A prospective cohort study of pulmonary function during pregnancy in women with and without asthma

Background and objective: Pregnancy alters the severity of asthma unpredictably. Uncertainty still exists about longitudinal changes in pulmonary function during pregnancy in both healthy and asthmatic women. This study aimed to compare pulmonary function changes during pregnancy in healthy and asthmatic women and to determine the relationship between pulmonary function and asthma-related quality of life during pregnancy. A secondary aim was to investigate the application of forced expiratory volume in 6?s (FEV₆) for monitoring asthma during pregnancy. Methods: Pregnant women with (n?=?20) and without asthma (n?=?20) had pulmonary function tests at 8–20, 21–28 and 29–40 weeks gestation. Those with asthma also completed the Asthma Control Questionnaire (ACQ) and mini Asthma Quality of Life Questionnaire (mAQLQ) at each visit. Results: Pulmonary function declined in both groups at follow-up #1 (more markedly in those with asthma) but then improved at follow-up #2 (more markedly in those with asthma). In those with asthma, ACQ scores increased, while mAQLQ scores declined at follow-up #1; whilst at follow-up #2 these changes were in the opposite direction. FEV₆ and forced vital capacity (FVC) were highly correlated (r?=?0.88, p?<?0.01) in asthmatics. Conclusions: Pulmonary function changes during second and third trimesters were more pronounced in asthmatics than in healthy women. FEV₆ monitoring may assist pregnant women and their health professionals in optimizing asthma management. The changes in pulmonary function in women with asthma were not significantly associated with changes in asthma control or asthma-related quality of life.     

Vitamin D deficiency and level of asthma control in women from North of Jordan: a case–control study

Introduction: Reduced vitamin-D levels in patients with asthma have been associated with impaired lung function, increased airway hyper-responsiveness, and reduced glucocorticoid responsiveness. Nationwide studies revealed a considerable prevalence of vitamin-D deficiency (VDD) in Jordanian women. Objective: A case–control study was conducted to determine the relationship between serum vitamin A and D levels and asthma among women in North of Jordan. Methods: Sixty-eight asthmatics, age range between 14 and 65 years and 77 healthy women, age range between 19 and 51 years, were enrolled. Asthma severity was classified using Global Initiative for Asthma (GINA) guidelines and Asthma Control Test (ACT) questionnaire. Serum vitamin-A and 25-hydroxyvitamin-D (25(OH)D3) levels were measured using high-performance liquid chromatography (HPLC) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods, respectively. Results: The prevalence of VDD (<15?ng/ml) was higher but not statistically significant for women with asthma compared with controls (95.6% vs. 87.0%; p?=?0.070). The severity of VDD correlated with the number of asthma medications (p?=?0.020). 25(OH)-D3 serum levels directly correlated with asthma control level using ACT score (p?=?0.012) and GINA classification (p?=?0.046). After adjusting for age, the odds of having VDD for asthmatic women were 35.9 times higher than that for women with no asthma. There was no difference in serum vitamin-A level between healthy and asthmatic women (p?=?0.214) and none had vitamin-A deficiency (<200?µg/dl). Conclusions: VDD is prevalent in women with asthma in northern Jordan. The severity of VDD correlated with poor asthma control and a need for more medications to control asthma. There was no association between vitamin-A and asthma.     

Prevalence,Demographics, and Health Outcomes of Comorbid Asthma and Overweight in Urban Children

Background. Asthma and overweight are epidemic in urban children but the relationship between these conditions is not fully understood. This study presents demographic and risk profiles of comorbidity for overweight asthmatic children, characterizes morbidity by comparing health outcomes among overweight asthmatics and healthy weight asthmatics, and examines socioeconomic factors associated with comorbidity. Objective. To construct a demographic profile of overweight asthmatic children in an urban setting and identify factors that contribute to prevalence. Method. Cross-sectional study of 5250 children in New York City public elementary schools using a parent-report questionnaire on body mass index, socioeconomic status, asthma, and asthma-related outcomes. Results. Prevalence of overweight (body mass index ≥ 85th percentile for age and gender) was 50.9%. The prevalence of overweight and ever being diagnosed with asthma was 10.9%. The prevalence of overweight with current asthma was 6.2%. Overweight current asthmatics had more night symptoms, missed school days, and asthma medication use than healthy weight asthmatics. Almost 50% of overweight current asthmatic children reported emergency department visits for asthma compared with 30% of healthy weight asthmatics. Comorbidity was most prevalent among males, Latinos, and children in low-income households, with the highest prevalence among Puerto Ricans. In multivariate analysis stratified by gender, the most significant factors associated with comorbidity among girls were low income and minority race/ethnicity, while among boys significant factors were parental education and parental history of asthma. Interestingly, there were few underweight children (7.8%) but they had high prevalence of asthma (13.8%). Conclusions. The comorbidity of overweight and asthma has a large impact on urban populations, causing greater disease burden than asthma alone. Overweight asthmatics show more uncontrolled asthma, evidenced by emergency department visits, quick-relief medication use, and days with asthma symptoms. The relationship between socioeconomic factors and the asthma–obesity comorbidity may vary by gender and requires further study to identify successful interventions to reduce disease in children.     

Incentive spirometry combined with expiratory positive airway pressure improves asthma control and quality of life in asthma: a randomised controlled trial

Objectives: The use of the incentive spirometer (IS) and expiratory positive airway pressure (EPAP) provides several benefits in patients with respiratory disorders. However, the effects of the use of these devices coupled (IS?+?EPAP) are still unknown in asthmatic patients. The aim of this study was to evaluate the effect of IS associated with EPAP on exercise tolerance (six-minute walk test – 6MWT), lung function (by spirometry), asthma control (Asthma Control Questionnaire – ACQ) and quality of life (Asthma Quality of Life Questionnaire – AQLQ) in patients with severe asthma. Methods: Patients were randomised into two groups: IS?+?EPAP (n?=?8) and control (n?=?6). The IS?+?EPAP group performed breathing exercises at home, twice daily for 20?min, over a period of 5 weeks. Results: There was no significant difference in spirometric variables and in the distance walked in the 6MWT in both groups. However, the IS?+?EPAP group showed an improvement in asthma control (p?=?0.002) and quality of life (p?=?0.02). Conclusions: These findings demonstrate that the IS?+?EPAP protocol, when performed at home, provides an improvement in asthma control and quality of life for patients with severe asthma when evaluated by ACQ and AQLQ, respectively.     

Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population

Background

Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early‐onset and late‐onset asthma in a CRS population using patient‐reported and clinical characteristics.

Methods

At enrollment into a clinical registry, CRS patients completed the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Asthma Control Test (ACT), mini‐Asthma Quality of Life Questionnaire (miniAQLQ), the 29‐item Patient‐Reported Outcomes Measurement Information System (PROMIS‐29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early‐onset (<18 years) and late‐onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi‐square, and Kruskal‐Wallis tests were used to compare patient responses.

Results

A total of 199 non‐asthmatic (56.1%), 71 early‐onset asthmatic (20.0%), and 85 late‐onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late‐onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT‐22, ACT, and miniAQLQ were not different between asthma groups, but late‐onset asthmatics had significantly lower physical function than non‐asthmatics (p = 0.008). Compared to non‐asthmatics, late‐onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund‐Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late‐onset asthmatics compared to early‐onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003).

Conclusion

While CRS‐specific and asthma‐specific patient‐reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late‐onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late‐onset asthma may predict more severe disease in CRS.

     

Exhaled Nitric Oxide in Pregnant Healthy and Asthmatic Women

Background. Measurement of fractioned exhaled nitric oxide (FE_NO) is useful for monitoring airway inflammation in asthma. Asthma is one of the most common diseases complicating pregnancy, and FE_NO may be helpful for monitoring asthma in pregnancy. However, some physiological alterations of FE_NO may be expected during healthy pregnancy due to vascular nitric oxide production. Until now no study assessed the level of FE_NO in asthmatic pregnant patients. Objective. We aimed to assess the possible use and reproducibility of FE_NO measurements in pregnant asthmatic women. We compared FE_NO concentrations between four groups of subjects: healthy nonpregnant and pregnant females and asthmatic nonpregnant and pregnant patients. We also investigated the relationship between FE_NO values and the level of asthma control in pregnant asthmatic patients. Methods. A total of 102 female subjects (35 healthy nonpregnant and 27 healthy pregnant females; 20 nonpregnant and 20 pregnant asthmatic women) were included in this cross-sectional study. Two FE_NO measurements were performed in each subject using an electrochemical sensor based device (NIOX MINO, Aerocrine, Solna, Sweden). Data are given as median with range. Results. The repeatability of FE_NO measurement was similar in pregnant and nonpregnant subjects. FE_NO levels did not differ significantly between healthy pregnant versus nonpregnant subjects (16.0 [8, 31] vs. 16.0 [9, 35] ppb). FE_NO levels were significantly increased in asthmatic women compared to healthy females (nonpregnant asthmatics: 38 [9, 54] ppb, p < 0.001 vs. healthy nonpregnant; pregnant asthmatic patients: 28 [10, 56] ppb; p < 0.05 vs. healthy pregnant). Conclusions. FE_NO level is not influenced by healthy pregnancy. In pregnant asthmatic patients FE_NO level is elevated compared to healthy pregnant subjects and correlates with the level of asthma control. Further studies are required to assess the use of FE_NO measurement to monitor asthma in this patient group.     

The Relationship between Perceived Stress and Morbidity among Adult Inner-City Asthmatics

Background. Psychological stress has been linked in some studies to asthma prevalence and outcomes in children. The authors sought to evaluate the relationship between perceived stress and morbidity among inner-city adults with asthma. Methods. The authors interviewed a prospective cohort of 326 moderate-to-severe asthmatics receiving care at two large, urban, hospital-based general medicine clinics in New York City and New Jersey. Psychological stress was assessed at baseline using the Perceived Stress Scale (PSS), a validated 4-item instrument. Outcomes included the Asthma Control Questionnaire (ACQ), the Asthma Quality of Life Questionnaire (AQLQ), and the Medication Adherence Reporting Scale (MARS) measured at baseline, 1, 3, and 12 months of enrollment. Results. Higher perceived stress was significantly correlated with worse asthma control (ACQ scores; r = .30 to .37, p < .0001), poor quality of life (AQLQ scores; r = ?.49 to ? .35, p < .0001), and decreased medication adherence (MARS scores; r = ?.25 to ?.15, p < .028) at baseline and across the follow-up interviews. In multivariate analyses, increased stress remained a significant predictor of worse ACQ (p < .0001), AQLQ scores (p < .0001), and MARS (p < .0001) after adjusting for age, sex, income, number of years with asthma, and comorbidities. Conclusions. Among inner-city asthmatics, higher perceived stress is strongly associated with increased asthma morbidity across a 1-year follow-up. Further research is needed to identify mechanisms mediating the association between stress and asthma morbidity in adults.     

The Relationship Between Asthma-Specific Quality of Life and Asthma Control

Few studies have quantitatively addressed the relationship between asthma-specific quality of life and asthma control as assessed by validated tools. Questionnaires were completed at home by a random sample of 542 adult asthmatic patients. The correlations of the two asthma control tools (Asthma Control Test? and Asthma Therapy Assessment Questionnaire?) with the quality of life tool (mini-Asthma Quality of Life Questionnaire) were strongest with the symptoms and activity domains (r = 0.63–0.77); lower with the emotions domain (r = 0.57–0.64); and lowest with the environment domain (r = 0.38–0.43). Asthma control tools reflect the symptoms and activity themes of asthma quality of life well, but reflect the environmental domain less well.     

Low Attenuation Area Is Associated with Airflow Limitation and Airway Hyperresponsiveness

Background. Asthma is a chronic inflammatory disorder of the airways characterized by airflow limitation and airway hyperresponsiveness. Lung density indices on quantitative computed tomography (QCT) are assumed to reflect the degree of air trapping originated from airflow limitation in airway diseases. Purpose. The present study investigated the availability of lung density indices on QCT in clinical evaluation of asthma. Methods. Eleven asthmatic patients and 48 healthy control subjects were prospectively evaluated by QCT, pulmonary function testing, and a methacholine challenge test. High-resolution computed tomography scans were performed at full-inspiratory and full-expiratory phases, and percentage of lung field occupied by low attenuation area (LAA%) and mean lung density (MLD) at both inspiratory and expiratory phases were measured. Results. MLD values at inspiratory phase were significantly increased in asthmatic patients compared with those in healthy control subjects. Inspiratory LAA% values were significantly decreased in asthmatics compared with the values in control subjects. On expiratory scans, MLD values of asthmatics were significantly lower than the values of control subjects. Expiratory LAA% values of asthmatics were significantly higher than the values of control subjects. The LAA% in the expiratory phase showed significant negative correlation with forced expiratory volume in 1 second (FEV₁), FEV₁/forced vital capacity, and the provocative dose of methacholine causing a 20% decrease in FEV₁ in asthmatic patients. Conclusion. These results suggest that lung density indices on QCT may be useful for clinical evaluation of asthmatic patients and increased LAA% in the expiratory phase is associated with airflow limitation and airway hyperresponsiveness in asthma.     

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.     

Relationship of circulating chemerin and omentin levels with Th17 and Th9 cell immune responses in patients with asthma

Objective: Adipokines are correlated with immune responses in asthma, but data on the roles of chemerin and omentin in asthma are limited. This study explored the relationship of chemerin and omentin levels with Th17 and Th9 cells in asthma. Methods: Seventy-six asthmatics were divided into intermittent-to-mild persistent (n = 28), moderate persistent (n = 26) and severe persistent (n = 22) and were enrolled in the study. Additionally, 20 healthy subjects were enrolled as controls. Clinical characteristics of the subjects, the Asthma Control Test, lung function, fractional exhaled nitric oxide score, and plasma chemerin and omentin levels were evaluated, and the percentages of Th17 and Th9 cells were determined by flow cytometry. Results: The percentages of Th17 and Th9 cells were higher in the moderate-to-severe persistent asthmatics than in the intermittent-to-mild persistent asthmatics or healthy controls (p < 0.05). The severe persistent asthma group had a higher chemerin level but lower omentin levels than the control group (p < 0.05). Chemerin levels were positively correlated with Th17 and Th9 cell percentages, while omentin levels were negatively correlated with Th17 and Th9 cell percentages (p < 0.01). Conclusions: The regulatory functions of adipokines on immune responses may be associated with pathogenesis and processes of asthma.     

Quality of life and economic features in elderly asthmatics

BACKGROUND: In the geriatric population, asthma tends to be overlooked. Moreover, typical symptoms of asthma may mimic chronic bronchitis and emphysema. OBJECTIVE: To compare the characteristics of asthma between elderly (>/=65 years) and adult (<65 years) asthma patients with regard to asthma severity, health-related quality of life, and direct expenditures for medical care generated by the disease. METHODS: A cross-sectional study was made in the asthmatic population older than 14 years in the area of Barcelona, Spain. Asthma severity was determined according to the International Consensus criteria of 1992. St. George's Respiratory Questionnaire (SGRQ) was used to measure the quality of life. Direct costs were calculated registering all costs generated by each patient per year. RESULTS: The study population consisted of 282 adult asthmatics and 51 elderly asthmatics. Asthma was more severe in the elderly group (mild 10%, moderate 35%, severe 55%) than in the adult group (mild 47%, moderate 35%, severe 18%). Elderly asthmatics had significantly higher total SGRQ scores (48 vs. 35, p < 0.001) than adult asthmatics, as well as significantly higher scores for all subscales. Asthma-derived direct costs in elderly asthmatics (mean USD 1,490 vs. USD 773) were double those in adult asthmatics, mainly due to higher costs of hospitalization and medication in the elderly. CONCLUSIONS: Asthma in elderly people as compared with asthma in adulthood was more severe and was associated with a worse health-related quality of life, and significantly higher expenditures for medical care.     

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.     

Expiratory flows and airway inflammation in elderly asthmatic patients

Asthma in the elderly is often underrecognized and suboptimally treated, resulting in an increased morbidity and mortality. The characteristics of asthma-related bronchitis and its optimal treatment remain to be determined in this population. We aimed to compare lung function and airway inflammation in elderly and younger asthmatic subjects. Data from two induced sputum databases were analyzed in three groups of asthmatic subjects (18-30 y, n = 136; 31-59 y, n = 385; 60-72 y, n = 172) and one group of healthy elderly subjects (60-89 y, n = 16). Expiratory flows and induced sputum cell counts were analyzed. Airway obstruction was more marked in elderly asthmatics compared with healthy elderly or younger asthmatic subjects (p < 0.01). An increase in sputum neutrophils and a decrease in macrophages and lymphocytes were observed in elderly asthmatics (p < 0.0001). Neutrophil percentages significantly increased with asthma severity in the young and the middle-aged groups, while they remained similar in elderly asthmatics regardless of asthma severity (p < 0.05). Neutrophil percentages weakly correlated with the dose of ICS in all asthmatics (r = 0.17, p < 0.0001). Age and dose of ICS were independent predictors of neutrophil percentage in asthmatic subjects in a regression model (R(2) = 0.12). Asthma in the elderly is associated with a more marked airway obstruction and sputum neutrophilia. Both age and the dose of corticosteroids need to be considered in the interpretation of the clinical relevance of sputum neutrophil count.     

Asthma in Patients Climbing to High and Extreme Altitudes in the Tibetan Everest Region

Objectives: The aim of this study was to investigate the behavior of asthma in patients traveling to high and extreme altitudes. Methods: Twenty-four Dutch patients with mild asthma did a trekking at high and extreme altitudes (up to 6410 m = 21030 ft) in the Tibetan Everest region. Asthma symptoms, use of asthma medication, symptoms of acute mountain sickness, spirometry, peripheral oxygen saturation, and heart rate were measured at 1300 m (baseline), and at 3875, 4310, 5175, and 6410 m. Asthma symptoms were assessed by means of a modified version of the Asthma Control Test. Symptoms of acute mountain sickness were scored by the Lake Louise self-report questionnaire. The expedition staff, consisting of seven healthy persons, acted as a control group. Results: In both asthmatics and controls, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) decreased with increasing altitude, whereas FEV1 as percent of FVC (FEV1%FVC) did not change. In both groups, peak expiratory flow (PEF) increased with increasing altitude. In general, differences in spirometric values between asthmatics and controls were not significant. Asthma symptoms did not change with increasing altitude. During ascent, less than half of the asthma patients increased their medication use. According to the Lake Louise score, no acute mountain sickness occurred, except for in the asthma group at 6410 m, which showed mild acute mountain sickness at that altitude. As expected, peripheral oxygen saturation decreased with increasing altitude in asthmatics and controls, differences between the two groups not being significant. In general, heart rate (at rest) did not change with altitude, except for an increase in asthmatics at 6410 m. Conclusions: These results suggest that traveling to high and extreme altitudes is safe for patients with mild asthma.     

Lower values of VEGF in endometrial secretion are a possible cause of subfertility in non-atopic asthmatic patients

Objective: Using endometrial secretion analysis, we assessed whether altered inflammatory cytokine levels can be detected in the uterine environment in asthma patients, thereby providing a possible cause of reduced fertility in asthmatics. Methods: Forty-four unexplained infertile women (aged 28–44) underwent asthma and allergy testing, questionnaires, endometrial secretion and blood samples in the mid-secretory phase of the menstrual cycle (day 19–23) during assisted reproduction. Differences in cytokines and growth factors were analyzed. Results: Mean log-VEGF in uteri was lower in asthma patients compared with controls (2.29 versus 2.70, p?=?0.028). This was mainly due to lower values of VEGF among women with non-atopic asthma compared with women with atopic asthma (1.86 versus 2.72, p?=?0.009) and with healthy controls (1.86 versus 2.70, p?=?0.01). Asthma treatment status had no effect on VEGF levels in uteri. Serum high sensitivity CRP was negatively correlated with VEGF in endometrial secretions. No other significant correlations were observed between peripheral blood values and markers found in utero. Conclusion: Asthma is associated with lower values of VEGF in uterine endometrial secretions, which might affect the receptiveness of the endometrium and thereby increase time to pregnancy. The effect appears to be associated with non-atopic asthma with general increased systemic inflammation.     

Gene Variants,mRNA and NOD1/2 Protein Levels in Tunisian Childhood Asthma

Introduction

Asthma is a common respiratory childhood disease that results from an interaction between genetic, environmental and immunologic factors. The implication of nucleotide-binding and oligomerization domain 1 and 2 (NOD1/CARD4, NOD2/CARD15) was highlighted in many inflammatory diseases.

Methods

In this case-control study, we analyzed the association of three NOD2 polymorphisms and one NOD1 variant, in 338 Tunisian asthmatic children and 425 healthy Controls, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. We also assessed NOD1 and NOD2 mRNA and protein levels by qRT-PCR and ELISA techniques.

Results

The homozygous AA genotype of rs2075820 was a risk factor for asthma (OR 2.39). The influence of the E266K variant in the presence of the heterozygous AG genotype was higher in male than female groups. The homozygous AA genotype was a risk factor associated with asthma, for patients aged between 6 and 18 years OR 2.39, IC95% (1.04–5.49) p < 0.01. The mRNA expression of NOD1, but not NOD2, was enhanced in asthma patients compared to Controls. We noted a significant difference between asthmatics and healthy controls in NOD1 protein expression (asthma patients : 31.18 ± 10.9 pg/ml, Controls: 20.10 ± 2.58 pg/ml; p < 0.001).

Conclusions

The NOD1 rs2075820 variant was associated with a higher childhood asthma risk and the NOD1 expression at mRNA and protein levels was significantly increased in asthma patients.

     

Inspiratory muscle function in asthmatic and healthy subjects: influence of age,nutrition and physical activity

Objective: To compare inspiratory muscle function (strength and endurance) between asthmatics and healthy controls, and the influence of age, nutritional status and physical activity on them. Methods: This is a cross-sectional study. Asthmatic and healthy subjects, aged 6 to 18 years old, recruited from two public schools in Southern Brazil were included in the study. Asthmatic subjects were selected using the criteria presented by the International Study on Asthma and Allergies in Children and control subjects based on the absence of respiratory symptoms. Anthropometric data was measured, body mass index calculated and subjects classified as normal weight, overweight or obese. Physical activity levels, maximum inspiratory pressure (MIP) and inspiratory muscle endurance (IME) were also evaluated. Results: A total of 314 participants were included, separated into control group (181) and asthmatics (133), with a total mean age of 11 years. When both groups were compared, there were no significant differences in both MIP and IME. However, when groups were analyzed subdivided in children and adolescents, IME was significantly reduced (p = 0.003) in asthmatic adolescents. Indeed, when groups were also stratified considering the nutritional status, IME showed a reduction in asthmatic adolescents with overweight (p = 0.042) and obesity (p = 0.041) when compared to healthy controls. No effects of physical activity levels between groups were found. Conclusions: Results demonstrate a reduction in the IME in asthmatic adolescents with overweight and obesity, indicating an association between asthma, nutritional status and respiratory muscle function.     

The frequency of sleep-disordered breathing in children with asthma and its effects on asthma control

Background: The presence of sleep-disordered breathing (SDB) in children with asthma may cause difficult to control asthma. Objectives: The aim of this study was to determine the frequency of SDB in children with asthma, to evaluate its effects on asthma control and to assess the risk factors associated with the presence of SDB. Methods: Parents of children who Sleep Questionnaire (PSQ) and the Childhood Asthma Control Test (C-ACT). Asthma control level was assessed according to Global Initiative for Asthma (GINA). Same ear–nose–throat (ENT) specialist evaluated all patients. A 4-point tonsil grading method and adenoid-nasopharynx ratio were used to categorize tonsil and adenoid size, respectively. Results: A total of 408 children (275 male, 67.4%) with a mean age of 8.1 ± 3.2 years were included. Nearly 40% of asthmatic children were not-well-controlled according to GINA and 34.6% of all patients had SDB according to PSQ. Multivariate logistic regression analysis revealed that coexistence of SDB [OR: 6.62, 95% CI (4.21–10.41); p < 0.001)] and tonsillar hypertrophy [OR: 3.47; 95% CI (1.05–11.5); p < 0.041] were independent risk factors for not-well-controlled asthma in asthmatic children after other established contributors to asthma control were adjusted. Conclusions: Our study showed that SDB is a strong risk factor for not-well-controlled asthma in asthmatic children independent of other confounders. In addition, tonsillar hypertrophy may have a role in the association between SDB and not-well-controlled asthma in childhood.     

Association of Overweight with Asthma Prevalence in Adolescents in Rio de Janeiro,Brazil

Objective: To evaluate the relationship between asthma and overweight in adolescents. Methods: Cross-sectional study including 13–14-year-old adolescents in Rio de Janeiro, Brazil. Asthma was defined according to the International Study of Asthma and Allergies in Childhood (ISAAC). Body Mass Index (BMI) was calculated; overweight was defined as BMI ≥ 85th percentile. The distribution of asthma and associated symptoms were compared according weight category using the χ² test for linear trend. The association between asthma and overweight, controlling for confounding variables, was studied using odds ratios (OR), confidence intervals (95% CI) and logistic regression, stratified by sex. Results: 2,858 (50.1% female) adolescents were studied; 458 (16.1%) were overweight and 13.3% asthmatic. Average BMI was higher among asthmatics (p = 0.01). When stratified, this difference remained only among girls (p = 0.03). Asthma prevalence increased with higher BMI (p = 0.02). Asthma was associated to overweight (OR = 1.51; 95% CI: 1.07–2.13), irrespective of sedentary lifestyle, smoking mother and presence of dog in the domicile, but only among the girls. Conclusions: In Rio de Janeiro adolescents, we found a positive association between asthma and overweight, exclusively among girls. This suggests that health policies related to asthma and overweight/obesity in this age group need to take sex into consideration.