Objectives The effect of occupational irritants on IgE sensitisation remains unknown. We investigated the association between occupational exposure to irritants and IgE sensitisation.Methods The study included a cross-sectional analysis of 924 adult participants to the first follow-up of the Epidemiological study of the Genetics and Environment of Asthma (EGEA2) and a longitudinal analysis of 271 children recruited at EGEA1 and followed up to adulthood (EGEA2). Allergen-specific IgE sensitisation to 162 allergens was assessed by microarray technology. Lifetime occupational exposure to irritants was evaluated by the occupational asthma-specific job-exposure matrix. Adjusted regression models were performed to evaluate (1) cross-sectional associations between irritant exposures with the number and cluster-based profiles of sIgE sensitisation and (2) longitudinal associations between childhood sIgE sensitisation and occupational irritant exposures in adulthood to assess a potential 'healthy hire effect'.Results Among adult-onset asthma participants, occupational exposure to irritants was associated with a lower number of sIgE sensitisation (adjusted mean ratio=0.63 (95% CI 0.39 to 1.02), p=0.06) and a lower risk of exhibiting house dust mite predominant and pollen/animal predominant sIgE sensitisation profiles (p=0.02 and 0.06 respectively). No association was observed in participants without asthma or with childhood-onset asthma. The longitudinal assessment showed no association.Conclusion This study, showing fewer sIgE sensitisations associated with occupational exposure to irritants in participants with adult-onset asthma but not in those with childhood-onset or no asthma, highlights the need to further explore the non-immunological mechanisms associated with exposure to respiratory irritants at work.

RATIONALE:Short-term ambient air pollution exposure may worsen asthma health. Effects of longer-term air pollution exposures on asthma exacerbations and risk mitigation by dietary factors are unknown. OBJECTIVES:To examine associations between 48-month air pollution exposure and asthma exacerbations and whether a plant-based diet modifies these relationships. METHODS:Women with asthma in the Nurses' Health Study II were followed from 1997 to 2014. We estimated 48-month time-varying average residential ambient fine particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) exposures using nationwide spatiotemporal models. Plant-based diet index (PDI) scores were calculated on the basis of food frequency questionnaires administered every 4 years. Air pollution and diet assessments were repeated measures within individuals, whereas asthma exacerbations in the past year were captured in 1998 and 2014. Average air pollutant exposure was assessed in the 48 months before each outcome assessment year. Single-pollutant and multipollutant logistic regression models with generalized estimating equations to account for repeated measures within participants were used to assess the effects of each air pollutant on asthma exacerbation risk. We also evaluated effect measure modification by PDI scores on the effects of each air pollutant on asthma exacerbation risk using two-way interaction terms. RESULTS:Of 4,326 participants, median 48-month PM2.5, NO2, and O3 concentrations were 13.7 μg/m3, 12.0 ppb, and 25.5 ppb, respectively, from July 1993 to June 1997 and 8.9 μg/m3, 6.6 ppb, and 27.8 ppb, respectively, from July 2009 to June 2013. In adjusted single-pollutant models, greater exposures to both PM2.5 and NO2 were associated with higher odds of asthma exacerbation (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.14-1.80; and OR, 1.25; 95% CI, 1.12-1.38, respectively). In multipollutant models, greater exposure to NO2 was associated with higher odds of asthma exacerbation (OR, 1.23; 95% CI, 1.06-1.42). There were no statistically significant interactions between pollutants and PDI score on asthma exacerbations. CONCLUSIONS:Long-term exposure to ambient NO2 and PM2.5, even at low concentrations, may increase asthma exacerbation risk in women but is not attenuated by a plant-based diet as measured herein. Further research is needed on the long-term effects of inhaled pollutants on asthma health and personal, modifiable strategies to reduce risk.

Background The household use of irritant and sprayed cleaning products is an established asthma risk factor, which could motivate consumers to turn to “green” products. However, only 2 cross-sectional studies, with inconsistent results, evaluated the potential respiratory health impacts of “green” products. Objective To investigate 2-years effects on asthma of household use of “green” products and irritants/sprays, using longitudinal data from the French NutriNet-Santé cohort. Methods The asthma symptom score and household use of “green” products and irritants/sprays were evaluated using standardized questionnaires in 2018 and 2020. The evolution of weekly use (persistent, increased vs no weekly use) was studied in association with (1) the asthma symptom score in 2020; (2) the incidence of asthma symptoms between 2018 and 2020 (incidence vs asymptomatic); and (3) the evolution of asthma symptoms between 2018 and 2020 (improvement, deterioration vs symptomatic stable) by logistic regressions. Models were adjusted for sex, age, smoking status, body mass index, educational level, and use of irritants/sprays (for “green” products). Results Our study was based on 30,012 adults (mean age: 49 ± 14 years; 74% women). For irritants/sprays, persistent (40%) and increased (26%) use was associated with asthma symptoms (mean score ratio MSR [95% CI values]: 1.26 [1.18-1.34], and MSR: 1.14 [1.06-1.22], respectively), incidence (odds ratio OR [95% CI values]: 1.30 [1.16-1.45], and OR: 1.07 [0.95-1.20], respectively), and deterioration (OR: 1.48 [1.19-1.85], and OR: 1.28 [1.01-1.64], respectively). For green products, persistent (20%) and increased (12%) use was associated with symptoms in 2020 (MSR: 1.08 [1.01-1.16], and MSR: 1.07 [0.99-1.16], respectively), and associations were suggested with incidence (OR: 1.09 [0.97-1.22], and OR: 1.11 [0.97-1.27], respectively). Conclusions Persistent and increased use of irritants/sprays but also of “green” products was associated with deleterious effects on asthma over time.

Objectives Diet and obesity exhibit complex interrelationships with asthma, particularly among elderly women. We aimed to clarify the impact of healthy diet assessed by the Alternate Healthy Eating Index-2010 (AHEI-2010) on: 1) the incidence of asthma symptoms, and 2) among women with symptoms in 2011, the change in asthma symptoms, while accounting for the potential mediating role of BMI. Design A nested case-control study on asthma with follow-up data. Setting Within the French E3N cohort. Participants 8621 elderly women (62 years on average in 1993) Measurements Dietary data were collected in 1993 and 2005 using semi-quantitative questionnaires. Using the validated asthma symptom score assessed in 2011 and 2018, asthma symptom incidence among women with no asthma symptom in 2011 (n = 5700) and change in asthma symptoms (reduced, stable, increased) among those with asthma symptoms in 2011 (n = 2921) were defined. BMI was calculated in 2008. Marginal structural models were used to estimate total, direct and indirect effects mediated by BMI. Results After adjustment for potential confounders, we found a significant indirect effect of healthier diet on lower risk of asthma symptoms incidence mediated by lower BMI (OR for AHEI-2010 quintile 5 vs quintile 1 = 0.95 (0.92–0.97)), without significant total (OR=0.87 (0.66–1.10)) nor direct (OR=0.92 (0.71–1.15)) effects. Among women with asthma symptoms, we also found a significant indirect effect of healthier diet on reduced asthma symptoms mediated by lower BMI (OR for AHEI-2010 >median vs ≤median=1.02 (1.00–1.03)) without significant total (OR=1.12 (0.94–1.34)) nor direct effects (OR=1.10 (0.93–1.31)). Conclusion A healthy diet was associated with reduced risk of asthma symptoms over time, partly through a lower BMI.

L’asthme est une maladie chronique des voies respiratoires inférieures, marqué par des crises aiguës et des symptômes intermittents tels que l’essoufflement, la toux et une respiration sifflante. Elle résulte d’une inflammation de la muqueuse bronchique, d’une hyperréactivité bronchique et d’une hypersécrétion de mucus, provoquant une obstruction variable mais réversible des voies aériennes. Cette pathologie, qui altère la qualité de vie des malades, peut nécessiter une hospitalisation dans ses formes graves. La prévalence de l’asthme a fortement augmenté au cours du XXe siècle dans les pays industrialisés, mais tend à se stabiliser voire à diminuer dans ces régions, alors qu’elle progresse toujours dans les pays à faible revenu. En France, plus de 4 millions de personnes sont asthmatiques, avec une prévalence chez les enfants estimée à 10–15 %, et chez les adultes à environ 9 %. Bien que survenant majoritairement pendant l’enfance, l’asthme peut survenir à tout âge. Il persiste toute la vie, avec des phases possibles de rémission. Il n’existe pas de traitement pour guérir de l’asthme, mais une prise en charge adaptée, comprenant des traitements quotidiens, des traitements de crise et l’évitement des facteurs déclenchants, permet un bon contrôle de la maladie. L’asthme est une maladie multifactorielle, résultant d’interactions entre des facteurs génétiques et environnementaux. Cette revue propose une mise au point sur les facteurs environnementaux (mode de vie, expositions professionnelles, facteurs de l’environnement intérieur puis extérieur) impliqués dans le développement de l’asthme et souligne plus particulièrement ceux pour lesquels des travaux récents ont permis de préciser leur rôle.

BACKGROUND:Disinfectants and cleaning products (DCPs) are important asthma risk factors among healthcare workers. However, healthcare work involves heterogenous cleaning tasks and co-exposure to many chemicals. These multidimensional aspects have rarely been considered. We aimed to identify patterns of occupational exposure to DCPs and study their associations with asthma. METHODS:CONSTANCES is a French population-based cohort of ≈220,000 adults. Current asthma and asthma symptom score were defined by questionnaire at inclusion (2012-2021). Healthcare workers completed a supplementary questionnaire on their current/last held occupation, workplace, and cleaning activities that were used in unsupervised learning algorithms to identify occupational exposure patterns. Logistic and negative binomial regression models, adjusted for potential confounders, were used to assess associations with asthma outcomes. RESULTS:In 5512 healthcare workers, four occupational exposure clusters were identified: Cluster1 (C1, 42%, reference), mainly characterized by low exposed nurses and physicians; C2 (7%), medical laboratory staff moderately exposed to common DCPs (chlorine/bleach, alcohol); C3 (41%), nursing assistants and nurses highly exposed to a few DCPs (mainly quaternary ammonium compounds); and C4 (10%), nurses and nursing assistants highly exposed to multiple DCPs (e.g., glutaraldehyde, hydrogen peroxide, and acids). Among women (n = 3734), C2 (mean score ratio [95% CI]: 1.31 [1.02; 1.68]) and C3 (1.18 [1.03; 1.36]) were associated with higher asthma symptom score, and an association was suggested between C3 and current asthma (odds ratio 1.22 [0.99; 1.51]). CONCLUSION:In a large population of healthcare workers, four DCP exposure patterns were identified, reflecting the heterogeneity of healthcare jobs. Two patterns, including one characterized by laboratory workers, were associated with greater asthma symptoms in women.

BackgroundThe role of the immune system in cancer defense is likely underappreciated. While there has been longstanding interest in the role of atopic diseases in cancer, only a few studies have tested this hypothesis.MethodsWe analyzed data from 202,055 women participating in the Nurses' Health Study (NHS) and the Nurses' Health Study II (NHS II) to explore whether asthma is associated with breast cancer. We used Cox proportional hazards models to link physician-diagnosed asthma with subsequent incidence of breast cancer.ResultsAcross the two cohorts, we identified 18,403 cases of physician-diagnosed asthma. During 4,393,760 person-years of follow-up, 11,096 incident cases of breast cancer were diagnosed. In NHS, women with asthma had a covariate-adjusted hazard ratio of 0.92 (95% CI: 0.86-0.99) to develop breast cancer compared to women without asthma; the respective HR in NHS II was 0.93 (0.84-1.03), and 0.92 (0.87-0.98) in the pooled analysis. Among never-smokers, the HR for breast cancer was 0.91 (0.81-1.02) in NHS, 0.81 (0.70-0.93) in NHS II, and 0.86 (0.77-0.97) combined. In two large prospective cohorts of women, participants with asthma had a somewhat lower risk of breast cancer. An active immune system may provide protection from breast cancer.ConclusionsIn these longitudinal studies, women with asthma had a somewhat lower risk of breast cancer. This association was most pronounced among never smokers. An active immune system may provide protection from breast cancer.

OBJECTIVE:The objective of this study is to assess the association between childhood exposure to pets and farm animals and the risk of developing rheumatoid arthritis (RA) in adulthood, using data from a large prospective cohort. METHODS:We analysed 78 473 women from the Etude Epidémiologique auprès des femmes de la Mutuelle générale de l'Education Nationale cohort, among whom 698 incident cases of RA were identified and validated. Childhood exposure to domestic pets (cats, dogs) and farm animals, as well as the age at first exposure, was self-reported by participants using predefined categorical options (eg, never, <1 year, 1-2 years, etc). HRs were estimated using Cox models, with confounders selected via directed acyclic graphs. RESULTS:Early exposure to pets (cats/dogs) between the ages of 1 year and 2 years compared with no exposure was associated with a lower risk of RA (adjusted HR (aHR) 0.57, 95% CI 0.34 to 0.95), regardless of smoking status. However, no association was observed with pet exposure at earlier (<1 year) or later ages. Conversely, exposure to farm animals (cows, sheep, pigs) during childhood was borderline associated with an increased risk of RA (aHR 1.26, 95% CI 1.00 to 1.59), irrespective of age at exposure. CONCLUSION:How and when children are exposed to animals could affect the risk of developing RA. Our results suggest a potential inverse association restricted to pet exposure at ages 1-2 years, but not at other ages, whereas exposure to farm animals was positively associated. These findings should be interpreted cautiously and warrant further investigation. TRIAL REGISTRATION NUMBER:NCT03285230.

BACKGROUND:Exposure to certain chemicals in disinfectants has been associated with vascular dysfunction in toxicological studies, but the association between disinfectant exposure and clinical cardiovascular disease (CVD) remains unclear. OBJECTIVE:The aim of this study was to evaluate the association between occupational exposure to disinfectants and subsequent risk of CVD among US nurses. METHODS:We included 75,675 participants from The Nurses' Health Study II who maintained a nursing job and reported data on occupational disinfectant exposure. We estimated hazard ratios (HR) and 95% confidence intervals (CIs) of incident CVD, including coronary heart disease (CHD) and stroke, using Cox proportional hazard models comparing job types and general disinfection tasks between participants. We also used a job-task-exposure matrix to evaluate the risk of CVD by frequency of cleaning/disinfection tasks and exposure levels of seven specific disinfectants (formaldehyde, glutaraldehyde, hypochlorite bleach, hydrogen peroxide, alcohol, quaternary ammonium compounds, and enzymatic cleaners). RESULTS:During 10 y of follow-up (2009-2019), we documented 726 incident cases of CVD. In fully adjusted models, the hazard ratio of CVD among nurses who worked in operating rooms was 1.72 [95% confidence interval (CI): 1.25, 2.36], in comparison with those working as educators or administrators. A similar pattern of associations was found when we separately assessed the risk for CHD and stroke [HR=1.69 (95% CI: 1.11, 2.58) and HR=1.69 (95% CI: 1.05, 2.74), respectively] among operating room nurses, in comparison with those working as educators or administrators. Those who used disinfectants weekly had modest elevations in CVD risk (HR=1.21; 95% CI: 1.04, 1.40), in comparison with women who never used disinfectants. The highest CVD risk was observed among nurses using disinfectants or spray or aerosol products 4-7 d/wk and those exposed to the highest levels of the seven specific disinfectants listed above. CONCLUSION:Exposure to disinfectants in real-world health care settings was associated with a higher risk of CVD, including CHD and stroke, among US nurses. https://doi.org/10.1289/EHP14945.

Asthma is a chronic disease of the lower respiratory tract, characterized by acute attacks and intermittent symptoms such as shortness of breath, coughing, and wheezing. Asthma results from inflammation of the bronchial mucosa, bronchial hyperreactivity, and excessive mucus secretion, leading to variable but reversible airway obstruction. This condition, which significantly impacts patients' quality of life, can require hospitalization in most severe cases. The prevalence of asthma has significantly increased during the 20th century in industrialized countries but tends to stabilize or decrease in these regions, while continuing to rise in low-income countries. In France, over 4 million people are affected by asthma, with prevalence estimates of 10-15 % among children and approximately 9 % among adults. Although asthma primarily develops during childhood, it can occur at any age. The disease persists throughout life, with possible phases of remission. There's currently no cure for asthma, but appropriate management, including daily treatment to prevent the inflammation and sensitivity of the airways, reliever treatments when symptoms occur and avoiding triggering factors, allows effective control of the condition. Asthma is a multifactorial disease resulting from interactions between genetic and environmental factors. This review focuses on environmental factors (lifestyle, indoor, and outdoor environmental factors) involved in asthma development and highlights those for which recent studies have suspected or clarified their roles. (c) 2025 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:Studies on indoor mould contamination and asthma in adults are scarce, although there is evidence of deleterious effects on childhood asthma. Associations between different mould contamination indicators and asthma were investigated in adults from the largest French prospective population-based cohort. METHODS:Participants completed standardized questionnaires: on visible mould and mouldy area size (0 m2, spots, <0.2 m2, [0.2 m2-1 m2], ]1 m2-3 m2] or >3 m2) in bathroom, kitchen, or main living quarters (living room, bedroom) in 2019, and on respiratory health (2019-2022). Associations between indoor mould with current asthma, asthma symptom score (sum of five respiratory symptoms in the last 12 months), and uncontrolled asthma (Asthma Control Test<20) were evaluated by zero-inflated negative binomial and logistic models adjusted for age, sex, smoking, education, dwelling type and French deprivation index. Sensitivity analyses: in subgroups, stratified by dwelling type or sex, and further adjustments for region, occupant-surface ratio, body mass index, occupant (owner/tenant) and rural/urban areas were performed. FINDINGS:Analyses included 28 596 adults (mean age: 55 years old, 55 % women, 70 % living in houses, 24 % reported at least one asthma symptom, 7.4 % current asthma of whom 15.1 % had uncontrolled asthma). Visible mould and mouldy area size>3 m2 were reported by 21.2 % and 0.3 % of participants, respectively. Visible mould in dwelling was significantly associated with current asthma, asthma symptom score and uncontrolled asthma (OR and mean score ratio (MSR) around 1.40), stronger effect in the main living quarters. Mouldy area size was significantly associated with higher risk of current asthma (all ORs≥1.29, p-trend<0.001) and increased asthma symptom score (all MSRs≥1.32, p-trend<0.001). No heterogeneity was found by dwelling type or sex. Results were consistent across sensitivity analyses. INTERPRETATION:Mouldy area size was associated with current asthma and asthma symptom score, even for small sizes, adding new insight of the associations between mould contamination and asthma in adults.

Fecal incontinence (FI) is a common condition associated with aging. Asthma and chronic obstructive pulmonary disease (COPD) are obstructive lung diseases associated with both urinary incontinence and increased intraabdominal pressures. We sought to evaluate whether these obstructive lung diseases increase the risk of developing FI. We prospectively examined the association between asthma, COPD and asthma/COPD overlap and risk of FI among women from the Nurses’ Health Study (NHS). We defined incident FI as ≥ 1 liquid or solid FI episode/month during four years of follow-up using self-administered, biennial questionnaires (2008–2012). Validated self-report of asthma and COPD were used from 1988 to 2008. We used Cox proportional hazards models to calculate multivariable-adjusted hazard ratios (aHRs) and 95

Objective: Obesity and type 2 diabetes (T2D) have been associated with low adherence to the 2017 French foodbased dietary guidelines, as assessed by the Programme National Nutrition Sante - guidelines score 2 (PNNS-GS2). Whether the association between T2D and PNNS-GS2 is direct or mediated by obesity has been little investigated. Research methods: The study included 71,450 women from the E3N-EPIC cohort, mean age of 52.9 y (SD 6.7). The simplified PNNS-GS2 was derived via food history questionnaire. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of T2D. Causal mediation analyses were used to decompose the total effect of sPNNS-GS2 on T2D into a direct effect and indirect effect mediated by body mass index (BMI) or the waist-hip ratio (WHR). Results: During a mean follow-up of 19 y, 3679 incident T2D cases were identified and validated. There was a linear association between adherence to sPNNS-GS2 and T2D (P-nonlinearity = 0.92). In the fully adjusted model, each 1-SD increase in the sPNNS-GS2 was associated with a lower T2D risk [HR (95% CI), 0.92 (0.89, 0.95)]. The overall associations were mainly explained by sPNNS-GS2-associated excess weight, with BMI and WHR mediating 52% and 58% of the associations, respectively. Conclusions: Higher adherence to French food-based dietary guidelines was associated with a lower risk of T2D in women, and a significant portion of this effect could be attributed to excess weight measured by BMI or WHR. This finding helps better understand the mechanisms underlying the diet-T2D association. (c) 2024 Elsevier Inc. All rights reserved.

Few studies evaluated the use of Household Disinfectant and Cleaning Products (HDCPs) during the COVID-19 pandemic, but no population-based cohorts used longitudinal data. We studied changes in HDCPs during the first lockdown, based on longitudinal data from the French population-based NutriNet-Santé and CONSTANCES cohorts. Based on standardized questionnaires on household cleaning tasks in 2018–2019 and around the first lockdown in France (March17-May3 2020), we compared the duration of weekly use of HDCPs (< 1 day/week, < 10 min/week; 10-30 min/week; > 30 min/week) and the household cleaning help (yes/no) before and during the lockdown period by Bhapkar and McNemar’s tests. Moreover, we assessed self-reported changes in the frequency of HDCPs during the lockdown from before (unchanged/increased). Analyses were carried on 31,105 participants of NutriNet-Santé (48 years, 75