{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T22:38:33Z","timestamp":1765233513771,"version":"3.41.2"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T00:00:00Z","timestamp":1682553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the relationship between antibiotic exposure and asthma in adults in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. A total of 51,124 participants were included, excluding those who were aged &amp;lt;\u200920\u2009years, female participants who were pregnant, and individuals who did not complete the prescription medications questionnaire and the medical conditions questionnaire regarding asthma status. Antibiotic exposure was defined as the utilization of antibiotics within the past 30\u2009days, categorized based on the Multum Lexicon Plus therapeutic classification system. Asthma was defined as having a history of asthma or having an asthma attack or wheezing symptoms in the past year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The risk of asthma was found to be 2.557 (95% CI: 1.811, 3.612), 1.547 (95% CI: 1.190, 2.011) and 2.053 (95% CI: 1.344, 3.137) times greater in participants who had used macrolide derivatives, penicillin and quinolones in the past 30\u2009days, respectively, compared with those not using antibiotics. After adjusting for demographic covariates and asthma-related factors, only macrolides derivatives were significantly associated with asthma in the 20\u201340 and 40\u201360 age groups. For individuals over 60\u2009years old, quinolones were significantly associated with asthma. The effect of different types of antibiotic with asthma varied in male and female populations. Moreover, higher socioeconomic status, greater BMI, younger age, smoking habits, history of infection, chronic bronchitis, emphysema, and family history of asthma were all identified as risk factors for asthma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our study indicated that three types of antibiotics were significantly associated with asthma in different subgroups of the population. Therefore, the use of antibiotics should be more strictly regulated.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1123555","type":"journal-article","created":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T12:32:04Z","timestamp":1682598724000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Relationships between antibiotic exposure and asthma in adults in the United States: results of the National Health and Nutrition Examination Survey between 1999 and 2018"],"prefix":"10.3389","volume":"11","author":[{"given":"Shaoli","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feilong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunlei","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guimin","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yijing","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongqing","family":"Hou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenqian","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junting","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.5334\/aogh.2412","article-title":"The global impact of asthma in adult populations","volume":"85","author":"Enilari","year":"2019","journal-title":"Ann Glob Health"},{"volume-title":"Asthma: Most Recent National Asthma Data","year":"2021","key":"ref2"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1111\/cea.13999","article-title":"Evidence for causal associations between prenatal and postnatal antibiotic exposure and asthma in children, England","volume":"51","author":"Souza da Cunha","year":"2021","journal-title":"Clin Exp Allergy"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1702070","DOI":"10.1183\/13993003.02070-2017","article-title":"Prenatal antibiotic exposure and childhood asthma: a population-based study","volume":"52","author":"Loewen","year":"2018","journal-title":"Eur Respir J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1038\/s41577-020-00420-y","article-title":"Early life microbial exposures and allergy risks: opportunities for prevention","volume":"21","author":"Renz","year":"2021","journal-title":"Nat Rev Immunol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1186\/s12887-016-0724-5","article-title":"A comparison of intestinal microbiota in a population of low-risk infants exposed and not exposed to intrapartum antibiotics: the Baby & Microbiota of the intestine cohort study protocol","volume":"16","author":"Simioni","year":"2016","journal-title":"BMC Pediatr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1001\/jamapediatrics.2019.4794","article-title":"Association between use of multiple classes of antibiotic in infancy and allergic disease in childhood","volume":"174","author":"Zven","year":"2020","journal-title":"JAMA Pediatr"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e180315","DOI":"10.1001\/jamapediatrics.2018.0315","article-title":"Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood","volume":"172","author":"Mitre","year":"2018","journal-title":"JAMA Pediatr"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1016\/j.trsl.2016.06.010","article-title":"The infant gut bacterial microbiota and risk of pediatric asthma and allergic diseases","volume":"179","author":"Johnson","year":"2017","journal-title":"Transl Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1111\/pai.12614","article-title":"Neonatal antibiotics in preterm infants and allergic disorders later in life","volume":"27","author":"Carstens","year":"2016","journal-title":"Pediatr Allergy Immunol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.mayocp.2020.07.019","article-title":"Association of infant antibiotic exposure with childhood health outcomes","volume":"96","author":"Aversa","year":"2021","journal-title":"Mayo Clin Proc"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1093\/cid\/ciaa262","article-title":"Antibiotic treatments during infancy, changes in nasal microbiota, and asthma development: population-based cohort study","volume":"72","author":"Toivonen","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e03335","DOI":"10.1128\/mBio.03335-20","article-title":"An antibiotic-impacted microbiota compromises the development of colonic regulatory T cells and predisposes to dysregulated immune responses","volume":"12","author":"Zhang","year":"2021","journal-title":"MBio"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1016\/S2213-2600(20)30052-7","article-title":"Decreasing antibiotic use, the gut microbiota, and asthma incidence in children: evidence from population-based and prospective cohort studies","volume":"8","author":"Patrick","year":"2020","journal-title":"Lancet Respir Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/19490976.2020.1870402","article-title":"Association between antibiotics and gut microbiome dysbiosis in children: systematic review and meta-analysis","volume":"13","author":"McDonnell","year":"2021","journal-title":"Gut Microbes"},{"year":"2002","key":"ref16"},{"key":"ref17","first-page":"1","article-title":"National health and nutrition examination survey: plan and operations, 1999-2010","volume":"56","author":"Zipf","year":"2013","journal-title":"Vital Health Stat Ser 1, Programs Collect Proced"},{"year":"2021","key":"ref18"},{"year":"2021","key":"ref19"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"e43214","DOI":"10.1371\/journal.pone.0043214","article-title":"Does pet ownership in infancy lead to asthma or allergy at school age? Pooled analysis of individual participant data from 11 European birth cohorts","volume":"7","author":"L\u00f8drup Carlsen","year":"2012","journal-title":"PLoS One"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"11938","DOI":"10.3390\/ijerph182211938","article-title":"Nutrient and food group intakes among U.S. children (2-5 years) differ by family income to poverty ratio, NHANES 2011-2018","volume":"18","author":"Fadeyev","year":"2021","journal-title":"Int J Environ Res Public Health"},{"volume-title":"Poverty Guidelines, Research, and Measurement","year":"2022","key":"ref22"},{"year":"2022","key":"ref23"},{"key":"ref24","first-page":"1","article-title":"National Center for Health Statistics guidelines for analysis of trends","volume":"179","author":"Ingram","year":"2018","journal-title":"Vital Health Stat Ser 2, Data Eval Meth Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1007\/s00281-019-00775-y","article-title":"Dysbiosis of the gut and lung microbiome has a role in asthma","volume":"42","author":"Hufnagl","year":"2020","journal-title":"Semin Immunopathol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1028209","DOI":"10.3389\/fimmu.2022.1028209","article-title":"Microbial dysbiosis and childhood asthma development: integrated role of the airway and gut microbiome, environmental exposures, and host metabolic and immune response","volume":"13","author":"Liu","year":"2022","journal-title":"Front Immunol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1016\/S2213-2600(20)30002-3","article-title":"Can perturbations in microbial maturation cause asthma?","volume":"8","author":"Stokholm","year":"2020","journal-title":"Lancet Respir Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1016\/j.it.2018.02.008","article-title":"Antibiotics as instigators of microbial Dysbiosis: implications for asthma and allergy","volume":"39","author":"Wypych","year":"2018","journal-title":"Trends Immunol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e1007260","DOI":"10.1371\/journal.ppat.1007260","article-title":"Expansion of commensal fungus Wallemia mellicola in the gastrointestinal mycobiota enhances the severity of allergic airway disease in mice","volume":"14","author":"Skalski","year":"2018","journal-title":"PLoS Pathog"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2071","DOI":"10.18632\/aging.101901","article-title":"Early-life vancomycin treatment promotes airway inflammation and impairs microbiome homeostasis","volume":"11","author":"Yang","year":"2019","journal-title":"Aging (Albany NY)"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1016\/S0140-6736(17)31281-3","article-title":"Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial","volume":"390","author":"Gibson","year":"2017","journal-title":"Lancet"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(17)31547-7","article-title":"Azithromycin in uncontrolled asthma","volume":"390","author":"Brusselle","year":"2017","journal-title":"Lancet"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"JC42","DOI":"10.7326\/ACPJC-2017-167-8-042","article-title":"Azithromycin reduced exacerbations and improved QoL in symptomatic asthma despite inhaled maintenance therapy","volume":"167","author":"Stanbrook","year":"2017","journal-title":"Ann Intern Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/S0140-6736(17)33318-4","article-title":"How does azithromycin improve asthma exacerbations?","volume":"391","author":"Crooks","year":"2018","journal-title":"Lancet"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1164\/rccm.201809-1739OC","article-title":"Long-term azithromycin reduces Haemophilus influenzae and increases antibiotic resistance in severe asthma","volume":"200","author":"Taylor","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1128\/AAC.02067-13","article-title":"Meta-analysis of the adverse effects of long-term azithromycin use in patients with chronic lung diseases","volume":"58","author":"Li","year":"2014","journal-title":"Antimicrob Agents Chemother"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1007\/s12016-014-8435-x","article-title":"Infection in severe asthma exacerbations and critical asthma syndrome","volume":"48","author":"Sandrock","year":"2015","journal-title":"Clin Rev Allergy Immunol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1586\/ers.09.60","article-title":"Role of infection in the development and exacerbation of asthma","volume":"4","author":"Guilbert","year":"2010","journal-title":"Expert Rev Respir Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1722","DOI":"10.1111\/j.1398-9995.2009.02208.x","article-title":"Linkage between smoking and asthma","volume":"64","author":"Pietinalho","year":"2009","journal-title":"Allergy"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1093\/cid\/ciaa085","article-title":"Dose, timing, and Spectrum of prenatal antibiotic exposure and risk of childhood asthma","volume":"72","author":"Turi","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"5649","DOI":"10.1073\/pnas.1503141112","article-title":"Global trends in antimicrobial use in food animals","volume":"112","author":"Van Boeckel","year":"2015","journal-title":"Proc Natl Acad Sci U S A"},{"key":"ref42","doi-asserted-by":"publisher","DOI":"10.1126\/science.aaw1944","article-title":"Global trends in antimicrobial resistance in animals in low-and middle-income countries","volume":"365","author":"Van Boeckel","year":"2019","journal-title":"Science"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"153859","DOI":"10.1016\/j.scitotenv.2022.153859","article-title":"Environmental antibiotics exposure in school-age children in Shanghai and health risk assessment: a population-based representative investigation","volume":"824","author":"Zhang","year":"2022","journal-title":"Sci Total Environ"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1007\/s10661-021-08887-5","article-title":"Contamination, distribution, and risk assessment of antibiotics in the urban surface water of the Pearl River in Guangzhou, South China","volume":"193","author":"Wang","year":"2021","journal-title":"Environ Monit Assess"},{"key":"ref45","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1001\/jama.1997.03550220061010","article-title":"Asthma","volume":"278","author":"Lemanske","year":"1997","journal-title":"JAMA"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1007\/s12016-019-08736-x","article-title":"The impact of environmental chronic and toxic stress on asthma","volume":"57","author":"Barnthouse","year":"2019","journal-title":"Clin Rev Allergy Immunol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"2412","DOI":"10.3390\/ijms22052412","article-title":"Genetics and epigenetics in asthma","volume":"22","author":"Ntontsi","year":"2021","journal-title":"Int J Mol Sci"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1123555\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T12:32:11Z","timestamp":1682598731000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1123555\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,27]]},"references-count":47,"alternative-id":["10.3389\/fpubh.2023.1123555"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1123555","relation":{},"ISSN":["2296-2565"],"issn-type":[{"type":"electronic","value":"2296-2565"}],"subject":[],"published":{"date-parts":[[2023,4,27]]},"article-number":"1123555"}}