Showing papers by "Josep M. Antó published in 2000"
TL;DR: The authors assessed the acute association between particulate air pollution and mortality among subjects suffering from chronic obstructive pulmonary disease by using a case-crossover analysis and reinforced the deleterious role of urban pollution.
Abstract: The authors assessed the acute association between particulate air pollution and mortality among subjects suffering from chronic obstructive pulmonary disease by using a case-crossover analysis. This design avoided the common concerns about the methods used to assess the acute effects of air pollution. The 1,845 men and the 460 women included were residents of Barcelona, Spain, who were over age 35 years, had died during the period 1990-1995, and had visited emergency rooms because of a chronic obstructive pulmonary disease exacerbation during the period 1985-1989. Particle levels (measured as black smoke at the city monitoring stations) were associated with mortality for all causes (odds ratio (OR) for an increase of 20 microg/m3, the interquartile change, adjusted for temperature, humidity, and influenza = 1.112, 95 percent confidence interval (CI): 1.017, 1.215). The association was stronger for respiratory causes (OR = 1.182, 95 percent CI: 1.025, 1.365), but was not significant for cardiovascular causes (OR = 1.077, 95 percent CI: 0.917, 1.264). Older women, patients admitted to intensive care units, and patients with a higher rate of emergency room visits were at greater risk of dying associated with black smoke. The results reinforced the deleterious role of urban pollution and provided information on factors possibly conferring susceptibility to the acute role of air pollution.
261 citations
TL;DR: The authors found a moderate to high prevalence of potentially modifiable risk factors in a large representative sample of patients hospitalized for a chronic obstructive pulmonary disease exacerbation, suggesting unsatisfactory features in their management.
Abstract: There is little information available concerning the extent to which chronic obstructive pulmonarv disease (COPD) patients are satisfactorily managed, especially, regards factors supposedly related to COPD exacerbation. The present study assessed the prevalence rates of potentially modifiable risk factors of COPD exacerbation in patients hospitalized for this reason. A systematic sample of one out of two patients admitted for COPD exacerbation, during 1 yr, in four tertiary hospitals in the Barcelona area, Spain, was performed. Patients answered a questionnaire and underwent anthropometric measurements, spirometric tests and arterial blood gas sampling. Prevalence rates and 95% confidence intervals (95% CI) for risk factors were obtained, and the generalized estimating equation (GEE) method was used to allow for patients to provide information on different admissions. The study recruited 353 patients (29 female) with a total of 404 admissions age (mean+/-SD) 69+/-9, median forced expiratory volume in one second (FEV1) 31% of predicted and mean partial pressure of oxygen (PO2) 63+/-13 mmHg. Of these, 28% had not received an influenza vaccination; a high number (86%) did not attend rehabilitation programmes; 28% of patients with PO2 < or =55 mmHg were not using long-term oxygen therapy (LTOT); among LTOT users, 18% used it <15 h a day; 43% of the total failed in some of the essential inhaler manoeuvres; 26% were current smokers; 21% of noncurrent smokers were exposed to passive smoking at home; current occupational exposure was low (5%). In summary, the authors found a moderate to high prevalence of potentially modifiable risk factors in a large representative sample of patients hospitalized for a chronic obstructive pulmonary disease exacerbation, suggesting unsatisfactory features in their management.
151 citations
TL;DR: It is concluded that the ECRHS multilingual translated respiratory symptoms questionnaire shows high internal consistency, suggesting that international comparisons are not affected by errors due to cross-cultural variations in the reporting of symptoms.
Abstract: We aimed to assess cross-cultural validity of the reporting of respiratory symptoms in the European Community Respiratory Health Study (ECRHS). A random sample of subjects from the general population (aged 20-44 yr), from 35 centers in 15 countries, answered a questionnaire and underwent allergy tests and airway challenge with methacholine. The overall response rate to the questionnaire was 60% (n = 16,635). Exploratory factor analysis was used to identify how symptoms were grouped (i.e., to specify factor structure), using data from the United Kingdom. Subsequently, a confirmatory factor analysis of the prespecified structure for the United Kingdom was assessed for each country in consecutive nested models, increasing at each step the number of parameters forced to be equal to the United Kingdom, and assessing the goodness of fit. Variables were clustered in the same four groups (factors) in all countries. The four factors, mutually adjusted, were associated with either bronchial responsiveness, atopy, or smoking, which provides coherence for the separation of the four factors. In the confirmatory factor analysis, when the load of each of the symptoms in the corresponding factor was prespecified, all countries except Spain showed an adequate fit; in Spain there were differences in answers concerning asthma treatment. We conclude that the ECRHS multilingual translated respiratory symptoms questionnaire shows high internal consistency, suggesting that international comparisons are not affected by errors due to cross-cultural variations in the reporting of symptoms.
70 citations
TL;DR: It is hypothesised that patients with COPD are more likely to die after increased exposure to urban air pollution than the general population.
Abstract: Many studies have shown an association between current daily levels of air pollution and daily mortality by respiratory and cardiovascular causes in the general population.1 However, the weak associations observed and the ecological nature of the exposure to air pollutants have created some doubts about plausibility of a causal relation. Specificity, which increases the plausibility of causal inference although its lack does not negate it, could be increased using a population more susceptible a priori.2Hence, we assessed the association between daily levels of air pollutants and daily mortality in a cohort of chronic obstructive pulmonary disease (COPD) patients in Barcelona for the years 1985 to 1989. We hypothesised that patients with COPD are more likely to die after increased exposure to urban air pollution than the general population.2
All patients attending emergency room services for either asthma …
51 citations
TL;DR: It is concluded that immunoresponse to individual allergens (particularly outdoor) is associated with the level of FEV1, and this association occurred independently of asthma, and in smokers and non-smokers, which may be of interest in natural history of chronic obstructive pulmonary disease (COPD).
Abstract: Background Atopy may impair ventilatory function, but results are controversial. We assess the association between individual reactivity to allergens and the level of baseline maximal one-second forced expiratory volume (FEV 1 ), by smoking and respiratory symptoms. Methods The 1472 participants (response 44.5%) of the five Spanish areas of the European Community Respiratory Health Survey (ECRHS) who performed respiratory function tests, skin prick tests and/or specific IgE against common aeroallergens (e.g. mites, pets, mould, pollens) are included. Bronchial hyperreactivity (BHR) was measured with a methacholine challenge. Results After adjusting for BHR and smoking, in addition to the other allergens, skin reactivity to Alternaria (‐208 ml; 95% CI : ‐451, 35) and IgE antibodies against cat (‐124 ml; 95% CI : ‐269, 21) and Timothy grass (‐115 ml, 95% CI : ‐190, ‐40) were associated with a decrease in FEV 1 in females. Among males, skin reactivity to olive showed the strongest association (‐111 ml; 95% CI : ‐261, 38). The associations were stronger in females. Smoking modifies the association for Alternaria and cat (P for interaction , 0.05). While cat is associated with a decrease in FEV 1 in current smokers (‐190 ml), Alternaria (‐336 ml) was associated among never smokers. The exclusion of subjects with asthma symptoms, or adjustment for respiratory symptoms, led to similar results. Conclusions We conclude that immunoresponse to individual allergens (particularly outdoor) is associated with the level of FEV 1 , and this association occurred independently of asthma, and in smokers and non-smokers, which may be of interest in natural history of chronic obstructive pulmonary disease (COPD).
44 citations
TL;DR: In this paper, the association between atopy and asthma in pregnant women from a semirural area of Tanzania (East Africa) was assessed by specific IgE (immunoglobulin E) antibodies to Dermatophagoides pteronyssinus (Der p 1) and cockroach.
Abstract: Background: Atopy is consistently associated with asthma, except in a study in Africa. We assessed the association between atopy and asthma in women from a semirural area of Tanzania (East Africa).
Methods: All pregnant women delivering at the district hospital during a 1-year period were recruited (n=658, 60.6% of those selected). Asthma was investigated by a standard questionnaire and atopy by specific IgE (immunoglobulin E) antibodies to Dermatophagoides pteronyssinus (Der p 1) and cockroach.
Results: The prevalence of wheezing chest was 10.7%; of asthma, 3.5%. Levels of specific IgE of >0.35 kU/l (73%) and high levels of total IgE (62% higher than 1000 kU/l) were highly prevalent. Specific IgE antibody levels in sera were not associated with asthma (3.8% of women with negative specific IgE to any antigen had asthma in comparison to 4.0% of women with positive specific IgE; odds ratio [OR]=1.06, 0.35–3.22). Total IgE was not different between women with asthma and women without asthma (P=0.36).
Conclusions: In tropical regions, the association between allergy and asthma is complex, and specific IgE reactivity to environmental allergens may not be related to asthma.
39 citations
TL;DR: The results suggest that chromosome 19p13 might harbor a genetic determinant of IgE-related traits, and studies in other population samples are needed to verify this finding.
Abstract: On the basis of studies with animal models, the gene for the low-affinity receptor for immunoglobulin E (IgE) (FCER2, CD23) has been implicated as a candidate for IgE-mediated allergic diseases and bronchial hyperreactivity, or related traits. Given evidence for genetic complexity in atopic disorders, we sought to study two European subpopulations, Finnish and Catalonian. We studied three phenotypic markers: ( 1 ) total serum IgE level; ( 2 ) asthma; and ( 3 ) specific IgE level for a mixture of the most common aeroallergens in Finland. Altogether, eight polymorphic markers spanning a region of 10 cM around the FCER2 gene on chromosome 19p13 were analyzed in 124 families. The physical order of the markers and the location of the FCER2 gene were confirmed by using radiation hybrids. The allele and haplotype association study showed a suggestive haplotype association (signficance of p < 0.03 based on a permutation test) for a high serum IgE response. In a subset of chromosomes segregating with asthma in families with two or more affected members, a single haplotype was found to be highly enriched (p 5 8.3 3 10 2 6 ). However, sequence polymorphisms, which would verify structural differences in the FCER2 gene, were not detected in the coding region of the receptor. Our results suggest that chromosome 19p13 might harbor a genetic determinant of IgE-related traits. Studies in other population samples are needed to verify this finding. Laitinen T, Ollikainen V, Lazaro C, Kauppi P, de Cid R, Anto JM, Estivill X, Lokki H, Mannila H, Laitinen LA, Kere J. Association study of the chromosomal region containing the FCER2 gene suggests it has a regulatory role in atopic disorders. AM J RESPIR CRIT CARE MED 2000;161:700‐706.
38 citations
TL;DR: The findings corroborated that not only the threshold but also the magnitude of the association presents a different range depending on the latitude, and is wider for southern locations.
Abstract: Background: Association between ischaemic heart disease (IHD) mortality and extreme values of weather temperature has been the focus of many previous studies. To what extent moderate changes in temperature also influence IHD mortality in milder regions, where either low temperatures or heat waves are exceptional, has been less Investigated. To further contribute to these issues we have investigated the association between weather temperature and IHD in Barcelona, Spain. Methods: A transfer function model was specified. The dependent variable was the daily time series of IHD while, weather temperature, relative humidity and air pollutants were the covariates. We also controlled for influenza epidemics and annual seasonality. In order to relax the restrictive assumptions (functional form and normality) imposed by the transfer function, this was modelled non-parametrically. The influence of unusual periods and outliers of weather temperature and humidity was also assessed. Results: A non-linear relationship between weather temperature and IHD existed. Our results suggested a temperature threshold (estimated in 21.06°C) in the relationship between IHD and weather temperature. The estimated value of the threshold was higher (23°C) for very humid days (relative humidity above 85%). The risk of an IHD death increased approximately 2.4% with every 1°C drop of temperature below 4.7°C and approximately 4% with every 1°C rise above 25°C. Conclusion: Our findings corroborated that not only the threshold but also the magnitude of the association presents a different range depending on the latitude, and is wider for southern locations. We suggest that the effect of temperature could account for the regional variations in IHD mortality.
24 citations
TL;DR: No association could be observed in this sample of Spanish asthmatics with the genes/regions studied, and there were no significant differences between asthmatic and control subjects for the polymorphic markers nor for the other variant of the β-subunit of the high-affinity IgE receptor (FcεRI-β) gene.
Abstract: A number of genes/regions have recently been reported to be linked to asthma or its related phenotypes (ie atopy and bronchial hyperresponsiveness), by genetic linkage and allele-sharing methods We have performed a case-control study comparing the allelic distribution of nine microsatellite markers and two genetic variants in a group of patients attended at emergency room departments because of an acute attack of asthma with respect to an external healthy population of controls A total of 146 asthmatic subjects and 50 population controls from Barcelona, Spain, were genotyped for nine microsatellite markers from some asthma/atopy candidate genes/regions: the beta-subunit of the high-affinity IgE receptor (Fc epsilonRI-beta) located on chromosome 11; the 5q31-32 candidate region; the T-cell receptor genes, TCR-alpha on chromosome 14 and TCR-beta on chromosome 7 Two genetic variants of the beta-subunit of the high-affinity IgE receptor (Fc epsilonRI-beta) gene were also analyzed None of the asthmatic or control individuals carried the Ile181Leu variant There were no significant differences between asthmatic and control subjects neither for the polymorphic markers nor for the other variant of the beta-subunit of the high-affinity IgE receptor (Fc epsilonRI-beta) gene No association could be observed in this sample of Spanish asthmatics with the genes/regions studied
13 citations
Journal Article•
4 citations
01 Jan 2000
TL;DR: This study assessed the association between atopy and asthma in women from a semirural area of Tanzania (East Africa) and found that atopy is consistently associated with asthma, except in a study in Africa.