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Cited by 7Asthma and respiratory diseasesOral microbiology and periodontitis researchOral Health Pathology and Treatment

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Diseases with oral manifestations among adult asthmatics in Finland: a population-based matched cohort study

Open access
Lemmetyinen, Riikka, Karjalainen, Jussi, But, Anna, Renkonen, Risto, Pekkanen, Juha, Haukka, Jari, Toppila-Salmi, Sanna·2021·BMJ Open
DOI 10.1136/bmjopen-2021-053133PMC PMC8720978
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Abstract

Objectives: Many comorbidities are associated with adult asthma and may exacerbate the asthma burden of disease. This study aims to investigate the risk for major oral diseases or oral-manifesting diseases in asthmatic compared with non-asthmatic adults. Design: We conducted a population-based matched cohort study with a 13.8-year follow-up. Setting: A baseline questionnaire was completed by participants in 1997 and follow-up data were extracted from the national hospital discharge registry of the National Institute for Health and Welfare in Finland from 1997 to 2014. Participants: A total of 1394 adults with asthma were matched with 2398 adults without asthma based on sex, age and area of residence. Asthmatic adults were identified from the Drug Reimbursement Register of the Finnish Social Insurance Institution based on a special drug reimbursement right resulting from asthma. Participants without asthma were identified from the Population Register. Main outcomes and measures: Oral health-related primary diagnoses were retrieved using codes from the International Classification of Diseases, 10th edition and divided into groups of diseases. Cox’s proportional hazards models stratified by matching unit and models matched and adjusted for pack-years, education level and body mass index (when possible) were used to evaluate the matched and further adjusted HRs for diseases comparing asthmatic and non-asthmatic cohorts. Results: Adult asthma was associated with a higher risk for any oral-manifesting disease (adjusted HR 1.41, 95% CI 1.11 to 1.80), herpes zoster (adjusted HR 6.18, 95% CI 1.21 to 31.6), benign tumours of the oral cavity and pharynx (matched HR 1.94, 95% CI 1.05 to 3.56) and dermatological diseases (pemphigus, pemphigoid, dermatitis herpetiformis, psoriasis and lichen planus, HR 1.67, 95% CI 1.01 to 2.78). Conclusions: In this study, adult asthmatics experienced a higher risk for a major oral disease or oral-manifesting disease.

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  • The relationship between inhaled corticosteroids and oral candidiasis is mainly due to decreases in salivary IgA and histamine from immunosuppressant actions, and to suppression of cellular immunity and phagocytosis.

    “in addition to suppressing cellular immunity and phagocytosis.”

    From Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health (2023) · cites this paper as [92]

    The Discussion says the immunosuppressive effects of inhaled corticosteroids promote oral candidiasis. It does not identify reduced salivary IgA or histamine, suppressed cellular immunity, or impaired phagocytosis as the mechanisms. The authors also state that their data could not establish a causal relationship. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The higher rate of herpes zoster in asthmatic subjects may be because asthmatic patients have an immune system deficiency, which may cause reactivation of the varicella zoster virus.

    “The authors pointed out that this may be because asthmatic patients have an immune system deficiency, which may cause reactivation of the varicella zoster virus.”

    From Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health (2023) · cites this paper as [92]

    The Results report a higher herpes zoster rate among asthmatic adults. The Discussion says herpes zoster results from varicella zoster virus reactivation and may occur because of immune deficiency, but it does not establish that the asthmatic patients had an immune deficiency or that this explained their higher rate. The supplied passages have no page numbers. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The rate of herpes zoster is almost seven times higher in asthmatic subjects than in non-asthmatic subjects.

    “The authors found that the rate of herpes zoster was almost seven times higher in asthmatic subjects than in non-asthmatic subjects.”

    From Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health (2023) · cites this paper as [92]

  • Only 20% of the inhaled corticosteroid dose actually reaches the lungs; most remains in the oral cavity and oropharynx.

    “considering that only 20% of the inhaled dose actually reaches the lungs, so most of the inhaled drug remains in the oral cavity and oropharynx”

    From Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health (2023) · cites this paper as [92]

    The Introduction and Discussion describe effects of inhaled asthma medications on oral health, but neither reports how much of an inhaled dose reaches the lungs or remains in the mouth and oropharynx. Searches for the 20% figure and drug deposition found no supporting passage in our copy. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Oral mucosal immunity normalizes upon discontinuation of corticosteroids.

    “However, it has been reported that oral mucosal immunity normalizes upon discontinuation of corticosteroids [50,59,89,90,91,92].”

    From Drugs Prescribed for Asthma and Their Adverse Effects on Dental Health (2023) · cites this paper as [92]

    The Discussion (page unavailable) says oral candidiasis is presumably common among users of inhaled corticosteroids, but it does not address what happens to oral mucosal immunity after treatment stops. Searches for normalization and discontinuation found no passage supporting that claim. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

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Citations

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Metadata

Authors
Lemmetyinen, R., Karjalainen, J., But, A., Renkonen, R., Pekkanen, J., Haukka, J., & Toppila-Salmi, S.
Affiliations
  • University of Helsinki (FI)
  • Tampere University (FI)
Corresponding author
Lemmetyinen, Riikka
ORCID
Venue
BMJ Open
Publisher
BMJ
Published
2021-12
Volume
11
Issue
12
Pages
e053133
ISSN
2044-6055 (ISSN-L)
DOI
10.1136/bmjopen-2021-053133
PMC
PMC8720978
OpenAlex
W4206509248
Cited by
7
References
1
Citations by year
2026: 1 · 2024: 3 · 2023: 3
FWCI
0.94
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Open (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by-nc)
  • STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
Funders
  • Finnish Allergy Research Foundation (Not Applicable)
  • The Research Foundation of the Pulmonary Diseases (Not Applicable)
  • Finnish Association of Otorhinolaryngology and Head and Neck Surgery (Not Applicable)
  • Tampereen TuberkuloosisäätiÖ (Not Applicable)
  • Yrjö Jahnssonin Säätiö (Not Applicable)
  • Väinö and Laina Kivi Foundation (Not Applicable)
  • Foundation of the Finnish Anti-Tuberculosis Association (Not Applicable)
  • The Finnish Society of Allergology and Immunology (Not Applicable)
  • Rehabilitation Funds of the Finnish Social Insurance Institution (Not Applicable)
  • Jane ja Aatos Erkon Säätiö (Not Applicable)
  • Suomen Lääketieteen Säätiö (Not Applicable)
  • Paulon Säätiö (Not Applicable)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
  • Health Sciences › Dentistry › General Dentistry › Oral Health Pathology and Treatment
Keywords
adult asthma, oral diseases, oral manifestations, comorbidities, herpes zoster, skin diseases, psoriasis, lichen planus, pemphigus, pemphigoid, dermatitis herpetiformis, hospital discharge diagnoses, risk factors
MeSH terms
Adult, Asthma, Finland, Humans, Risk Factors, Cohort Studies, Proportional Hazards Models

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