Giuseppina Cuttitta

Urinary leukotriene E4 in the assessment of nocturnal asthma

BACKGROUND Urinary leukotriene E4 (LTE4) is a marker of the bodys production of cysteinyl LTs, important mediators of airway inflammation. The role of the latter in nocturnal asthma is a topic of increasing interest. OBJECTIVE This investigation was aimed at determining whether nighttime attacks are associated with increased release of LTs, expressed by urinary LTE4, and the relationship between the two phenomena. METHODS Three groups were studied: group A, seven control subjects; group B, nine asthmatic patients without nocturnal attacks; and group C, nine asthmatic patients with a comparable daytime FEV1 but who were experiencing nocturnal exacerbations (morning dips in peak expiratory flow greater than 20%). Urine was collected over 24 hours in three samples (9:00 AM to 3:00 PM; 3:00 PM to 9:00 PM; and 9:00 PM to 9:00 AM). LTE4 was measured by high-performance liquid chromatography and radioimmunoassay and expressed as nanograms per millimole of creatinine. RESULTS No significant differences between urinary LTE4 were noticed within groups A and B. Conversely, in group C urinary LTE4 at night (geometric mean with 95% confidence interval; 35.16 with 28.77-42.85) was significantly higher than that of the other samples (respectively 23.12 with 17.78-30.06, p less than 0.05; and 25.18 with 21.03-30.13, p less than 0.02); it was also significantly higher than in all the samples of other groups. A significant (p less than 0.02) linear correlation was observed between morning dip in peak expiratory flow and the log urinary LTE4 in the nocturnal sample. CONCLUSION These results indicate the role of LTs in nocturnal asthma and suggest that urinary LTE4 may be a useful marker of this condition.

A cross-sectional study assessing the relationship between BMI, asthma, atopy, and eNO among schoolchildren.

BACKGROUND Increased body weight may influence airway inflammatory mechanisms. OBJECTIVE To assess whether overweight-obesity (OW-O), evaluated as increased body mass index, is associated either with exhaled nitric oxide (eNO), a marker of airway inflammation, or with allergic sensitization in a large sample of children and adolescents. METHODS A cross-sectional, epidemiological study was performed on a population sample of schoolchildren evaluating 708 subjects (age 10-16 years; BMI 13-39 kg/m(2)) by respiratory health questionnaire, skin prick tests, spirometry, and eNO measure. RESULTS Prevalence rates were: OW-O 16.4%, asthma ever (A) 11.9%, and rhinoconjunctivitis (RC) 14.8%. Asthma ever and allergic sensitization were significantly more frequent among OW-O (21.0 and 51.6%) than in non-OW-O (10.2 and 37.0%, respectively). The forced expiratory volume in 1 second (FEV(1))/forced vital capacity (FVC) ratio was not significantly different between OW-O and non-OW-O. Exhaled NO (median and interquartile range) was 15.3 (11.2-23.1) ppb in the overall sample, 20.3 (12.9-35.8) ppb among allergic subjects, and 13.9 (10.6-18.3) ppb among nonallergic subjects (P<.0001). No significant difference between OW-O and non OW-O subjects was found in eNO levels. Similarly, OW-O subjects with A or RC did not show significantly higher eNO levels than non-OW-O. In a logistic regression model, presence of allergic sensitization, A, and RC, and not OW-O, were significant predictors of increased eNO. CONCLUSIONS In children, OW-O was not associated with increased eNO levels, but it was an independent risk factor for asthma and allergic sensitization.

The Burden of Rhinitis and Rhinoconjunctivitis in Adolescents

Purpose Rhinitis and conjunctivitis are common diseases worldwide that are frequently associated. Nevertheless, the risk factors for rhinoconjunctivitis are not well-described and the impact of conjunctivitis on rhinitis and asthma in children remains unknown. This study explored the different risk factors and evaluated the burden of rhinoconjunctivitis among adolescents. Methods This was a cross-sectional study conducted on a random sample of schoolchildren, aged 10-17 years, using skin prick tests and a self-administered questionnaire on respiratory health investigating the impact of rhinitis and rhinoconjunctivitis on daily activities. Results A complete evaluation was obtained for 2,150 children. The prevalence of rhinitis alone was 18.2% and rhinitis associated with conjunctivitis was 20.5%. Rhinoconjunctivitis was more frequently associated with females, a parental history of atopy, domestic exposure to mold/dampness, passive smoke exposure, and reported truck traffic in residential streets. Moreover, rhinoconjunctivitis was associated with a higher level of allergic sensitization. The prevalence of current asthma was 1.7% in subjects without rhinitis or rhinoconjunctivitis, 5.1% in rhinitis and 10.7% in rhinoconjunctivitis. In a logistic model, rhinoconjunctivitis yielded a 2-fold risk for current asthma with respect to rhinitis. Subjects with rhinoconjunctivitis had poorer quality of life (QoL); there was an impact on daily activities in 4.6% of rhinitis and 10.7% of rhinoconjunctivitis. Conclusions Ocular symptoms increase the role of rhinitis as a risk factor for asthma and its impact on daily activities in children.

Bronchial hyperresponsiveness in children with atopic rhinitis: a 7‐year follow‐up

Background:  A high prevalence of bronchial hyperresponsiveness (BHR) was found in atopic subjects with rhinitis. Those subjects may be at higher risk for developing bronchial asthma. We evaluated, in a 7‐year follow‐up, BHR and atopy in a homogeneous population of nonasthmatic children with allergic rhinitis (AR), and their role in asthma development.

An elevated body mass index increases lung volume but reduces airflow in Italian schoolchildren.

Background Asthma and obesity are important and growing health issues worldwide. Obesity is considered a risk factor for asthma, due to the induction of changes in airway mechanics and altered airway inflammation. Methods We cross-sectionally investigated the effect of increased weight on pulmonary function in a large population sample of healthy children, aged 10–17 yrs living in Palermo, Italy. Explanatory effect of weight on lung function variables were evaluated by multiple linear regression models, taking into account height, gender, and age-class. Results Among the 2,393 subjects, FVC and FEV1 were positively correlated to weight. Multiple regression models showed that the weight beta coefficient for FEV1 was significantly lower with respect to that for FVC (0.005 and 0.009 l/kg, respectively), indicating a different magnitude in explanatory effect of weight on FVC and FEV1. Both FEV1/FVC and FEF25–75%/FVC ratios were negatively correlated to weight, while FEF25–75% was not significantly correlated. Similar results were obtained also when 807 symptomatic subjects were introduced in the model through a sensitivity analysis. Conclusion In healthy children, the disproportionate increase of FEV1 and FVC with weight produces airflow decrease and consequently apparent poorer lung function independently from respiratory disease status.

Effect of indoor nitrogen dioxide on lung function in urban environment

BACKGROUND High levels of indoor NO2 are associated with increased asthma symptoms and decreased expiratory peak flows in children. We investigated the association of exposure to domestic indoor NO2, objectively measured in winter and spring, with respiratory symptoms and lung function in a sample of adolescents from a southern Mediterranean area. METHODS From a large school population sample (n=2150) participating in an epidemiological survey in the urban area of the City of Palermo (southern Italy), a sub-sample of 303 adolescents was selected which furnished an enriched sample for cases of current asthma. All subjects were evaluated by a health questionnaire, skin prick tests and spirometry. One-week indoor NO2 monitoring of their homes was performed by diffusive sampling during spring and again during winter. RESULTS We found that about 25% of subjects were exposed to indoor NO2 levels higher than the 40µg/m(3) World Health Organization limit, during both spring and winter. Moreover, subjects exposed to the highest indoor NO2 concentrations had increased frequency of current asthma (p=0.005), wheeze episodes in the last 12 months (p<0.001), chronic phlegm (p=0.013), and rhinoconjunctivitis (p=0.008). Finally, subjects with a personal history of wheeze ever had poorer respiratory function (FEF25-75%, p=0.01) when exposed to higher indoor NO2 concentrations. CONCLUSIONS Home exposure to high indoor NO2 levels frequently occurs in adolescents living in a southern Mediterranean urban area and is significantly associated with the risks for increased frequency of both respiratory symptoms and reduced lung function.

Prevalence of Nocturnal Asthma in a General Population Sample: Determinants and Effect of Aging

Nocturnal asthma (NA) is important because of clinical and prognostic implications. Previous data on prevalence may be overestimated, because they are derived from selected series. Observations on monitoring of peak expiratory flow in elderly asthmatics suggested that prevalence of NA may increase with age. This study was designed to estimate the prevalence of NA-related symptoms in a sample drawn from a general population and evaluate the role of aging. Subjects (1100, mean age 41.9, SD 22.8 years) were randomly selected from the lists of seven general practitioners. A questionnaire on nighttime and morning NA-associated symptoms was used and frequence of occurrence was rated as never, sometimes (less than once a week), and often (once a week or more). In the overall sample, symptoms were experienced “sometimes” by 2.3%–4.9% of subjects, whereas the response “often” was given by 0.9%–1.6% of subjects. Among subjects with a diagnosis of asthma, symptoms occurred sometimes in 16.7%–23.7% and often in 5%–15%. Symptoms reported the morning after were significantly more frequent among patients aged 65 years and older (p < 0.005), whereas the difference for nighttime symptoms was not statistically significant in different age groups, confirming an age-related blunted sensitivity. Logistic regression analysis shows that a diagnosis of asthma is the most important correlate of symptoms, with odds ratio (OR) up to 14.78 for cough; advanced age also proved to be an independent risk factor (OR 3.35–4.97). In conclusion, although the prevalence of NA was previously overestimated, our results indicate its importance, particularly among elderly patients who are exposed to a prominent risk of underdiagnosis and un-dertreatment.

Rhinitis as a risk factor for depressive mood in pre-adolescents: a new approach to this relationship

Respiratory allergic symptoms impact on social life and school activities, influencing the patients mood states. We evaluated the relationships between allergic respiratory diseases and depressive/anxious mood in a large sample of Italian middle school students, using the partial directed acyclic graph (P‐DAG).

Association of Blattella germanica sensitization with atopic diseases in pediatric allergic patients.

To cite this article: La Grutta S, Cibella F, Passalacqua G, Cuttitta G, Liotta G, Ferlisi A, Viegi G. Association of Blattella germanica sensitization with atopic diseases in pediatric allergic patients. Pediatr Allergy Immunol 2011; 22: 521–527.

Relationship between domestic smoking and metals and rare earth elements concentration in indoor PM2.5 - The Indoor and Outdoor Air Quality and Respiratory Health in Malta and Sicily

Abstract Cigarette smoke is the main source of indoor chemical and toxic elements. Cadmium (Cd), Thallium (Tl), Lead (Pb) and Antimony (Sb) are important contributors to smoke‐related health risks. Data on the association between Rare Earth Elements (REE) Cerium (Ce) and Lanthanum (La) and domestic smoking are scanty. To evaluate the relationship between cigarette smoke, indoor levels of PM2.5 and heavy metals, 73 children were investigated by parental questionnaire and skin prick tests. The houses of residence of 41 “cases” and 32 “controls” (children with and without respiratory symptoms, respectively) were evaluated by 48‐h PM2.5 indoor/outdoor monitoring. PM2.5 mass concentration was determined by gravimetry; the extracted and mineralized fractions of elements (As, Cd, Ce, La, Mn, Pb, Sb, Sr, Tl) were evaluated by ICP‐MS. PM2.5 and Ce, La, Cd, and Tl indoor concentrations were higher in smoker dwellings. When corrected for confounding factors, PM2.5, Ce, La, Cd, and Tl were associated with more likely presence of respiratory symptoms in adolescents. We found that: i) indoor smoking is associated with increased levels of PM2.5, Ce, La, Cd, and Tl and ii) the latter with increased presence of respiratory symptoms in children. Graphical abstract Figure. No Caption available. HighlightsTobacco smoke releases heavy metals (HM) and REE in indoor dwellings.Elemental content in indoor PM2.5 was measured in smoking and non smoking dwellings.Extracted and mineralized fractions of elements were evaluated by ICP‐MS.Indoor smoke was associated with increase of specific elemental fractions in PM2.5.Increased levels of HM and REE are associated with respiratory symptoms in children.