Annelies De Smet (ESOC)

1. 2 February 2011UA meets ULg PIPO project

2. Overview Epidemiology of asthma and allergies Cross-sectional vs. longitudinal research The PIPO birth cohort The PIPO staff

3. Overview Epidemiology of asthma and allergies Cross-sectional vs. longitudinal research The PIPO birth cohort The PIPO staff

4. Epidemiology of asthma and allergies ≥300 million (4.3%) people worldwide 2 large international epidemiological studies: ECRHS in adults ISAAC in schoolchildren

6. School children: 6-7 years and 13-14 years

7. Assessment of prevalence of symptoms of asthma, atopic eczema and rhinoconjunctivitis

8. Phases:

9. Phase 1 (1994-1995): 156 centres in 56 countries

10. Phase 2 (1998): 30 centres in 22 countries

11. Phase 3 (2002-2003): 237 centres in 98 countries

13. Results of ISAAC and ECRHS Both studies showed a particularly high prevalence of reported asthma and allergy symptoms in English-speaking countries (i.e. Australia, New Zealand, the UK, the USA and Canada) Both studies showed high asthma and allergy prevalence in Western Europe, with lower prevalences in Eastern and Southern Europe The ISAAC showed that centres in Latin America also had particularly high symptom prevalence The rest of the world outside of the Americas and Western Europe generally showed relatively low asthma prevalence, in particular in developing countries

14. Is the prevalence of asthma and allergies still increasing? Recent reports of a decline in prevalence of allergies Review of 48 high quality reports by Anandan et al. Allergy 2010: 65: 152-167 Conclusions: the isolated reports of a decline in asthma prevalence appear to reflect improvements in the quality of care the asthma prevalence is continuing to increase or remaining stable in most parts of the world.

15. Overview Epidemiology of asthma and allergies Cross-sectional vs. longitudinal research The PIPO birth cohort The PIPO staff

16. Cross-sectional vs. longitudinal research

17. Overview Epidemiology of asthma and allergies Cross-sectional vs. longitudinal research The PIPO birth cohort The PIPO staff

18. The PIPO birth cohort Prospectivebirth cohort on the Influence of Perinatal factors on the Occurrence of Asthma and Allergies (PIPO) Recruitment: 1997-2001 ± 5 months of pregnancy Gynaecologists Province of Antwerp, Belgium

20. To study the naturalcourse of respiratory and allergysymptoms

21. To studyimmunological profiles

22. To studyevolution in lungfunctionPerspective: To studyassociationsbetweenasthmaand allergyphenotypes and genotypes and gene-environmentinteractions

23. Flowchart up to 1 year

24. Flowchart 1,5 to 4 years

25. Flowchart up to 8 years

27. Content of the questionnaires Screening Questionnaire: History of asthma and allergies of mother. Father and mother questionnaire: asthma and allergy history of father and mother First home visit: Family composition Family history (respiratory, eye and nasal symptoms, hay fever, skin, food allergy) Maternal smoking Bedroom+ mattress mother

28. Content of the questionnaires Second home visit: Delivery (type, complications, length, weight, head circumference, Apgar) Nutrition of the child (breastfeeding, bottle feeding, solids) Diseases of children (vaccination, skin, respiratory, nasal and eye symptoms, gastrointestinal symptoms, drugs, smoke exposure) Pets House (age of the building, heating, stove, insulation) Pregnancy (active and passive maternal smoking, diet, diseases, medications, vitamins and minerals, animals) Outside (traffic and industry) Washing habits at 3 months Data from father and mother (professional, work-related complaints) Day care (furnishing, heating, animals)

29. Content of the questionnaires 6 months: Nutrition (breastfeeding, bottle feeding) Vaccination Interior of the house (the child's bed, mattress) Child care (facility, traffic, heating) Smoke exposure Pets 12 months telephonic anamnesis: Fever (reason, medication) Respiratory symptoms (upper and lower respiratory medication) Skin symptoms + treatment Gastrointestinal symptoms Weight curve

30. Content of the questionnaires 12 months environmental factors Food Other severe familial disorders Interior of the house Vaccination Pets Smoke exposure Childcare Washing habits Education of parents 12 months food frequency questionnaire Breastfeeding Bottle feeding Introduction of solid food

31. Content of the questionnaires 18, 24, 30, 36, 42 months questionnaire Food Interior of the house Vaccinations Pets Smoke exposure Childcare Washing habits Diseases of the child (skin, respiratory, nasal and eye complaints, hay fever, fever, otitis media, gastrointestinal symptoms, medication)

32. Content of the questionnaires 4, 5, 6, 7, 8 years questionnaire Family composition Food Interior of the house Pets Smoke exposure Childcare Diseases of the Child (skin, respiratory, nasal and eye complaints, hay fever, fever, medication otitis media, other diseases, homeopathy) Sleep and behaviour of the child (sleep patterns, polyps, tonsils, behavioural problems, bedwetting, teeth) Physical activity Traffic

33. Lungfunction tests At 4 years of age: Forcedoscillationtechnique (FOT) + reversibility At 8-10 years of age: FOT + reversibility Spirometry + reversibility Exhalednitric oxide (eNO)

35. Blood samples: Genetics

36. Strengths of PIPO Inclusion before the end of pregnancy  information on prenatal exposures Longitudinal follow-up: prenatal to pre-puberty  temporal relationships between early-life factors and development of asthma and allergies Data collection: questionnaires + objective measurements Blood samples for genetic analyses Multidisciplinary approach

37. Overview Epidemiology of asthma and allergies Cross-sectional vs. longitudinal research The PIPO birth cohort The PIPO staff

38. PIPO staff: supervisors Supervisor: Joost Weyler, MD, PhD (Epidemiology and SocialMedicine) Co-supervisor: Ellie Oostveen, MSc, PhD (RespiratoryMedicine) Co-supervisor: Margo Hagendorens, MD, PhD (Pediatrics and Immunology)

39. PIPO staff: scientificpersonnel ESOC: Jos Droste, MD Sandra Dom, MSc Immunology: Chris Bridts, MSc Pediatrics: Elke Dierckx, MD

40. PIPO staff: ATP Administrative management: Chris Daenen (ESOC) Lab technician: Christel Mertens (Immunology) Lungfunctiontechnician: Ria Heyndrickx (RespiratoryMedicine)