Risk factors for atopic and non-atopic asthma in school-aged children from high, and low and middle income countries

Charlotte E Rutter, Harriet Mpairwe, Camila A Figueiredo, Mary Njoroge, Steven Robertson, Hajar Ali, Collin Brooks, Jeroen Douwes,Philip J Cooper, Martha Chico, Natalia Romero-Sandoval, Alvaro A Cruz,Mauricio L Barreto,Neil Pearce, Lucy Pembrey

crossref(2024)

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摘要
Background Although it is well established that there are different asthma phenotypes, little is known about risk factors and mechanisms for non-atopic asthma. We compared risk factors for atopy, atopic asthma (AA) in atopics, and non-atopic asthma (NAA) in non-atopics, in children in a wide variety of countries. Methods Using four studies, across 23 countries, we assessed asthma status and atopy (skin prick tests) for children aged 6-17, plus risk factors from housing, heating, animals, family, diet, and air-quality categories. Using mixed effects logistic regression models we assessed 4 pathways to asthma: Pathway 1: comparing NAA with non-atopic non-asthma (risk factors for NAA among non-atopics); Pathway 2: comparing atopic non-asthma with non-atopic non-asthma (risk factors for atopy); Pathway 3: comparing AA with atopic non-asthma (risk factors for AA among atopics); Pathway 4: comparing AA with non-atopic non-asthma (risk factors for AA among non-atopics). Results Our final sample of 32,741 children comprised 67% non-atopic non-asthmatics, 15% atopic non-asthmatics, 8% with AA and 10% with NAA. Risk factors were similar for AA in atopic individuals and NAA in non-atopic individuals (Pearson's correlation r=0.81). In contrast, risk factors for atopy in non-asthmatics differed from those for AA in atopic individuals (r=-0.06). Discussion These findings indicate that although atopy increases the risk of asthma, the risk factors for subsequently developing asthma are generally the same in atopics and non-atopics. This raises important questions about the role of atopy in asthma, particularly whether it is an inherent part of the aetiological process or is coincidental.
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