Sex and gender in asthma

Asthma is a heterogenous disease, and its prevalence and severity are different in males versus females through various ages. As children, boys have an increased prevalence of asthma. As adults, women have an increased prevalence and severity of asthma. Sex hormones, genetic and epigenetic variations, social and environmental factors, and responses to asthma therapeutics are important factors in the sex differences observed in asthma incidence, prevalence and severity. For women, fluctuations in sex hormone levels during puberty, the menstrual cycle and pregnancy are associated with asthma pathogenesis. Further, sex differences in gene expression and epigenetic modifications and responses to environmental factors, including SARS-CoV-2 infections, are associated with differences in asthma incidence, prevalence and symptoms. We review the role of sex hormones, genetics and epigenetics, and their interactions with the environment in the clinical manifestations and therapeutic response of asthma.

BMI trajectory in childhood is associated with asthma incidence at young adulthood mediated by DNA methylation

Purpose Body mass index (BMI) is associated with asthma but associations of BMI temporal patterns with asthma incidence are unclear. Previous studies suggest that DNA methylation (DNAm) is associated with asthma status and variation in DNAm is a consequence of BMI changes. This study assessed the direct and indirect (via DNAm) effects of BMI trajectories in childhood on asthma incidence at young adulthood. Methods Data from the Isle of Wight (IoW) birth cohort were included in the analyses. Group-based trajectory modelling was applied to infer latent BMI trajectories from ages 1 to 10 years. An R package, ttscreening, was applied to identify differentially methylated CpGs at age 10 years associated with BMI trajectories, stratified for sex. Logistic regressions were used to further exclude CpGs with DNAm at age 10 years not associated with asthma incidence at 18 years. CpGs discovered via path analyses that mediated the association of BMI trajectories with asthma incidence in the IoW cohort were further tested in an independent cohort, the Avon Longitudinal Study of Children and Parents (ALSPAC). Results Two BMI trajectories (high vs. normal) were identified. Of the 442,474 CpG sites, DNAm at 159 CpGs in males and 212 in females were potentially associated with BMI trajectories. Assessment of their association with asthma incidence identified 9 CpGs in males and 6 CpGs in females. DNAm at 4 of these 15 CpGs showed statistically significant mediation effects (p-value < 0.05). At two of the 4 CpGs (cg23632109 and cg10817500), DNAm completely mediated the association (i.e., only statistically significant indirect effects were identified). In the ALSPAC cohort, at all four CpGs, the same direction of mediating effects were observed as those found in the IoW cohort, although statistically insignificant. Conclusion The association of BMI trajectory in childhood with asthma incidence at young adulthood is possibly mediated by DNAm.

HUBUNGAN INDEKS MASSA TUBUH DENGAN STATUS KONTROL PASIEN ASMA DI RSUD KOTA MATARAM TAHUN 2019

Latar Belakang: Asma merupakan salah satu masalah utama baik di negara maju dan negera berkembang. Pada tahun 2017 angka kejadian asma di berbagai negara sekitar 1-18% dan diperkirakan sebanyak 300 juta penduduk di dunia menderita asma menurut Global Initiatif for Astma (GINA). Kejadian asma dipengaruhi oleh banyak faktor diantaranya usia, jenis kelamin, perokok aktif maupun pasif, genetik, Indeks massa tubuh (IMT. Penurunan faal paru dapat diakibatkan IMT berlebih kurang sehingga meningkatkan terjadinya asma. Indeks Massa Tubuh (IMT) merupakan salah satu faktor pejamu penyebab asma yang dapat di modifikasi karena reversibel. Seseorang dengan IMT berlebih (over-weight-obesitas) maupun IMT kurang (underweight) cenderung memiliki perubahan pada sistem tubuh yang menimbulkan perburukan pada asma sehingga menjadi tidak terkontrol. Tujuan: Mengetahui hubungan indek massa tubuh dengan status kontrol pasien asma di RSUD Kota Mataram Tahun 2019. IMT bersifat Metode: Penelitian ini merupakan analitik observasional, dengan rancangan cross sectional. Sumber data yang digunakan dalam penelitian ini berupa data sekunder dari rekam medik pasien asma yang menjalani rawat jalan di RSUD Kota Mataram 2019. Sampel pada penelitian ini berjumlah 118 orang. Analisis data menggunakan rank spearman. Hasil: Hasil analisis menggunakan Rank Spearmen didapatkan nilai p-value 0,000 (p-value 0,05), yang berarti terdapat hubungan antara IMT dengan status kontrol pasien asma di RSUD Kota Mataram tahun 2019. Kesimpulan: Terdapat hubungan antara Indeks Massa Tubuh dengan status kontrol pasien asma di RSUD Kota Mataram tahun 2019.Kata Kunci: Indeks Massa Tubuh, Status Kontrol, Asma. ABSTRACTBackground: Asthma is one of the main problems in both developed and developing countries. In 2017 the prevalence of asthma incidence in various countries was around 1-18% and an estimated 300 million people in the world suffer from asthma according to the Global Initiatif for Astma (GINA). The asthma incidence influenced by many factors. These factors include age, sex, active and passive smoker, genetics, body mass index (BMI). Decreased lung function can be caused by excess BMI and low BMI which increases the asthma insidence. Body Mass Index (BMI) is one of the factors of host that caused asthma can be modified because they were reversible. A person with an over-weight-obesity and underweight BMI tends was have changes in the body's systems that worsen asthma so that becomes uncontrollable. Purpose: Knowing the correlation between body mass index and control status of asthma patients at RSUD Kota Mataram in 2019. Methods: This reseacrh was an observational analytic study, with a cross sectional design. The data source used in this study is secondary data from the medical records of asthma patients who was undergoing outpatient care at the Mataram City Hospital 2019. Data was collected from 118 samples. Data analysis used rank spearman. Results There is a correlation between Body Mass Index and the control status of asthma patients at Mataram City Hospital in 2019. Key Words: Asthma, body mass index, asthma control status.Key Words: body mass index, control status, asthma.

Long-term exposure to low-level air pollution and incidence of asthma: the ELAPSE project

BackgroundLong-term exposure to ambient air pollution has been linked to childhood-onset asthma, although evidence is still insufficient. Within the multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we examined the associations of long-term exposures to particulate matter with a diameter <2.5 µm (PM2.5), nitrogen dioxide (NO2) and black carbon (BC) with asthma incidence in adults.MethodsWe pooled data from three cohorts in Denmark and Sweden with information on asthma hospital diagnoses. The average concentrations of air pollutants in 2010 were modelled by hybrid land-use regression models at participants’ baseline residential addresses. Associations of air pollution exposures with asthma incidence were explored with Cox proportional hazard models, adjusting for potential confounders.ResultsOf 98 326 participants, 1965 developed asthma during a mean follow-up of 16.6 years. We observed associations in fully adjusted models with hazard ratios of 1.22 (95% CI 1.04–1.43) per 5 μg·m−3 for PM2.5, 1.17 (95% CI 1.10–1.25) per 10 µg·m−3 for NO2 and 1.15 (95% CI 1.08–1.23) per 0.5×10−5 m−1 for BC. Hazard ratios were larger in cohort subsets with exposure levels below the European Union and US limit values and possibly World Health Organization guidelines for PM2.5 and NO2. NO2 and BC estimates remained unchanged in two-pollutant models with PM2.5, whereas PM2.5 estimates were attenuated to unity. The concentration–response curves showed no evidence of a threshold.ConclusionsLong-term exposure to air pollution, especially from fossil fuel combustion sources such as motorised traffic, was associated with adult-onset asthma, even at levels below the current limit values.

High but stable incidence of adult-onset asthma in northern Sweden over the last decades

BackgroundThe prevalence of asthma has increased both among children and adults during the latter half of the 20th century. The prevalence among adults is affected by the incidence of asthma in childhood but also in adulthood. Time trends in asthma incidence are poorly studied.AimThe aim was to study the incidence of adult-onset asthma from 1996–2006 and 2006–2016, and compare the risk factor patterns.MethodsWithin the Obstructive Lung Disease in Northern Sweden (OLIN) studies, two randomly selected population-based samples in ages 20–69 years participated in postal questionnaire surveys about asthma in 1996 (n=7104, 85%) and 2006 (n=6165, 77%), respectively. A 10-year follow-up of the two cohorts with the same validated questionnaire was performed, and n=5709 and n=4552, respectively, responded. Different definitions of population at risk were used in the calculations of asthma incidence. The protocol followed a study performed 1986 to 1996 in the same area.ResultsThe crude incidence rate of physician-diagnosed asthma was 4.4/1000/year (men 3.8, women 5.5) from 1996–2006, and 4.8/1000/year (men 3.7, women 6.2) from 2006–2016. When correcting for possible under-diagnosis at study entry, the incidence rate was 2.4/1000/year from 1996–2006 and 2.6/1000/year from 2006–2016. The incidence rates were similar across age groups. Allergic rhino-conjunctivitis was the main risk factor for incident asthma in both observation periods (risk ratios 2.4–2.6).ConclusionsThe incidence of adult-onset asthma has been stable over the last two decades, and on similar level since the 1980s. The high incidence contributes to the increase in asthma prevalence.