Prevention of chronic respiratorydiseases in childhood and its impact later in life Nikos Papado...
The high burden of chronic respiratory diseases (CRD) www.who.int/respiratory/
Asthma starts early in life
The Melbourne cohortAm J Respir Crit Care Med. 2000 Dec;162(6):2177-81
Aim:To predict and prevent any long-term effects
Understanding mechanisms Papadopoulos et al. Allergy (2007)
Asthma starts with an infection • In 140 children, 47 of which were hospitalized for RSV bronchiolitis. • Asthma outco...
12 month follow-up: Persistence (>= 2 additional episodes of wheeze) 35 15 ...
Asthma is an allergic disease AllergenDendritic cell IL-1 MBP ECP ...
Asthma persists in allergic children Illi et al. Lancet 2006
Mechanisms of interaction
Synergy between virus & allergen exposure in hospital admissions 25 20 15Risk 10 5 0...
The PreDicta hypothesis (Atopy & Infection other risk Infection Asthma ...
Other contributors• Weather• Pollution• Stress• Tobacco smoke
How can we prevent childhood CRD? Early pharmacological treatment Infection control Alle...
Early treatment in school-age children 12 Yearly change of FEV1 % 1...
Intervention effects• No long-term effect in fluticasone-treated childrenGuilbert et al. (2006) NEJM 354:19
J Allergy Clin Immunol 2010;126:256-62
Is a rhinovirus vaccine possible ?Niespodziana, Papadopoulos, Valenta et al. FASEB J 2012
Allergen avoidance• Only thorough allergen avoidance may have results – Allergen testing required
Allergen-specific Immunotherapy may prevent disease progression Jacobsen et al. Allergy 62:943-948.
Effects of passive exposure to ETS Doctor ...
Conclusions• Chronic respiratory diseases, including asthma, place a high burden on public health• Asthma, the most frequ...
Conclusions• Early treatment, allergen avoidance, infection control and environmental tobacco avoidance may alleviate th...
Call for actionPublic Health: 1. Facilitate allergen immunotherapy • Awareness campaigns • Monitoring • Up...
Prevention of Chronic Respiratory Diseases in Childhood and its Impact Later in Life
Prevention of Chronic Respiratory Diseases in Childhood and its Impact Later in Life
Prevention of Chronic Respiratory Diseases in Childhood and its Impact Later in Life
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Prevention of Chronic Respiratory Diseases in Childhood and its Impact Later in Life

GRF One Health Summit 2012, Davos: Presentation by Prof. Nikos Papadopoulos - Secretary General - European Academy of Allergy Clinical Immunology EAACI
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Prevention of Chronic Respiratory Diseases in Childhood and its Impact Later in Life

  • 1. Prevention of chronic respiratorydiseases in childhood and its impact later in life Nikos PapadopoulosAllergy Dpt, 2nd Pediatric Clinic,University of Athens, EAACI Secretary General
  • 2. The high burden of chronic respiratory diseases (CRD) www.who.int/respiratory/
  • 3. Asthma starts early in life
  • 4. The Melbourne cohortAm J Respir Crit Care Med. 2000 Dec;162(6):2177-81
  • 5. Aim:To predict and prevent any long-term effects
  • 6. Understanding mechanisms Papadopoulos et al. Allergy (2007)
  • 7. Asthma starts with an infection • In 140 children, 47 of which were hospitalized for RSV bronchiolitis. • Asthma outcome at 7.5 years higher in cases 35 30% 30Children with 25 asthma at age 207.5 years 15 (%) 10 5 3% 0 RSV Control (n=47) (n=93) Sigurs N et al. Am J Respir Crit Care Med 2000;161:1501-1507
  • 8. 12 month follow-up: Persistence (>= 2 additional episodes of wheeze) 35 15 (42%) RSV (+) Relapses 64 24 21 (87%) Bronchiolitis cases RV (+) Relapses 5 5 (100%) RSV-RV(+) Relapses Controls: 5/52 (9.6%)Papadopoulos et al. unpublished 3/5 were RV(+)
  • 9. Asthma is an allergic disease AllergenDendritic cell IL-1 MBP ECP LTs IgE PGs Th0-cell PAF B-cell Eosinophil Mast cell IL-4 IL-13 IL-10 Eotaxin IL-5 RANTES IFN- histamin Th1-cell Th2-cell VCAM-1 ICAM-1 E- selectin Systemic circulation
  • 10. Asthma persists in allergic children Illi et al. Lancet 2006
  • 11. Mechanisms of interaction
  • 12. Synergy between virus & allergen exposure in hospital admissions 25 20 15Risk 10 5 0 Murray et al. Thorax (2005)
  • 13. The PreDicta hypothesis (Atopy & Infection other risk Infection Asthma factors) ‘Blocked’ state Possibly Increased Repeated bronchiolitis susceptibility of events hyperreactivitywww.predicta.eu
  • 14. Other contributors• Weather• Pollution• Stress• Tobacco smoke
  • 15. How can we prevent childhood CRD? Early pharmacological treatment Infection control Allergen avoidance ETS avoidance
  • 16. Early treatment in school-age children 12 Yearly change of FEV1 % 10 P = 0.02 8 6 4 2 0 <2 2–3 3–5 >5 Asthma duration at the beginning of therapy with budesonide Agertoft and Pedersen, Respir Med 1994
  • 17. Intervention effects• No long-term effect in fluticasone-treated childrenGuilbert et al. (2006) NEJM 354:19
  • 18. J Allergy Clin Immunol 2010;126:256-62
  • 19. Is a rhinovirus vaccine possible ?Niespodziana, Papadopoulos, Valenta et al. FASEB J 2012
  • 20. Allergen avoidance• Only thorough allergen avoidance may have results – Allergen testing required
  • 21. Allergen-specific Immunotherapy may prevent disease progression Jacobsen et al. Allergy 62:943-948.
  • 22. Effects of passive exposure to ETS Doctor Current diagnosed Ever wheeze wheeze asthma 1.31 ** 1.21 Either parent smoking 1.53 ** Father current smoker 1.21# 1.16 1.50 * mother current smoker 1.26 * 1.18 1.24 Active smoking during pregnancy 1.55 ** 1.40 ** 1.56* passive exposure to ETS during pregnancy 1.22 # 1.31 * 1.36 #Xepapadaki, Papadopoulos et al. Ped Allergy Immunol 2009
  • 23. Conclusions• Chronic respiratory diseases, including asthma, place a high burden on public health• Asthma, the most frequent chronic disease in children, starts early in life, with a respiratory infection• Interactions between allergy and infection lead to chronic persistent disease
  • 24. Conclusions• Early treatment, allergen avoidance, infection control and environmental tobacco avoidance may alleviate the long-term impact• Allergen-specific immunotherapy may prevent disease progression
  • 25. Call for actionPublic Health: 1. Facilitate allergen immunotherapy • Awareness campaigns • Monitoring • Updating of National healthcare policies 2. Drastically reduce ETS exposureResearch: 3. Focus on infection-related consequences

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