Asthma
Asthma is a common chronic inflammatory disease of the airways characterized by wheezing, shortness of breath, chest tightness, and cough. Asthma is closely associated with atopic dermatitis (AD), and individuals with AD have a marked increased risk of la
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Asthma Simon F. Thomsen
Contents
17.1
17.1
Introduction ..............................................
169
17.2
Clinical Characteristics of Asthma ........
170
17.3
Asthma Is a Multifactorial Disorder ......
170
17.4
Natural History of Asthma......................
171
17.5
Why FLG Mutations Are Thought to Increase the Risk of Asthma ...............
172
Association Between FLG Mutations and Asthma...............................................
172
17.6 17.7 17.7.1 17.7.2 17.7.3 17.7.4 17.7.5 17.7.6 17.7.7 17.7.8 17.8
FLG Mutations Predispose to Asthma Selectively in Patients with AD ................ Case-Control and Family Studies .............. Population Studies ..................................... Other Risk Alleles...................................... Populations of Non-European Descent ...... Interaction with Environmental Exposures ................................................... FLG Mutations and Asthma Severity ........ FLG Mutations and Intermediate Asthma Phenotypes ................................................. Association Between FLG Mutations and Asthma in Other Patient Populations .........
172 173 173 174 176 176 176 177 178
Other Genotypes Interacting with FLG Mutations May Increase the Risk of Asthma ..................................................
179
Conclusion ..............................................................
179
References ...............................................................
179
S.F. Thomsen, MD, PhD Department of Dermatology, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen DK-2400, Denmark e-mail: [email protected]
Introduction
Asthma is a chronic inflammatory respiratory disease affecting up to one-fourth of the population in industrialized countries [1]. Moreover, asthma remains undiagnosed in a considerable proportion of the population [2]. During the second half of the last century, the prevalence of asthma has risen to epidemic proportions, mainly in developed countries, but, more recently, also in developing countries. After a period, primarily between the 1960s and the 1990s, with a high number of new asthma cases, the incidence now seems to have reached a plateau; in some countries with a formerly high incidence, the incidence seems to have declined [1]. The reasons for the rapid increase in asthma prevalence are imperfectly understood, but since it has occurred more rapidly than changes to the genome sequence would allow, environmental factors have been evoked. According to the hygiene hypothesis formulated by British epidemiologist David Strachan in 1989, lifestyle changes associated with a decreased microbial diversity in industrialized societies during the second half of the last century such as higher standards of personal cleanliness, better household amenities, and increased use of antibiotics are responsible [3]. These factors are thought to have affected asthma susceptibility in the population through a complex developmental interplay with genetic factors. Of particular interest, a recent populati
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