Cold weather-related sensitivity among asthmatics and determinants affecting it

Abstract Asthma is a chronic airways disease affecting 7–9% of the Finnish working-age adults, and it has been reported to become more prevalent in Finland and internationally. Allergic rhinitis is also common among the general population and occurs frequently in the same individuals as asthma. Population studies have found that cold air causes respiratory symptoms commonly among the Finns. Especially those who have chronic lung diseases are sensitive to cold. In addition, the winter season is reported to increase morbidity due to respiratory diseases worldwide, and asthma patients are even at an increased risk of dying on cold days. The aim of this study was to investigate potential sensitivity to cold air among adults with asthma and/or allergic rhinitis, their perceived functional disability and potential exacerbation of disease symptoms. We applied three population-based epidemiological studies. In two studies, populations with either allergic rhinitis or, asthma, or both were compared with individuals without either of these conditions. In the third study, asthma patients were divided into four groups based on their ACT score for asthma control. Cold weather-related respiratory symptoms were common already among young asthmatic adults, and allergic rhinitis together with asthma increased the symptom prevalences even more than asthma alone. Among young adults with asthma, 33% reported having cold weather-related shortness of breath, whereas 51% of those who had both asthma and allergic rhinitis reported such symptoms compared with 7% without these diseases. Cold weather-related functional disability was associated with asthma and/or allergic rhinitis, and exacerbation of health problems was associated especially with asthma. Poor asthma control increased the occurrence of cold weather-related symptoms. As many as 84–87% of those who had the poorest asthma control, according to the ACT score, reported cold weather-related shortness of breath. This study provides new evidence on the occurrence of cold weather-related respiratory symptoms and resulting functional disability in Finnish adults with asthma and/or allergic rhinitis. These results are relevant for populations living and working in cold environments and provide useful information for asthmatics on means to maintain the ability to function and work, even in the cold.Tiivistelmä Astma on kansantauti, jota sairastaa 7–9 % suomalaisista työikäisistä aikuisista, ja se yleistyy niin Suomessa kuin kansainvälisesti. Myös allerginen nuha on yleinen väestössä, ja sitä esiintyy useasti samoilla henkilöillä kuin astmaa. Väestötutkimuksissa on todettu kylmän ilman aiheuttavan hengitystieoireita hyvin yleisesti suomalaisilla, mutta erityisesti niillä, joilla on joku keuhkosairaus. Lisäksi tiedetään, että talvikausi lisää maailmanlaajuisesti hengitystiesairauksista johtuvaa sairastavuutta, ja astmaa sairastavilla on jopa suurentunut riski kuolla kylminä päivinä. Tutkimuksen tarkoituksena oli tutkia aikuisten astmaa ja/tai allergista nuhaa sairastavien kylmäoireherkkyyttä sekä koettua toimintahaittaa ja sairausoireiden pahenemista kolmea väestöpohjaista kyselytutkimusta hyödyntäen. Kahdessa osajulkaisussa väestöryhmiä, joilla oli joko allerginen nuha, astma tai sekä allerginen nuha että astma, verrattiin henkilöihin, joilla ei ole kumpaakaan näistä sairauksista. Kolmannen osajulkaisun aineistossa astmaa sairastavat jaettiin neljään ryhmään astmatasapainoa kuvaavan ACT-pisteytyksen perusteella. Kylmän ilman aiheuttamat hengitystieoireet olivat yleisiä jo nuorilla astmaa sairastavilla aikuisilla, ja allerginen nuha yhdessä astman kanssa lisäsi oireiden esiintyvyyttä enemmän kuin pelkkä astman sairastaminen. Astmaa sairastavista nuorista aikuisista 33 % ilmoitti kokevansa kylmän ilman aiheuttamaa hengenahdistusta, ja 51 % astmaa ja allergista nuhaa sairastavista. Kylmän ilman aiheuttama toimintahaitta oli yhteydessä astman ja/tai allergisen nuhan sairastamiseen, ja sairausoireiden paheneminen etenkin astman sairastamiseen. Huono astman tasapaino lisäsi kylmän ilman aiheuttamia hengitystieoireita, jopa 84–87 % ACT-pisteytyksen perusteella huonoimman astmatasapainon ryhmästä koki kylmästä ilmasta aiheutuvaa hengenahdistusta. Tutkimus tuo uutta tietoa kylmän sään aiheuttamien hengitystieoireiden esiintyvyydestä sekä näistä aiheutuvasta toimintahaitasta astmaa ja/tai allergista nuhaa sairastavilla suomalaisilla aikuisilla. Tutkimustieto on merkityksellinen väestölle, joka asuu ja työskentelee kylmässä ympäristössä, ja jonka avulla voidaan tarjota astmaa sairastaville keinoja ylläpitämään toiminta- ja työkykyään myös kylmässä

Subtypes of asthma and cold weather-related respiratory symptoms

Abstract (1) Poor asthma control increases the occurrence of cold weather-related symptoms among adult asthmatics. We assessed whether the subtype of asthma, taking into account the severity of the asthma, plays a role in these symptoms. (2) We conducted a population-based cross-sectional study of 1995 adult asthmatics (response rate 40.4%) living in northern Finland using a questionnaire that asked about cold weather-related respiratory symptoms including (1) shortness of breath, (2) prolonged cough, (3) wheezing, (4) phlegm production, and (5) chest pain, as well as questions related to the subtype of asthma. For women, the subtypes identified using latent class analysis were: (1) Controlled, mild asthma, (2) Partly controlled, moderate asthma, (3) Uncontrolled, unknown severity, and (4) Uncontrolled, severe asthma, and for men: (1) Controlled, mild asthma, (2) Uncontrolled, unknown severity, and (3) Partly controlled, severe asthma. (3) According to the subtypes of asthma, more severe and more poorly controlled asthma were related to the increased prevalence of cold weather-related respiratory symptoms when compared with those with mild, controlled asthma. This trend was especially clear for wheezing and chest pain. For example, in men, the adjusted prevalence ratio of wheezing was 1.55 (95% CI 1.09–2.19) in uncontrolled asthma with unknown severity and 1.84 (95% CI 1.26–2.71) in partly controlled severe asthma compared with controlled, mild asthma. (4) Our study provides evidence for the influence of subtypes of asthma on experiencing cold weather-related respiratory symptoms. Both women and men reported more cold weather-related symptoms when their asthma was more severe and uncontrolled compared with those who had mild and well-controlled asthma

Association between regular exercise and asthma control among adults:the population-based Northern Finnish Asthma Study

Abstract Previously those with asthma were often advised to avoid strenuous exercise because of fear for exercise-induced asthmatic reactions, but recent findings suggest many beneficial effects on health related to exercise. We elaborated on the relation between regular exercise and asthma control among adults. This was a population-based cross-sectional Northern Finnish Asthma Study (NoFAS), in which altogether 1922 adult subjects 17–73 years old living in Northern Finland answered the NoFAS questionnaire. The determinant of interest was the total amount of regular exercise during leisure time, measured in hours per week and categorized into no, low (>0≤2h per week), medium (>2 ≤5h), high (>5≤10h) and very high (>10h) exercise categories. The outcome of interest was asthma control, which was assessed based on the Asthma Control Test (ACT). As statistical methods we applied analysis of variance (ANOVA) and Poisson regression. ACT score increased gradually, i.e. asthma control improved, with an increasing amount of exercise from no exercise (mean ACT = 19.4; difference from the reference: -1.57, 95% CI -2.12 to -1.01) to high exercise reference category (mean = 21.0), but was slightly lower (mean = 20.3; -0.64, 95% CI -1.27 to -0.02) in the very high exercise category. Such non-linear relation was present both in women and in men. In conclusion, we provide evidence that moderate to high regular exercise improves asthma control among adults with asthma. Advice about regular exercise should be included as an important part of asthma management for adults

Cold weather increases respiratory symptoms and functional disability especially among patients with asthma and allergic rhinitis

Abstract Cold weather affects the respiratory epithelium and induces bronchial hyperresponsiveness. We hypothesized that individuals with allergic rhinitis or/and asthma experience cold weather-related functional disability (FD) and exacerbation of health problems (EH) more commonly than individuals without these. This was a population-based study of 7330 adults aged 25–74 years. The determinants of interest, including doctor-diagnosed asthma and allergic rhinitis, and the outcomes, including cold weather-related FD and EH, were measured using a self-administered questionnaire. The prevalences of cold-related FD and EH were 20.3% and 10.3%, respectively. In Poisson regression, the risk of FD increased in relation to both allergic rhinitis (adjusted prevalence ratio (PR) 1.19, 95% CI 1.04–1.37 among men; 1.26, 95% CI 1.08–1.46 among women), asthma (1.29, 0.93–1.80; 1.36, 0.92–2.02, respectively) and their combination (1.16, 0.90–1.50; 1.40, 1.12–1.76, respectively). Also the risk of cold weather-related EH was related to both allergic rhinitis (1.53, 1.15,−2.04 among men; 1.78, 1.43–2.21 among women), asthma (4.28, 2.88–6.36; 3.77, 2.67–5.34, respectively) and their combination (4.02, 2.89–5.59; 4.60, 3.69–5.73, respectively). We provide new evidence that subjects with allergic rhinitis or/and asthma are more susceptible to cold weather-related FD and EH than those without pre-existing respiratory diseases

Clinical-grade patches as a medium for enrichment of sweat-extracellular vesicles and facilitating their metabolic analysis

Abstract Cell-secreted extracellular vesicles (EVs), carrying components such as RNA, DNA, proteins, and metabolites, serve as candidates for developing non-invasive solutions for monitoring health and disease, owing to their capacity to cross various biological barriers and to become integrated into human sweat. However, the evidence for sweat-associated EVs providing clinically relevant information to use in disease diagnostics has not been reported. Developing cost-effective, easy, and reliable methodologies to investigate EVs’ molecular load and composition in the sweat may help to validate their relevance in clinical diagnosis. We used clinical-grade dressing patches, with the aim being to accumulate, purify and characterize sweat EVs from healthy participants exposed to transient heat. The skin patch-based protocol described in this paper enables the enrichment of sweat EVs that express EV markers, such as CD63. A targeted metabolomics study of the sweat EVs identified 24 components. These are associated with amino acids, glutamate, glutathione, fatty acids, TCA, and glycolysis pathways. Furthermore, as a proof-of-concept, when comparing the metabolites’ levels in sweat EVs isolated from healthy individuals with those of participants with Type 2 diabetes following heat exposure, our findings revealed that the metabolic patterns of sweat EVs may be linked with metabolic changes. Moreover, the concentration of these metabolites may reflect correlations with blood glucose and BMI. Together our data revealed that sweat EVs can be purified using routinely used clinical patches, setting the foundations for larger-scale clinical cohort work. Furthermore, the metabolites identified in sweat EVs also offer a realistic means to identify relevant disease biomarkers. This study thus provides a proof-of-concept towards a novel methodology that will focus on the use of the sweat EVs and their metabolites as a non-invasive approach, in order to monitor wellbeing and changes in diseases