Urinary leukotriene E4 levels in atopic and non-atopic preschool children with recurrent episodic (viral) wheezing: a potential marker?

Backround: Reliable biological markers for the differentiation of asthma phenotypes in preschool children with wheezing are lacking. The purpose of the study is to assess the relationship of urinary Leukotriene E4 (U-LTE4) to particular asthma phenotypes in preschool children with recurrent episodic (viral) wheezing following upper respiratory tract infections with or without atopic predisposition. Methods: Ninety-six preschool patients with recurrent episodic wheezing participated, 52 atopic and 44 non-atopic, during exacerbation and in remission. Exacerbation was defined on clinical basis (wheeze in the presence of coryzal symptoms). Atopy was determined by specific serum IgE measurement and skin-prick testing. U-LTE4 was determined by enzyme immunoassay. Thirty-six age-matched, non-asthmatic, non-atopic children served as controls. Results: During exacerbation, U-LTE4 was significantly higher in all children with recurrent episodic wheezing in comparison to A: Remission: 642.20?±?268 versus 399.45?±?204, p value <0.001 and B: Controls: 642.20?±?268 versus 271.39?±?83, p value <0.001. Atopic patients demonstrated significantly higher levels of U-LTE4 compared to non-atopic, both during exacerbation 872.13?±?246 versus 613.15?±?150, p value?=?0.0013 and during remission 507.59?±?182 versus 283.59?±?160, p value <0.001. During remission, a highly significant difference of U-LTE4 was found when controls were compared to atopic patients: 271.39?±?83 versus 507.59?±?182, p value?=?0.002 but not when compared to non-atopic ones: 271.39?±?83 versus 283.59?±?160, p value?=?0.432. Conclusion: U-LTE4 is strongly associated with the acute wheeze episode in preschool children, more so in atopics. Increased basal levels of U-LTE4 occur only in atopics. This suggests a potential role of U-LTE4 as a marker of atopic, virus-induced asthma in preschool children.     

Outpatient pulmonary rehabilitation for severe asthma with fixed airway obstruction: Comparison with COPD

Background: The benefit of exercise has been demonstrated in asthma, but the role of pulmonary rehabilitation (PR) in people with severe asthma, especially with airway obstruction, has been less investigated. The activity limitation mechanisms differ in asthma and COPD, so the effect of a PR program not specific to asthma is unclear. Methods: We retrospectively compared the effect of an ambulatory PR program in nonsmoking patients with severe asthma and airway obstruction (FEV1/FVC ratio <70% and FEV1?<?80% measured twice, not under an exacerbation) and sex-, age-, FEV1-, and BMI-matched COPD controls. Results: We included 29 patients, each with asthma and COPD. Airway obstruction was moderate (median FEV1 57% [44–64]). VO₂ at peak was higher for asthma than COPD patients (19.0 [15.7–22.2] vs 16.1 [15.3–19.6] ml.min^?1.kg^?1, p?=?0.05). After PR, asthma and COPD groups showed a significant and similar increase in constant work cycling test of 378 [114–831] s and 377 [246–702] s. Changes in Hospital Anxiety and Depression Scale (HAD) total score were similar (–2.5 [–7.0 to 0.0] vs –2.0 [–5.0 to 2.0], p?>?0.05). Quality of life on the St. George’s Respiratory Questionnaire (SGRQ) was significantly improved in both groups (–14.0 [–17.7 to –2.0], p?<?0.005 and –8.3 [–13.0 to –3.6], p?<?0.0001). Conclusion: Outpatient PR is feasible and well tolerated in patients with severe asthma with fixed airway obstruction. A nondedicated program strongly improves HAD and SGRQ scores and constant work-rate sub-maximal cycling, with similar amplitude as with COPD.     

Lung-volume controlled computerised tomography in real-life acute severe asthma

Objective: It is not known how airway structure is altered during real-life acute asthma exacerbations. The aim of this study was to examine changes in airway structure during acute asthma exacerbations and at convalescence by using lung-volume controlled high resolution computerised tomography (HRCT). Methods: Eight subjects with acute asthma exacerbation admitted to hospital were recruited. HRCT was performed within 72?h of admission (n?=?8) and repeated after 8 weeks of convalescence (n?=?7). Individual airways were carefully matched on acute and convalescent CT data sets for comparisons of airway parameters. A novel methodology was employed for standardisation of lung volumes to permit valid comparisons of lung imaging. Measurements of bronchial cross sectional airway area (Aa) and bronchial luminal area (Ai)?for each matched airway were obtained using a validated program. Results: The airway wall thickness was analysed as wall area (WA) calculated as a percentage: WA%?=?WA/Aa?×?100. Wilcoxon signed-rank testing was used to compare acute and convalescent asthma and Spearman’s correlation to examine associations. Airway lumen (Ai) areas were similar in both acute and stable asthma phases (6.6?±?3.1?mm² versus 7.2?±?3.8?mm² p?=?0.8). However, the airway wall was significantly thickened during acute asthma exacerbations compared to convalescence (62?±?4% versus 55?±?7%; p?=?0.01). There was no correlation between airway structure dimensions and lung function measurements. Conclusions: This is the first study to demonstrate an increase in airway wall thickness during real-life acute asthma exacerbation. However, narrowing of the airway lumen area was variable and will require larger studies able to detect small differences. These results suggest that airway wall thickening linked to mucosal inflammation is likely to characterise acute asthma in vivo but that changes in the airway lumen accompanying bronchoconstriction may be more heterogeneous.     

The influence of hospitalizations due to exacerbations or spontaneous pneumothoraxes on the quality of life,mental function and symptoms of depression and anxiety in patients with COPD or asthma

Background: Patients with bronchial asthma or chronic obstructive pulmonary disease (COPD) frequently have a low quality of life (QoL) in addition to depression symptoms. The aim of this study was to compare the QoL, depression symptoms, mental function and anxiety in patients with asthma or COPD exacerbations or spontaneous pneumothoraxes (SP) to patients with stable disease. Materials and methods: Patients with a confirmed diagnosis of severe (III degree) bronchial asthma or COPD were included in this study. Prospective observations of asthma or COPD exacerbations or SP were performed over a three-year period. QoL was assessed using St. George’s Respiratory Questionnaire (SGRQ). In addition, the AQ20 questionnaire (AQ20), the Hospital Anxiety and Depression Scale (HADS) and the Mini-Mental State Examination (MMSE) were administered. Results: A total of 233 patients (112 with asthma and 121 with COPD; mean age 57.9?±?11.9 years) were included in the study. Patients with COPD or asthma had a low QoL as estimated by the SGRQ (mean?±?SD: 27.5?±?12.9 and 25.1?±?10.2 for asthma and COPD, respectively). Asthma exacerbations, COPD exacerbations or SP requiring hospitalization were associated with lower SGRQ scores over the three-year observation period (41.5?±?11.7, 57.9?±?14.3 and 65.3?±?11.4, respectively). The mean MMSE score significantly decreased after an asthma exacerbation compared to the baseline (29.9?±?2.1 versus 27.2?±?3.1; p?p?p?Conclusion: Low QoL and mental impairment were observed in patients with asthma and COPD. In addition, the QoL significantly decreased following hospitalizations due to exacerbations or SP.     

Cardiorespiratory and sensory responses to exercise in well-controlled asthmatics

Objectives: The purpose of this study was to evaluate detailed ventilatory, cardiovascular and sensory responses to cycle exercise in sedentary patients with well-controlled asthma and healthy controls. Methods: Subjects included sedentary patients meeting criteria for well-controlled asthma (n?=?14), and healthy age- and activity-matched controls (n?=?14). Visit 1 included screening for eligibility, medical history, anthropometrics, physical activity assessment, and pre- and post-bronchodilator spirometry. Visit 2 included spirometry and a symptom limited incremental cycle exercise test. Detailed ventilatory, cardiovascular and sensory responses were measured at rest and throughout exercise. Results: Asthmatics and controls were well matched for age, body mass index and physical activity levels. Baseline forced expiratory volume in 1?second (FEV₁) was similar between asthmatics and controls (98?±?10 versus 95?±?9% predicted, respectively, p?>?0.05). No significant differences were observed between asthmatics and controls for maximal oxygen uptake (31.8?±?5.6 versus 30.6?±?5.9?ml/kg/min, respectively, p?>?0.05) and power output (134?±?35 versus 144?±?32?W, respectively, p?>?0.05). Minute ventilation (V_E) relative to maximum voluntary ventilation (V_E/MVV) was similar between groups at maximal exercise with no subjects showing evidence of ventilatory limitation. Asthmatics and controls achieved similar age-predicted maximum heart rates (92?±?7 versus 93?±?8% predicted, respectively, p?>?0.05). Ratings of perceived breathing discomfort and leg fatigue were not different between groups throughout exercise. Conclusions: The results of this study indicate that sedentary patients with well-controlled asthma have preserved sensory and cardiorespiratory responses to exercise with no evidence of exercise impairment or ventilatory limitation.     

The impact of concomitant allergic rhinitis on asthma control: a cross-sectional nationwide survey in China

Objectives: Understanding the interactions between allergic rhinitis (AR) and asthma is important for asthma management. This study explored the clinical features of AR as a comorbidity in Chinese asthmatic patients and its impact on asthma control. Methods: This cross-sectional survey was conducted among 20?051 patients with asthma in an out-patient setting and covered all of the territories of China. The patients were interviewed face-to-face. A standardized questionnaire was completed by each patient. AR was defined according to the ARIA criteria. The level of asthma control was assessed by the Asthma Control Test. A score ≤19 indicated poorly controlled asthma. Results: AR was present in 69.9% of patients with asthma. Of them, 72.4% had intermittent symptoms, and 93.1% presented with moderate/severe symptoms. Cold air, irritant air and household mites were the most common triggers for AR. A higher percentage of patients with AR experienced poorly controlled asthma compared with those without AR (56.2% versus 51.5%, p?p?p?p?p?=?0.004) and a prior skin prick test (OR: 0.90, p?=?0.003) showed a significantly negative association with poorly controlled asthma. Conclusion: This study confirms that concomitant AR and asthma are highly prevalent in China and that AR is associated with poor asthma control.     

Correlation of TSLP,IL-33, and CD4 + CD25 + FOXP3 + T regulatory (Treg) in pediatric asthma

Objective: Newly discovered cytokines TSLP and IL33 are being studied as important indicators of Th2 inflammation and their effect on Treg cells is likely to modulate immune response. We attempted to study TSLP and IL-33 and then correlated with Tregs in order to find possible biomarker in these patients. Methods: Sixty-five children (37 with asthma only and 28 with asthma and rhinitis) aged 6.4?±?3.2 years (patient group) and 15 healthy children aged 8.0?±?2.6 years (control group) were recruited in this study. In vitro analysis of TSLP and IL-33 was done in serum samples of 65 newly diagnosed children for allergic asthma and 15 healthy children using the sandwich ELISA method. The expression of Treg cells (CD4?+?CD25?+?FOXP3+) was analyzed by flow cytometry. Results: The mean TSLP in the patient group (592?±?68?pg/ml) was significantly higher than controls (215?±?45?pg/ml) (p?<?0.05). Alternatively, the expression of FOXP3?+?T reg cells was significantly lower in the patient group (52?±?36) compared with the controls (95.9?±?3.6) (p?=?0.003). IL-33 was also significantly higher (4044?±?413?pg/ml) in the patient group compared with the controls (3282?±?331.5?pg/ml) (p?=?0.0001). The expression of Treg cells was negatively correlated with the TSLP (r?=??0.23, p?=?0.07). Asthma control test (ACT) was also negatively correlated with TSLP in the patient group (r?=??0.14, p?>?0.05). Conclusion: Children with asthma show elevated serum levels of TSLP, which correlated negatively with asthma control test and Treg cells. TSLP may be used as a biomarker for inflammation in pediatric asthma patients.     

The Improvement of Cognitive Functions in Patients with Bronchial Asthma after Therapy

Background. The severity of asthma in older people is frequently underestimated because of underdiagnosis and undertreatment. There are a number of reasons for this. In elderly patients, chronic diseases can be related to declining cognitive function. This situation could influence diagnosis and treatment. The objective of this study was to evaluate the influence of appropriate asthma therapy on cognitive function. Methods. A total of 359 participants diagnosed with bronchial asthma, 219 women and 140 men with a mean age of 69?±?4.03 years, were included in this study. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) at the beginning of this study and after 1 year. Patients were divided into three subgroups based on their initial MMSE scores dementia, mild cognitive impairment (MCI), and good cognition. Results. At the beginning of this study, 31.2% of patients presented uncontrolled asthma, 46.2% exhibited partly controlled asthma, and 25.1% had well-controlled asthma. A significant improvement in control over the patients' asthma was observed over the course of this study. After 1 year of treatment, the mean MMSE score significantly increased in initially demented patients, from 18.2?±?3.1 (mean?±?SD) to 21.9?±?2.1 (p < .01); in subjects with MCI, from 25.4?±?0.9 to 27.2?±?1.2; and in patients with good cognition, from 27.4?±?0.7 to 29.7?±?0.4 (chi-square test, p < .01). Conclusion. Proper control of asthma in patients with cognitive impairments can improve some cognitive functions.     

Prevalence of bronchoconstriction induced by eucapnic voluntary hyperpnoea in recreationally active individuals

Objective: Exercise-induced bronchoconstriction (EIB) is more prevalent in elite athletes than in the general population. Many of these athletes provide a positive eucapnic voluntary hyperpnoea (EVH) challenge without previous diagnosis of EIB. It is unknown whether this is specific to elite athletes or whether the same risk applies to recreationally active individuals. The purpose of this study was to investigate the prevalence of a positive EVH challenge in a population of recreationally active individuals. Methods: 136 recreationally active individuals (Age: 21.9?±?3.7 years; Height: 175?±?9?cm; Weight: 70.9?±?10.0?kg) without previous history of asthma or EIB, volunteered to take part in the study. All participants completed an EVH challenge, which was deemed positive if FEV₁ fell ≥10% from baseline at two consecutive time points, and was reversible following inhalation of a short acting β₂-agonist. Results: 18 of 136 (13.2%) participants had a positive EVH challenge. Of the 18 individuals, the fall in FEV₁ from baseline ranged from ?12% to ?50%. At baseline, percentage predicted FEV₁ (97.5?±?12.5% versus 104.9?±?10%; p?1/FVC ratio (79.5?±?6.9% versus 87.8?±?5.5%; p?25-75 (3.73?±?1.00 versus 4.73?±?1.00?l/s; p?p?Conclusions: Overall, 13.2% of recreationally active individuals with no previous history of asthma presented with a positive EVH challenge. Individuals who are recreationally active may benefit from an objective bronchial provocation challenge, given that self-reported symptoms alone only provide a supportive role towards a valid EIB diagnosis.     

Long-term efficacy and safety of bronchial thermoplasty in patients with moderate-to-severe persistent asthma: a systemic review and meta-analysis

Objective: To evaluate the long-term efficacy and safety of bronchial thermoplasty (BT) in the treatment of patients with moderate-to-severe persistent asthma. Methods: We therefore performed a systematic literature review of peer-reviewed studies focusing on BT intervention in asthma control published between January 2000 and June 2014. Three randomized controlled studies and extension studies met the inclusion criteria (n?=?6). Outcomes assessed after BT included spirometric data, adverse respiratory events, emergency room (ER) visits and hospitalization for respiratory illness. One-year and 5-year follow-up data were defined as V1 and V5, respectively. Results: There were 249 BT-treated subjects in total who had a 1-year follow-up (V1), whereas 216 of them finished a 5-year follow-up (V5). No evidence of significant decline was found in pre-bronchodilator FEV₁ (% predicted) (WMD?=?0.75; 95% CI: 3.36 to 1.85; p?=?0.57), or in post-bronchodilator FEV₁ (% predicted) (WMD?=?0.62; 95% CI: 3.32 to 2.08; p?=?0.65) between V1 and V5. In addition, the frequency of respiratory adverse events was reduced significantly during the follow-up (RR?=?3.41, 95% CI: 2.96–3.93, p?<?0.00001). The number of ER visits for adverse respiratory events remained unchanged (RR?=?1.06, 95% CI: 0.77–1.46, p?=?0.71) after BT treatment. There was no statistically significant increase in the incidence of hospitalization for respiratory adverse events (V5 vs. V1, RR?=?1.47, 95% CI: 0.69–3.12, p?=?0.32). Conclusions: These data demonstrate long-term benefits of BT with regard to both asthma control and safety for moderate-to-severe asthmatic patients.     

Children with untreated coeliac disease have sub-clinical cardiac dysfunction: a longitudinal observational analysis

Introduction: We assessed cardiac function (CF) in celiac disease (CD) patients and the effect of gluten-free diet (GFD) on CF.

Methods: Prospective evaluation of CF using conventional and tissue doppler echocardiography in 50 CD patients (age 4.2?±?1.1 years) at diagnosis and after a year of GFD (group 1), 100 CD children (group 2; 47 compliant and 53 non-compliant) in follow-up and 25 healthy controls.

Results: Untreated CD (n?=?50) children had larger left ventricle end diastolic dimension (35.33?±?0.87 vs. 32.90?±?0.91 mm; p?=?.04), reduced (<55%) left ventricular ejection fraction (20% vs. 0%; p?=?.01) and a higher (>0.6) myocardial performance index (MPI, 66% vs. 0%; p ≤ .01) as compared to controls. Re-evaluation after one year with good dietary compliance showed changes in isovolumic relaxation time (72.5?±?4.2 vs. 50.62?±?2.69; p?=?.0001) and deceleration time (121.05?±?10.1 vs. 99.87?±?8.5; p?=?.02), reflecting improved cardiac diastolic function. GFD compliant patients had lower MPI than non-compliant (0.60?±?.03 vs. 0.66?±?.08; p?=?.04), reflecting improvement in load-independent echocardiographic parameters.

Conclusions: Subclinical cardiac dysfunction is common in CD children at diagnosis. Improvement

in echocardiographic parameters occurs with GFD and non-compliant children continue to have

persistent cardiac dysfunction.     

The effectiveness of an indoor intermittent training program for improving lung function,physical capacity,body composition and quality of life in children with asthma

Objective: The objective of this study is to analyze the effects of a 12-week indoor intermittent training program on lung function, physical capacity, body composition and quality of life in children with asthma. Methods: Participants were randomized in an experimental group (EG, 58 children, age?=?11.55?±?1.01 years) and in a control group (CG, 47 children, age?=?11.51?±?1.42 years). The training program was conducted indoors and consisted of alternating high- and low-intensity stimuli, for three sessions of 60?min/week, for 12 weeks. Physical exercise and sports activities were organized to follow the criteria of the American College of Sports Medicine (1999) and previous interventions’ studies. Results: In EG, there was a significant improvement (p?p?Conclusions: An indoor intermittent training program with these characteristics has improved lung function, physical capacity, body composition and quality of life in children with asthma. These training adaptations are particularly relevant for those patients suffering from asthma as a regular physical exercise routine will greatly improve their quality of life.     

Benefits of completing pulmonary rehabilitation in patients with asthma

Background: Asthma affects 30 million Americans and results in reduced productivity and quality of life. Pulmonary rehabilitation (PR) is known to improve physical conditioning and exercise performance in chronic lung diseases such as COPD, however, few studies have examined its benefits in patients with asthma. We aimed to determine the benefits of PR in this population as well as the predictors of completion of therapy. Methods: We performed a retrospective review of data from patients with a diagnosis of asthma who participated in PR at our institution from 1996 to 2013. Nine hundred and nineteen patients participated in the program of whom 75 were referred with a primary diagnosis of asthma. Patients underwent physiologic testing and their symptoms and quality of life were assessed using validated questionnaires. For patients who completed PR (n?=?37), data obtained at the initial and exit visit was compared. Characteristics of completers were compared to non-completers to determine predictors of successful completion. Results: Individuals with asthma completing PR had improvement from baseline to exit visit in Six Minute Walk Distance (326 vs. 390 feet; p?<?0.0001), decreased body mass index (33 vs. 32?kg/m²; p?<?0.046), decreased Beck Depression Inventory scores (15 vs. 9; p?<?0.0009), and increased Short Form-36 scores (345 vs. 445; p?=?0.0005). In a multivariate logistic regression analysis, lower depression scores predicted completion (OR 1.08, 95% CI 1.02–1.15, p?=?0.02). Conclusion: Patients with asthma who completed PR had improvement in physical function and emotional well-being. Depression is a risk factor for non-completion of PR. Further research is needed to determine which patients will benefit most from therapy.     

Lower esophageal sphincter pressures in patients of bronchial asthma and its correlation with spirometric parameters: a case-control study

Objectives: The cause–effect relationship between bronchial asthma and gastro-esophageal reflux (GER) is known, but studies have not been able to confirm the improvement of lung function with anti-acid therapy. Hypotensive lower esophageal sphincter (LES) may lead to both acid and non-acid reflux, resulting in asthma symptoms and decreased lung function. The objectives of our study were, firstly, to compare basal LES pressure between adult patients of asthma and normal controls and, secondly, to correlate the basal LES pressure with spirometric parameters in these patients. Methods: Thirty patients, aged between 18 and 65 years, diagnosed as cases of bronchial asthma and 27 healthy controls were included in the study. All the participants were subjected to esophageal manometry after overnight fasting and basal LES pressures were recorded. Then, spirometry was done 2?h after meal and pre- and post-bronchodilator FEV₁, FVC, PEFR were obtained for the asthma group. Results and conclusions: There is significant difference between basal LES pressure in patients of bronchial asthma and control population (8.70?±?2.67?mmHg versus 16.64?±?5.52, p?<?0.0001). 66.67% of the asthma patients have reduced LES pressures (<10?mmHg). The correlation coefficient between basal LES pressure and prebronchodilator FEV₁% predicted is 0.596 (p?<?0.0001, 95% CI 0.3002–0.7872). Obstructive airway impairment in adult patients of bronchial asthma is associated with hypotensive LES. GER, due to hypotensive LES may contribute to deterioration of spirometric parameters in asthma patients.     

High Flow Nasal Therapy Use in Patients with Acute Exacerbation of COPD and Bronchiectasis: A Feasibility Study

Abstract

The efficacy and feasibility of high flow nasal therapy (HFNT) use in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and bronchiectasis is unknown. We performed a single-center, single-arm prospective observational study in patients with AECOPD, documented bronchiectasis, pH ≥ 7.35, respiratory rate (RR) ≥ 26 breaths/minute despite receiving maximal medical treatment and oxygen via face mask up to 10?L/m. Patients received HFNT (Airvo 2, Fisher & Paykel) at a gas flow of 50?L/min and FIO₂ adjusted to maintain SpO₂ ≥92%. Dyspnea, rated by Borg scale, RR, arterial blood gases and mucus production (ranging from 1 to 3) were collected before and 1?h after starting HFNT and then every 24?h for 3?days. Tolerance was measured using a visual analogic scale (VAS). Fifteen patients were enrolled. After 24?h, patients showed a significant improvement in dyspnea score [Borg scale from 6.7?±?1.4 to 4.1?±?1.3 (p<.001)]; RR decreased from 29.6?±?2.7?breaths/min to 23.2?±?2.9?breaths/min (p<.001); pCO2 significantly decreased after 24?h [58.4?±?13 vs. 51.7?±?8.2 (p=.003)] while quantity of mucus production increased [(1.1?±?0,6 vs. 2.4?±?0.7, p<.001)]. No patient received invasive or noninvasive mechanical ventilation. Overall VAS score for HFNT tolerance was 6.5. HFNT was effective in improving dyspnea score, decreasing RR, improving gas exchange, and increasing mucus production in patients with AECOPD and coexisting bronchiectasis. Moreover, no safety concerns on its use were detected. Nevertheless, due to the single-arm design, the effect of HFNT could not be isolated from standard pharmacological treatment due to the study design.     

Alteration in systemic markers of oxidative and antioxidative status in Tunisian patients with asthma: relationships with clinical severity and airflow limitation

Objective: This study aims to determine the systemic oxidant-antioxidant status in Tunisian patients with asthma. Methods: We evaluated the levels of malondialdehyde (MDA) as thiobarbituric acid complexes, total protein carbonyls (PCs) and advanced oxidation protein products (AOPP). The levels of total thiols, protein sulfhydryls, glutathione (GSH), together with hydrogen peroxide, ascorbic acid, iron and total antioxidant status (TAS) were colorimetrically estimated. Glutathione peroxidase (GSH-Px), catalase (CAT) and superoxide dismutase (SOD) activities were assessed in plasma and erythrocytes by spectrophotometry. We also determined the levels of nitric oxide (NO) and peroxynitrite in plasma from asthmatic patients and healthy controls. The volume of fractionated exhaled NO (Fe_NO) was evaluated by the Medisoft HypAir method. Estimation of DNA damage was determined using the comet assay. Results: Asthmatic patients showed increased levels of MDA in comparison to healthy controls (p?<?0.001), while no significant difference was found in protein carbonyls (p?=?0.79) and AOPP (p?=?0.98). Patients with asthma also had significantly lower levels of total thiols (355.9?±?15.72 versus 667.9?±?22.65, p?<?0.001), protein sulfhydryls (333.99?±?16.41 versus 591.95?±?24.28, p?<?0.001) and glutathione (p?<?0.001). They also showed decreased GSH-Px activity (p?<?0.001), whereas no significant differences in measurements of catalase and SOD enzyme activities were observed between the two groups (respectively, p?=?0.06 and p?=?0.55). In addition, ascorbic acid and nitric oxide levels were decreased in asthmatics in comparison to controls (p?<?0.01). Conclusions: Our findings highlight that oxidative stress and defective anti-oxidative status are major alterations in Tunisian patients with asthma.     

Hyperventilation in asthma: A validation study of the Nijmegen Questionnaire – NQ

Introduction: The Nijmegen questionnaire (NQ) has previously been used for screening the hyperventilation syndrome (HVS) in asthmatics. However, no validity study has been reported so far. Objective: To examine the validity and reliability of the NQ in asthma patients and identify the prevalence of HVS. Methods: The NQ (n?=?162) was examined for translation, construct, cross-sectional and discriminant validity as well as for internal consistency and test–retest reliability. Results: Principal component analysis and exploratory factor analysis revealed a single factor solution with 11 items and 58.6% of explained variability. These 11 NQ items showed high internal consistency (Cronbach's alpha?=?0.92) and test–retest reliability (IR?=?0.98). Higher NQ scores were found in the following subgroups: women versus men (p?p?p?p?2 (ETCO₂) ≤35 versus >35?mmHg (p?17 discriminated the participants with regard to the presence of HVS. The NQ showed 92.73% sensitivity and 91.59% specificity. The total NQ score was found significantly correlated with ETCO₂ (r?=??0.68), RR (r?=?0.66) and BHT (r?=??0.65). The prevalence of HVS was found 34%. Conclusion: The NQ is a valid and reliable questionnaire for screening HVS in patients with stable mild-to-moderate asthma.     

Evaluation of inhaler technique,adherence to therapy and their effect on disease control among children with asthma using metered dose or dry powder inhalers

Objective: To address the problems about correct use of inhaler devices, adherence to inhaler corticosteroid treatment and the effects of these problems on the control of asthma. Methods: Children with asthma were evaluated for the correct use of inhaler devices and adherence to therapy using a questionnaire. Effect of these on control of asthma was defined. Results: A hundred and seventy-one patients and/or their families were interviewed. The mean age was 8.29?±?4.65 years (1–19) and 62.6% were male. Metered dose inhaler (MDI) with spacer was used by 119 (69.5%) patients and 52 (30.5%) used dry powder inhalers (DPIs). The devices were used correctly by 68.1% of patients using MDI and 34.6% of patients using DPI (p?<?0.001). The most common improper step was “breathe in from the spacer 5–6 times or 10?s” for MDI (24.4%) and “exhale to residual volume” for DPI (51.9%). Frequency of correct use was higher in patients trained 3 times (p?<?0.001). Asthma was controlled more frequently among correct users (p?<?0.001). Partial or poor adherence was showed 22.8% of patients. Patients with mothers who had lower educational status had higher frequency of incorrect use of inhaler device (p?=?0.007). Conclusion: It was found that asthma control was better among correct users. Repetitive training about using devices may contribute improving inhaler technique. Especially children whose mothers had low education level and patients using DPI should be evaluated more carefully.     

Patients’ beliefs and behaviors related to treatment adherence in patients with asthma requiring maintenance treatment in Asia

Objectives: To identify patients’ beliefs or behaviors related to treatment adherence and to assess association between asthma control and adherence in Asian patients with asthma. Methods: We conducted a cross-sectional observational study of adult patients with asthma from specialist clinics in six Asian countries. Patients who were deemed by their treating physicians to require a maintenance treatment with an inhaler for at least 1 year were recruited. Patients completed a 12-item questionnaire related to health beliefs and behaviors, the 8-item Morisky Medication Adherence Scale (MMAS-8), the Asthma Control Test (ACT?), and the Standardized Asthma Quality of Life Questionnaire (AQLQ-S). Results: Of the 1054 patients recruited, 99% were current users of inhaled corticosteroids. The mean ACT score was 20.0?±?4.5 and 64% had well-controlled asthma. The mean MMAS-8 score was 5.5?±?2.0 and 53% were adherent. Adherence was significantly associated with patients’ understanding of the disease and inhaler techniques, and with patients’ acceptance of inhaler medicines in terms of benefits, safety, convenience, and cost (p?p?=?0.001), “Taking medicines more than once a day is inconvenient” (p?=?0.002), and “Sometimes I skip my inhaler to use it over a longer period” (p?Conclusions: Our study showed that patients’ acceptance of the benefits, convenience and cost of inhaler medications have a significant impact on treatment adherence in the participating Asian countries.     

Factors influencing the levels of exhaled carbon monoxide in asthmatic children

Objective: Bronchial asthma is characterised by chronic airway inflammation commonly associated with increased oxidative stress. Exhaled carbon monoxide (eCO) levels could act as markers of both oxidative stress and allergic inflammation. We aimed to study eCO levels in asthmatics and detect the possible factors influencing them. Methods: We studied 241 asthmatic children and 75 healthy children. The differences in eCO levels among various asthmatic phenotypes and the correlations between eCO and other measured parameters (spirometric indices, Asthma Control Test score, exhaled nitric oxide, total IgE, blood eosinophils and marker of oxidative damage of proteins) were analysed. Results: Levels of eCO widely differed according to the selected characteristics of asthma. Asthmatics showed higher eCO concentrations than controls (1.44?±?0.12?ppm vs. 0.91?±?0.11?ppm, p?p?Conclusions: In a population of asthmatic children, eCO levels could be considered as a marker of both allergic inflammation and oxidative stress in the airways. Concomitant AR and asthma control were the most important factors affecting the levels of eCO in asthmatic children. However, our results do not support the use of routine eCO in the clinical practice.