Imperial College London

DrElaineFuertes

Faculty of MedicineNational Heart & Lung Institute

Imperial College Junior Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 7939e.fuertes

 
 
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Location

 

Emmanuel Kaye BuildingRoyal Brompton Campus

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Summary

 

Publications

Publication Type
Year
to

72 results found

Amaral A, Burney P, Patel J, Minelli C, Mejza F, Mannino D, Seemungal T, Padukudru Anand M, Loh LC, Janson C, Juvekar S, Denguezli M, Harrabi I, Wouters E, Cherkaski H, Mortimer K, Jogi R, Bateman E, Fuertes E, Al Ghobain M, Tan W, Obaseki D, El Sony A, Studnicka M, Aquart-Stewart A, Koul P, Lawin H, Nafees A, Awopeju O, Erhabor G, Gislason T, Welte T, Gulsvik A, Nielsen R, Gnatiuc L, Kocabas A, Marks G, Sooronbaev T, Mbatchou Ngahane B, Barbara C, Buist ASet al., 2021, Chronic airflow obstruction and ambient particulate air pollution, Thorax, ISSN: 0040-6376

Smoking is the most well-established cause of chronic airflow obstruction (CAO) but particulate air pollution and poverty have also been implicated. We regressed sex-specific prevalence of CAO from 41 Burden of Obstructive Lung Disease study sites against smoking prevalence from the same study, the gross national income per capita and the local annual mean level of ambient particulate matter (PM2.5) using negative binomial regression. The prevalence of CAO was not independently associated with PM2.5 but was strongly associated with smoking and was also associated with poverty. Strengthening tobacco control and improved understanding of the link between CAO and poverty should be prioritised.

Journal article

Fuertes E, Jarvis D, 2021, The complex interplay between greenness and air pollution in respiratory health, Thorax, ISSN: 0040-6376

Journal article

Lam H, Jarvis D, Fuertes E, 2021, Interactive effects of allergens and air pollution on respiratory health: A systematic review, Science of the Total Environment, Vol: 757, ISSN: 0048-9697

BackgroundStudies have demonstrated an adverse role of outdoor allergens on respiratory symptoms. It is unknown whether this effect is independent or synergistic of outdoor air pollutants.MethodsWe systematically reviewed all epidemiological studies that examined interaction effects between counts of outdoor airborne allergens (pollen, fungal spores) and air pollutants, on any respiratory health outcome in children and adults. We searched the MEDLINE, EMBASE and Scopus databases. Each study was summarized qualitatively and assessed for quality and risk of bias (International Prospective Register for Systematic Reviews, registration number CRD42020162571).ResultsThirty-five studies were identified (15 timeseries, eight case-crossovers, 11 panels and one cohort study), of which 12 reported a significant statistical interaction between an allergen and air pollutant. Eight interactions were related to asthma outcomes, including one on lung function measures and wheeze, three to medical consultations for pollinosis and one to allergic symptoms (nasal, ocular or bronchial). There was no consensus as to which allergen or air pollutant is more likely to interact. No study investigated whether interactions are stronger in atopic individuals.ConclusionDespite strong evidence from small experimental studies in humans, only a third of studies identified significant allergen-pollutant interactions using common epidemiological study designs. Exposure misclassification, failure to examine subgroups at risk, inadequate statistical power or absence of population-level effects are possible explanations.

Journal article

Fuertes E, Marcon A, Potts L, Pesce G, K Lhachimi S, Jani V, Calciano L, Adamson A, K Quint J, Jarvis D, Janson C, Accordini S, Minelli Cet al., 2021, Health Impact assessment to predict the impact of tobacco price increases on COPD burden in Italy, England and Sweden, Scientific Reports, Vol: 11, ISSN: 2045-2322

Raising tobacco prices effectively reduces smoking, the main risk factor for chronic obstructive pulmonary disease (COPD). Using the Health Impact Assessment tool “DYNAMO-HIA”, this study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices, with larger increases considered in secondary analyses. A dynamic Markov-based multi-state simulation modelling approach estimated the effect of changes in smoking prevalence states and probabilities of transitioning between smoking states on future smoking prevalence, COPD burden and life expectancy in each country. Data inputs included demographics, smoking prevalences and behaviour and COPD burden from national data resources, large observational cohorts and datasets within DYNAMO-HIA. In the 20% price increase scenario, the cumulative number of COPD incident cases saved over 40 years was 479,059 and 479,302 in Italy and England (populous countries with higher smoking prevalences) and 83,694 in Sweden (smaller country with lower smoking prevalence). Gains in overall life expectancy ranged from 0.25 to 0.45 years for a 20 year-old. Increasing tobacco prices would reduce COPD burden and increase life expectancy through smoking behavior changes, with modest but important public health benefits observed in all three countries.

Journal article

Russell MA, Dharmage S, Fuertes E, Marcon A, Carsin A-E, Pascual Erquicia S, Heinrich J, Johannessen A, Abramson MJ, Amaral A, Cerveri I, Demoly P, Garcia-Larsen V, Jarvis D, Martinez-Moratalla J, Nowak D, Palacios-Gomez L, Squillacioti G, Raza W, Emtner M, Garcia-Aymerich Jet al., 2021, The effect of physical activity on asthma incidence over 10 years: population-based study, ERJ Open Research, Vol: 7, ISSN: 2312-0541

Journal article

Fuertes E, Brauer M, 2020, The Outdoor Environment, Occupational and Environmental Lung Disease (ERS Monograph), Publisher: European Respiratory Society, Pages: 301-316, ISBN: 9781849841245

Air pollution levels continue to be high worldwide, vary greatly within and between countries, and contribute to a substantial burden of disease. There is convincing evidence that long-term exposure to air pollution adversely affects numerous health outcomes. This chapter presents the recent and growing epidemiological evidence for its effect on respiratory health, focusing on asthma and lung function. Further research should prioritise the pollutant mixtures most detrimental to health and identify the most appropriate health protection measures. Respiratory health is also influenced by outdoor pollen and mould exposures, which are not commonly monitored or regulated by standards. Climate change and interactions with air pollutants influence the growing pattern of outdoor allergens, affecting allergic and asthmatic symptom onset, duration and severity. These changes occur gradually but can result in acute outbreaks of disease, such as thunderstorm-related asthma. While waiting for the implementation of effective controls, there are some limited actions individuals can take to reduce their exposure to air pollution and outdoor allergens.

Book chapter

Bédard A, Carsin A-E, Fuertes E, Accordini S, Dharmage SC, Garcia-Larsen V, Heinrich J, Janson C, Johannessen A, Leynaert B, Sánchez-Ramos JL, Peralta GP, Pin I, Squillacioti G, Weyler J, Jarvis D, Garcia-Aymerich Jet al., 2020, Physical activity and lung function - cause or consequence?, PLoS One, Vol: 15, ISSN: 1932-6203

Concerns exist that the positive association of physical activity with better lung function, which has been suggested in previous longitudinal studies in smokers, is due to reverse causation. To investigate this, we applied structural equation modeling (SEM), an exploratory approach, and marginal structural modeling (MSM), an approach from the causal inference framework that corrects for reverse causation and time-dependent confounding and estimates causal effects, on data from participants in the European Community Respiratory Health Survey (ECRHS, a multicentre European cohort study initiated in 1991–1993 with ECRHS I, and with two follow-ups: ECRHS II in 1999–2003, and ECRHS III in 2010–2014). 753 subjects who reported current smoking at ECRHS II, with repeated data on lung function at ECRHS I, II and III, physical activity at ECRHS II and III, and potential confounders at ECRHS I and II, were included in the analyses. SEM showed positive associations between physical activity and lung function in both directions. MSM suggested a protective causal effect of physical activity on lung function (overall difference in mean β (95% CI), comparing active versus non-active individuals: 58 mL (21–95) for forced expiratory volume in one second and 83 mL (36–130) for forced vital capacity). Our results suggest bi-directional causation and support a true protective effect of physical activity on lung function in smokers, after accounting for reverse causation and time-dependent confounding.

Journal article

Gayle A, Quint JK, Fuertes E, 2020, Understanding the relationships between environmental factors and exacerbations of COPD, Expert Review of Respiratory Medicine, Vol: 15, Pages: 39-50, ISSN: 1747-6348

IntroductionExacerbations of chronic obstructive pulmonary disease (COPD) are associated with a significant health burden both for patients and healthcare systems. Exposure to various environmental factors increases the risk of exacerbations.Areas coveredWe searched PubMed and assessed literature published within the last 10 years to include epidemiological evidence on the relationships between air pollution, temperature and COPD exacerbation risk as well as the implications of extreme weather events on exacerbations.Expert opinionOngoing climate change is expected to increase air pollution levels, global temperature and the frequency and severity of extreme weather events, all of which are associated with COPD exacerbations. Further research is needed using patient-focused methodological approaches to better understand and quantify these relationships, so that effective mitigation strategies that decrease the risk of exacerbations can be developed.

Journal article

Lenoir A, Fuertes E, Gómez Real F, Leynaert B, van der Plaat D, Jarvis Det al., 2020, Lung function changes over eight years and testosterone markers in both sexes: UK Biobank, ERJ Open Research, Vol: 6, ISSN: 2312-0541

Higher levels of testosterone have been associated with better lung function in cross-sectional population-based studies. The role of testosterone on lung function in women, and on lung function decline in men or women is unclear. We studied 5,114 men and 5,467 women in UK Biobank with high-quality spirometry at baseline (2006-10) and 8.4 years later. We studied cross-sectional associations of total testosterone (TT), calculated free testosterone (cFT), free androgen index (FAI) and sex-hormone binding globulin (SHBG) with FEV1, FVC and FEV1/FVC using linear regression and associations of baseline markers with lung function decline using linear mixed effects regression. Men with higher levels of TT had higher FEV1 (27.56 ml per interquartile range (IQR) increase TT, 95%CI 5.43 to 49.68) and FVC (48.06 ml, 95%CI 22.07 to 74.06) at baseline. Higher cFT levels were associated with higher FEV1 and FVC among physically active men only. In women, higher FAI and cFT levels were associated with lower lung function at baseline, and higher levels of TT, cFT and FAI were associated with slightly attenuated FEV1 and FVC decline. Higher levels of SHBG were associated with better lung function in both sexes but slightly accelerated decline in men.In this population-based sample, higher levels of TT were associated with better lung function in men and higher levels of cFT with better lung function in physically active men. A small attenuation of lung function decline with higher levels of TT, cFT and FAI was seen in women only.

Journal article

Fuertes E, Markevych I, Thomas R, Boyd A, Granell R, Mahmoud O, Heinrich J, Garcia-Aymerich J, Roda C, Henderson J, Jarvis Det al., 2020, Residential greenspace and lung function up to 24 years of age: the ALSPAC birth cohort, Environment International, Vol: 140, ISSN: 0160-4120

BackgroundResiding in greener areas is increasingly linked to beneficial health outcomes, but little is known about its effect on respiratory health.ObjectiveWe examined associations between residential greenness and nearby green spaces with lung function up to 24 years in the UK Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort.MethodsLung function was measured by spirometry at eight, 15 and 24 years of age. Greenness levels within circular buffers (100–1000 m) around the birth, eight-, 15- and 24-year home addresses were calculated using the satellite-derived Normalized Difference Vegetation Index and averaged (lifetime greenness). The presence and proportion of green spaces (urban green spaces, forests and agricultural land) within a 300 m buffer was determined. First, associations between repeated greenness and green space variables and repeated lung function parameters were assessed using generalized estimation equations (N = 7094, 47.9% male). Second, associations between lifetime average greenness and lifetime average proportion of green spaces with lung function at 24-years were assessed using linear regression models (N = 1763, 39.6% male). All models were adjusted for individual and environmental covariates.ResultsUsing repeated greenspace and lung function data at eight, 15 and 24 years, greenness in a 100 m buffer was associated with higher FEV1 and FVC (11.4 ml [2.6, 20.3] and 12.2 ml [1.8, 22.7], respectively, per interquartile range increase), as was the presence of urban green spaces in a 300 m buffer (20.3 ml [−0.1, 40.7] and 23.1 ml [-0.3, 46.5] for FEV1 and FVC, respectively). These associations were independent of air pollution, urbanicity and socio-economic status. Lifetime average greenness within a 100 m buffer and proportion of agricultural land within a 300 m buffer were associated with better lung function at 24 years but adjusting for asthma attenuated these associations.DiscussionThis study provides suggest

Journal article

Carsin A-E, Keidel D, Fuertes E, Imboden M, Weyler J, Nowak D, Heinrich J, Pascual Erquicia S, Martinez-Moratalla J, Huerta I, Sanchez J-L, Schaffner E, Caviezel S, Beckmeyer-Borowko A, Raherison C, Pin I, Demoly P, Leynaert B, Cerveri I, Squillacioti G, Accordini S, Gislason T, Svanes C, Toren K, Forsberg B, Janson C, Jogi R, Emtner M, Gómez Real F, Jarvis D, Guerra S, Dharmage SC, Probst-Hensch N, Garcia-Aymerich Jet al., 2020, Regular physical activity levels and incidence of restrictive spirometry pattern: a longitudinal analysis of two population-based cohorts, American Journal of Epidemiology, Vol: 189, Pages: 1521-1528, ISSN: 0002-9262

A restrictive spirometry pattern is associated with high morbidity and mortality. Whether practicing regular physical activity protects against this pattern has never been studied. We estimated the association between regular physical activity and the incidence of restrictive spirometry pattern. Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and physical activity were assessed between 2000–2002 in the ECRHS (n=2,757, 39-67 years) and SAPALDIA (n=2,610, 36–82 years) population-based European cohorts, and again approximately 10-years later (2010–2013). Subjects with restrictive or obstructive spirometry pattern at baseline were excluded. We assessed the association of being active at baseline (defined as being physically active ≥2-3 times/wk for ≥1 h) with restrictive spirometry pattern at follow-up (defined as a post-bronchodilator FEV1/FVC ≥Lower Limit of Normal and FVC<80% predicted) using modified Poisson regression, adjusting for relevant confounders. After 10 years of follow-up, 3.3% of participants had developed restrictive spirometry pattern. Being physically active was associated with a lower risk of developing this phenotype (RR=0.76, 95% CI=0.59-0.98). This association was stronger among those overweight and obese, compared to those with normal weight (Pinteraction=0.06). In two large European studies, adults practicing regular physical activity were at lower risk of developing restrictive spirometry pattern after 10 years.

Journal article

Fuertes E, van der Plaat D, Portas L, Minelli Cet al., 2020, Recommended reading from the genomic and environmental medicine section, American Journal of Respiratory and Critical Care Medicine, Vol: 201, Pages: 1425-1427, ISSN: 1073-449X

Journal article

Fuertes E, van der Plaat D, Minelli C, 2020, Antioxidant genes and susceptibility to air pollution for respiratory and cardiovascular health, Free Radical Biology and Medicine, Vol: 151, Pages: 88-98, ISSN: 0891-5849

Oxidative stress occurs when antioxidant defences, which are regulated by a complex network of genes, are insufficient to maintain the level of reactive oxygen species below a toxic threshold. Outdoor air pollution has long been known to adversely affect health and one prominent mechanism of action common to all pollutants is the induction of oxidative stress. An individual's susceptibility to the effects of air pollution partly depends on variation in their antioxidant genes. Thus, understanding antioxidant gene-pollution interactions has significant potential clinical and public health impacts, including the development of targeted and cost-effective preventive measures, such as setting appropriate standards which protect all members of the population. In this review, we aimed to summarize the latest epidemiological evidence on interactions between antioxidant genes and outdoor air pollution, in the context of respiratory and cardiovascular health. The evidence supporting the existence of interactions between antioxidant genes and outdoor air pollution is strongest for childhood asthma and wheeze, especially for interactions with GSTT1, GSTM1 and GSTP1, for lung function in both children and adults for several antioxidant genes (GSTT1, GSTM1, GSTP1, HMOX1, NQO1, and SOD2) and, to a more limited extent, for heart rate variability in adults for GSTM1 and HMOX1. Methodological challenges hampering a clear interpretation of these findings and understanding of true potential heterogeneity are discussed.

Journal article

Amaral A, Burney P, Fuertes E, Jarvis Det al., 2020, Body mass index and weight change are associated with adult lung function trajectories: a prospective European survey, Thorax, Vol: 4, Pages: 313-320, ISSN: 0040-6376

Background: Previous studies have reported an association between weight increase and excess lung function decline in young adults followed for short periods. We aimed to estimate lung function trajectories during adulthood according to 20-years weight change profiles, using data from the population-based European Community Respiratory Health Survey (ECRHS).Methods: We included 3,673 participants recruited at age 20-44 years with repeated measurements of weight and lung function (FVC, FEV1) in three study waves (1991-93, 1999-2003, 2010-14) until they were 39-67 years. We classified subjects into weight change profiles according to baseline BMI categories and weight change over 20 years. We estimated trajectories of lung function over time as a function of weight change profiles using population-averaged generalised estimating equations.Results: In individuals with normal BMI, overweight and obesity at baseline, moderate (0.25–1kg/year) and high weight gain (>1kg/year) during follow-up were associated with accelerated FVC and FEV1 declines. Compared to participants with baseline normal BMI and stable weight (±0.25kg/year), obese with high weight gain during follow-up had -1,011 ml [95%CI: -1,259 to -763] lower estimated FVC at 65 years, despite similar estimated FVC levels at 25 years. Obese individuals at baseline who lost weight (<-0.25kg/year) exhibited an attenuation of FVC and FEV1 declines. We found no association between weight change profiles and FEV1/FVC decline. Conclusion: Moderate and high weight gain over 20-years was associated with accelerated lung function decline, while weight loss was related to its attenuation. Control of weight gain is important for maintaining good lung function in adult life.

Journal article

Fuertes E, Sunyer J, Gehring U, Porta D, Forastiere F, Cesaroni G, Vrijheid M, Guxens M, Annesi-Maesano I, Slama R, Maier D, Kogevinas M, Bousquet J, Chatzi L, Lertxundi A, Basterrechea M, Esplugues A, Ferrero A, Wright J, Mason D, McEachan R, Garcia-Aymerich J, Jacquemin Bet al., 2020, Associations between air pollution and pediatric eczema, rhinoconjunctivitis and asthma: a meta-analysis of European birth cohorts, Environment International, Vol: 136, ISSN: 0160-4120

BackgroundUncertainly continues to exist regarding the role of air pollution on pediatric asthma and allergic conditions, especially as air pollution levels have started to decrease in recent decades.ObjectiveWe examined associations of long-term air pollution levels at the home address with pediatric eczema, rhinoconjunctivitis and asthma prevalences in five birth cohorts (BIB, EDEN, GASPII, RHEA and INMA) from seven areas in five European countries.MethodsCurrent eczema, rhinoconjunctivitis and asthma were assessed in children aged four (N = 6527) and eight years (N = 2489). A multi-morbidity outcome (≥2 conditions versus none) was also defined. Individual outdoor levels of nitrogen dioxide (NO2), nitrogen oxides, mass of particulate matter with an aerodynamic diameter <10 μm (PM10), 10–2.5 μm (PMcoarse) and <2.5 μm (PM2.5), and PM2.5 absorbance were assigned to the birth, four- and eight-year home addresses using highly defined spatial air pollution exposure models. Cohort-specific cross-sectional associations were assessed using logistic regression models adjusted for demographic and environmental covariates and combined in a random effects meta-analysis.ResultsThe overall prevalence of pediatric eczema, rhinoconjunctivitis and asthma at four years was 15.4%, 5.9% and 12.4%. We found no increase in the prevalence of these outcomes at four or eight years with increasing air pollution exposure. For example, the meta-analysis adjusted odds ratios (95% confidence intervals) for eczema, rhinoconjunctivitis and asthma at four years were 0.94 (0.81, 1.09), 0.90 (0.75, 1.09), and 0.91 (0.74, 1.11), respectively, per 10 μg/m3 increase in NO2 at the birth address, and 1.00 (0.81, 1.23), 0.70 (0.49, 1.00) and 0.88 (0.54, 1.45), respectively, per 5 μg/m3 increase in PM2.5 at the birth address.DiscussionIn this large meta-analysis of five birth cohorts, we found no indication of adverse effects of long-term air pollution exposure on the prevalen

Journal article

Roda C, Mahmoud O, Peralta GP, Fuertes E, Granell R, Serra I, Henderson J, Jarvis D, Garcia-Aymerich Jet al., 2020, Physical-activity trajectories during childhood and lung function at 15 years: findings from the ALSPAC cohort, International Journal of Epidemiology, Vol: 49, Pages: 131-141, ISSN: 1464-3685

BACKGROUND: Although physical activity has many known health benefits, its association with lung function in childhood/adolescence remains unclear. We examined the association of physical-activity trajectories between 11 and 15 years with lung function at 15 years in 2266 adolescents. METHODS: A population-based cohort of 14 305 singleton births alive at 1 year was recruited in the UK population-based Avon Longitudinal Study of Parents and Children cohort. Physical activity (counts/minute and moderate-to-vigorous physical activity) was assessed for 7 days using an accelerometer at 11, 13 and 15 years. We identified sex-specific physical-activity trajectories applying K-means for longitudinal data in children with at least two accelerometer measurements (n = 3584). We then estimated the sex-specific associations of these trajectories with post-bronchodilation lung-function parameters using multivariable linear-regression models (n = 2266, 45% boys). RESULTS: Fewer than 7% of participants met the WHO physical-activity recommendations (i.e. daily average of at least 60 minutes of moderate-to-vigorous physical activity). Boys were substantially more active than girls. In both sexes, we identified three distinct physical-activity trajectories ('low': 39.8% boys, 45.8% girls; 'moderate': 42.9% boys, 41.4% girls; and 'high' physical activity: 17.3% boys, 12.8% girls). Girls in the moderate and high physical-activity trajectories had 0.11 L [95% confidence interval (CI): 0.04-0.19] and 0.15 L (95% CI: 0.03-0.26) higher forced vital capacity than their less-active peers. No association was observed in boys. CONCLUSIONS: Higher childhood physical activity relates to higher lung-function levels in adolescent girls. A better understanding of the mechanisms underlying this association should be pursued.

Journal article

EguiluzGracia I, Mathioudakis AG, Bartel S, Vijverberg SJH, Fuertes E, Comberiati P, Cai YS, Tomazic PV, Diamant Z, Vestbo J, Galan C, Hoffmann Bet al., 2020, The need for clean air: the way air pollution and climate change affect allergic rhinitis and asthma, Allergy, Vol: 75, Pages: 2170-2184, ISSN: 0105-4538

Air pollution and climate change have a significant impact on human health and well‐being and contribute to the onset and aggravation of allergic rhinitis and asthma among other chronic respiratory diseases. In Westernized countries, households have experienced a process of increasing insulation and individuals tend to spend most of their time indoors. These sequelae implicate a high exposure to indoor allergens (house dust mites, pets, molds, etc.), tobacco smoke and other pollutants, which have an impact on respiratory health. Outdoor air pollution derived from traffic and other human activities not only has a direct negative effect on human health but also enhances the allergenicity of some plants and contributes to global warming. Climate change modifies the availability and distribution of plant‐ and fungal‐derived allergens and increases the frequency of extreme climate events. This review summarizes the effects of indoor air pollution, outdoor air pollution and subsequent climate change on asthma and allergic rhinitis in children and adults and addresses the policy adjustments and lifestyle changes required to mitigate their deleterious effects.

Journal article

Fuertes E, Heinrich J, 2020, Does traffic proximity at home and school influence asthma exacerbations?, Journal of Allergy and Clinical Immunology, Vol: 145, Pages: 100-102, ISSN: 0091-6749

Journal article

Fuertes E, Carsin A-E, Garcia-Larsen V, Guerra S, Pin I, Leynaert B, Accordini S, Martinez-Moratalla J, Antó JM, Urrutia I, Le Gouellec A, Heinrich J, Gislason T, Jõgi R, Janson C, Jarvis D, Garcia-Aymerich Jet al., 2019, The role of C-reactive protein levels on the association of physical activity with lung function in adults, PLoS One, Vol: 14, ISSN: 1932-6203

ObjectiveRegular physical activity may be associated with improved lung function via reduced systemic inflammation, although studies exploring this mechanism are rare. We evaluated the role of C-reactive protein in blood, which is a common marker of systemic inflammation, on the association of physical activity with forced expiratory volume in one second and forced vital capacity.MethodsCross-sectional data on spirometry, C-reactive protein levels and self-reported physical activity (yes/no; ≥2 times and ≥1hr per week of vigorous physical activity) were available in the European Community Respiratory Health Survey (N = 2347 adults, 49.3% male, 28–56 years-old). A subsample was also assessed 10 years later using the International Physical Activity Questionnaire, and tertiles of Metabolic Equivalent of Task—minutes per week spent in vigorous, moderate and walking activities were calculated (N = 671, 49.6% male, 40–67 years-old). Adjusted cross-sectional mixed linear regression models and the “mediate” package in “R” were used to assess the presence of mediation.ResultsDespite positive significant associations between nearly all physical activity metrics with forced expiratory volume in one second and forced vital capacity, there was no evidence that C-reactive protein levels played a role. An influence of C-reactive protein levels was only apparent in the smaller subsample when comparing the medium to low tertiles of moderate activity (mean difference [95% CIs]: 21.1ml [5.2, 41.9] for forced expiratory volume in one second and 17.3ml [2.6, 38.0] for forced vital capacity).ConclusionsIn a population of adults, we found no consistent evidence that the association of physical activity with forced expiratory volume in one second or forced vital capacity is influenced by the level of C-reactive protein in blood.

Journal article

Peralta GP, Fuertes E, Granell R, Mahmoud O, Roda C, Serra I, Jarvis D, Henderson J, Garcia-Aymerich Jet al., 2019, Childhood body composition trajectories and adolescent lung function: Findings from the ALSPAC study, American Journal of Respiratory and Critical Care Medicine, Vol: 200, Pages: 75-83, ISSN: 1073-449X

RATIONALE: Body composition changes throughout life may explain the inconsistent associations reported between body mass index (BMI) and lung function in children. OBJECTIVES: To assess the associations of body weight and composition trajectories from 7 to 15 years with lung function at 15 years and lung function growth between 8 and 15 years. METHODS: Sex-specific BMI, lean body mass index (LBMI) and fat mass index (FMI) trajectories were developed using Group-Based Trajectory Modeling on data collected at least twice between 7 and 15 years from 6,964 children (49% boys) in the UK Avon Longitudinal Study of Parents and Children birth cohort. Associations of these trajectories with post-bronchodilation lung function parameters at 15 years and with lung function growth rates from 8 to 15 years were assessed using multivariable linear regression models, stratified by sex, in a subgroup with lung function data (n=3,575). MEASUREMENTS AND MAIN RESULTS: For all body mass measures we identified parallel trajectories that increased with age. There was no consistent evidence of an association between the BMI trajectories and lung function measures. Higher LBMI trajectories were associated with higher levels and growth rates of FVC, FEV1, and FEF25-75 in both sexes (e.g. boys in the highest LBMI trajectory had on average a 0.62L [95%CI: 0.44; 0.79, p-trend<0.0001] higher FVC at 15 years than boys in the lowest trajectory). Increasing FMI trajectories were associated with lower levels and growth rates of FEV1 and FEF25-75 only in boys and lower levels of FEV1/FVC in both sexes. CONCLUSIONS: Higher lean body mass during childhood and adolescence is consistently associated with higher lung function at 15 years in both sexes, whereas higher fat mass is associated with lower levels of only some lung function parameters.

Journal article

Keidel D, Maria Anto J, Basagana X, Bono R, Burte E, Carsin A-E, Forsberg B, Fuertes E, Galobardes B, Heinrich J, de Hoogh K, Jarvis D, Kunzli N, Leynaert B, Marcon A, Le Moual N, de Nazelle A, Schindler C, Siroux V, Stempfelet M, Sunyer J, Temam S, Tsai M-Y, Varraso R, Jacquemin B, Probst-Hensch Net al., 2019, The role of socioeconomic status in the association of lung function and air pollution - A pooled analysis of three adult ESCAPE cohorts, International Journal of Environmental Research and Public Health, Vol: 16, ISSN: 1660-4601

Ambient air pollution is a leading environmental risk factor and its broad spectrum ofadverse health effects includes a decrease in lung function. Socioeconomic status (SES) is knownto be associated with both air pollution exposure and respiratory function. This study assesses therole of SES either as confounder or effect modifier of the association between ambient air pollutionand lung function. Cross-sectional data from three European multicenter adult cohorts were pooledto assess factors associated with lung function, including annual means of home outdoor NO2.Pre-bronchodilator lung function was measured according to the ATS-criteria. Multiple mixedlinear models with random intercepts for study areas were used. Three different factors (education,occupation and neighborhood unemployment rate) were considered to represent SES. NO2 exposurewas negatively associated with lung function. Occupation and neighborhood unemployment rateswere not associated with lung function. However, the inclusion of the SES-variable education improvedthe models and the air pollution-lung function associations got slightly stronger. NO2 associationswith lung function were not substantially modified by SES-variables. In this multicenter Europeanstudy we could show that SES plays a role as a confounder in the association of ambient NO2 exposurewith lung function.

Journal article

Carsin AE, Fuertes E, Schaffner E, Jarvis D, Antó JM, Heinrich J, Bellisario V, Svanes C, Keidel D, Imboden M, Weyler J, Nowak D, Martinez-Moratalla J, Gullón JA, Sanchez Ramos JL, Caviezel S, Beckmeyer-Borowko A, Raherison C, Pin I, Demoly P, Cerveri I, Accordini S, Gislason T, Toren K, Forsberg B, Janson C, Jogi R, Emtner M, Gómez Real F, Raza W, Leynaert B, Pascual S, Guerra S, Dharmage SC, Probst-Hensch N, Garcia-Aymerich Jet al., 2019, Restrictive spirometry pattern is associated with low physical activity levels. A population based international study, Respiratory Medicine, Vol: 146, Pages: 116-123, ISSN: 0954-6111

Introduction: Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry. Methods: Restrictive spirometry pattern was defined as a having post-bronchodilator FEV1/FVC ≥ Lower Limit of Normal and a FVC<80% predicted in two population-based studies (ECRHS-III and SAPALDIA3). Physical activity was measured using the International Physical Activity Questionnaire. The odds of having low physical activity (<1st study-specific tertile) was evaluated using adjusted logistic regression models. Results: Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET·min/week in ECRHS, and 3519 vs 3945 MET·min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95%CI 1.07–1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding. Conclusion: Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.

Journal article

Fuertes EI, Markevych I, Jarvis D, Vienneau D, de Hoogh K, Maria Antó J, Bowatte G, Bono R, Corsico A, Emtner M, Gislason T, Antonio Gullón J, Heinrich J, Henderson J, Holm M, Johannessen A, Leynaert B, Marcon A, Marchetti P, Martínez Moratalla J, Pascual S, Probst-Hensch N, Sánchez-Ramos JL, Siroux V, Sommar J, Weyler J, Kuenzli N, Jacquemin B, Garcia-Aymerich Jet al., 2018, Residential air pollution does not modify the positive association between physical activity and lung function in current smokers in the ECRHS study, Environment International, Vol: 120, Pages: 364-372, ISSN: 0160-4120

BackgroundVery few studies have examined whether a long-term beneficial effect of physical activity on lung function can be influenced by living in polluted urban areas.ObjectiveWe assessed whether annual average residential concentrations of nitrogen dioxide (NO2) and particulate matter with aerodynamic diameters < 2.5 μm (PM2.5) and <10 μm (PM10) modify the effect of physical activity on lung function among never- (N = 2801) and current (N = 1719) smokers in the multi-center European Community Respiratory Health Survey.MethodsAssociations between repeated assessments (at 27–57 and 39–67 years) of being physically active (physical activity: ≥2 times and ≥1 h per week) and forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were evaluated using adjusted mixed linear regression models. Models were conducted separately for never- and current smokers and stratified by residential long-term NO2, PM2.5 mass and PM10 mass concentrations (≤75th percentile (low/medium) versus >75th percentile (high)).ResultsAmong current smokers, physical activity and lung function were positively associated regardless of air pollution levels. Among never-smokers, physical activity was associated with lung function in areas with low/medium NO2, PM2.5 mass and PM10 mass concentrations (e.g. mean difference in FVC between active and non-active subjects was 43.0 mL (13.6, 72.5), 49.5 mL (20.1, 78.8) and 49.7 mL (18.6, 80.7), respectively), but these associations were attenuated in high air pollution areas. Only the interaction term of physical activity and PM10 mass for FEV1 among never-smokers was significant (p-value = 0.03).ConclusionsPhysical activity has beneficial effects on adult lung function in current smokers, irrespective of residential air pollution levels in Western Europe. Trends among never-smokers living in high air pollution areas are less clear.

Journal article

Hüls A, Klümper C, MacIntyre EA, Brauer M, Melén E, Bauer M, Berdel D, Bergström A, Brunekreef B, Chan-Yeung M, Fuertes E, Gehring U, Gref A, Heinrich J, Standl M, Lehmann I, Kerkhof M, Koppelman GH, Kozyrskyj AL, Pershagen G, Carlsten C, Krämer U, Schikowski T, TAG Study Groupet al., 2018, Atopic dermatitis: Interaction between genetic variants of GSTP1, TNF, TLR2 & TLR4 and air pollution in early life, Pediatric Allergy and Immunology, Vol: 29, Pages: 596-605, ISSN: 1399-3038

BACKGROUND: Associations between traffic-related air pollution (TRAP) and childhood atopic dermatitis (AD) remain inconsistent, possibly due to unexplored gene-environment interactions. The aim of this study was to examine whether a potential effect of TRAP on AD prevalence in children is modified by selected single nucleotide polymorphisms (SNPs) related to oxidative stress and inflammation. METHODS: Doctor-diagnosed AD up to age 2 years and at 7-8 years, as well as AD symptoms up to age 2 years, were assessed using parental-reported questionnaires in six birth cohorts (N=5,685). Associations of nitrogen dioxide (NO2) estimated at the home address of each child at birth, and nine SNPs within the GSTP1, TNF, TLR2, or TLR4 genes with AD were examined. Weighted genetic risk scores (GRS) were calculated from the above SNPs and used to estimate combined marginal genetic effects of oxidative stress and inflammation on AD and its interaction with TRAP. RESULTS: GRS was associated with childhood AD and modified the association between NO2 and doctor-diagnosed AD up to the age of 2 years (p(interaction)=0.029). This interaction was mainly driven by a higher susceptibility to air pollution in TNF rs1800629 minor allele (A) carriers. TRAP was not associated with the prevalence of AD in the general population. CONCLUSIONS: The marginal genetic association of a weighted GRS from GSTP1, TNF, TLR2, and TLR4 SNPs and its interaction with air pollution supports the role of oxidative stress & inflammation in AD. This article is protected by copyright. All rights reserved.

Journal article

Butland BK, Anderson HR, van Donkelaar A, Fuertes EI, Brauer M, Brunekreef B, Martin RV, ISAAC Phase Three Study Groupet al., 2018, Ambient air pollution and the prevalence of rhinoconjunctivitis in adolescents: A worldwide ecological analysis, Air Quality, Atmosphere and Health, Vol: 11, Pages: 755-764, ISSN: 1873-9326

Whether exposure to outdoor air pollution increases the prevalence of rhinoconjunctivitis in children is unclear. Using data from Phase Three of the International Study of Asthma and Allergies in childhood (ISAAC) we investigated associations of rhinoconjunctivitis prevalence in adolescents with model-based estimates of ozone, and satellite-based estimates of fine (diameter <2.5µm) particulate matter (PM2.5) and nitrogen dioxide (NO2). Information on rhinoconjunctivitis (defined as self-reported nose symptoms without a cold or flu accompanied by itchy watery eyes in the past 12 months) was available on 505,400 children aged 13-14 years, in 183 centres in 83 countries. Centre-level prevalence estimates were calculated and linked geographically with estimates of long-term average concentrations of NO2, ozone and PM2.5. Multi-level models were fitted adjusting for population density, climate, sex and Gross National Income. Information on parental smoking, truck traffic and cooking fuel was available for a restricted set of centres (77 in 36 countries). Between-centres within-countries, the estimated change in rhinoconjunctivitis prevalence per 100 children, was 0.171 (95% Confidence Interval; -0.013, 0.354) per 10% increase in PM2.5, 0.096 (-0.003, 0.195) per 10% increase in NO2 and -0.186 (-0.390, 0.018) per 1 ppbV increase in ozone. Between-countries, rhinoconjunctivitis prevalence was significantly negatively associated with both ozone and PM2.5. In the restricted dataset, the latter association became less negative following adjustment for parental smoking and open fires for cooking. In conclusion, there were no significant within-country associations of rhinoconjunctivitis prevalence with study pollutants. Negative between-country associations with PM2.5 and ozone require further investigation.

Journal article

Marcon A, Locatelli F, Keidel D, Beckmeyer-Borowko AB, Cerveri I, Dharmage SC, Fuertes E, Garcia-Aymerich J, Heinrich J, Imboden M, Janson C, Johannessen A, Leynaert B, Pascual Erquicia S, Pesce G, Schaffner E, Svanes C, Urrutia I, Jarvis D, Probst-Hensch NM, Accordini S, Ageing Lungs in European Cohorts ALEC studyet al., 2018, Airway responsiveness to methacholine and incidence of COPD: an international prospective cohort study, Thorax, Vol: 73, Pages: 825-832, ISSN: 1468-3296

BACKGROUND: It has been debated, but not yet established, whether increased airway responsiveness can predict COPD. Recognising this link may help in identifying subjects at risk. OBJECTIVE: We studied prospectively whether airway responsiveness is associated with the risk of developing COPD. METHODS: We pooled data from two multicentre cohort studies that collected data from three time points using similar methods (European Community Respiratory Health Survey and Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). We classified subjects (median age 37 years, 1st-3rd quartiles: 29-44) by their level of airway responsiveness using quintiles of methacholine dose-response slope at the first examination (1991-1994). Then, we excluded subjects with airflow obstruction at the second examination (1999-2003) and analysed incidence of COPD (postbronchodilator FEV1/FVC below the lower limit of normal) at the third examination (2010-2014) as a function of responsiveness, adjusting for sex, age, education, body mass index, history of asthma, smoking, occupational exposures and indicators of airway calibre. RESULTS: We observed 108 new cases of COPD among 4205 subjects during a median time of 9 years. Compared with the least responsive group (incidence rate 0.6 per 1000/year), adjusted incidence rate ratios for COPD ranged from 1.79 (95% CI 0.52 to 6.13) to 8.91 (95% CI 3.67 to 21.66) for increasing airway responsiveness. Similar dose-response associations were observed between smokers and non-smokers, and stronger associations were found among subjects without a history of asthma or asthma-like symptoms. CONCLUSIONS: Our study suggests that increased airway responsiveness is an independent risk factor for COPD. Further research should clarify whether early treatment in patients with high responsiveness can slow down disease progression.

Journal article

Fuertes EI, Carsin A-E, Antó JM, Bono R, Corsico AG, Demoly P, Gislason T, Gullón J-A, Janson C, Jarvis D, Heinrich J, Holm M, Leynaert B, Marcon A, Moratalla JM, Nowak D, Pascual S, Probst-Hensch N, Raherison C, Raza W, Real FG, Russell M, Sánchez-Ramos JL, Weyler J, Garcia Aymerich Jet al., 2018, Leisure-time vigorous physical activity is associated with better lung function: the prospective ECRHS study, Thorax, Vol: 73, Pages: 376-384, ISSN: 1468-3296

Objective We assessed associations between physical activity and lung function, and its decline, in the prospective population-based European Community Respiratory Health Survey cohort.Methods FEV1 and FVC were measured in 3912 participants at 27–57 years and 39–67 years (mean time between examinations=11.1 years). Physical activity frequency and duration were assessed using questionnaires and used to identify active individuals (physical activity ≥2 times and ≥1 hour per week) at each examination. Adjusted mixed linear regression models assessed associations of regular physical activity with FEV1 and FVC.Results Physical activity frequency and duration increased over the study period. In adjusted models, active individuals at the first examination had higher FEV1 (43.6 mL (95% CI 12.0 to 75.1)) and FVC (53.9 mL (95% CI 17.8 to 89.9)) at both examinations than their non-active counterparts. These associations appeared restricted to current smokers. In the whole population, FEV1 and FVC were higher among those who changed from inactive to active during the follow-up (38.0 mL (95% CI 15.8 to 60.3) and 54.2 mL (95% CI 25.1 to 83.3), respectively) and who were consistently active, compared with those consistently non-active. No associations were found for lung function decline.Conclusion Leisure-time vigorous physical activity was associated with higher FEV1 and FVC over a 10-year period among current smokers, but not with FEV1 and FVC decline.

Journal article

Fuertes EI, Standl M, Markevych I, Bischof W, Heinrich Jet al., 2018, Is the association between pet ownership and indoor endotoxin levels confounded or modified by outdoor residential greenspace?, Science of the Total Environment, Vol: 625, Pages: 716-721, ISSN: 0048-9697

BackgroundPet ownership is consistently associated with higher indoor endotoxin concentrations, but may also be related to the amount of greenspace around the home. This study examined whether the association between pet ownership and higher indoor endotoxin concentrations is confounded or modified by residential greenspace.MethodsInformation on pet ownership was collected at the time of recruitment of the German LISA birth cohort. Endotoxin levels were measured in settled house dust sampled from mothers' mattresses (N = 1197) and living room floors (N = 390). Greenspace around the home was assessed as the mean Normalized Difference Vegetation Index in 100 m, 500 m and 1000 m buffers around the home, and as the distance to the nearest urban and natural green space. Linear regression models assessed cross-sectional associations between pet ownership and log-transformed endotoxin levels, adjusted for known predictors of endotoxin levels. Confounding by greenspace was assessed by additionally adjusting the models for each greenspace variable. Effect modification was assessed by including interaction terms between pet ownership and each greenspace variable, and by model stratification.ResultsDog and cat ownership were associated with higher endotoxin levels in mothers' mattresses, whereas only dog ownership was associated with endotoxin levels in the floor samples. All associations were highly robust to further adjustment for greenspace, and there was little evidence to suggest any effect modification (interaction terms had p-values > 0.05).ConclusionsResidential greenspace did not confound or modify the association between pet ownership and indoor endotoxin levels. Studies should continue investigating whether pets influence the indoor environment only by their presence, or also by acting as transmission vectors of the outdoors.

Journal article

Tischer C, Dadvand P, Basagana X, Fuertes E, Bergström A, Gruzieva O, Melen E, Berdel D, Heinrich J, Koletzko S, Markevych I, Standl M, Sugiri D, Cirugeda L, Estarlich M, Fernández-Somoano A, Ferrero A, Ibarlueza J, Lertxundi A, Tardón A, Sunyer J, Anto JMet al., 2017, Urban upbringing and childhood respiratory and allergic conditions: A multi-country holistic study., Environmental Research, Vol: 161, Pages: 276-283, ISSN: 0013-9351

OBJECTIVE: We integratively assessed the effect of different indoor and outdoor environmental exposures early in life on respiratory and allergic health conditions among children from (sub-) urban areas. METHODS: This study included children participating in four ongoing European birth cohorts located in three different geographical regions: INMA (Spain), LISAplus (Germany), GINIplus (Germany) and BAMSE (Sweden). Wheezing, bronchitis, asthma and allergic rhinitis throughout childhood were assessed using parental-completed questionnaires. We designed "environmental scores" corresponding to different indoor, green- and grey-related exposures (main analysis, a-priori-approach). Cohort-specific associations between these environmental scores and the respiratory health outcomes were assessed using random-effects meta-analyses. In addition, a factor analysis was performed based on the same exposure information used to develop the environmental scores (confirmatory analysis, data-driven-approach). RESULTS: A higher early exposure to the indoor environmental score increased the risk for wheezing and bronchitis within the first year of life (combined adjusted odds ratio: 1.20 [95% confidence interval: 1.13-1.27] and 1.28 [1.18-1.39], respectively). In contrast, there was an inverse association with allergic rhinitis between 6 and 8 years (0.85 [0.79-0.92]). There were no statistically significant associations for the outdoor related environmental scores in relation to any of the health outcomes tested. The factor analysis conducted confirmed these trends. CONCLUSION: Although a higher exposure to indoor related exposure through occupants was associated with an increased risk for wheezing and bronchitis within the 1st year, it might serve as a preventive mechanism against later childhood allergic respiratory outcomes in urbanized environments through enhanced shared contact with microbial agents.

Journal article

Markevych I, Schoierer J, Hartig T, Chudnovsky A, Hystad P, Dzhambov AM, de Vries S, Triguero-Mas M, Brauer M, Nieuwenhuijsen MJ, Lupp G, Richardson EA, Astell-Burt T, Dimitrova D, Feng X, Sadeh M, Standl M, Heinrich J, Fuertes Eet al., 2017, Exploring pathways linking greenspace to health: Theoretical and methodological guidance, Environmental Research, Vol: 158, Pages: 301-317, ISSN: 0013-9351

BACKGROUND: In a rapidly urbanizing world, many people have little contact with natural environments, which may affect health and well-being. Existing reviews generally conclude that residential greenspace is beneficial to health. However, the processes generating these benefits and how they can be best promoted remain unclear. OBJECTIVES: During an Expert Workshop held in September 2016, the evidence linking greenspace and health was reviewed from a transdisciplinary standpoint, with a particular focus on potential underlying biopsychosocial pathways and how these can be explored and organized to support policy-relevant population health research. DISCUSSIONS: Potential pathways linking greenspace to health are here presented in three domains, which emphasize three general functions of greenspace: reducing harm (e.g. reducing exposure to air pollution, noise and heat), restoring capacities (e.g. attention restoration and physiological stress recovery) and building capacities (e.g. encouraging physical activity and facilitating social cohesion). Interrelations between among the three domains are also noted. Among several recommendations, future studies should: use greenspace and behavioural measures that are relevant to hypothesized pathways; include assessment of presence, access and use of greenspace; use longitudinal, interventional and (quasi)experimental study designs to assess causation; and include low and middle income countries given their absence in the existing literature. Cultural, climatic, geographic and other contextual factors also need further consideration. CONCLUSIONS: While the existing evidence affirms beneficial impacts of greenspace on health, much remains to be learned about the specific pathways and functional form of such relationships, and how these may vary by context, population groups and health outcomes. This Report provides guidance for further epidemiological research with the goal of creating new evidence upon which to develop polic

Journal article

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