Showing papers by "Josep M. Antó published in 2019"
University of Marburg1, National Institutes of Health2, McMaster University3, University of Manchester4, National and Kapodistrian University of Athens5, University of Crete6, Transylvania University7, Ghent University Hospital8, Charité9, Woolcock Institute of Medical Research10, Humanitas University11, University of Cartagena12, University of South Florida13, University of Porto14, Federal University of Bahia15, King's College London16, Saint Louis University17, Hospital Clínico San Carlos18, Erasmus University Rotterdam19, University of Helsinki20, Odense University Hospital21, Katholieke Universiteit Leuven22, University of Amsterdam23, Chiba University24, Wrocław Medical University25, Ukrainian Medical Stomatological Academy26, Hacettepe University27, Medical University of Łódź28, Boston Children's Hospital29, Vilnius University30, National Research Council31, Oslo University Hospital32, University of Oslo33, University of Beira Interior34, University of Copenhagen35, University of Naples Federico II36, University of Barcelona37, Monash University38, University of Messina39, Ajou University40, Charles University in Prague41, University of Genoa42, Pasteur Institute43, University of Southampton44, Nippon Medical School45, University of Edinburgh46, Medical University of Warsaw47, University College London48, Imperial College London49, Medical University of Graz50, University of Coimbra51, European Union of Medical Specialists52, University of Turku53, University of Bari54, Nova Southeastern University55, Celal Bayar University56
TL;DR: Care pathways for AIT are reviewed using strict criteria and simple recommendations are provided that can be used by all stakeholders including healthcare professionals.
Abstract: Allergen immunotherapy (AIT) is a proven therapeutic option for the treatment of allergic rhinitis and/or asthma. Many guidelines or national practice guidelines have been produced but the evidence-based method varies, many are complex and none propose care pathways. This paper reviews care pathways for AIT using strict criteria and provides simple recommendations that can be used by all stakeholders including healthcare professionals. The decision to prescribe AIT for the patient should be individualized and based on the relevance of the allergens, the persistence of symptoms despite appropriate medications according to guidelines as well as the availability of good-quality and efficacious extracts. Allergen extracts cannot be regarded as generics. Immunotherapy is selected by specialists for stratified patients. There are no currently available validated biomarkers that can predict AIT success. In adolescents and adults, AIT should be reserved for patients with moderate/severe rhinitis or for those with moderate asthma who, despite appropriate pharmacotherapy and adherence, continue to exhibit exacerbations that appear to be related to allergen exposure, except in some specific cases. Immunotherapy may be even more advantageous in patients with multimorbidity. In children, AIT may prevent asthma onset in patients with rhinitis. mHealth tools are promising for the stratification and follow-up of patients.
140 citations
National Institutes of Health1, University Medical Center Groningen2, Erasmus University Rotterdam3, Pompeu Fabra University4, Karolinska Institutet5, University of Southampton6, Norwegian Institute of Public Health7, Oslo University Hospital8, University of Western Australia9, Curtin University10, University of California, San Francisco11, Anschutz Medical Campus12, University of Bristol13, North Carolina State University14, University of Southern California15, Imperial College London16, Ludwig Maximilian University of Munich17, University of Helsinki18, Université du Québec à Chicoutimi19, Stockholm County Council20, Duke University21, University of Paris22, University of Southern Denmark23, University of Oulu24, University of Memphis25, Oulu University Hospital26, Helsinki University Central Hospital27, Boston Children's Hospital28, King's College London29, Utrecht University30, Max Planck Society31, Emory University32, Karolinska University Hospital33
TL;DR: This article identified differential DNA methylation profiles in newborns and children related to childhood asthma, and identified differentially methylated regions in the newborns' DNA and children's DNA methylations.
Abstract: Background Epigenetic mechanisms, including methylation, can contribute to childhood asthma. Identifying DNA methylation profiles in asthmatic patients can inform disease pathogenesis. Objective We sought to identify differential DNA methylation in newborns and children related to childhood asthma. Methods Within the Pregnancy And Childhood Epigenetics consortium, we performed epigenome-wide meta-analyses of school-age asthma in relation to CpG methylation (Illumina450K) in blood measured either in newborns, in prospective analyses, or cross-sectionally in school-aged children. We also identified differentially methylated regions. Results In newborns (8 cohorts, 668 cases), 9 CpGs (and 35 regions) were differentially methylated (epigenome-wide significance, false discovery rate Conclusion Novel loci differentially methylated in newborns represent potential biomarkers of risk of asthma by school age. Cross-sectional associations in children can reflect both risk for and effects of disease. Asthma-related differential methylation in blood in children was substantially replicated in eosinophils and respiratory epithelium.
133 citations
TL;DR: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations as discussed by the authors.
111 citations
TL;DR: The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status.
Abstract: Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional.
104 citations
Karolinska Institutet1, University of Groningen2, University of Bristol3, University of Southern California4, Johns Hopkins University5, University of Michigan6, Institute for Systems Biology7, Imperial College London8, University of Hasselt9, International Agency for Research on Cancer10, Catholic University of Leuven11, University of Turin12, Boston Children's Hospital13, Erasmus University Rotterdam14, Spanish National Research Council15, Norwegian Institute of Public Health16, University of Paris17, University of Grenoble18, Utrecht University19, Icahn School of Medicine at Mount Sinai20, Brigham and Women's Hospital21, Ben-Gurion University of the Negev22, United States Department of Health and Human Services23, Columbia University24
TL;DR: Several differentially methylated CpGs and DMRs associated with prenatal PM exposure were identified in newborns, with annotation to genes previously implicated in lung-related outcomes.
Abstract: Background: Prenatal exposure to air pollution has been associated with childhood respiratory disease and other adverse outcomes. Epigenetics is a suggested link between exposures and health outcom...
98 citations
Pompeu Fabra University1, Université Paris-Saclay2, University of Porto3, University of Coimbra4, University of Salerno5, University of Bari6, Federal University of Bahia7, University of São Paulo8, Universidade Federal de Santa Catarina9, Mexican Social Security Institute10, Vilnius University11, European Union of Medical Specialists12, Medical University of Łódź13, Medical University of Warsaw14, Heidelberg University15, University of Cologne16, University of Paris17, University of Montpellier18, University of Barcelona19, Medical University of Graz20, Leiden University Medical Center21, University of Amsterdam22, University of Edinburgh23, University of Helsinki24, University of Turku25, National and Kapodistrian University of Athens26, University of Manchester27, University of Crete28, Eskişehir Osmangazi University29, Istanbul University30, Celal Bayar University31, Woolcock Institute of Medical Research32, Monash University33, Ghent University Hospital34, Odense University Hospital35, Karolinska Institutet36, Uppsala University37, Transylvania University38, Saint Louis University39, University of South Florida40, Nova Southeastern University41, McMaster University42, French Institute of Health and Medical Research43
TL;DR: This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible on medication use, disease control, and work productivity in patients with AR.
Abstract: Background: Mobile health can be used to generate innovative insights into optimizing treatment to improve allergic rhinitis (AR) control.Objectives: A cross-sectional real-world observational study was undertaken in 22 countries to complement a pilot study and provide novel information on medication use, disease control, and work productivity in the everyday life of patients with AR.Methods: A mobile phone app (Allergy Diary, which is freely available on Google Play and Apple stores) was used to collect the data of daily visual analogue scale (VAS) scores for (1) overall allergic symptoms; (2) nasal, ocular, and asthma symptoms; (3) work; and (4) medication use by using a treatment scroll list including all allergy medications (prescribed and over-the-counter) customized for 22 countries. The 4 most common intranasal medications containing intranasal corticosteroids and 8 oral H-1-antihistamines were studied.Results: Nine thousand one hundred twenty-two users filled in 112,054 days of VASs in 2016 and 2017. Assessment of days was informative. Control of days with rhinitis differed between no (best control), single (good control for intranasal corticosteroid-treated days), or multiple (worst control) treatments. Users with the worst control increased the range of treatments being used. The same trend was found for asthma, eye symptoms, and work productivity. Differences between oral H-1-antihistamines were found.Conclusions: This study confirms the usefulness of the Allergy Diary in accessing and assessing behavior in patients with AR. This observational study using a very simple assessment tool (VAS) on a mobile phone had the potential to answer questions previously thought infeasible.
96 citations
University of Porto1, University of Beira Interior2, University of Coimbra3, Humanitas University4, University of Turin5, University of Bari6, University of Salerno7, University of Amsterdam8, Leiden University Medical Center9, Federal University of Bahia10, Universidade Federal de Santa Catarina11, Mexican Social Security Institute12, European Union of Medical Specialists13, Vilnius University14, University of Paris15, University of Montpellier16, French Institute of Health and Medical Research17, Université Paris-Saclay18, University of Grenoble19, Pasteur Institute20, University of Zurich21, Medical University of Łódź22, Medical University of Warsaw23, University of Barcelona24, University of Edinburgh25, University of Mainz26, Charité27, University of Cologne28, Medical University of Graz29, University of Helsinki30, University of Turku31, Istanbul University32, Celal Bayar University33, National and Kapodistrian University of Athens34, University of Manchester35, University of Crete36, Woolcock Institute of Medical Research37, Monash University38, Catholic University of Cordoba39, Karolinska Institutet40, Uppsala University41, Ghent University Hospital42, Université catholique de Louvain43, Odense University Hospital44, McMaster University45, Laval University46, Transylvania University47, Buck Consultants48, University of South Florida49, Saint Louis University50, Johns Hopkins University51, Chiba University52, Nova Southeastern University53
TL;DR: Mobile Airways Sentinel NetworK aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care.
Abstract: Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases. MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients. Include patients, health care professionals (pharmacists and physicians), authorities, patient’s associations, private and public sectors. MASK is deployed in 23 countries and 17 languages. 26,000 users have registered. MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour). (i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.
91 citations
TL;DR: ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
Abstract: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted “patient activation”, (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Sante as a Good Practice in the field of digitally-enabled, integrated, person-centred care. In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
72 citations
TL;DR: Higher residential surrounding greenness and living closer to natural environments contribute to better physical functioning at older ages, including slower 10-year decline in walking speed.
71 citations
University of Naples Federico II1, University of Porto2, Woolcock Institute of Medical Research3, Medical University of Warsaw4, Lithuanian University of Health Sciences5, Scottish Government6, Karolinska University Hospital7, University of Paris8, Université Paris-Saclay9, Charité10, University of Würzburg11, University of Edinburgh12, University of Salerno13, University of Coimbra14, Vilnius University15, European Union of Medical Specialists16, Humboldt University of Berlin17, University of Cologne18, University of Barcelona19, University of Manchester20, National and Kapodistrian University of Athens21, University of Crete22, Buck Consultants23, Medical University of Graz24, Federal University of Bahia25, Medical University of Łódź26, University of Helsinki27, Ghent University Hospital28, Katholieke Universiteit Leuven29, University of Amsterdam30, Boston Children's Hospital31, Karolinska Institutet32, Uppsala University33, Odense University Hospital34, Monash University35, Eskişehir Osmangazi University36, Istanbul University37, Hacettepe University38
TL;DR: MASK‐rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient‐centred ICT system and a mobile phone app central to MASK is available in 22 countries.
Abstract: Background
Mobile technology may help to better understand the adherence to treatment. MASK‐rhinitis (Mobile Airways Sentinel NetworK for allergic rhinitis) is a patient‐centred ICT system. A mobile phone app (the Allergy Diary) central to MASK is available in 22 countries.
Objectives
To assess the adherence to treatment in allergic rhinitis patients using the Allergy Diary App.
Methods
An observational cross‐sectional study was carried out on all users who filled in the Allergy Diary from 1 January 2016 to 1 August 2017. Secondary adherence was assessed by using the modified Medication Possession Ratio (MPR) and the Proportion of days covered (PDC) approach.
Results
A total of 12 143 users were registered. A total of 6 949 users reported at least one VAS data recording. Among them, 1 887 users reported ≥7 VAS data. About 1 195 subjects were included in the analysis of adherence. One hundred and thirty‐six (11.28%) users were adherent (MPR ≥70% and PDC ≤1.25), 51 (4.23%) were partly adherent (MPR ≥70% and PDC = 1.50) and 176 (14.60%) were switchers. On the other hand, 832 (69.05%) users were non‐adherent to medications (MPR <70%). Of those, the largest group was non‐adherent to medications and the time interval was increased in 442 (36.68%) users.
Conclusion and clinical relevance
Adherence to treatment is low. The relative efficacy of continuous vs on‐demand treatment for allergic rhinitis symptoms is still a matter of debate. This study shows an approach for measuring retrospective adherence based on a mobile app. This also represents a novel approach for analysing medication‐taking behaviour in a real‐world setting.
68 citations
01 Jan 2019
TL;DR: Novel loci differentially methylated in newborns represent potential biomarkers of risk of asthma by school age, and Asthma-related differential methylation in blood in children was substantially replicated in eosinophils and respiratory epithelium.
Abstract: BACKGROUND
Epigenetic mechanisms, including methylation, can contribute to childhood asthma. Identifying DNA methylation profiles in asthmatic patients can inform disease pathogenesis.
OBJECTIVE
We sought to identify differential DNA methylation in newborns and children related to childhood asthma.
METHODS
Within the Pregnancy And Childhood Epigenetics consortium, we performed epigenome-wide meta-analyses of school-age asthma in relation to CpG methylation (Illumina450K) in blood measured either in newborns, in prospective analyses, or cross-sectionally in school-aged children. We also identified differentially methylated regions.
RESULTS
In newborns (8 cohorts, 668 cases), 9 CpGs (and 35 regions) were differentially methylated (epigenome-wide significance, false discovery rate < 0.05) in relation to asthma development. In a cross-sectional meta-analysis of asthma and methylation in children (9 cohorts, 631 cases), we identified 179 CpGs (false discovery rate < 0.05) and 36 differentially methylated regions. In replication studies of methylation in other tissues, most of the 179 CpGs discovered in blood replicated, despite smaller sample sizes, in studies of nasal respiratory epithelium or eosinophils. Pathway analyses highlighted enrichment for asthma-relevant immune processes and overlap in pathways enriched both in newborns and children. Gene expression correlated with methylation at most loci. Functional annotation supports a regulatory effect on gene expression at many asthma-associated CpGs. Several implicated genes are targets for approved or experimental drugs, including IL5RA and KCNH2.
CONCLUSION
Novel loci differentially methylated in newborns represent potential biomarkers of risk of asthma by school age. Cross-sectional associations in children can reflect both risk for and effects of disease. Asthma-related differential methylation in blood in children was substantially replicated in eosinophils and respiratory epithelium.
TL;DR: The findings of the present study suggest that middle-aged and older adults living in greener neighbourhoods are at lower risk of metabolic syndrome than those living in neighbourhoods with less greenspace.
Woolcock Institute of Medical Research1, University of Porto2, University of Beira Interior3, University of Naples Federico II4, Medical University of Warsaw5, Lithuanian University of Health Sciences6, American Pharmacists Association7, Scottish Government8, Karolinska University Hospital9, University of North Carolina at Chapel Hill10, Transylvania University11, Ghent University Hospital12, Buck Consultants13, Odense University Hospital14, McMaster University15, Humanitas University16, University of South Florida17, Leiden University Medical Center18, University of Minho19, Federal University of Bahia20, University of Montpellier21, University of Paris22, Université Paris-Saclay23, Saint Louis University24, Ain Shams University25, University of Chile26, University of Helsinki27, Katholieke Universiteit Leuven28, Ukrainian Medical Stomatological Academy29, Charité30, University of Würzburg31, Medical University of Łódź32, Vilnius University33, Oslo University Hospital34, Rashid Hospital35, Biomax Informatics AG36, University of Coimbra37, Royal College of Surgeons in Ireland38, University of Cologne39, University of Barcelona40, Johns Hopkins University41, Russian National Research Medical University42, Nippon Medical School43, Monash University44, Chiba University45, Charles University in Prague46, University of Manchester47, National and Kapodistrian University of Athens48, Ajou University49, University of Marburg50, Boston Children's Hospital51, University of Cape Town52, University of Crete53, Medical University of Graz54, Emek Medical Center55, University of Edinburgh56, University of Salerno57, University of Toronto58, European Union of Medical Specialists59, University of Turku60, University of Bari61, Nova Southeastern University62, Uppsala University63, Harvard University64, Celal Bayar University65, Catholic University of Cordoba66, Beijing Tongren Hospital67, Humboldt University of Berlin68
TL;DR: This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis, including a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease.
Abstract: Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.
TL;DR: The findings suggest that the epigenetic status of the newborn affects respiratory health and disease across the life course, of which up to 30% were associated with later-life asthma and COPD.
Abstract: Rationale We aimed to identify differentially methylated regions (DMRs) in cord blood DNA associated with childhood lung function, asthma and chronic obstructive pulmonary disease (COPD) across the life course. Methods We meta-analysed epigenome-wide data of 1688 children from five cohorts to identify cord blood DMRs and their annotated genes, in relation to forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC) ratio and forced expiratory flow at 75% of FVC at ages 7–13 years. Identified DMRs were explored for associations with childhood asthma, adult lung function and COPD, gene expression and involvement in biological processes. Results We identified 59 DMRs associated with childhood lung function, of which 18 were associated with childhood asthma and nine with COPD in adulthood. Genes annotated to the top 10 identified DMRs were HOXA5, PAOX, LINC00602, ABCA7, PER3, CLCA1, VENTX, NUDT12, PTPRN2 and TCL1A. Differential gene expression in blood was observed for 32 DMRs in childhood and 18 in adulthood. Genes related with 16 identified DMRs were associated with respiratory developmental or pathogenic pathways. Interpretation Our findings suggest that the epigenetic status of the newborn affects respiratory health and disease across the life course.
Ghent University Hospital1, Pompeu Fabra University2, National Institutes of Health3, Catholic University of the Sacred Heart4, Woolcock Institute of Medical Research5, University of Genoa6, Federal University of Bahia7, University of Paris8, Charité9, University of Amsterdam10, University of Porto11, University of Helsinki12, Medical University of Łódź13, Vilnius University14, University of Beira Interior15, Karolinska Institutet16, University of Barcelona17, University of Manchester18, Pasteur Institute19, University of Edinburgh20, Medical University of Graz21, Nova Southeastern University22, University of Bari23, Celal Bayar University24
TL;DR: This review summarizes some existing mHealth apps for allergic rhinitis and reviews those in which testing has been published, and discusses mHealth tools enabling the digital transformation of health and care, empowering citizens and building a healthier society.
University of Helsinki1, Fudan University2, University of Cape Town3, Post Graduate Institute of Medical Education and Research4, Universidade Federal de Minas Gerais5, Leiden University Medical Center6, University of Minho7, Federal University of Bahia8, National Institutes of Health9, Finnish Environment Institute10, Istanbul University11, Katholieke Universiteit Leuven12, Medical University of Łódź13, Tbilisi State University14, Shahid Beheshti University of Medical Sciences and Health Services15, Tishreen University16, Showa University17, Medical University of Warsaw18, University of Illinois at Chicago19, University of Toronto20, Vilnius University21, Celal Bayar University22
TL;DR: The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratorial Diseases (GARD) in Helsinki, August 2018.
Abstract: The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) in Helsinki, August 2018. New approaches are needed to improve respiratory health and reduce premature mortality of chronic diseases by 30% till 2030 (UN Sustainable Development Goals, SDGs). Planetary health is defined as the health of human civilization and the state of the natural systems on which it depends. Planetary health and human health are interconnected, and both need to be considered by individuals and governments while addressing several SDGs. The concept of the Nature Step has evolved from innovative research indicating, how changed lifestyle in urban surroundings reduces contact with biodiverse environments, impoverishes microbiota, affects immune regulation and increases risk of NCDs. The Nature Step calls for strengthening connections to nature. Physical activity in natural environments should be promoted, use of fresh vegetables, fruits and water increased, and consumption of sugary drinks, tobacco and alcohol restricted. Nature relatedness should be part of everyday life and especially emphasized in the care of children and the elderly. Taking “nature” to modern cities in a controlled way is possible but a challenge for urban planning, nature conservation, housing, traffic arrangements, energy production, and importantly for supplying and distributing food. Actions against the well-known respiratory risk factors, air pollution and smoking, should be taken simultaneously. In Finland and elsewhere in Europe, successful programmes have been implemented to reduce the burden of respiratory disorders and other NCDs. Unhealthy behaviour can be changed by well-coordinated actions involving all stakeholders. The growing public health concern caused by NCDs in urban surroundings cannot be solved by health care alone; a multidisciplinary approach is mandatory.
Ghent University Hospital1, Pompeu Fabra University2, Catholic University of the Sacred Heart3, National Institutes of Health4, Woolcock Institute of Medical Research5, University of Genoa6, Federal University of Bahia7, University of Paris8, Charité9, University of Amsterdam10, University of Porto11, University of Helsinki12, Medical University of Łódź13, Vilnius University14, University of Beira Interior15, Karolinska Institutet16, University of Barcelona17, University of Manchester18, Pasteur Institute19, University of Edinburgh20, Medical University of Graz21, Nova Southeastern University22, University of Bari23, Celal Bayar University24
TL;DR: A review of mobile health apps for allergic rhinitis can be found in this article, where the authors discuss apps that include risk factors of the disease, examine the impact of these apps in phenotype discovery, and provide real-world evidence for care pathways.
Abstract: Smart devices and Internet-based applications (apps) are largely used in allergic rhinitis and may help to address some unmet needs. However, these new tools need to first of all be tested for privacy rules, acceptability, usability, and cost-effectiveness. Second, they should be evaluated in the frame of the digital transformation of health, their impact on health care delivery, and health outcomes. This review (1) summarizes some existing mobile health apps for allergic rhinitis and reviews those in which testing has been published, (2) discusses apps that include risk factors of allergic rhinitis, (3) examines the impact of mobile health apps in phenotype discovery, (4) provides real-world evidence for care pathways, and finally (5) discusses mobile health tools enabling the digital transformation of health and care, empowering citizens, and building a healthier society.
TL;DR: An incidence ‘sex shift’ in chronic respiratory diseases from a male predominance before puberty to a more sex-balanced incidence after puberty onset is found, which may partly explain the previously reported sex shift in prevalence.
Abstract: Introduction To understand the puberty-related sex shift in the prevalence of asthma and rhinitis as single entities and as respiratory multimorbidities, we investigated if there is also a sex-specific and puberty-related pattern of their incidences. Methods We used harmonised questionnaire data from 18 451 participants in five prospective observational European birth cohorts within the collaborative MeDALL (Mechanisms of the Development of Allergy) project. Outcome definitions for IgE-associated and non-IgE-associated asthma, rhinitis and respiratory multimorbidity (first occurrence of coexisting asthma and rhinitis) were based on questionnaires and the presence of specific antibodies (IgE) against common allergens in serum. For each outcome, we used proportional hazard models with sex–puberty interaction terms and conducted a one-stage individual participant data meta-analysis. Results Girls had a lower risk of incident asthma (adjusted HR 0.67, 95% CI 0.61 to 0.74), rhinitis (0.73, 0.69 to 0.78) and respiratory multimorbidity (0.58, 0.51 to 0.66) before puberty compared with boys. After puberty onset, these incidences became more balanced across the sexes (asthma 0.84, 0.64 to 1.10; rhinitis 0.90, 0.80 to 1.02; respiratory multimorbidity 0.84, 0.63 to 1.13). The incidence sex shift was slightly more distinct for non-IgE-associated respiratory diseases (asthma 0.74, 0.63 to 0.87 before vs 1.23, 0.75 to 2.00 after puberty onset; rhinitis 0.88, 0.79 to 0.98 vs 1.20, 0.98 to 1.47; respiratory multimorbidity 0.66, 0.49 to 0.88 vs 0.96, 0.54 to 1.71) than for IgE-associated respiratory diseases. Discussion We found an incidence ‘sex shift’ in chronic respiratory diseases from a male predominance before puberty to a more sex-balanced incidence after puberty onset, which may partly explain the previously reported sex shift in prevalence. These differences need to be considered in public health to enable effective diagnoses and timely treatment in adolescent girls.
TL;DR: Higher PA is associated with attenuated decline in lung function and reduced health status (symptoms domain) deterioration in moderate-to-very severe COPD patients.
Abstract: Introduction: Chronic obstructive pulmonary disease (COPD) progression is variable and affects several disease domains, including decline in lung function, exercise capacity, muscle strength, and health status as well as changes in body composition. We aimed to assess the longitudinal association of physical activity (PA) with these a priori selected components of disease progression. Methods: We studied 114 COPD patients from the PAC-COPD cohort (94% male, mean [SD], 70 yr [8 yr] of age, 54 [16] forced expiratory volume in 1 s % predicted) at baseline and 2.6 yr (0.6 yr) later. Baseline PA was assessed by accelerometry. Multivariable general linear models were built to assess the association between PA and changes in lung function, functional exercise capacity, muscle strength, health status, and body composition. All models were adjusted for confounders and the respective baseline value of each measure. Results: Per each 1000 steps higher baseline PA, forced expiratory volume in 1 s declined 7 mL less (P < 0.01), forced vital capacity 9 mL less (P = 0.03) and carbon monoxide diffusing capacity 0.10 mL[middle dot]min-1[middle dot]mm Hg-1 less (P = 0.04), while the St George's Respiratory Questionnaire symptom domain deteriorated 0.4 points less (P = 0.03), per year follow-up. Physical activity was not associated with changes in functional exercise capacity, muscle strength, other domains of health status or body composition. Conclusions: Higher PA is associated with attenuated decline in lung function and reduced health status (symptoms domain) deterioration in moderate-to-very severe COPD patients.
University of Grenoble1, University of Verona2, Pompeu Fabra University3, French Institute of Health and Medical Research4, Ludwig Maximilian University of Munich5, Uppsala University6, Swiss Tropical and Public Health Institute7, Lille University of Science and Technology8, University of Bordeaux9, National Institutes of Health10, Paris Diderot University11
TL;DR: This work aimed to estimate risk of poor asthma events between asthma clusters identified 20 years earlier, and confirmed the identification of particular phenotypes confirming phenotypic heterogeneity of asthma.
Abstract: Background Research based on cluster analyses led to the identification of particular phenotypes confirming phenotypic heterogeneity of asthma. The long-term clinical course of asthma phenotypes defined by clustering analysis remains unknown, although it is a key aspect to underpin their clinical relevance. We aimed to estimate risk of poor asthma events between asthma clusters identified 20 years earlier. Methods The study relied on two cohorts of adults with asthma with 20-year follow-up, ECRHS (European Community Respiratory Health Survey) and EGEA (Epidemiological study on Genetics and Environment of Asthma). Regression models were used to compare asthma characteristics (current asthma, asthma exacerbations, asthma control, quality of life, and FEV1 ) at follow-up and the course of FEV1 between seven cluster-based asthma phenotypes identified 20 years earlier. Results The analysis included 1325 adults with ever asthma. For each asthma characteristic assessed at follow-up, the risk for adverse outcomes differed significantly between the seven asthma clusters identified at baseline. As compared with the mildest asthma phenotype, ORs (95% CI) for asthma exacerbations varied from 0.9 (0.4 to 2.0) to 4.0 (2.0 to 7.8) and the regression estimates (95% CI) for FEV1 % predicted varied from 0.6 (-3.5 to 4.6) to -9.9 (-14.2 to -5.5) between clusters. Change in FEV1 over time did not differ significantly across clusters. Conclusion Our findings show that the long-term risk for poor asthma outcomes differed between comprehensive adult asthma phenotypes identified 20 years earlier, and suggest a strong tracking of asthma activity and impaired lung function over time.
University of Helsinki1, Fudan University2, University of Cape Town3, Post Graduate Institute of Medical Education and Research4, Universidade Federal de Minas Gerais5, Leiden University Medical Center6, University of Minho7, Federal University of Bahia8, National Institutes of Health9, Finnish Environment Institute10, Istanbul University11, Katholieke Universiteit Leuven12, Medical University of Łódź13, Tbilisi State University14, Shahid Beheshti University of Medical Sciences and Health Services15, Tishreen University16, Showa University17, Medical University of Warsaw18, University of Illinois at Chicago19, University of Toronto20, Vilnius University21, Celal Bayar University22
TL;DR: The growing public health concern caused by NCDs in urban surroundings cannot be solved by health care alone; a multidisciplinary approach is mandatory.
Abstract: The Nature Step to Respiratory Health was the overarching theme of the 12th General Meeting of the Global Alliance against Chronic Respiratory Diseases (GARD) in Helsinki, August 2018. New approaches are needed to improve respiratory health and reduce premature mortality of chronic diseases by 30% till 2030 (UN Sustainable Development Goals, SDGs). Planetary health is defined as the health of human civilization and the state of the natural systems on which it depends. Planetary health and human health are interconnected, and both need to be considered by individuals and governments while addressing several SDGs. The concept of the Nature Step has evolved from innovative research indicating, how changed lifestyle in urban surroundings reduces contact with biodiverse environments, impoverishes microbiota, affects immune regulation and increases risk of NCDs. The Nature Step calls for strengthening connections to nature. Physical activity in natural environments should be promoted, use of fresh vegetables, fruits and water increased, and consumption of sugary drinks, tobacco and alcohol restricted. Nature relatedness should be part of everyday life and especially emphasized in the care of children and the elderly. Taking “nature” to modern cities in a controlled way is possible but a challenge for urban planning, nature conservation, housing, traffic arrangements, energy production, and importantly for supplying and distributing food. Actions against the well-known respiratory risk factors, air pollution and smoking, should be taken simultaneously. In Finland and elsewhere in Europe, successful programmes have been implemented to reduce the burden of respiratory disorders and other NCDs. Unhealthy behaviour can be changed by well-coordinated actions involving all stakeholders. The growing public health concern caused by NCDs in urban surroundings cannot be solved by health care alone; a multidisciplinary approach is mandatory.
Pompeu Fabra University1, Utrecht University2, University of Antwerp3, Ludwig Maximilian University of Munich4, University of Bordeaux5, University of Paris6, Paris Diderot University7, University of Pavia8, University of Iceland9, Sahlgrenska University Hospital10, Umeå University11, Uppsala University12, Boston Public Health Commission13, Swiss Tropical and Public Health Institute14, Monash University15, Tartu University Hospital16, University of Gothenburg17, Aarhus University18, San Francisco VA Medical Center19, Cardiff University20, University of Turin21, Oregon Health & Science University22
TL;DR: Occupational exposures are associated with chronic phlegm and CB, and the evidence is strongest for metals and mineral dust exposure; the observed differences between men and women warrant further investigation.
Abstract: OBJECTIVES: Chronic bronchitis (CB) is an important chronic obstructive pulmonary disease (COPD)-related phenotype, with distinct clinical features and prognostic implications. Occupational exposur ...
Swiss Tropical and Public Health Institute1, University of Basel2, University of Turin3, Umeå University4, University of Bristol5, Helmholtz Zentrum München6, Ludwig Maximilian University of Munich7, Imperial College London8, French Institute of Health and Medical Research9, University of Verona10, Versailles Saint-Quentin-en-Yvelines University11, University of Grenoble12, University of Washington13
TL;DR: It is shown that SES plays a role as a confounder in the association of ambient NO2 exposure with lung function, and the inclusion of the SES-variable education improved the models and the air pollution-lung function associations got slightly stronger.
Abstract: Ambient air pollution is a leading environmental risk factor and its broad spectrum of adverse health effects includes a decrease in lung function. Socioeconomic status (SES) is known to be associated with both air pollution exposure and respiratory function. This study assesses the role of SES either as confounder or effect modifier of the association between ambient air pollution and lung function. Cross-sectional data from three European multicenter adult cohorts were pooled to assess factors associated with lung function, including annual means of home outdoor NO2. Pre-bronchodilator lung function was measured according to the ATS-criteria. Multiple mixed linear models with random intercepts for study areas were used. Three different factors (education, occupation and neighborhood unemployment rate) were considered to represent SES. NO2 exposure was negatively associated with lung function. Occupation and neighborhood unemployment rates were not associated with lung function. However, the inclusion of the SES-variable education improved the models and the air pollution-lung function associations got slightly stronger. NO2 associations with lung function were not substantially modified by SES-variables. In this multicenter European study we could show that SES plays a role as a confounder in the association of ambient NO2 exposure with lung function.
TL;DR: This work has identified genes and pathways for atopy and atopic asthma in children and adolescents, using transcriptome-wide data from WBCs and whole blood samples and identified multiple asthma-relevant genotype–expression pairs, such as rs2255888/ALOX15.
Abstract: Early allergic sensitisation (atopy) is the first step in the development of allergic diseases such as atopic asthma later in life. Genes and pathways associated with atopy and atopic asthma in children and adolescents have not been well characterised. A transcriptome-wide association study (TWAS) of atopy and atopic asthma in white blood cells (WBCs) or whole blood was conducted in a cohort of 460 Puerto Ricans aged 9–20 years (EVA-PR study) and in a cohort of 250 Swedish adolescents (BAMSE study). Pathway enrichment and network analyses were conducted to further assess top findings, and classification models of atopy and atopic asthma were built using expression levels for the top differentially expressed genes (DEGs). In a meta-analysis of the study cohorts, both previously implicated genes (e.g. IL5RA and IL1RL1) and genes not previously reported in TWASs (novel) were significantly associated with atopy and/or atopic asthma. Top novel genes for atopy included SIGLEC8 (p=8.07×10−13), SLC29A1 (p=7.07×10−12) and SMPD3 (p=1.48×10−11). Expression quantitative trait locus analyses identified multiple asthma-relevant genotype–expression pairs, such as rs2255888/ALOX15. Pathway enrichment analysis uncovered 16 significantly enriched pathways at adjusted p We have identified genes and pathways for atopy and atopic asthma in children and adolescents, using transcriptome-wide data from WBCs and whole blood samples.
TL;DR: Google Trends is a web‐based surveillance tool that explores the searching trends of specific queries via Google to reflect the real‐life epidemiology of allergic rhinitis and asthma but the validation of GTs against pollen concentrations is missing at the country level.
Abstract: Background Google Trends (GTs) is a web-based surveillance tool that explores the searching trends of specific queries via Google. This tool proposes to reflect the real-life epidemiology of allergic rhinitis and asthma. However, the validation of GTs against pollen concentrations is missing at the country level. Objectives In the present study, we used GTs (a) to compare the terms related to allergy in France, (b) to assess seasonal variations across the country for 5 years and (c) to compare GTs and pollen concentrations for 2016. Methods Google Trends queries were initially searched to investigate the terms reflecting pollen and allergic diseases. 13- and 5-year GTs were used in France. Then, 5-year GTs were assessed in all metropolitan French regions to assess the seasonality of GTs. Finally, GTs were compared with pollen concentrations (Reseau National de Surveillance en Aerobiology) for 2016 in seven regions (GTs) and corresponding cities (pollen concentrations). Results The combination of searches for "allergy" as a disease, "pollen" as a disease cause and "ragweed" as a plant was needed to fully assess the pollen season in France. "Asthma" did not show any seasonality. Using the 5-year GTs, an annual and clear seasonality of queries was found in all regions depending on the predicted pollen exposure for spring and a summer peak but not for winter peaks. The agreement between GT queries and pollen concentrations is usually poor except for spring trees and grasses. Moreover, cypress pollens are insufficiently reported by GTs. Conclusions Google Trends cannot predict the pollen season in France.
University of Montpellier1, Pasteur Institute2, Transylvania University3, University of Paris4, Ghent University Hospital5, Buck Consultants6, Woolcock Institute of Medical Research7, National Institutes of Health8, Humanitas University9, University of Cartagena10, Nova Southeastern University11, McMaster University12, University of Porto13, Federal University of Bahia14, Erasmus University Rotterdam15, Chiba University16, Medical University of Łódź17, Vilnius University18, University of Beira Interior19, University of Coimbra20, University of Naples Federico II21, University of Barcelona22, University of Manchester23, University of Oulu24, Welsh Government25, University of Edinburgh26, Medical University of Warsaw27, Imperial College London28, University of Helsinki29, University of Crete30, Leiden University Medical Center31, University of Bari32, Celal Bayar University33, Free University of Berlin34
TL;DR: In this paper, the authors proposed real-life ICPs, centred around the patient with rhinitis and using mHealth monitoring of environmental exposure, to support the transformation of the health care system into integrated care with organizational health literacy.
Abstract: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. MASK (Mobile Airways Sentinel NetworK) (1), a new development of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative (2), and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health) (3), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs—centred around the patient with rhinitis and using mHealth monitoring of environmental exposure.
Pompeu Fabra University1, Ghent University Hospital2, Woolcock Institute of Medical Research3, University of Helsinki4, Katholieke Universiteit Leuven5, University of Amsterdam6, Medical University of Łódź7, Medical University of Warsaw8, McMaster University9, University of Edinburgh10, Nova Southeastern University11
TL;DR: ARIA has evolved, with strong political commitment, from the first multimorbidity guideline in respiratory diseases to an exemplar for the future digital transformation of health and care for the management of patients with long-term conditions.
Abstract: ARIA has evolved, with strong political commitment, from the first multimorbidity guideline in respiratory diseases to an exemplar for the future digital transformation of health and care for the management of patients with long-term conditionshttp://bit.ly/35fBlhN
Pompeu Fabra University1, Biomax Informatics AG2, Charité3, French Institute of Health and Medical Research4, Pierre-and-Marie-Curie University5, Odense University Hospital6, Oslo University Hospital7, University of Bologna8, Utrecht University9, Stockholm County Council10, Karolinska Institutet11, University of Bradford12, Paris Descartes University13, Loughborough University14, Centre for Health Protection15
TL;DR: In asthma and allergy birth cohorts, the harmonization of data for pooled analyses is feasible, and high inferential comparability may be achieved, and the MeDALL approach can be used in other collaborative projects.
Abstract: The numbers of international collaborations among birth cohort studies designed to better understand asthma and allergies have increased in the last several years. However, differences in definitions and methods preclude direct pooling of original data on individual participants. As part of the Mechanisms of the Development of Allergy (MeDALL) Project, we harmonized data from 14 birth cohort studies (each with 3-20 follow-up periods) carried out in 9 European countries during 1990-1998 or 2003-2009. The harmonization process followed 6 steps: 1) organization of the harmonization panel; 2) identification of variables relevant to MeDALL objectives (candidate variables); 3) proposal of a definition for each candidate variable (reference definition); 4) assessment of the compatibility of each cohort variable with its reference definition (inferential equivalence) and classification of this inferential equivalence as complete, partial, or impossible; 5) convocation of a workshop to agree on the reference definitions and classifications of inferential equivalence; and 6) preparation and delivery of data through a knowledge management portal. We agreed on 137 reference definitions. The inferential equivalence of 3,551 cohort variables to their corresponding reference definitions was classified as complete, partial, and impossible for 70%, 15%, and 15% of the variables, respectively. A harmonized database was delivered to MeDALL investigators. In asthma and allergy birth cohorts, the harmonization of data for pooled analyses is feasible, and high inferential comparability may be achieved. The MeDALL harmonization approach can be used in other collaborative projects.
Katholieke Universiteit Leuven1, Pasteur Institute2, Transylvania University3, University of Paris4, Pompeu Fabra University5, Ghent University Hospital6, Buck Consultants7, Woolcock Institute of Medical Research8, National Institutes of Health9, Humanitas University10, University of Cartagena11, Nova Southeastern University12, McMaster University13, University of Porto14, Federal University of Bahia15, University of Amsterdam16, Erasmus University Rotterdam17, Chiba University18, Medical University of Łódź19, Vilnius University20, University of Beira Interior21, University of Coimbra22, University of Naples Federico II23, University of Barcelona24, University of Manchester25, University of Oulu26, Welsh Government27, University of Edinburgh28, Medical University of Warsaw29, Imperial College London30, University of Helsinki31, University of Crete32, Leiden University Medical Center33, University of Bari34, Celal Bayar University35, Charité36
TL;DR: MASK (Mobile Airways Sentinel NetworK) and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health) are proposing real-life integrated care pathways (ICPs) -centred around the patient with rhinitis and using mHealth monitoring of environmental exposure.
Abstract: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system for integrated care with organizational health literacy. MASK (Mobile Airways Sentinel NetworK) (1), a new development of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health) (2), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life integrated care pathways (ICPs) (3)-centred around the patient with rhinitis and using mHealth monitoring of environmental exposure (4).
An expert meeting took place at the Pasteur Institute in Paris, December 3, 2018. The aim was to discuss next-generation care pathways: (I) Patient participation, health literacy and self-care through technology-assisted “patient activation”; (II) Implementation of care pathways by pharmacists and (III) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) assessed by mobile technology.
The EU (5) and global political agendas are of great importance in supporting health care transformation. MASK has been recognized by DG Sante as a Good Practice (6) in the field of digitally-enabled, integrated, person-centred care.
The one-day meeting objectives were clear (Figure 1). The meeting was followed by a workshop. The present paper reports the background of the two-day meeting.