Effects of prematurity and intrauterine growth on respiratory health and lung function in childhood.

OBJECTIVE--To determine whether birth weight and gestational age are associated with respiratory illness and lung function in children aged 5-11 years. DESIGN--Cross sectional analysis of parent reported birth weight, gestational age, and respiratory symptoms; parental smoking and social conditions; forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory rates between 25% and 75% and 75% and 85% (FEF25-75 and FEF75-85), and height. SETTING--Primary schools in England and Scotland in 1990. SUBJECTS--5573 children aged 5-11 (63.3% of eligible children) had respiratory symptoms analysed and 2036 children (67.1% of eligible children) had lung function measured. MAIN OUTCOME MEASURES--Symptoms of asthma, bronchitis, occasional and frequent wheeze, cough first thing in the morning, and cough at any other time and lung function. RESULTS--Birth weight adjusted for gestational age was significantly associated with all lung function measurements, except FEF25-75. The association remained for FVC (b = 0.475, 95% confidence interval 0.181 to 0.769) and FEV1 (b = 0.502, 0.204 to 0.800) after adjustment for gestational age, parental smoking, and social factors. FEF75-85 was the only lung function related to gestational age. Respiratory symptoms, especially wheeze most days (adjusted odds ratio 0.9, 0.84 to 0.97) were significantly associated with prematurity. Every extra week of gestation reduced the risk of severe wheeze by about 10%. CONCLUSIONS--Lung function is affected mainly by intrauterine environment while respiratory illness, especially wheezing, in childhood is related to prematurity.     

Effect of inhaled corticosteroids on episodes of wheezing associated with viral infection in school age children: randomised double blind placebo controlled trial.

OBJECTIVES: To determine the effect of regular prophylactic inhaled corticosteroids on wheezing episodes associated with viral infection in school age children. DESIGN: Randomised, double blind, placebo controlled trial. SETTING: Community based study in Southampton. SUBJECTS: 104 children aged 7 to 9 years who had had wheezing in association with symptoms of upper and lower respiratory tract infection in the preceding 12 months. INTERVENTIONS: After a run in period of 2-6 weeks children were randomly allocated twice daily inhaled beclomethasone dipropionate 200 micrograms or placebo through a Diskhaler for 6 months with a wash out period of 2 months. Children were assessed monthly. MAIN OUTCOME MEASURES: Forced expiratory volume in 1 second (FEV1); bronchial responsiveness to methacholine (PD20); percentage of days with symptoms of upper and lower respiratory tract infection with frequency, severity, and duration of episodes of upper and lower respiratory symptoms and of reduced peak expiratory flow rate. RESULTS: During the treatment period there was a significant increase in mean FEV1 (1.63 v 1.53 1; adjusted difference 0.09 1 (95% confidence interval 0.04 to 0.14); P = 0.001) and methacholine PD20 12.8 v 7.2 mumol/l; adjusted ratio of means 1.7 (1.2 to 2.4); P = 0.007) in children receiving beclomethasone dipropionate compared with placebo. There were, however, no significant differences in the percentage of days with symptoms or in the frequency, severity, or duration of episodes of upper or lower respiratory symptoms or of reduced peak expiratory flow rate during the treatment period between the two groups. CONCLUSIONS: Although lung function is improved with regular beclomethasone dipropionate 400 micrograms/day, this treatment offers no clinically significant benefit in school age children with wheezing episodes associated with viral infection.     

Changes to airborne pollen counts across Europe

A progressive global increase in the burden of allergic diseases has affected the industrialized world over the last half century and has been reported in the literature. The clinical evidence reveals a general increase in both incidence and prevalence of respiratory diseases, such as allergic rhinitis (common hay fever) and asthma. Such phenomena may be related not only to air pollution and changes in lifestyle, but also to an actual increase in airborne quantities of allergenic pollen. Experimental enhancements of carbon dioxide (CO[Formula: see text]) have demonstrated changes in pollen amount and allergenicity, but this has rarely been shown in the wider environment. The present analysis of a continental-scale pollen data set reveals an increasing trend in the yearly amount of airborne pollen for many taxa in Europe, which is more pronounced in urban than semi-rural/rural areas. Climate change may contribute to these changes, however increased temperatures do not appear to be a major influencing factor. Instead, we suggest the anthropogenic rise of atmospheric CO[Formula: see text] levels may be influential.     

京津冀地区气传花粉数据分析

花粉作为城市大气污染物成分之一, 严重影响人类的居住环境和生命健康, 是政府部门和科学界共同关注的热点问题。为此, 该文基于近60年来已发表的京津冀地区气传花粉数据, 总结了该地区主要气传花粉种类及其季节性分布特征, 表明气传花粉浓度的年际变化基本遵循双峰型规律, 即春季高峰以柏科、杨柳科和桦木科等乔木植物花粉为主, 夏秋季高峰以蒿属、葎草属/大麻(Cannabis sativa)以及藜科/苋科等草本植物花粉占优势; 探讨了影响气传花粉浓度的主导气象因子、花粉症发病特点等应当注意的问题; 指出土地改造和行道树种植等人类活动可能对北京地区的气传花粉组成变化产生影响。最后, 文中强调未来气传花粉的长期监测在大气环境评估、花粉过敏防治和城市绿化建设等方面具有重要作用。     

北京主要气传致敏花粉年浓度峰值日期预测

花粉是我国北方引发过敏性鼻炎最主要过敏原,花粉症发病期与花粉浓度高峰期吻合。基于北京地区2012至2020年花粉季多站、逐日分类花粉浓度观测数据分析,得出北京地区花粉浓度在3月上旬至5月中旬(可进一步划分为3月中旬至4月上旬和4月下旬至5月上旬两个高峰期)和8月中旬至9月中旬分别存在两个高峰期,第一个高峰期内优势致敏花粉种类为柏科、杨柳科和松科,第二个高峰期内优势致敏花粉种类为桑科、菊科蒿属和藜科。根据优势致敏花粉年浓度峰值日期观测数据,使用与花粉采样站点位置相匹配的逐日气象观测数据累积值,基于作物模型概念和模糊逻辑原理建立了北京地区主要气传致敏花粉年浓度峰值日期预测模型。经检验,柏科、杨柳科、松科、桑科、菊科蒿属和藜科花粉模型预测准确率分别为87.8%、80.0%、64.4%、86.7%、78.8%和81.8%。基于北京地区主要气传致敏花粉年浓度峰值日期预测模型可为本地花粉症防治提供理论参考。     

Pollen season and climate: Is the timing of birch pollen release in the UK approaching its limit?

In light of heightened interest in the response of pollen phenology to temperature, we investigated recent changes to the onset of Betula (birch) pollen seasons in central and southern England, including a test of predicted advancement of the Betula pollen season for London. We calculated onset of birch pollen seasons using daily airborne pollen data obtained at London, Plymouth and Worcester, determined trends in the start of the pollen season and compared timing of the birch pollen season with observed temperature patterns for the period 1995–2010. We found no overall change in the onset of birch pollen in the study period although there was evidence that the response to temperature was nonlinear and that a lower asymptotic start of the pollen season may exist. The start of the birch pollen season was strongly correlated with March mean temperature. These results reinforce previous findings showing that the timing of the birch pollen season in the UK is particularly sensitive to spring temperatures. The climate relationship shown here persists over both longer decadal-scale trends and shorter, seasonal trends as well as during periods of ‘sign-switching’ when cooler spring temperatures result in later start dates. These attributes, combined with the wide geographical coverage of airborne pollen monitoring sites, some with records extending back several decades, provide a powerful tool for the detection of climate change impacts, although local site factors and the requirement for winter chilling may be confounding factors.     

空气致敏花粉污染研究进展

对空气致敏花粉污染概念的提出 ,空气致敏花粉污染的特点和影响因素 ,花粉采集方法的改进以及空气致敏花粉污染的研究进展等方面进行了总结 ,指出了研究中存在的问题 ,并对研究前景进行了展望     

Community study of role of viral infections in exacerbations of asthma in 9-11 year old children.

OBJECTIVE--To study the association between upper and lower respiratory viral infections and acute exacerbations of asthma in schoolchildren in the community. DESIGN--Community based 13 month longitudinal study using diary card respiratory symptom and peak expiratory flow monitoring to allow early sampling for viruses. SUBJECTS--108 Children aged 9-11 years who had reported wheeze or cough, or both, in a questionnaire. SETTING--Southampton and surrounding community. MAIN OUTCOME MEASURES--Upper and lower respiratory viral infections detected by polymerase chain reaction or conventional methods, reported exacerbations of asthma, computer identified episodes of respiratory tract symptoms or peak flow reductions. RESULTS--Viruses were detected in 80% of reported episodes of reduced peak expiratory flow, 80% of reported episodes of wheeze, and in 85% of reported episodes of upper respiratory symptoms, cough, wheeze, and a fall in peak expiratory flow. The median duration of reported falls in peak expiratory flow was 14 days, and the median maximum fall in peak expiratory flow was 81 l/min. The most commonly identified virus type was rhinovirus. CONCLUSIONS--This study supports the hypothesis that upper respiratory viral infections are associated with 80-85% of asthma exacerbations in school age children.     

Factors Influencing the Onset of Chronic Respiratory Disease

To investigate the effect of different environmental and personal factors on ventilatory function 10,971 children resident and going to school in four areas of Kent were examined. Details of past respiratory illnesses were obtained by a questionary completed by the parents; the examination included measurement of height, weight, and peak expiratory flow.Area of residence, social class, family size, and a past history of pneumonia, bronchitis, or asthma were found to be associated with differing levels of peak expiratory flow. These four factors acted independently, and the effects were additive. It is suggested that environment in the early years of life can produce adverse changes which may exist throughout life and contribute to the development of chronic respiratory disease.     

Accuracy of mini peak flow meters in indicating changes in lung function in children with asthma.

OBJECTIVE--To assess whether mini flow meters used to measure peak expiratory flow can track changes in lung function and indicate clinically important changes. DESIGN--Comparison of measurements with a spirometer and different brands of mini flow meter; the meters were allocated to subjects haphazardly. SUBJECTS--12 boys with asthma aged 11 to 17 attending boarding school. MAIN OUTCOME MEASURES--Peak expiratory flow measured twice daily for three months with a spirometer and at least one of four brands of mini flow meter. RESULTS--The relation between changes in lung function measured with the spirometer and those measured with the mini flow meters was generally poor. In all, 26 episodes (range 1-3 in an individual child) of clinically important deterioration in lung function were detected from the records obtained with the spirometer. One mini flow meter detected six of 19 episodes, one detected six of 15, one detected six of 18, and one detected three of 21. CONCLUSIONS--Not only are the absolute values of peak expiratory flow obtained with mini flow meters inaccurate but the clinical message may also be incorrect. These findings do not imply that home monitoring of peak expiratory flow has no place in the management of childhood asthma but that the values obtained should be interpreted cautiously.     

Respiratory Function in Healthy Taiwanese Infants: Tidal Breathing Analysis,Passive Mechanics,and Tidal Forced Expiration

Background

Although infant lung function (ILF) testing is widely practiced in developed Western countries it is not typically performed in Eastern countries, and lung measurements are scarce for Asian infants. Therefore, this study aimed to establish normal reference values for Taiwanese infants.

Materials and Methods

Full-term infants without any chronic diseases and major anomalies were enrolled in the Prediction of Allergies in Taiwanese Children (PATCH) cohort study. Detailed medical data, such as body weight and length, birth history, and histories of previous illness and hospitalization were recorded. Lung function measurements such as analysis of tidal breathing, passive respiratory mechanics, and forced tidal expiratory flow-volume curves were obtained through Jaeger Masterscreen BabyBody Paediatrics System. Multiple linear analyses were performed to determine various parameters of the lung function tests.

Results

ILF test parameters were collected from 126 infants, and 189 tests were performed. The results revealed that the ratio of time to peak expiratory flow to total expiratory time, the ratio of volume to peak expiratory flow to total expiratory volume, and the ratio of inspiratory time to total respiratory time remained relatively constant despite differences in age. However, body length is the strongest independent variable influencing tidal volume, respiratory rate, resistance, compliance, and maximal expiratory flow at functional residual capacity.

Conclusion

According to our review of relevant literature, this is the first study to establish a reference data of ILF tests in the Asian population. This study provided reference values and regression equations for several variables of lung function measurements in healthy infants aged less than 2 years. With these race-specific reference data, ILF can more precisely and efficiently diagnose respiratory diseases in infants of Chinese ethnicity.     

A systematic review of the effects of temperature and precipitation on pollen concentrations and season timing,and implications for human health

Climate and weather directly impact plant phenology, affecting airborne pollen. The objective of this systematic review is to examine the impacts of meteorological variables on airborne pollen concentrations and pollen season timing. Using PRISMA methodology, we reviewed literature that assessed whether there was a relationship between local temperature and precipitation and measured airborne pollen. The search strategy included terms related to pollen, trends or measurements, and season timing. For inclusion, studies must have conducted a correlation analysis of at least 5 years of airborne pollen data to local meteorological data and report quantitative results. Data from peer-reviewed articles were extracted on the correlations between seven pollen indicators (main pollen season start date, end date, peak date, and length, annual pollen integral, average daily pollen concentration, and peak pollen concentration), and two meteorological variables (temperature and precipitation). Ninety-three articles were included in the analysis out of 9,679 articles screened. Overall, warmer temperatures correlated with earlier and longer pollen seasons and higher pollen concentrations. Precipitation had varying effects on pollen concentration and pollen season timing indicators. Increased precipitation may have a short-term effect causing low pollen concentrations potentially due to “wash out” effect. Long-term effects of precipitation varied for trees and weeds and had a positive correlation with grass pollen levels. With increases in temperature due to climate change, pollen seasons for some taxa in some regions may start earlier, last longer, and be more intense, which may be associated with adverse health impacts, as pollen exposure has well-known health effects in sensitized individuals.

     

An epidemiological approach investigating respiratory disease response in sensitive individuals to indoor and outdoor pollen exposure in Tucson,Arizona

Summary We conducted this study during the early spring to demonstrate direct response between increases in atmospheric pollen concentrations and symptom prevalence in a general population. We examined pollen concentrations indoors, outdoors and regionally in 31 households with similar background vegetation, pollen concentration, TSP and pollulant gas levels. Indoor pollen concentrations were low but persistent (X=16 grains/m³ air); local outdoor concentrations were 3 times greater. Regional daily mean pollen values of grasses, ragweed, mulberry and total pollen were compared with symptom scores using X² contingency tests. We obtained daily symptom scores and measures of peak expiratory flow from 121 individuals characterized as ?normal?, ?atopic? or ?peak flow responsive?. In atopic individuals, prevalence of nasal symptoms increased with pollen concentration increases for ragweed, mulberry and total pollen exposure. No significant response was found with spring grasses whose atmospheric pollen concentration was limited in the selected cluster. Decrease of lung function in the peak flow responsive population was found associated with mulberry pollen only. The small pollen grain size may result in greater tracheo-bronchial deposition.     

Allergenic pollen season variations in the past two decades under changing climate in the United States

Many diseases are linked with climate trends and variations. In particular, climate change is expected to alter the spatiotemporal dynamics of allergenic airborne pollen and potentially increase occurrence of allergic airway disease. Understanding the spatiotemporal patterns of changes in pollen season timing and levels is thus important in assessing climate impacts on aerobiology and allergy caused by allergenic airborne pollen. Here, we describe the spatiotemporal patterns of changes in the seasonal timing and levels of allergenic airborne pollen for multiple taxa in different climate regions at a continental scale. The allergenic pollen seasons of representative trees, weeds and grass during the past decade (2001–2010) across the contiguous United States have been observed to start 3.0 [95% Confidence Interval (CI), 1.1–4.9] days earlier on average than in the 1990s (1994–2000). The average peak value and annual total of daily counted airborne pollen have increased by 42.4% (95% CI, 21.9–62.9%) and 46.0% (95% CI, 21.5–70.5%), respectively. Changes of pollen season timing and airborne levels depend on latitude, and are associated with changes of growing degree days, frost free days, and precipitation. These changes are likely due to recent climate change and particularly the enhanced warming and precipitation at higher latitudes in the contiguous United States.     

Six years of observation of airborne and deposited pollen in central European Russia: first results

The aim of the study was to compare the pollen spectra recorded in rural and urban environments in order to examine whether pollen data obtained in the urban environment could also represent the situation in surrounding rural areas and how urban planting affects the regional pollen spectrum. Daily airborne pollen observations were performed with a volumetric Hirst type trap in Moscow (Russia). Modified Tauber traps were located in the Moscow region. The Tauber traps were installed and treated according to Pollen Monitoring Programme (PMP) guidelines. Spearman correlation coefficients were determined between the percentage of total pollen recorded in the Tauber and Hirst type samplers. The data showed that the Tauber spectra are characterised by higher taxonomic variability, mainly due to the greater occurrence of local herbaceous plants. Pollen types registered by Hirst type samplers were predominantly represented by anemophilous arboreal species, used in urban planting. A significant correlation for annual sums was only observed for Betula pollen, the most abundant component in both sampler types. Data obtained in big cities for dominant taxa can be extrapolated to the surrounding rural territories. The simultaneous use of volumetric and gravimetric samplers can be very useful for palaeo-ecological studies to evaluate the presence of local and transported pollen.     

肺炎支原体抗体阳性对咳嗽变异性哮喘患儿肺功能的影响研究

目的:通过探讨肺炎支原体(MP)抗体阳性感染对咳嗽变异性哮喘(CVA)患儿肺功能的影响,为临床治疗提供依据。方法:选择2012年6月~2014年6月本院收治的CVA患儿共60例,依据支原体抗体检查和肺功能检测结果,分为CVA合并MP组(合并组)和CVA组,检测两组患儿初诊时肺通气功能、支气管激发试验阳性率,分析初诊时、治疗1、3个月后MP抗体对肺功能第一秒用力呼吸容积/用力肺活量(FEV1%)的影响。结果:初诊时两组患儿肺活量(FVC)、最大呼气峰流速(PEF)、FEV1%、最大中段呼气流速(MMEF75/25)实测值均低于预测值(P0.05),合并组MMEF75/25预测值/实测值的比值较CVA组高(P0.05)。支气管激发试验阳性患儿中,合并组以轻度和极轻度为主,CVA组以重度和中度为主(P0.05)。MP抗体滴度持续阳性和阴性患儿FEV1%无统计学差异(P0.05)。结论:合并MP抗体阳性CVA患儿气道高反应性程度较低,小气道阻塞加重,对肺通气功能无影响。     

陕西中部黄土高原地区空气花粉组成及其与气候因子的关系——以洛川县下黑木沟村为例

空气花粉研究是现代孢粉学、植被变迁与预测的重要内容之一.陕西省黄土高原地区洛川县2007-2009连续2a的空气花粉分析表明:空气花粉组成与区域植被分布特征和植物花期一致.与2007—2008年相比,2008-2009年的花粉总通量及蒿属花粉通量明显增加,但木本植物花粉通量降低,这主要与2008-2009年降水明显偏少密切相关.2007-2008年降雨量高于500 mm,花粉组合中乔木花粉百分比高于30％,表现出森林植被特点;2008-2009年降雨量少于450 mm,花粉组合中草本花粉高于80％,乔木花粉低于10％,更多表现出草原植被特点.但从植被观测来看并没有明显的变化,表明花粉组合较植被对气候变化更为敏感.主要花粉类型与气候因子的相关分析表明:气候因子影响空气花粉的组成及数量.栎属、松属、蔷薇科花粉数量主要受春季温度影响,温度越高花粉数量越多;其他季节花粉数量主要受相对湿度影响,湿度越低,花粉数量越大.榆属花粉数量主要与冬季温度有关,温度越高,花粉数量越高.杨属只受春季温度影响,春季温度越低,花粉数量越多.胡颓子科花粉含量主要受春季相对湿度、风速影响,相对湿度越低,风速越大,花粉数量越多.绝大多数草本花粉数量均主要受春、冬季相对湿度及风速影响,相对湿度越低,风速越大,花粉数量越高;此外,禾本科花粉数量还受春季温度影响,温度越高,花粉数量越多;菊科花粉数量在夏秋季节还受温度、湿度和风速的共同影响,温度越低,湿度越低,风速越大,花粉数量越多.这些结果表明,黄土高原中部地区的空气花粉特征能反映区域植被组成,且对气候变化非常敏感,对认识和预测当地气候变化与植被动态等具有重要意义.     

Incidence of allergic rhinitis in general practice, 1981-92.

OBJECTIVES--To determine the epidemiology of hay fever and to consider the role of pollution. DESIGN--Examination of data on weekly incidence of allergic rhinitis and hay fever by age, sex, region, and location. SETTING--Royal College of General Practitioners Weekly Returns Service. Practice data were based on registered populations of 220,000 in 1981, rising to 700,000 in 1992 from England and Wales. MAIN OUTCOME MEASURES--Numbers of new cases of hay fever and allergic rhinitis. Data on pollen counts for Darlington, Derby, and London. RESULTS--The incidence of allergic rhinitis fluctuated greatly from year to year but showed no trend. Peaks in hay fever coincided with peak pollen counts. No important differences were found between urban and rural locations or different parts of the country with respect to both size and timing of the peaks. Incidence was highest in children (5-14 years). CONCLUSIONS--The similarity of the results throughout England and Wales does not support an important role for local pollutants in hay fever. However, the possibility that levels of pollutants are high enough to act as an adjuvant in hay fever across the whole study area has not been excluded.     

Transition from dynamically maintained to relaxed end-expiratory volume in human infants

Newborn infants, in contrast to adults, dynamically maintain end-expiratory lung volume (EEV) above relaxation volume. The purpose of this study was to determine at what age children develop a breathing strategy that is relaxed, i.e., determined by the mechanical characteristics of the lung and chest wall. Forty studies were performed in 27 healthy infants and children aged 1 mo to 8 yr during natural sleep. Volume changes were recorded with the use of respiratory inductance plethysmography (RIP). The volume signal was differentiated to yield flow. Flow-volume representations were generated for a random sample of the recorded breaths to determine the predominant breathing strategy utilized, i.e., relaxed, interrupted, or indeterminate. The respiratory pattern was predominantly interrupted below 6 mo of age and predominantly relaxed over 1 yr of age. Mixed patterns were observed in children 6-12 mo of age. The number of breaths that could not be classified (indeterminate) decreased with age. Respiratory frequency measured from the sample of breaths decreased with age and was accompanied by an increase in expiratory time. We conclude that a relaxed EEV develops at the end of the first year of life and may be related to changes in the mechanical properties of the chest wall associated with growth as well as changes in respiratory timing.