Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma: a population-based cohort.

Background: Although women with severe non-allergic asthma may represent a substantial proportion of adults with asthma in clinical practice, gender differences in the incidence of allergic and non-allergic asthma have been little investigated in the general population.

Methods: Gender differences in asthma prevalence, reported diagnosis and incidence were investigated in 9091 men and women randomly selected from the general population and followed up after 8-10 years as part of the European Community Respiratory Health Survey. The protocol included assessment of bronchial responsiveness, IgE specific to four common allergens and skin tests to nine allergens.

High prevalence of COPD symptoms in the general population contrasting with low awareness of the disease.

Introduction: Chronic obstructive pulmonary disease (COPD) is underdiagnosed because of limited disease awareness with trivialization of the symptoms in the general population.

Methods: A survey was conducted in a representative sample (n=2758) of individuals older than 40 years of age in the general population of France. Respiratory symptoms and knowledge about COPD were assessed in individuals with or at risk for COPD (n=860, 31% of the sample).

Effect of smoking on symptoms of allergic rhinitis.

Background: Tobacco smoking is common in patients with allergic rhinitis.

Objective: To examine the impact of smoking on allergic rhinitis.

Methods: Two cross-sectional studies (performed between March 1, 2002, and February 28, 2003) assessed the impact of tobacco smoking on the symptoms and quality of life of untreated patients with diagnosed allergic rhinitis who had consulted with primary care physicians (472 patients) and specialists (672 patients).

Evolution of asthma severity in a cohort of young adults: is there any gender difference?

Introduction: Little is known about the distribution of asthma severity in men and women in the general population. The objective of our study was to describe asthma severity and change in severity according to gender in a cohort of adult asthmatics

Methods: Subjects with asthma were identified from random samples of the 22 to 44 year-olds from the general population, screened for asthma from 1991 to 1993 in 48 centers from 22 countries and followed-up during 1998-2002, as part of the European Community Respiratory Health Survey (ECRHS). All participants to follow-up with current asthma at baseline were eligible for the analysis.

[The gap between the high impact and low awareness of COPD in the population].

Introduction: Chronic obstructive pulmonary disease (COPD) is markedly under-diagnosed, which may relate to under-reporting of symptoms and poor awareness of the disease.

Methods: A survey was conducted in a sample of the French general population aged 40-75 years (n=2758) to assess respiratory symptoms and level of knowledge of the disease in subjects with or at-risk of COPD (n=860, 31%).

Results: The high frequency of dyspnoea (MRC dyspnoea grade > or =1: 40%) contrasted with that of subjects spontaneously reporting respiratory problems (9%).

Implementation of guidelines for allergic rhinitis in specialist practices. A randomized pragmatic controlled trial.

Background: Guidelines for allergic rhinitis are more effective than free-treatment choice in the control of seasonal allergic rhinitis.

Objective: To validate the ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines in the treatment of intermittent and persistent allergic rhinitis induced by pollens.

Design: A multicenter, open-label, parallel, pragmatic randomized study compared two therapeutic strategies during a 2-week treatment course.

[Characteristics of the patients included in the French cohort of patients with emphysema caused by alpha-1 antitrypsin deficiency].

Introduction: Alpha-1 antitrypsin deficiency is associated with the occurrence of pulmonary emphysema. The aim of this study is to describe the characteristics of patients with alpha-1 antitrypsin deficiency associated pulmonary emphysema.

Methods: We describe a prospective cohort study including adult patients with alpha-1 antitrypsin deficiency associated pulmonary emphysema confirmed by CT scan living in France.

Is age at menopause increasing across Europe? Results on age at menopause and determinants from two population-based studies.

Objective: To investigate the variability and determinants of menopause age in two European cohort studies, the European Respiratory Health Survey and the Swiss Air Pollution and Lung Disease in Adults Cohort.

Methods: Age at menopause was estimated in 5,288 women, aged 30 to 60 years, randomly selected in nine European countries between 1998 and 2002. Determinants of natural and surgically induced menopause were investigated by Cox regression and heterogeneity by meta-analysis.

Rhinitis and onset of asthma: a longitudinal population-based study.

Background: A close relation between asthma and allergic rhinitis has been reported by several epidemiological and clinical studies. However, the nature of this relation remains unclear. We used the follow-up data from the European Community Respiratory Health Survey to investigate the onset of asthma in patients with allergic and non-allergic rhinitis during an 8.

Geographical distribution of atopic rhinitis in the European Community Respiratory Health Survey I.

Background: No large studies in adults has examined geographical variation in the prevalence of nasal allergy/allergic rhinitis in adults or considered the proportion of reported nasal symptoms on exposure to allergen attributable to atopy. The aim of this report was to describe the geographic distribution of subjects with nasal symptoms who are sensitized as determined by skin prick tests, using data from the European Community Respiratory Health Survey I.

Methods: Information on the presence of nasal allergy, nasal symptoms on exposure to allergen and atopy using skin prick tests was collected from 15,394 adults aged 20-44 years living in 35 centres in 15 countries.

FEV1/FVC and FEV1 for the assessment of chronic airflow obstruction in prevalence studies: do prediction equations need revision?

Little is known on the long-term validity of reference equations used in the calculation of FEV(1) and FEV(1)/FVC predicted values. This survey assessed the prevalence of chronic airflow obstruction in a population-based sample and how it is influenced by: (i) the definition of airflow obstruction; and (ii) equations used to calculate predicted values. Subjects aged 45 or more were recruited in health prevention centers, performed spirometry and fulfilled a standardized ECRHS-derived questionnaire.

Predictors of outcomes in COPD exacerbation cases presenting to the emergency department.

The aim of the present prospective multicentric study was to develop a simple rule for the prediction of poor outcome in patients presenting to emergency departments with initially non-life threatening-chronic obstructive pulmonary disease (COPD) exacerbations in a real-life setting. All patients with an acute exacerbation of COPD visiting the emergency departments of 103 hospitals during a 3-month period were included, except those who immediately required intensive care unit admission and/or ventilatory support. The data collected included patient characteristics, in-hospital outcomes (mortality and length of stay) and mode of discharge (unsupported or need for post-hospital assistance).

The effect of an information leaflet upon knowledge and awareness of COPD in potential sufferers. A randomized controlled study.

Background: Chronic obstructive pulmonary disease (COPD) is markedly under-diagnosed, which may be related to the under-reporting of symptoms and poor awareness of the disease. We hypothesized that written information on COPD may help increase awareness of the disease in people at risk of developing it.

Objectives: To evaluate the impact of an information leaflet sent by postal mail on the level of knowledge of COPD in subjects with or at risk of COPD.

Impact of chronic airflow obstruction in a working population.

Data on the individual and collective impact of chronic airflow obstruction at a population level are scarce. In a nationwide survey, dyspnoea, quality of life and missed working days were compared between subjects with and without spirometrically diagnosed chronic airflow obstruction. Subjects aged > or =45 yrs were recruited in French health prevention centres (n = 5,008).

Lung function, respiratory symptoms, and the menopausal transition.

Background: There is limited information on potential changes in respiratory health when women enter the menopausal transition.

Objective: We sought to investigate whether the menopausal transition is related to lung function and asthma and whether body mass index (BMI) modifies associations.

Methods: Four thousand two hundred fifty-nine women from 21 centers (ECRHS II, 2002) responded to a questionnaire concerning women's health.

Frequency and impact of allergic rhinitis in asthma patients in everyday general medical practice: a French observational cross-sectional study.

Background: Allergic rhinitis (AR) and asthma are inflammatory conditions of the airways that often occur concomitantly. This observational, cross-sectional, national study was undertaken to describe the frequency and severity of AR in asthmatic patients. The impact of AR on the quality of life and the therapeutic management of patients in everyday general medical practice were also assessed.

Interaction between a heme oxygenase-1 gene promoter polymorphism and serum beta-carotene levels on 8-year lung function decline in a general population: the European Community Respiratory Health Survey (France).

Oxidative stress is thought to play a major role in the pathogenesis of chronic obstructive pulmonary disease, characterized by impaired lung function. A large number (> or =33) of GT repeats (L-allele) in the gene of the powerful antioxidant enzyme heme oxygenase-1 has been associated with susceptibility to accelerated lung function decline. In contrast, beta-carotene may help to protect against accelerated decline.

Evidence for linkage of a new region (11p14) to eczema and allergic diseases.

Asthma, allergic rhinitis (AR) and atopic dermatitis also called eczema are allergic co-morbidites, which are likely to depend on pleiotropic genetic effects as well as on specific genetic factors. After a previous genome-wide linkage screen conducted for asthma and AR in a sample of 295 French EGEA families ascertained through asthmatic subjects, the aim here was to search for genetic factors involved in eczema and more particularly the ones shared by the three allergic diseases using the same EGEA data. In this sake, eczema and phenotypes of "allergic disease" accounting for the joint information on the presence/absence of the three diseases were examined by linkage analyses using the maximum likelihood binomial method.

Pharmacoeconomic assessment of specific immunotherapy versus current symptomatic treatment for allergic rhinitis and asthma in France.

Objectives: The therapeutic benefit of specific immunotherapy (SIT) in allergic rhinitis and asthma has been endorsed by expert consensus. This study compared the cost/efficacy (C/E) of SIT with current symptomatic treatments (CST) for allergic rhinitis and asthma.

Methods: A C/E analysis was performed using a decision tree model.

Allergic rhinitis and onset of bronchial hyperresponsiveness: a population-based study.

Rationale: Patients with allergic rhinitis have more frequent bronchial hyperresponsiveness (BHR) in cross-sectional studies.

Objectives: To estimate the changes in BHR in nonasthmatic subjects with and without allergic rhinitis during a 9-year period.

Methods: BHR onset was studied in 3,719 subjects without BHR at baseline, who participated in the follow-up of the European Community Respiratory Health Survey.

[Epidemiological study on the Genetics and Environment of Asthma, bronchial hyperresponsiveness and atopy (EGEA) - First results of a multi-disciplinary study].

The French co-operative epidemiological study EGEA realised in 1991/95 combines a case control study and a study of the families of asthmatic cases. A synthesis of the results already obtained is presented. Smoking was related to IgE, even in asthmatics and was clearly related to the clinical severity of asthma, an aspect insufficiently taken into account.

ETB receptor polymorphism is associated with airway obstruction.

Background: Endothelin-1 (EDN1) has been involved in the development of airway obstruction and inflammation in asthma. Several polymorphisms have been identified among the genes encoding for preproET1, an inactive precursor of ET-1, and for ETA (EDNRA) and ETB (EDNRB), the two receptors for EDN1. In the present work, we hypothesised that molecular variation in these genes could be a major determinant of the degree of bronchial obstruction.

Visual analog scales can assess the severity of rhinitis graded according to ARIA guidelines.

Background: The allergic rhinitis and its impact on asthma (ARIA) guidelines provide a new classification of allergic rhinitis, but a quantitative analysis for severity assessment is lacking.

Objective: To study whether a visual analog scale (VAS) for global rhinitis symptoms could be used to assess the disease severity according to ARIA.

Methods: Three thousand fifty-two allergic rhinitis patients seen in primary care were tested.

[Association of lung function decline with the microsatellite polymorphism in the heme oxygenase-1 gene promoter, in a general population sample. Results from the Longitudinal European Community Respiratory Health Survey (ECRHS-France)].

Heme oxygenase (HO1) acts against oxidants which are thought to play a major role in the pathogenesis of chronic obstructive pulmonary disease (COPD). A (GT)n repeat polymorphism in the HO1 gene promoter can modulate the transcription of this gene in response to oxidative stress. We postulated that this polymorphism might be associated with the degree and decline of lung function in subjects exposed to oxidative stress (smokers).

Physical activity and bronchial hyperresponsiveness: European Community Respiratory Health Survey II.

Background: Identification of the risk factors for bronchial hyperresponsiveness (BHR) would increase the understanding of the causes of asthma. The relationship between physical activity and BHR in men and women aged 28.0-56.