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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "122" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "María Jesús Cruz, Christian Romero-Mesones, Xavier Muñoz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "María Jesús" "apellidos" => "Cruz" "email" => array:1 [ 0 => "mj.cruz@vhir.org" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Christian" "apellidos" => "Romero-Mesones" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Xavier" "apellidos" => "Muñoz" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER Enfermedades Respiratorias (CibeRes), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Puede la contaminación ambiental causar asma?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Asthma is a worldwide health problem that is of particular significance in industrialized countries, where prevalence, which can range between 8% and 10% of the population, is increasing.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> This generates a high socioeconomic burden in terms of absenteeism from work and school, use of resources (consultations, hospitalizations), and deaths. The World Health Organization (WHO) estimates that globally around 235 million people suffer from asthma.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> In Spain, it is estimated that 3 million individuals are asthmatic.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although the increase in asthma figures may be due to improvements in diagnosis criteria and techniques, the importance of factors such as environmental pollution in industrialized countries must be taken into consideration.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> Environmental pollutants can aggravate existing asthma,<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5–9</span></a> or may be the cause of the disease. It is well known that high levels of particulate matter (diesel particles), ozone, sulfur dioxide and nitrous oxide (O<span class="elsevierStyleInf">3</span>, SO<span class="elsevierStyleInf">2</span> and NO<span class="elsevierStyleInf">2</span>) can precipitate the onset of symptoms in asthma patients, increasing the number of visits to the emergency services and hospitalizations due to worsening disease.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> However, a more controversial claim is that environmental pollution may be the cause of asthma. Chanel et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> showed that living near roads with heavy traffic could account for 15%–30% of all new cases of asthma in children. Similarly, Gehring et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a> found that exposure to environmental pollution in early life could contribute to the development of asthma during childhood and adolescence. The SCAPE study also showed that an increase of 10<span class="elsevierStyleHsp" style=""></span>μg/m<span class="elsevierStyleSup">3</span> in the environmental concentration of NO<span class="elsevierStyleInf">2</span> was associated with the appearance of new cases of asthma in adults, although no association was found for increased particulate matter (PM).<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To establish causality, both significant epidemiological associations and biological plausibility need to be demonstrated. In this respect, the exact mechanisms by which environmental pollution can aggravate or cause asthma are still unclear. In individuals with asthma, exposure to high concentrations of environmental pollutants can induce changes in lung function, basically via irritative mechanisms mediated by transient receptor potential (TRP) cation channel receptors. However, exposure to lower concentrations, as observed in European cities, may produce more specific inflammatory changes.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a> For example, exposure to ozone can produce neutrophilic inflammation in the lung, along with macrophage and epithelial cell changes that would generate proinflammatory mediators such as IL6, IL8 or TNFα.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">10</span></a> Diesel particles can increase neutrophilic inflammation and the production of TH17 lymphocytes, which, combined with allergens, may cause increased bronchial hyperresponsiveness.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In individuals without previous asthma, the combination of certain genetic factors and exposure to environmental contaminants may be the cause of the disease. Recent studies have shown a relationship between environmental pollutants and certain allelic variations in genes, some of which are involved in oxidative stress and inflammation.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">12,13</span></a> Thus, some gene polymorphisms encoding antioxidant enzymes, such as glutathione S-transferase, may increase the risk of asthmatic responses to exposure to pollutants. Furthermore, the interaction of these genes with TNF can cause changes in the inflammatory response that predispose to the development of asthma.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Environmentally-induced epigenetic changes could also cause asthma: environmental contaminants can directly cause epigenetic modifications. For example, exposure to diesel particulates has been shown to affect the methylation of genes involved in the innate immune system<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> and asthma.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> Pollution can also indirectly cause epigenetic changes by modifying the composition of the microbiome. The mechanisms by which a specific microbiome can affect the epigenome have not yet been exactly clarified, but metabolic activity may play a relevant role.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In addition to these genetic and epigenetic factors, changes in certain immunological mechanisms may also play an important role in the development of asthma. Animal and in vitro models suggest that exposure to pollutants such as diesel particles can cause the immune system to differentiate towards a TH2 and TH17 type mechanism. Interactions may also occur between allergens and diesel particles that could increase their antigenic properties, facilitating the development of asthma.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> In any case, more in-depth studies on individual exposure to pollution and the phenotypic characterization of asthma are needed to broaden our understanding of the effect of atmospheric pollutants on the incidence of asthma.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In short, it seems likely that environmental pollution must be taken into consideration as a causative factor, not only of exacerbations but also of the disease itself, when treating a patient with asthma. On a wider level, although reducing the effects of pollution on health is to a large extent beyond the reach of the healthcare community, as medical professionals we must continue to make the authorities aware of the serious impact of environmental pollution on health. There is little doubt that much progress will be made in asthma research in the coming years, which will be of great interest to both the medical community and to society in general.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">MJC receives funding from the Miguel Servet research program of the Instituto de Salud Carlos III (CP12/03101).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cruz MJ, Romero-Mesones C, Muñoz X. ¿Puede la contaminación ambiental causar asma? Arch Bronconeumol. 2018;54:121–122.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0085" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2016. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.ginasthma.org/">http://www.ginasthma.org</a> [accessed 19.09.17]." ] ] ] 1 => array:3 [ "identificador" => "bib0090" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Health Organization. Asthma 2017. 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Year/Month | Html | Total | |
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2024 October | 87 | 27 | 114 |
2024 September | 63 | 13 | 76 |
2024 August | 79 | 37 | 116 |
2024 July | 60 | 21 | 81 |
2024 June | 65 | 41 | 106 |
2024 May | 67 | 42 | 109 |
2024 April | 46 | 30 | 76 |
2024 March | 44 | 20 | 64 |
2024 February | 48 | 19 | 67 |
2023 March | 17 | 3 | 20 |
2023 February | 51 | 22 | 73 |
2023 January | 27 | 40 | 67 |
2022 December | 69 | 35 | 104 |
2022 November | 79 | 38 | 117 |
2022 October | 66 | 36 | 102 |
2022 September | 52 | 34 | 86 |
2022 August | 56 | 46 | 102 |
2022 July | 45 | 49 | 94 |
2022 June | 50 | 34 | 84 |
2022 May | 55 | 47 | 102 |
2022 April | 48 | 31 | 79 |
2022 March | 55 | 41 | 96 |
2022 February | 46 | 41 | 87 |
2022 January | 68 | 45 | 113 |
2021 December | 51 | 46 | 97 |
2021 November | 53 | 41 | 94 |
2021 October | 64 | 47 | 111 |
2021 September | 59 | 49 | 108 |
2021 August | 34 | 26 | 60 |
2021 July | 42 | 17 | 59 |
2021 June | 75 | 43 | 118 |
2021 May | 62 | 58 | 120 |
2021 April | 200 | 100 | 300 |
2021 March | 132 | 26 | 158 |
2021 February | 153 | 22 | 175 |
2021 January | 88 | 25 | 113 |
2020 December | 102 | 25 | 127 |
2020 November | 92 | 18 | 110 |
2020 October | 78 | 18 | 96 |
2020 September | 87 | 12 | 99 |
2020 August | 62 | 24 | 86 |
2020 July | 58 | 23 | 81 |
2020 June | 40 | 12 | 52 |
2020 May | 101 | 19 | 120 |
2020 April | 88 | 28 | 116 |
2020 March | 81 | 18 | 99 |
2020 February | 101 | 16 | 117 |
2020 January | 111 | 29 | 140 |
2019 December | 87 | 22 | 109 |
2019 November | 94 | 33 | 127 |
2019 October | 89 | 17 | 106 |
2019 September | 78 | 7 | 85 |
2019 August | 44 | 26 | 70 |
2019 July | 38 | 14 | 52 |
2019 June | 56 | 19 | 75 |
2019 May | 57 | 22 | 79 |
2019 April | 41 | 23 | 64 |
2019 March | 97 | 23 | 120 |
2019 February | 44 | 22 | 66 |
2019 January | 43 | 24 | 67 |
2018 December | 55 | 24 | 79 |
2018 November | 73 | 32 | 105 |
2018 October | 88 | 33 | 121 |
2018 September | 42 | 15 | 57 |
2018 April | 0 | 1 | 1 |