The association of diet with respiratory symptoms and asthma in schoolchildren in Taipei, Taiwan.

This study aimed to evaluate the association of diet with respiratory symptoms and asthma in schoolchildren in Taipei, Taiwan. An in-class interview survey elicited experiences of asthma and respiratory symptoms and consumption frequencies of the major food categories in 2290 fifth graders. Respiratory symptoms surveyed included persistent cough, chest tightness, wheezing with cold, wheezing without cold, dyspnea-associated wheezing, and exercise-induced cough or wheezing. Results showed that the consumption of sweetened beverages had the strongest association with respiratory symptoms and was positively associated with six of the seven respiratory symptoms (all p < 0.05). The adjusted odds ratios (aOR) ranged from 1.05 (95% confidence interval (CI = 1.01-1.09) for exercise-induced cough to 1.09 (95% CI = 1.03-1.16) for wheezing without cold. Egg consumption was associated with 5 of the 7 respiratory symptoms. Consumptions of seafood, soy products, and fruits were each negatively associated with one of the seven respiratory symptoms (all p < 0.05). Consumption of seafood was negatively associated with physician-diagnosed asthma and consumptions of sweetened beverages and eggs were positively associated with suspected asthma (p < 0.05). In conclusion, the study suggests that diet is associated with the respiratory symptoms in schoolchildren in Taipei. Consumptions of sweetened beverages and eggs are associated with increased risk of respiratory symptoms and asthma whereas consumptions of soy products and fruits are associated with reduced risk of respiratory symptoms.     

The Association of Diet with Respiratory Symptoms and Asthma in Schoolchildren in Taipei,Taiwan

This study aimed to evaluate the association of diet with respiratory symptoms and asthma in schoolchildren in Taipei, Taiwan. An in-class interview survey elicited experiences of asthma and respiratory symptoms and consumption frequencies of the major food categories in 2290 fifth graders. Respiratory symptoms surveyed included persistent cough, chest tightness, wheezing with cold, wheezing without cold, dyspnea-associated wheezing, and exercise-induced cough or wheezing. Results showed that the consumption of sweetened beverages had the strongest association with respiratory symptoms and was positively associated with six of the seven respiratory symptoms (all p < 0.05). The adjusted odds ratios (aOR) ranged from 1.05 (95% confidence interval (CI = 1.01–1.09) for exercise-induced cough to 1.09 (95% CI = 1.03–1.16) for wheezing without cold. Egg consumption was associated with 5 of the 7 respiratory symptoms. Consumptions of seafood, soy products, and fruits were each negatively associated with one of the seven respiratory symptoms (all p < 0.05). Consumption of seafood was negatively associated with physician-diagnosed asthma and consumptions of sweetened beverages and eggs were positively associated with suspected asthma (p < 0.05). In conclusion, the study suggests that diet is associated with the respiratory symptoms in schoolchildren in Taipei. Consumptions of sweetened beverages and eggs are associated with increased risk of respiratory symptoms and asthma whereas consumptions of soy products and fruits are associated with reduced risk of respiratory symptoms.     

Vocal cord dysfunction in children and adolescents

Vocal cord dysfunction (VCD) is a nonorganic disorder of the larynx that involves unintentional paradoxical adduction of the vocal cords while breathing. The resultant symptoms can include dyspnea, chest tightness, cough, throat tightness, wheezing, or voice change. Most patients with VCD are female, and among adolescents and children, VCD tends to be triggered by exercise and is typically confused with exercise-induced asthma. Both gastroesophageal reflux disease (GERD) and psychiatric illness have been reported as having strong associations with VCD, although, to date, there is no evidence that either causes VCD. VCD often coexists with asthma, and should be suspected in any patient in whom asthma treatment fails. Confirming the diagnosis involves direct visualization of abnormal vocal cord motion, and this usually only occurs during symptoms. Adolescent athletes often require free running exercise challenge to reproduce their symptoms and confirm abnormal vocal cord motion laryngoscopically. The primary treatment for VCD involves a combination of patient education and speech therapy, and, in most cases, patients may resume their activities without significant limitation.     

Athleten, Asthma und Anstrengung

Exercise can provoke asthmatic symptoms, such as dyspnea, especially in children and adolescents with asthma with a prevalence of 40–90?%; however, asthma-like symptoms can also occur in athletes without an underlying asthma. To obtain a straightforward definition of exercise-provoked symptoms is was decided that the term exercise-induced asthma (EIA) covers the symptoms and signs of asthma, such as recurrent breathlessness, coughing, wheezing and chest tightness, whereas exercised-induced bronchoconstriction (EIB) describes an expiratory obstructive reaction in lung function after a standardized exercise test. In both conditions, the pathophysiology includes cooling of the airways, an increased loss of moisture from the respiratory tract and activation of inflammatory cells of the airways with a relevant release of mediators. This could in the long term, induce a chronic inflammatory response of the bronchi, which could be predominantly eosinophilic (allergic; early onset phenotype) or predominantly neutrophilic/eosinophic (irritative; late onset phenotype). Diagnosis of EIA or EIB must include a typical anamnesis in combination with a positive lung function testing due to exercise reaction or metacholine provocation. In some athletes, especially the late onset phenotype, a eucapnic hyperventilation test, a mannitol bronchial provocation or a field exercise test may be helpful. For participants of the Olympic Games from 1996 until 2006, a sport-specific incidence of up to 20?% among athletes applying inhaled β₂-agonists with a verified diagnosis of asthma were recognized with an emphasis on endurance disciplines. Clearly, before diagnosing EIA or EIB, differential diagnoses favoring vocal cord dysfunction, poor physical fitness or overtraining have to be considered. Adequate warm-up helps to reduce symptoms. Due to the inflammatory basis of the disease, inhaled corticosteroids and/or leucotrien receptor antagonists are considered useful drugs for long-term control and prevention. In addition inhaled β₂-agonists are effective drugs for immediate inhibition of bronchoconstriction. Further diagnostic evaluation has to be considered if adequate inhalative treatment does not control asthma symptoms. Anti-doping regulations have to be applied for competitive athletes.     

A population survey of respiratory symptoms in the elderly

Reversible airways obstruction is not uncommon in the elderly, but may be overlooked because of the high prevalence of other disorders with a similar presentation. In a search for patterns of symptoms which might predict treatable airways obstruction, we carried out a survey of men and women aged 65 yrs and over. Postal questionnaires were completed by 2,161 subjects selected at random from the lists of three general practices. Almost 60% of the sample complained of one or more respiratory symptoms. Smoking was a more important risk factor than age, sex or social class, and was associated particularly with wheeze, morning phlegm and chest tightness on waking. Several groups of symptoms tended to cluster in the same individuals. The two most closely related were chest tightness and breathlessness in response to animals, dust and feathers. Responses to irritants tended to cluster according to the symptom produced (cough, breathlessness or wheeze) rather than the provoking stimulus (smoke, cold air, household chemicals or traffic fumes). There was no evidence for the existence of the "bronchial irritability syndrome" which has been linked with asthma in younger adults. The relationship of symptoms to respiratory function and bronchial reactivity will be reported in a further publication.     

支气管哮喘患者与胃食管返流的症状相关性

目的　探讨胃食管返流 (GER)与成人中、重度支气管哮喘的症状相关性 ,了解 2 4h食管pH监测对哮喘合并GER的诊断价值及抗返流治疗对合并GER的哮喘患者症状的影响。方法　对 2 6例常规治疗后仍有顽固性咳嗽等症状的成人哮喘患者进行 2 4h食管pH监测 ,严格记录监测期间患者出现的各种症状 ,每小时记录 1次呼气峰流速 (PEF)。筛选出适当病例分组抗返流治疗并观察疗效。结果　 2 6例中有 15例DeMeester总积分≥ 14 72 ,2例虽DeMeester总积分 <14 72 ,但咳嗽与返流的症状相关概率 (SAP)≥ 95 % ,共筛选出 17例。将 17例患者随机分为治疗组 (9例 )和对照组 (8例 )。经抗返流治疗后 ,治疗组咳嗽、胸闷和胸骨后烧灼感等症状均较对照组有明显改善 ,2 4hPEF波动率治疗前 [(3 8± 8) % ]、后 [(16± 3 ) % ]比较差异有显著性 (P <0 0 5 )。结论　 (1)中、重度支气管哮喘患者具有较高的GER发生率 (5 8% )。 (2 ) 2 4h食管pH监测有助于了解哮喘患者的症状与GER的相关性。 (3 )对于有GER并与哮喘症状密切相关的患者 ,抗返流治疗可显著地改善其症状及PEF波动率     

Clinical diagnosis of current asthma: predictive value of respiratory symptoms in the SAPALDIA study. Swiss Study on Air Pollution and Lung Diseases in Adults.

Bronchial asthma is a very common disease which often remains underdiagnosed. The aim of this study was to determine the predictive value of the most common respiratory symptoms and to explore the best symptom combinations to predict diagnosis of asthma. A questionnaire comprising common respiratory symptoms was submitted to 9,651 subjects aged 18-60 yrs, randomly selected from the Swiss population, of whom 225 subjects (2.3%) had current asthma as confirmed by their general practitioner. Based on these data the authors calculated the predictive values of single symptoms and symptom combinations to diagnose asthma. Wheezing was the most sensitive single symptom (sensitivity 75%). Simple symptoms such as wheezing with dyspnoea, chronic phlegm or chronic cough had specificity greater than 95%. Wheezing with dyspnoea (WD) or nocturnal dyspnoea (ND) had the best positive predictive value (PPV) as isolated symptoms (24% and 21%, respectively). When combining symptoms, wheezing associated with daily dyspnoea at rest or nocturnal dyspnoea showed the best PPV (42% and 39%, respectively), almost double single symptoms such as WD or ND. Wheezing associated with at least two of the three nocturnal symptoms (nocturnal dyspnoea, nocturnal cough or nocturnal chest tightness) had a sensitivity of 80% to diagnose asthma. In conclusion, respiratory symptoms obtained by medical history are reliable predictors of asthma. The findings suggest that particular combinations of symptoms are clinically useful in the differential diagnosis of asthma.     

The role of nerves in asthma

Asthma is a syndrome characterized by reversible episodes of wheezing, cough, and sensations of chest tightness and breathlessness. These symptoms are secondary to changes in the activity of the nervous system. The mechanisms by which the nervous system is altered such that the symptoms of asthma occur have not yet been elucidated. Airway inflammation associated with asthma may affect neuronal activity at several points along the neural reflex pathway, in cluding the function of the primary afferent (sensory) nerves, integration within the central nervous system, synaptic transmission within autonomic ganglia, and transmission at the level of the postganglionic neuroeffector junction. We provide a brief overview of these interactions and the relevance they may have to asthma.     

A prospective study of asthma incidence and its predictors: the RHINE study.

The objective of this longitudinal study was to estimate the incidence rate of asthma, and to compare the incidence between subjects with or without baseline reporting of certain respiratory symptoms. A follow-up of the random population samples in the European Respiratory Health Survey (ECRHS) in Sweden, Norway, Denmark, Iceland and Estonia was conducted in 1999-2001, in a population aged 30-54 yrs at follow-up (n=14,731). Asthma was defined as reporting either asthma or physician-diagnosed asthma, and a reported year when asthma symptoms were first noticed. Incidence rates, incidence rate ratios and hazard ratios were calculated with 95% confidence intervals. The incidence rate of asthma was 2.2 cases per 1,000 person-yrs. The incidence was higher among females (2.9 cases.1,000 person-yrs(-1)) than among males (1.5 cases.1,000 person-yrs(-1)). When subjects with baseline reporting of wheezing were excluded, the incidence rate decreased to 1.7 cases.1,000 person-yrs(-1), with a further decrease to 1.5 cases.1,000 person-yrs(-1) after exclusion of subjects with wheezing, nocturnal dyspnoea, chest tightness and cough. There was a strong association between onset of asthma and wheezing at baseline. In this prospective, population-based study, the incidence rate of asthma in the whole population sample ranged 1.5-2.2.1,000 person-yrs(-1), with a higher incidence range among females. The incidence was dependent on the extent to which subjects with respiratory symptoms were excluded from follow-up. Hence, for comparability between studies, the exclusion criteria in the follow-up population must be stated.     

Swimming and asthma: factors underlying respiratory symptoms in competitive swimmers

Background: Swimming is recommended for asthmatics. However, many competitive swimmers report asthmatic symptoms. While some studies identify the swimming environment as a trigger for allergy and asthmatic symptoms, even more studies suggest swimming to be suitable for people with allergies and asthma. The factors behind the symptoms were studied first by determining the prevalence of asthma, allergy and self‐reported asthmatic symptoms in experienced Finnish swimmers and then by examining the relationships between the reported symptoms and the main triggering factors: medical history, environment and exercise intensity. Materials and Methods: Top swimmers (n = 332) of the Finnish Swimming Association registry (N = 4578) were asked to complete a structured questionnaire on their medical history, swimming background, swimming environment and symptoms in different swimming intensities. Two hundred experienced swimmers, 107 females and 93 males, with an average age of 18.5 [standard deviation (SD) = 3.0] years and a swimming training history of 9 (SD = 3.8) years completed the questionnaire. Results: Physician‐diagnosed asthma was reported by 32 swimmers (16%), including 24 (12%) with exercise‐induced asthma. Physician‐diagnosed allergy was reported by 81 (41%) swimmers. Asthmatic symptoms during swimming were described by 84 subjects (42%). Most symptoms occurred when swimming exceeded speeds corresponding to the lactic/anaerobic threshold. Family history of asthma was significant and the most important risk factor for asthmatic symptoms. Conclusions: The prevalence of asthma in swimmers was higher than in the general population but not different from that in other endurance athletes. Family history of asthma and increased swimming intensity had the strongest associations with the reported asthmatic symptoms. Please cite this paper as: Päivinen MK, Keskinen KL and Tikkanen HO. Swimming and asthma: factors underlying respiratory symptoms in competitive swimmers. The Clinical Respiratory Journal 2010; 4: 97–103.     

Quality of Life and clinical symptoms in asthmatic subjects.

OBJECTIVE: Quality of Life (QoL) measurements are more responsive to clinically significant changes than conventional clinical measures. The aim of the study was to evaluate the relationship between asthma symptoms and QoL in asthmatic patients. METHODS: A total of 277 asthmatics subjects, divided into three groups showing different symptoms, underwent complete clinical evaluation, baseline respiratory function, and methacholine challenge test and completed an Asthma Quality of Life Questionnaire (AQLQ). RESULTS: One hundred and forty-five subjects with asthmatic crisis, chest tightness, and dyspnea (group 3) reported a significantly lower median value in single domains and all items compared to the values scored by the 97 subjects with wheezing, rhinitis, and conjunctivitis (group 2) (p < 0.01). No statistical significance was found between the 35 patients of group 1 (with only cough) and group 3. CONCLUSIONS: The main advantage for the clinician is to evaluate important areas in which QoL could be improved and the possibility to correct and optimize compliance to chronic therapy.     

Occupational dust or gas exposure and prevalences of respiratory symptoms and asthma in a general population

The relationship of occupational airborne, exposure to respiratory symptoms and asthma was examined using a self-administered questionnaire in a cross-sectional survey of a random sample (n = 4,992 subjects) of the general population aged 15-70 yrs of Hordaland county, Norway. The response rate was 90%. Twenty nine percent of the population had a history of occupational dust or gas exposure, 5% reported having been exposed to asbestos at work, and 4% reported quartz exposure. A history of occupational dust or gas exposure was associated with morning cough, chronic cough, phlegm when coughing, breathlessness on exercise, occasional wheezing and a physician's diagnosis of asthma after adjusting for sex, age, smoking habits and urban-rural area of residence. The adjusted relative odds ratios for the respiratory disorders in subjects exposed to dust or gas ranged from 1.6-1.9. The population attributable risk of occupational dust or gas exposure for the respiratory disorders ranged from 11-19%. The study indicates that respiratory disorders are independently associated with occupational airborne exposure in a Norwegian general population sample.     

Exercise-induced respiratory symptoms are poor predictors of bronchoconstriction

Exercise-induced asthma (EIA) is a possible cause of poor physical performance in children. No data are available on the value of respiratory symptoms to discriminate children with bad physical fitness from children with EIA. We evaluated respiratory symptoms in school-age children during and after exercise in relation to EIA. The population of 149 primary schools (849 classes with 15,241 children) was enrolled in the study. EIB was assessed using the 6-min free-running-test (6MFRT) in 15,241 children. At the end or at premature arrest of the 6MFRT, signs reported by the children and clinical symptoms observed by supervising physicians were recorded. Peak flow measurements were obtained before and 5 and 10 min after the 6MFRT, a decrease of 15% or more being defined as significant. The 6MFRT was positive in 7.4% of primary schoolchildren. Girls were more likely to have a positive test than boys (8.5% vs. 6.4%, P < 0.001), and children living in urban areas more than those living in rural areas (8.9% vs. 7.0%, P < 0.01). Premature arrest was seen in 3.5% (i.e., n = 353) of the children. The main reasons for premature arrest were dyspnea and chest pain. Among them, only 21% had a positive 6MFRT, while 89% with a positive 6MFRT could terminate the test. Premature arrest, breathlessness, chest tightness, wheezing, and cough had a positive predictive value to detect a EIA of 21.9%, 20.8%, 36.4%, 41.2%, and 28.3%, respectively, and a sensitivity of 10.8%, 29.5%, 14.9%, 4.8%, and 13.0%, respectively. In conclusion, EIA was detected in 7.4% of schoolchildren. A slightly higher incidence was observed in girls and children from an urban area. Neither premature arrest nor clinical signs and symptoms were good predictors of EIA in primary schoolchildren.     

Gender differences in the perception of asthma and respiratory symptoms in a population sample of asthma patients in four Brazilian cities

OBJECTIVE:

To evaluate the impact of asthma, by gender, in a population sample of asthma patients in Brazil.

METHODS:

We conducted face-to-face interviews with 400 subjects (> 12 years of age) included in a national probability telephone sample of asthma patients in the Brazilian state capitals of São Paulo, Rio de Janeiro, Curitiba, and Salvador. Each of those 400 subjects completed a 53-item questionnaire that addressed five asthma domains: symptoms; impact of asthma on quality of life; perception of asthma control; exacerbations; and treatment/medication.

RESULTS:

Of the 400 patients interviewed, 272 (68%) were female. In relation to respiratory symptoms, the proportion of women reporting extremely bothersome symptoms (cough with sputum, tightness in the chest, cough/shortness of breath/tightness in the chest during exercise, nocturnal shortness of breath, and nocturnal cough) was greater than was that of men. Daytime symptoms, such as cough, shortness of breath, wheezing, and tightness in the chest, were more common among women than among men. Women also more often reported that their asthma interfered with normal physical exertion, social activities, sleep, and life in general. Regarding the impact of asthma on quality of life, the proportion of subjects who reported that asthma caused them to feel that they had no control over their lives and affected the way that they felt about themselves was also greater among women than among men.

CONCLUSIONS:

Among women, asthma tends to be more symptomatic, as well as having a more pronounced effect on activities of daily living and on quality of life.     

Does bronchial hyperresponsiveness in asthma matter?

Bronchial hyperresponsiveness is a fundamental component of the asthmatic inflammatory process causing airway narrowing on exposure to a bronchoconstrictor stimulus. This in turn causes patients to experience symptoms of breathlessness, chest tightness, cough and wheeze. Bronchial challenge tests can be performed in the laboratory to establish the degree of bronchial hyperresponsiveness to both direct and indirect stimuli. The extent to which asthma pharmacotherapy attenuates bronchial hyperresponsiveness is therefore an important measure of efficacy. This review article discusses the effects of inhaled and oral asthma treatment upon bronchial hyperresponsiveness and highlights how, in conjunction with conventional measures of asthma control, it can be used as an aid to optimally manage patients.     

Does Bronchial Hyperresponsiveness in Asthma Matter?

Bronchial hyperresponsiveness is a fundamental component of the asthmatic inflammatory process causing airway narrowing on exposure to a bronchoconstrictor stimulus. This in turn causes patients to experience symptoms of breathlessness, chest tightness, cough and wheeze. Bronchial challenge tests can be performed in the laboratory to establish the degree of bronchial hyperresponsiveness to both direct and indirect stimuli. The extent to which asthma pharmacotherapy attenuates bronchial hyperresponsiveness is therefore an important measure of efficacy. This review article discusses the effects of inhaled and oral asthma treatment upon bronchial hyperresponsiveness and highlights how, in conjunction with conventional measures of asthma control, it can be used as an aid to optimally manage patients.     

Airway eosinophilia is associated with wheeze but is uncommon in children with persistent cough and frequent chest colds

The role of eosinophilic airway inflammation in the variant asthma syndromes of cough and chest colds is not well defined. We tested the hypothesis that children with persistent cough and chest colds have increased sputum eosinophils, similar to those with wheeze. The parents of 390 primary school children completed a symptoms questionnaire. Children with wheeze (n = 28), cough (n = 12), recurrent chest colds (n = 17), and no symptoms (control subjects, n = 26), underwent allergy skin prick tests, spirometry, hypertonic saline inhalation challenge, and sputum induction, and then completed a peak expiratory flow (PEF) and symptoms diary over a 2-mo period. Children with wheeze had significantly reduced PEF (p = 0.001) and higher sputum eosinophils when compared with the cough, chest cold, and control groups (3.1% versus 0.5%, 0%, 0%; p = 0.03). The prevalence of eosinophilic bronchitis (sputum eosinophils > 2.5%) was 45% in the wheeze group, which was significantly higher than the control group (9.35%, p = 0.04). Eosinophilic bronchitis was present in two children with cough (20%) and two with chest colds (15%, p > 0.05 versus control). In these groups, eosinophilic bronchitis was not associated with airway hyperresponsiveness (AHR) to hypertonic saline (p > 0.05). Children with cough and chest colds reported greater exposure to environmental tobacco smoke. In conclusion, this community-based survey of children with chronic respiratory symptoms has shown that wheeze is a good discriminator for the presence of eosinophilic bronchitis, and that persistent cough and recurrent chest colds without wheeze should not be considered a variant of asthma. Eosinophilic bronchitis did occur in a significant minority of these "variant asthma" syndromes.     

Health effects of daily indoor nitrogen dioxide exposure in people with asthma.

Household gas appliances produce nitrogen dioxide (NO2), which may be associated with an increase in symptoms in asthmatics. The relationship between indoor NO2 exposure, and respiratory symptoms in people with asthma was evaluated. Self-reported asthmatics (n=125) wore lapel badges that measured NO2 daily over 6 weeks at home. Outdoor pollutants, spores and meteorological parameters were measured daily, in addition to smoking status and demographic factors. Seven asthma symptoms were recorded in diaries, for analysis by same day and also with 1 day lag exposures, using a generalized estimating equation. Significant interactions were demonstrated between NO2 at age < or =14 yrs, with respect to the symptoms of chest tightness on the same day (odds ratio (OR): 1.29, 95% confidence interval (CI): 1.16-1.43) and with a 1 day lag (OR: 1.29, 95% CI: 1.14-1.46), breathlessness on exertion with a 1 day lag (OR: 1.13, 95% CI: 1.00-1.28), daytime asthma attacks on the same day (OR: 1.13, 95% CI: 1.02-1.26) night asthma attacks on the same day (OR: 1.16, 95% CI:1.03-1.30) and with a 1 day lag (OR: 1.15, 95% CI; 1.03-1.29) after adjustment for potential confounders. A significant interaction between NO2 and age 35-49 yrs was demonstrated for coughs with a 1 day lag (OR: 1.15, 95% CI: 1.01-1.31). Daily personal exposures to NO2 are associated with asthmatic symptoms in children.