to exposed to tobacco smoke. Dietary PUFAs intake information were obtained from 24 h recall interview. The weighted univariate and multivariate were utilized to explore the effect of PUFAs on the association of asthma and TSE, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs). These moderating effects were further explored based on the age, gender and body mass index (BMI) and sedentary time. Results Totally, 7981 eligible children and adolescents were included, with the mean age of 11.96 ± 0.06 years old. Of whom, 1.024 (12.83%) had current asthma. After adjusted all covariates, we found children and adolescents with TSE had high occurrence of current asthma (AOR = 1.2, 95% CI 1.03–1.63); We also found omega-3 PUFAs intake ( P for interaction = 0.010), not omega-6 PUFAs ( P for interaction = 0.546), has a moderating effect on the association of TSE and current asthma. Moreover, we further observed that children and adolescents with TSE and low omega-3 PUFAs intake had high occurrence of current asthma (AOR = 1.58, 95% CI 1.19–2.10), while no significant association was found in children and adolescents with high omega-3 PUFAs intake (all P  > 0.05). This moderating effect was more prominent in children and adolescents aged ≤ 12 years old (AOR = 1.62, 95% CI 1.06–2.47), girls (AOR = 2.14, 95% CI 1.15–3.98), overweight (AOR = 1.87, 95% CI 1.01–3.47) and sedentary time > 6 h (AOR = 1.96, 95% CI 1.00–3.86). Conclusion We found dietary omega-3 PUFAs plays a moderating effect on the association of asthma and TSE in children and adolescents, especially in children and adolescents aged ≤ 12 years, girls, overweight or sedentary time > 6 h. This moderating effect suggested higher omega-3 intake has potential benefits in decreasing the occurrence of asthma in children and adolescents who exposed to tobacco smoke.

This study aimed to determine the prevalence and correlates of uncontrolled asthma among children with current asthma in four US states. We also determined the rates and correlates of asthma-related hospitalization, urgent care center (UCC), or emergency department (ED) visits. We analyzed the 2019 Behavioral Risk Factor Surveillance Survey (BRFSS) Asthma Call-back Survey (ACBS) datasets. Asthma control status was classified as well-controlled or uncontrolled asthma based on day- and night-time asthma symptoms, activity limitation or use of rescue medications. Multivariable logistic regression models were used to identify the correlates of uncontrolled asthma and asthma-related hospitalization or UCC/ED visits. Among 249 children with current asthma, 55.1% had uncontrolled asthma while 40% reported asthma-related hospitalization or UCC/ED visits in the past year. Non-Hispanic ethnicity, ages of 0-9 and 15-17 years, household income <$25,000, and not having a flu vaccination had higher odds of uncontrolled asthma. Conversely, asthma self-management education and households with two children compared to one were positively associated with uncontrolled asthma. For healthcare utilization, male and non-Hispanic children, along with those from households earning <$25,000 exhibited higher odds of asthma-related hospitalization and UCC/ED visits. Uncontrolled asthma and asthma-related visits to UCC/ED and hospitalization are common among children with current asthma. These outcomes are influenced by low household income and male sex, among other factors which call for multi-faceted interventions by healthcare providers and policymakers. Targeted strategies to effectively manage asthma and reduce the need for emergency healthcare services are recommended.

Background No national research has yet explored the prevalence of asthma among adults in Lebanon. This study aims to evaluate the prevalence of physician-diagnosed asthma and current asthma, and their determinants among Lebanese adults 16 years old or above. Methods A cross-sectional study was carried out using a multistage cluster sampling. The questionnaire used collected information on asthma, respiratory symptoms, and risk factors. Results The prevalence of physician-diagnosed asthma was 6.7% (95% CI 5–8.7%), and that of current asthma was 5% (95% CI 3.6–6.9%). Chronic symptoms such as cough, wheezing, and shortness of breath were worst at night. Factors positively associated with physician-diagnosed asthma were a secondary educational level (adjusted OR, aOR = 4.45), a family history of chronic respiratory diseases (aOR = 2.78), lung problems during childhood (15.9), and allergic rhinitis (4.19). Additionally, consuming fruits and vegetables less than once per week (3.36), a family history of chronic respiratory diseases (3.92), lung problems during childhood (9.43), and allergic rhinitis (8.12) were positively associated with current asthma. Conclusions The prevalence of asthma was within the range reported from surrounding countries. However, repeated cross-sectional studies are necessary to evaluate trends in asthma prevalence in the Lebanese population.

Solvents are used in many workplaces and may be airway irritants but few studies have examined their association with asthma. We studied this question in CONSTANCES (cohort of ‘CONSulTANts des Centres d’Examens de Santé’), a large French cohort. Current asthma and asthma symptom scores were defined by participant-reported respiratory symptoms, asthma medication or attacks, and the sum of 5 symptoms, in the past 12 months, respectively. Lifetime exposures to 5 organic solvents, paints and inks were assessed by questionnaire and a population-based Job-Exposure Matrix (JEM). Cross-sectional associations between exposures and outcomes were evaluated by gender using logistic and negative binomial regressions adjusted for age, smoking habits and body mass index. Analyses included 115,757 adults (54% women, mean age 47 years, 9% current asthma). Self-reported exposure to ≥1 solvent was significantly associated with current asthma in men and women, whereas using the JEM, a significant association was observed only in women. Significant associations between exposures to ≥1 solvent and asthma symptom score were observed for both self-report (mean score ratio, 95%CI, women: 1.36, 1.31–1.42; men: 1.34, 1.30–1.40) and JEM (women: 1.10, 1.07–1.15; men: 1.14, 1.09–1.18). Exposure to specific solvents was significantly associated with higher asthma symptom score. Occupational exposure to solvents should be systematically sought when caring for asthma.

Objectives Although data on the prevalence of current asthma among adults and children are available at national, regional, and state levels, such data are limited at the substate level (eg, urban–rural classification and county). We examined the prevalence of current asthma in adults and children across 6 levels of urban–rural classification in each state. Methods We estimated current asthma prevalence among adults for urban–rural categories in the 50 states and the District of Columbia and among children for urban–rural categories in 27 states by analyzing 2016-2018 Behavioral Risk Factor Surveillance System survey data. We used the 2013 National Center for Health Statistics 6-level urban–rural classification scheme to define urban–rural status of counties. Results During 2016-2018, the current asthma prevalence among US adults in medium metropolitan (9.5%), small metropolitan (9.5%), micropolitan (10.0%), and noncore (9.6%) areas was higher than the asthma prevalence in large central metropolitan (8.6%) and large fringe metropolitan (8.7%) areas. Current asthma prevalence in adults differed significantly among the 6 levels of urban–rural categories in 19 states. In addition, the prevalence of current asthma in adults was significantly higher in the Northeast (9.9%) than in the South (8.7%) and the West (8.8%). The current asthma prevalence in children differed significantly by urban–rural categories in 7 of 27 states. For these 7 states, the prevalence of asthma in children was higher in large central metropolitan areas than in micropolitan or noncore areas, except for Oregon, in which the prevalence in the large central metropolitan area was the lowest. Conclusions Knowledge about county-level current asthma prevalence in adults and children may aid state and local policy makers and public health officers in establishing effective asthma control programs and targeted resource allocation.

Background Current asthma prevalence among adults in the United States has reached historically high levels. Although national-level estimates indicate that asthma prevalence among adults increased by 33% from 2000 to 2009, state-specific temporal trends of current asthma prevalence and their contributing risk factors have not been explored. Methods We used 2000–2009 Behavioral Risk Factor Surveillance System data from all 50 states and the District of Columbia (D.C.) to estimate state-specific current asthma prevalence by 2-year periods (2000–2001, 2002–2003, 2004–2005, 2006–2007, 2008–2009). We fitted a series of four logistic-regression models for each state to evaluate whether there was a statistically significant linear change in the current asthma prevalence over time, accounting for sociodemographic factors, smoking status, and weight status (using body mass index as the indicator). Results During 2000–2009, current asthma prevalence increased in all 50 states and D.C., with significant increases in 46/50 (92%) states and D.C. After accounting for weight status in the model series with sociodemographic factors, and smoking status, 10 states (AR, AZ, IA, IL, KS, ME, MT, UT, WV, and WY) that had previously shown a significant increase did not show a significant increase in current asthma prevalence. Conclusions There was a significant increasing trend in state-specific current asthma prevalence among adults from 2000 to 2009 in most states in the United States. Obesity prevalence appears to contribute to increased current asthma prevalence in some states.

Personal smoking is widely regarded to be the primary cause of chronic bronchitis (CB) in adults, but with limited knowledge of contributions by other factors, including current asthma. We aimed to estimate the independent and relative contributions to adult CB from other potential influences spanning childhood to middle age. The population-based Tasmanian Longitudinal Health Study cohort, people born in 1961, completed respiratory questionnaires and spirometry in 1968 (n=8,583). Thirty-seven years later, in 2004, two-thirds responded to a detailed postal survey (n=5,729), from which the presence of CB was established in middle age. A subsample (n=1,389) underwent postbronchodilator spirometry between 2006 and 2008 for the assessment of chronic airflow limitation, from which nonobstructive and obstructive CB were defined. Multivariable and multinomial logistic regression models were used to estimate relevant associations. The prevalence of CB in middle age was 6.1% (95% confidence interval [CI]: 5.5, 6.8). Current asthma and/or wheezy breathing in middle age was independently associated with adult CB (odds ratio [OR]: 6.2 [95% CI: 4.6, 8.4]), and this estimate was significantly higher than for current smokers of at least 20 pack-years (OR: 3.0 [95% CI: 2.1, 4.3]). Current asthma and smoking in middle age were similarly associated with obstructive CB, in contrast to the association between allergy and nonobstructive CB. Childhood predictors included allergic history (OR: 1.3 [95% CI: 1.1, 1.7]), current asthma (OR: 1.8 [95% CI: 1.3, 2.7]), \"episodic\" childhood asthma (OR: 2.3 [95% CI: 1.4, 3.9]), and parental bronchitis symptoms (OR: 2.5 [95% CI: 1.6, 4.1]). The strong independent association between current asthma and CB in middle age suggests that this condition may be even more influential than personal smoking in a general population. The independent associations of childhood allergy and asthma, though not childhood bronchitis, as clinical predictors of adult CB raise the possibility of some of this burden having originated in childhood.

This chapter contains sections titled: Introduction The extracellular matrix (ECM) and the airway smooth muscle (ASM) ASM and integrins The ASM cell and inflammation The ASM cell and infection References