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March 2012

American Thoracic Society Issues Report on Climate Change and Human Health

The American Thoracic Society has published a report on climate change and human health which outlines 27 key recommendations on issues of importance to respiratory health, including mitigation and adaptation measures that can be taken; recognition of challenges specific to low-resource countries; and research infrastructure needs.

The report is based on discussions at a May 2010 ATS workshop in New Orleans, Louisiana which was attended by a range of U.S. and international experts, as well as representatives of international respiratory societies and key U.S. government agencies. The panel included experts from both clinical and nonclinical fields, individuals who represented patients and society at large, and a methodologist who specializes in systematic reviews to identify the evidence base and develop evidence-based recommendations.

“Workshop participants identified key climate change factors that can significantly impact respiratory health, such as heat, air pollution, and airborne allergans; identified critical research questions; and recommended the mechanisms and infrastructure that would be needed to address these questions,” says Kent Pinkerton, PhD, chair of the ATS Environmental Health Policy Committee and co-chair of the Writing Committee. “Their recommendations should help inform physicians, researchers, and policy makers, and provide a roadmap for action.”

Research needs recognized by the panel include the study of the health effects of heat (epidemiology, heat stress and adaptation, and vulnerable populations); air pollution (human exposure studies, climate-forced air pollution, and co-benefits and trade-offs); and natural, seasonal climate conditions (disease cycles, the effects of climate-forced changes on human migration, allergy, vector-and zoonotic-borne disease, humidity, precipitation and mold, desertification, and forest fires).

Clinicians and researchers were advised to expand educational outreach to other clinicians and public health practitioners; establish cross-disciplinary training programs on the interactions between climate change and human health; assist in the development and funding of climate change research centers; and incorporate the study of climate change and human health into existing international research collaboratives.

The panel also made a number of recommendations for the mitigation of and adaptation to climate change. These included changing the behavior of individuals and communities through educational programs and other measures; increasing the voice and impact of the clinical community on climate change issues; building healthy buildings and communities; increasing respiratory resilience to environmental stressors; and studying the health effects of new, alternative energy sources.

Lastly, the panel recommended that monitoring and alert systems be established or improved for pollen tracking, air quality monitoring, and weather forecasting.

“There is increasing evidence that the effects of climate change do affect the onset and exacerbations of respiratory diseases,” Dr. Pinkerton says. “The recommendations in this report from experts in the field will help guide future efforts to address this important public health issue.”

The full text of the report is available at http://pats.atsjournals.org/content/9/1/3.abstract

Inflammatory Biomarkers Improve the Clinical Prediction of Mortality in COPD

The addition of changes in inflammatory biomarkers to established clinical variables improves the prediction of mortality in patients with chronic obstructive pulmonary disease (COPD), according to a new study.

“COPD is characterized by low-grade inflammation, so we hypothesized that the addition of inflammatory biomarkers to established predictive factors would improve the prediction of mortality,” said lead author Bartolome Celli, lecturer in medicine at Harvard Medical School and member of the Pulmonary and Critical Care Division of Brigham and Women’s Hospital in Boston. “We found that the addition of a panel of selected biomarkers to clinical variables significantly improved the ability of clinical variables to predict mortality in these patients.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The researchers analyzed prospectively collected data on 1,843 COPD patients from the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Of these 1,843 patients, 168 (9.1%) died during the three-year follow-up.

Clinical predictors of morality included age, BODE (Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity) index , and incidence of hospitalizations due to exacerbations of COPD in the year prior to the study. A predictive model for mortality using these clinical variables had a C-statistic (which measures the ability of how well a clinical prediction rule can correctly rank-order patients by risk) of 0.686. Adding interleukin-6 (IL-6) to the predictive model significantly improved the C-statistic to 0.708, and the addition of a panel of biomarkers including white blood cell counts, IL-6, C-reactive protein (CRP), interleukin-8 (IL-8), fibrinogen, chemokine (C-C-motif) ligand 18 (CCL-18), and surfactant protein D (SP-D) further improved the C-statistic to 0.726.

“This panel of selected biomarkers was not only elevated in non-survivors in our cohort, but was associated with mortality over three years of follow-up after adjusting for clinical variables known to predict mortality in patients with COPD,” said Dr. Celli. “Except for IL-6, these biomarkers improved the predictive value of our model only marginally when considered individually, but they improved the model significantly when analyzed as a group.”

The study had several limitations, including the lack of a study adjudication committee to specify causes of death, the exclusion of some biomarkers thought to be important in the pathobiology of COPD, and the lack of a validating cohort.

“Adding white blood cell counts and measurement of changes in systemic levels of IL-6, CRP, IL-8, fibrinogen, CCL-18, and SP-D significantly improves the ability of clinical variables to predict mortality in patients with COPD,” said Dr. Celli. “This is the first study to show that the addition of biomarker levels to clinical predictors in COPD patients adds relevant prognostic information.”

To read the article in full, please visit: http://www.thoracic.org/about/newsroom/press-releases/resources/celli.pdf

Contact for article: Bartolome R. Celli, M.D. Pulmonary and Critical Care Division, Brigham and Women’s Hospital, 75 Francis Street, Boston. MA, 02115
Phone: 857-307-0310
Email: bcelli@partners.org

Low Serum Adiponectin Levels Predict Future Risk for Asthma in Women

Low serum adiponectin levels predict an increased future risk for developing asthma in middle-aged women, particularly among smokers, according to a new study.

“Adiposity is known to be related to asthma. Although a causal link between adiponectin (a protein produced by adipose tissue) and asthma has been demonstrated in mice, the evidence in humans has been conflicting,” said lead author Akshay Sood, MD, MPH, associate professor in the Division of Pulmonary and Critical Care Medicine at the University of New Mexico Health Sciences Center School of Medicine.

“In an earlier cross-sectional study, we found an association between low serum adiponectin levels and prevalent asthma among women, but the direction of this association is not known,” Dr. Sood continued. “In the current study, we examined the longitudinal association between asthma and adiponectin and found that low serum adiponectin concentrations, independent of obesity, predicted a higher risk for developing asthma.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The researchers analyzed data on 1,450 women, including 1,011 pre-menopausal women, from the 10, 15, and 20 year examinations of the Coronary Artery Risk Development in Young Adults (CARDIA) study.

Being in the lowest tertile of serum adiponectin concentrations (<7 mg/L) at year 15 was a significant predictor of a higher risk of incident asthma at year 20, particularly among current smokers. Low serum adiponectin concentrations were a more important predictor of risk for incident asthma than body mass index. Having asthma at year 10 did not predict serum adiponectin concentrations at year 15.

The study had several limitations, including the use of self-report for asthma diagnoses and the possibility that using only CARDIA patients who had serum adiponectin measured may have introduced selection bias.

“Our results show that low serum adiponectin levels in middle-aged women are associated with an elevated risk of developing asthma in the future,” concluded Dr. Sood. “This suggests that raising systemic adiponectin concentrations could potentially be useful as an asthma prevention measure in women, particularly those that smoke.”

To read the article in full, please visit: http://www.thoracic.org/about/newsroom/press-releases/resources/Sood.pdf.

Contact for article: Akshay Sood, M.D., M.P.H.; Associate Professor, Division of Pulmonary and Critical Care Medicine; University of New Mexico Health Sciences Center School of Medicine; Department of Medicine; 1 University of New Mexico; MSC 10 5550, ACC 5; Albuquerque, NM 87131
Phone: (505) 272-4751;
Email: asood@salud.unm.edu

Children Who Develop Asthma Have Lung Function Deficits and Increased Bronchial Responsiveness as Neonates

Children who develop asthma by age seven have deficits in lung function and increased bronchial responsiveness as neonates, a new study from researchers in Denmark suggests.

“Previous research on the relationship between neonatal lung function and the development of asthma has been conflicting,” said lead author Hans Bisgaard, MD, DMSci, professor of pediatrics at the University of Copenhagen and head of the Danish Pediatric Asthma Centre. “Our study shows that children with asthma by age seven already had significant airflow deficits and increased bronchial responsiveness as neonates. Lung function deficits also progressed throughout childhood in our study, suggesting a potential opportunity for early intervention.”

The findings were published online ahead of print publication in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.

The prospective study enrolled a birth cohort of 411 at-risk children of asthmatic mothers. Spirometry was performed at one month in 403 (98 percent) children and again at age seven in 317 (77 percent).

Significant neonatal airflow deficits, as measured by forced expiratory flow at 50 percent% of vital capacity and forced expiratory volume after 0.5 seconds, were observed among the 14 percent of children who developed asthma by age seven. Bronchial responsiveness to methacholine, which provokes narrowing of the airways, was also significantly associated with the development of asthma. Neonatal airway reactivity was a stronger predictor of asthma than neonatal lung function.

“We found that approximately 40% of the airflow deficit that was associated with asthma in our study was present at birth, while 60% developed through early childhood along with the disease,” noted Dr. Bisgaard. “This indicates that both prenatal and early childhood mechanisms are potential intervention targets for the prevention of asthma.”

The study used a homogenous study sample, which might limit extrapolation of the results to other populations.

“It seems that lung function changes associated with asthma occur very early in life and maybe even before birth,” concluded Dr. Bisgaard. “This may explain the lack of effect from early intervention with inhaled corticosteroids and should direct research into the pathogenesis and prevention of asthma towards the earliest phases of life.”

To read the article in full, please visit: http://www.thoracic.org/about/newsroom/press-releases/resources/bisgaard.pdf.

Contact for article:Hans Bisgaard, MD, DMSci, Copenhagen Prospective Studies on Asthma in Childhood; Health Sciences, University of Copenhagen & The Danish Pediatric Asthma Center; Copenhagen University Hospital, Gentofte, LedreborgAlle 34, 2820 Gentofte, Copenhagen, Denmark
Phone: +45 3977 7360
Email: Bisgaard@copsac.com

American Thoracic Society Applauds EPA's Proposed Carbon Pollution Standards

Yesterday, the U.S. Environmental Protection Agency proposed, for the first time, national power plant carbon pollution standards for new power plants.

Nicholas S. Hill, MD, President of the American Thoracic Society, congratulated the EPA for proposing Clean Air Act standards to control carbon pollution for power plants. Dr. Hill stated, “The ATS believes that global climate change is real and likely to have important adverse health effects on human health, including respiratory health.”

Dr. Hill noted that the ATS recently published in the Proceedings of the American Thoracic Society a workshop report: Respiratory Health Effects of Global Climate Change. The workshop report explores the respiratory health effects of global climate change, which include:

  • changing pollen releases impacting asthma and allergic rhinitis,
  • heat waves causing critical care–related diseases,
  • climate-driven air pollution increases exacerbating asthma and chronic obstructive pulmonary disease,
  • desertification increasing particulate matter (PM) exposures,
  • and climate-related changes in food and water security impacting infectious respiratory disease through malnutrition (pneumonia, upper respiratory infections).

Because of the strength of the existing data from multiple scientific disciplines, trends in weather patterns, sea temperatures and ice measurements around the globe, and the breadth and severity of likely climate-forced human health issues, the ATS takes the following positions:

  1. The ATS endorses the findings of the 4th Intergovernmental Panel on Climate Change;
  2. The ATS supports research to explore the human health effects of climate change:
  3. The ATS supports state, federal and international policy coordination to develop adaptive strategies to respond to the predicted human health effects of climate change;
  4. The ATS encourages Congress and the President to propose and adopt national and international policies to reduce the emissions of greenhouse gasses.

“The EPA’s proposed rules are important and timely and we look forward to reviewing them and providing further comment,” said Dr. Hill.