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Associations of early-life factors and indoor environmental exposure with asthma among children: a case–control study in Chongqing, China

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Abstract

Background

Childhood asthma has substantial effects on children’s health. It is important to identify influencing factors in early life in the development of childhood asthma. We aim to evaluate the effects of early-life factors and indoor environmental exposure on childhood asthma in Chongqing, China.

Method

We designed a case–control study to enrol children with asthma aged 3 to < 14 years old and controls in Chongqing, China. The “Children’s Early Life and Indoor Environment Survey” was used to collect the early-life factors and indoor environmental exposure of foetuses in utero and of infants during the first 3 years of life. A multivariate logistic regression model was used to evaluate the association between independent variables and childhood asthma and the interaction of early-life factors and environmental exposure.

Results

A total of 160 asthma cases and 247 controls were included in this study. The mean ages of the cases and controls were 5.53 ± 1.88 and 5.72 ± 2.34 years, respectively (P = 0.192). Early-life factors and indoor environmental exposure were independently associated with childhood asthma. Infectious diseases of the respiratory system in children under 3 years old [adjusted odds ratio (OR) = 5.76, 95% confidence interval (CI) 2.49–13.30], bedroom air conditioner use (adjusted OR = 4.61, 95% CI 1.45–14.64), and bedroom dampness/mould (adjusted OR = 2.98, 95% CI 1.54–5.75) ranked as the three most significant exposures associated with the risk of childhood asthma. Other factors associated with an increased risk of childhood asthma included second-hand smoke exposure in early life (adjusted OR = 1.93, 95% CI 1.24–3.00), neonatal pneumonia (adjusted OR = 1.90, 95% CI 1.05–3.42) and maternal allergic diseases during pregnancy (adjusted OR = 2.13, 95% CI 1.10–4.10). The interaction effects of child second-hand smoke exposure with other covariates were not found to be statistically significant.

Conclusions

Early-life factors and indoor environmental exposure are closely related to childhood asthma in Chongqing, China. Further interventions and management in the early life of children should be considered to prevent and control childhood asthma in Chongqing and similar cities.

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Data availability

Data are only available on an approved request to the corresponding author.

References

  1. Lenney W. The burden of pediatric asthma. Pediatr Pulmonol Suppl. 1997;15:13–6.

    Article  CAS  PubMed  Google Scholar 

  2. Lipstein EA, Perrin JM, Kuhlthau KA. School absenteeism, health status, and health care utilization among children with asthma: associations with parental chronic disease. Pediatrics. 2009;123:E60–6.

    Article  PubMed  Google Scholar 

  3. Asher MI, Montefort S, Bjorksten B, Lai CKW, Strachan DP, Weiland SK, et al. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC phases one and three repeat multicountry cross-sectional surveys. Lancet. 2006;368:733–43.

    Article  PubMed  Google Scholar 

  4. Asher I, Pearce N. Global burden of asthma among children. Int J Tuberc Lung Dis. 2014;18:1269–78.

    Article  CAS  PubMed  Google Scholar 

  5. National Cooperative Group on Childhood Asthma, Institute of Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Chinese Center for Disease Control and Prevention. Third nationwide survey of childhood asthma in urban areas of China. Zhonghua Er Ke Za Zhi. 2013;51:729–35 (in Chinese).

  6. Li X, Song PG, Zhu YJ, Lei HH, Chan KY, Campbell H, et al. The disease burden of childhood asthma in China: a systematic review and meta-analysis. J Glob Health. 2020;10:010801.

  7. Zhang MZ, Chu SS, Xia YK, Wang DD, Wang X. Environmental exposure during pregnancy and the risk of childhood allergic diseases. World J Pediatr. 2021;17:467–75.

    Article  CAS  PubMed  Google Scholar 

  8. Akar-Ghibril N, Phipatanakul W. The indoor environment and childhood asthma. Curr Allergy Asthma Rep. 2020;20:43.

    Article  PubMed  Google Scholar 

  9. O’Connor GT, Lynch SV, Bloomberg GR, Kattan M, Wood RA, Gergen PJ, et al. Early-life home environment and risk of asthma among inner-city children. J Allergy Clin Immunol. 2018;141:1468–75.

    Article  PubMed  Google Scholar 

  10. Cereta AD, Oliveira VR, Costa IP, Guimaraes LL, Afonso JPR, Fonseca AL, et al. Early life microbial exposure and immunity training effects on asthma development and progression. Lausanne. 2021;8:662262.

  11. Litonjua AA, Carey VJ, Burge HA, Weiss ST, Gold DR. Exposure to cockroach allergen in the home is associated with incident doctor-diagnosed asthma and recurrent wheezing. J Allergy Clin Immunol. 2001;107:41–7.

    Article  CAS  PubMed  Google Scholar 

  12. Douwes J, van Strien R, Doekes G, Smit J, Kerkhof M, Gerritsen J, et al. Does early indoor microbial exposure reduce the risk of asthma? The prevention and incidence of asthma and mite allergy birth cohort study. J Allergy Clin Immunol. 2006;117:1067–73.

    Article  PubMed  Google Scholar 

  13. von Mutius E, Vercelli D. Farm living: effects on childhood asthma and allergy. Nat Rev Immunol. 2010;10:861–8.

    Article  Google Scholar 

  14. Stoltz DJ, Jackson DJ, Evans MD, Gangnon RE, Tisler CJ, Gern JE, et al. Specific patterns of allergic sensitization in early childhood and asthma & rhinitis risk. Clin Exp Allergy. 2013;43:233–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Jolliffe DA, Greenberg L, Hooper RL, Griffiths CJ, Camargo CA Jr, Kerley CP, et al. Vitamin D supplementation to prevent asthma exacerbations: a systematic review and meta-analysis of individual participant data. Lancet Resp Med. 2017;5:881–90.

    Article  CAS  Google Scholar 

  16. Miliku K, Azad MB. Breastfeeding and the developmental origins of asthma: current evidence, possible mechanisms, and future research priorities. Nutrients. 2018;10:995.

    Article  PubMed Central  Google Scholar 

  17. Loewen K, Monchka B, Mahmud SM, 't Jong G, Azad MB. Prenatal antibiotic exposure and childhood asthma: a population-based study. Eur Resp J. 2018;52:1702070.

  18. Toivonen L, Schuez-Havupalo L, Karppinen S, Waris M, Hoffman KL, Camargo CA Jr, et al. Antibiotic treatments during infancy, changes in nasal microbiota, and asthma development: population-based cohort study. Clin Infect Dis. 2020;72:1546–54.

    Article  PubMed Central  Google Scholar 

  19. The Seventh National Census of Chongqing. http://tjj.cq.gov.cn/zwgk_233/fdzdgknr/tjxx/sjjd_55469/202105/t20210513_9277447.html. Accessed 13 May 2021.

  20. Chen YZ, National Cooperation Group on Childhood Asthma China. Comparative analysis of the state of asthma prevalence in children from two nation-wide surveys in 1990 and 2000 years. Zhonghua Jie He He Hu Xi Za Zhi. 2004;27:112–6 (in Chinese).

  21. Liu CH, Hong JG, Shang YX, Sun J, Duolikun M, Shan MN, et al. Comparison of asthma prevalence in children from 16 cities of China in 20 years. CJPP. 2015;30:596–600.

    CAS  Google Scholar 

  22. China NBoSo: China Statistical Yearbook. https://data.cnki.net/area/Yearbook/Single/N2020100004?z=D22. Accessed 6 Nov 2021.

  23. Reddel HK, FitzGerald JM, Bateman ED, Bacharier LB, Becker A, Brusselle G, et al. GINA 2019: a fundamental change in asthma management: treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents. Eur Respir J. 2019;53:1901046.

    Article  PubMed  Google Scholar 

  24. Bao Y, Chen A, Fu Z, Li C, Liu C, Xiang L, et al. Guidelines for the diagnosis and prevention of children's bronchial asthma (2016 edition). Zhonghua Er Ke Za Zhi. 2016;54:167–81 (in Chinese).

    Google Scholar 

  25. Bornehag CG, Sundell J, Sigsgaard T. Dampness in buildings and health (DBH): report from an ongoing epidemiological investigation on the association between indoor environmental factors and health effects among children in Sweden. Indoor Air. 2004;14(Suppl 7):59–66.

    Article  PubMed  Google Scholar 

  26. Zhou PE, Qian ZM, McMillin SE, Vaughn MG, Xie ZY, Xu YJ, et al. Relationships between long-term ozone exposure and allergic rhinitis and bronchitic symptoms in Chinese children. Toxics. 2021;9:221.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Li J, Wang H, Chen Y, Zheng J, Wong GWK, Zhong N. House dust mite sensitization is the main risk factor for the increase in prevalence of wheeze in 13- to 14-year-old schoolchildren in Guangzhou city. China Clin Exp Allergy. 2013;43:1171–9.

    CAS  PubMed  Google Scholar 

  28. Lodge CJ, Dharmage SC. Breastfeeding and perinatal exposure, and the risk of asthma and allergies. Curr Opin Allergy Clin Immunol. 2016;16:231–6.

    Article  CAS  PubMed  Google Scholar 

  29. Togias A, Gergen PJ, Hu JW, Babineau DC, Wood RA, Cohen RT, et al. Rhinitis in children and adolescents with asthma: ubiquitous, difficult to control, and associated with asthma outcomes. J Allergy Clin Immunol. 2019;143:1003-1011.e10.

    Article  PubMed  Google Scholar 

  30. Dick S, Friend A, Dynes K, AlKandari F, Doust E, Cowie H, et al. A systematic review of associations between environmental exposures and development of asthma in children aged up to 9 years. BMJ Open. 2014;4:e006554.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Tang J, Shen J, Zhang S, Ho H, Ran S. A pilot study on secondhand smoke exposure among pregnant women in Chongqing, China: a combined questionnaire, saliva cotinine test, and ultrasound flow index analysis. Front Public Health. 2020;8:290.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Wang B, Chen H, Chan YL, Wang G, Oliver BG. Why do intrauterine exposure to air pollution and cigarette smoke increase the risk of asthma? Front Cell Dev Biol. 2020;8:38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Bonner K, Scotney E, Saglani S. Factors and mechanisms contributing to the development of preschool wheezing disorders. Expert Rev Respir Med. 2021;15:745–60.

    Article  CAS  PubMed  Google Scholar 

  34. Hassan MZ, Chowdhury MAB, Hassan I, Chowdhury F, Schaefer N, Chisti MJ. Respiratory viral infection in early life and development of asthma in childhood: a protocol for systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e15419.

    Article  Google Scholar 

  35. Jartti T, Gern JE. Role of viral infections in the development and exacerbation of asthma in children. J Allergy Clin Immunol. 2017;140:895–906.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Lee WM, Lemanske RF Jr, Evans MD, Vang F, Pappas T, Gangnon R, et al. Human rhinovirus species and season of infection determine illness severity. Am J Respir Crit Care Med. 2012;186:886–91.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Quinn LA, Shields MD, Sinha I, Groves HE. Respiratory syncytial virus prophylaxis for prevention of recurrent childhood wheeze and asthma: a systematic review. Syst Rev. 2020;9:269.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Wu P, Dupont WD, Griffin MR, Carroll KN, Mitchel EF, Gebretsadik T, et al. Evidence of a causal role of winter virus infection during infancy in early childhood asthma. Am J Respir Crit Care Med. 2008;178:1123–9.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Thomsen SF, van der Sluis S, Stensballe LG, Posthuma D, Skytthe A, Kyvik KO, et al. Exploring the association between severe respiratory syncytial virus infection and asthma: a registry-based twin study. Am J Respir Crit Care Med. 2009;179:1091–7.

    Article  PubMed  Google Scholar 

  40. Carroll KN, Gebretsadik T, Escobar GJ, Wu PS, Li SX, Walsh EM, et al. Respiratory syncytial virus immunoprophylaxis in high-risk infants and development of childhood asthma. J Allergy Clin Immunol. 2017;139:66-71.e3.

    Article  PubMed  Google Scholar 

  41. Scheltema NM, Nibbelke EE, Pouw J, Blanken MO, Rovers MM, Naaktgeboren CA, et al. Respiratory syncytial virus prevention and asthma in healthy preterm infants: a randomised controlled trial. Lancet Respir Med. 2018;6:257–64.

    Article  PubMed  Google Scholar 

  42. Moreno-Galdó A, Pérez-Yarza EG, Ramilo O, Rubí T, Escribano A, Torres A, et al. Recurrent wheezing during the first 3 years of life in a birth cohort of moderate-to-late preterm infants. Pediatr Allergy Immunol. 2020;31:124–32.

    Article  PubMed  Google Scholar 

  43. Bisgaard H, Hermansen MN, Bønnelykke K, Stokholm J, Baty F, et al. Association of bacteria and viruses with wheezy episodes in young children: prospective birth cohort study. BMJ. 2010;341:c4978.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Tang HHF, Lang A, Teo SM, Judd LM, Gangnon R, Evans MD, et al. Developmental patterns in the nasopharyngeal microbiome during infancy are associated with asthma risk. J Allergy Clin Immunol. 2021;147:1683–91.

    Article  CAS  PubMed  Google Scholar 

  45. Russell SL, Gold MJ, Hartmann M, Willing BP, Thorson L, Wlodarska M, et al. Early life antibiotic-driven changes in microbiota enhance susceptibility to allergic asthma. EMBO Rep. 2012;13:440–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Patrick DM, Sbihi H, Dai DLY, Al Mamun A, Rasali D, Rose C, et al. Decreasing antibiotic use, the gut microbiota, and asthma incidence in children: evidence from population-based and prospective cohort studies. Lancet Respir Med. 2020;8:1094–105.

    Article  CAS  PubMed  Google Scholar 

  47. Hazir T, Qazi S, Nisar YB, Ansari S, Maqbool S, Randhawa S, et al. Assessment and management of children aged 1–59 months presenting with wheeze, fast breathing, and/or lower chest indrawing; results of a multicentre descriptive study in Pakistan. Arch Dis Child. 2004;89:1049–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Nantanda R, Ostergaard MS, Ndeezi G, Tumwine JK. Clinical outcomes of children with acute asthma and pneumonia in Mulago hospital, Uganda: a prospective study. BMC Pediatr. 2014;14:285.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Castro-Rodriguez JA, Forno E, Rodriguez-Martinez CE, Celedón JC. Risk and protective factors for childhood asthma: what is the evidence? J Allergy Clin Immunol Pract. 2016;4:1111–22.

    Article  PubMed  PubMed Central  Google Scholar 

  50. von Mutius E, Smits HH. Primary prevention of asthma: from risk and protective factors to targeted strategies for prevention. Lancet. 2020;396:854–66.

    Article  Google Scholar 

  51. Hill DA, Spergel JM. The atopic march: critical evidence and clinical relevance. Ann Allergy Asthma Immunol. 2018;120:131–7.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Hu Y, Chen Y, Liu S, Jiang F, Wu M, Yan C, et al. Breastfeeding duration modified the effects of neonatal and familial risk factors on childhood asthma and allergy: a population-based study. Respir Res. 2021;22:41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Renz H, Skevaki C. Early life microbial exposures and allergy risks: opportunities for prevention. Nat Rev Immunol. 2021;21:177–91.

    Article  CAS  PubMed  Google Scholar 

  54. van den Elsen LWJ, Garssen J, Burcelin R, Verhasselt V. Shaping the gut microbiota by breastfeeding: the gateway to allergy prevention? Front Pediatr. 2019;7:47.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Bode L, Contractor N, Barile D, Pohl N, Prudden AR, Boons GJ, et al. Overcoming the limited availability of human milk oligosaccharides: challenges and opportunities for research and application. Nutr Rev. 2016;74:635–44.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Du CQ, Li BZ, Yu W. Indoor mould exposure: characteristics, influences and corresponding associations with built environment-a review. J Build Eng. 2021;35:11.

    Google Scholar 

  57. Wang H, Li B, Yu W, Wang J, Norback DJB. Early-life exposure to home dampness associated with health effects among children in Chongqing, China. Build Environ. 2015;94:327–34.

    Article  Google Scholar 

  58. Cai J, Li B, Yu W, Yao Y, Wang L, Li B, et al. Associations of household dampness with asthma, allergies, and airway diseases among preschoolers in two cross-sectional studies in Chongqing, China: repeated surveys in 2010 and 2019. Environ Int. 2020;140:105752.

    Article  PubMed  Google Scholar 

  59. Hu Y, Liu W, Huang C, Zou ZJ, Zhao ZH, Shen L, et al. Home dampness, childhood asthma, hay fever, and airway symptoms in Shanghai, China: associations, dose-response relationships, and lifestyle’s influences. Indoor Air. 2014;24:450–63.

    Article  CAS  PubMed  Google Scholar 

  60. Shorter C, Crane J, Pierse N, Barnes P, Kang J, Wickens K, et al. Indoor visible mold and mold odor are associated with new-onset childhood wheeze in a dose-dependent manner. Indoor Air. 2018;28:6–15.

    Article  CAS  PubMed  Google Scholar 

  61. Cai J, Li BZ, Yu W, Wang H, Du CQ, Zhang YP, et al. Household dampness-related exposures in relation to childhood asthma and rhinitis in China: a multicentre observational study. Environ Int. 2019;126:735–46.

    Article  PubMed  Google Scholar 

  62. Hu YB, Chen YT, Liu SJ, Jiang F, Wu MQ, Yan CH, et al. Increasing prevalence and influencing factors of childhood asthma: a cross-sectional study in Shanghai, China. World J Pediatr. 2021;17:419–28.

    Article  PubMed  Google Scholar 

  63. Fu X, Norback D, Yuan QQ, Li YL, Zhu XH, Hashim JH, et al. Indoor microbiome, environmental characteristics and asthma among junior high school students in Johor Bahru, Malaysia. Environ Int. 2020;138:105664.

    Article  PubMed  Google Scholar 

  64. D’Amato G, Holgate ST, Pawankar R, Ledford DK, Cecchi L, Al-Ahmad M, et al. Meteorological conditions, climate change, new emerging factors, and asthma and related allergic disorders. A statement of the World Allergy Organization. World Allergy Organ J. 2015;8:25.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Sublett JL. Effectiveness of air filters and air cleaners in allergic respiratory diseases: a review of the recent literature. Curr Allergy Asthma Rep. 2011;11:395–402.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Jaakkola JJK, Nafstad P, Magnus P. Environmental tobacco smoke, parental atopy, and childhood asthma. Environ Health Perspect. 2001;109:579–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Harju M, Keski-Nisula L, Georgiadis L, Heinonen S. Parental smoking and cessation during pregnancy and the risk of childhood asthma. BMC Public Health. 2016;16:428.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Murphy KR, Solis J. National asthma education and prevention program 2020 guidelines: what’s important for primary care. J Fam Pract. 2021;70:S19-28.

    PubMed  Google Scholar 

  69. Mochizuki H, Kusuda S, Okada K, Yoshihara S, Furuya H, Simoes EAF, et al. Palivizumab prophylaxis in preterm infants and subsequent recurrent wheezing. Six-year follow-up study. Am J Respir Crit Care Med. 2017;196:29–38.

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Acknowledgements

We sincerely appreciate all the children, parents, and others who were involved in the study.

Funding

The study was funded by Scientific Research & Innovation Experiment Project of Chongqing Medical University (grant/award number: SRIEP202107), Chongqing Health Commission and Chongqing Municipal Bureau of Science and Technology Key Funding (grant/award number: 2019ZDXM017).

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Authors and Affiliations

  1. The First Clinical College, Chongqing Medical University, Chongqing, China

    Yun-Tian Deng, Wen-Kui Xiong, Shuo Wang & Rui Zhu

  2. Pediatric Outpatient, Chongqing Health Center for Women and Children, Chongqing, China

    Xue-Mei Li

  3. National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China

    En-Mei Liu

  4. Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China

    En-Mei Liu

  5. School of Public Health and Management, Chongqing Medical University, Chongqing, China

    Yu-Bin Ding

  6. School of Public Health and Management, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Chongqing Medical University, No. 1, Medical School Road, Yu zhong District, Chongqing, China

    Zhao-Hui Zhong

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  1. Yun-Tian Deng
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  2. Xue-Mei Li
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Contributions

DYT performed the statistical analysis and drafted the manuscript, contributed to the study design and participants recruitment. LXM and LEM conceived the study and developed its design. XWK, WS and ZR were involved in the study design and participants recruitment. DYB and ZZH supervised the field work and revised the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Zhao-Hui Zhong.

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Ethical approval

The ethical application and the consent procedure of this study were approved by the Ethics Committees of Chongqing Medical University (2021016) and Chongqing Health Center for Women and Children (2019005).

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No financial or non-financial benefits have been received or will be received from any party related directly or indirectly to the subject of this article. The authors have no conflict of interest to declare.

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Deng, YT., Li, XM., Liu, EM. et al. Associations of early-life factors and indoor environmental exposure with asthma among children: a case–control study in Chongqing, China. World J Pediatr 18, 186–195 (2022). https://doi.org/10.1007/s12519-021-00506-0

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