Journal of Asthma最新文献

Background: Poorly controlled pediatric asthma increases morbidity, reduces quality of life, and raises healthcare use. Caregiver education on asthma and medication use is essential for control. In Vietnam, pediatric asthma services are centralized at tertiary centers, limiting access for many families. Telemedicine may help bridge these gaps.

Objectives: To evaluate the effectiveness of telemedicine education on asthma control in children with uncontrolled asthma and its impact on caregiver knowledge, attitudes, and children's MDI technique.

Methods: We conducted a pragmatic randomized clinical trial among children aged 4-16 years with uncontrolled asthma. Participants were randomized 1:1, stratified by age and sex, to receive either a structured educational video call or a brief scheduling call. Changes in C-ACT/ACT scores, caregiver knowledge, caregiver attitudes, and children's MDI technique were compared between groups. A multivariable generalized linear model was used to identify factors associated with improvement in asthma control.

Results: Baseline characteristics were comparable between groups. At a median follow-up of five weeks (IQR 4-8), C-ACT scores were higher in the intervention than control group (median 25.0 vs 19.5, p < .001), with mean change exceeding the minimal clinically important difference. Caregiver knowledge and attitudes and children's MDI technique also improved more in the intervention group (p < .001 for all). In multivariable models, telemedicine education was independently associated with greater improvement in asthma control (β = 4.24, 95% CI: 2.64-5.85, p < .001).

Conclusion: Telemedicine-based education improved asthma control and caregiver-related outcomes and may serve as an effective supportive strategy where access to pediatric asthma services is limited.

Background: Asthma is a significant public health burden worldwide, owing to its prevalence and mortality. The key factor in the death of patients with asthma is oxidative stress. The diet is an important source of both exogenous oxidants and antioxidants. The Composite Dietary Antioxidant Index (CDAI) comprehensively evaluates the antioxidant capacity of the diet, but whether CDAI can assess the risk of death in patients with asthma is unclear.

Objective: This study aimed to investigate the prognostic significance of the CDAI in all-cause mortality in adult asthma patients over 20 years of age.

Method: This study employed a retrospective observational approach to analyze data extracted from the National Health and Nutrition Examination Survey (NHANES) database spanning the period from 1999 to 2018. The participants were divided into three groups based on tertiles of the CDAI. The primary outcome of the study was all-cause mortality, which was analyzed using the Kaplan-Meier survival curve, restricted cubic spline (RCS) and Cox proportional hazards model.

Result: Among 6,066 individuals aged 20 years and over diagnosed with asthma, with a mean age of 45.1 (0.3) years, Kaplan-Meier survival analysis showed a significantly lower all-cause mortality rate in those with a high CDAI category (P-log rank <0.001). Furthermore, the fully adjusted model (Model 3) demonstrated that for each unit increase in the CDAI, there was a corresponding 4% decrease in the probability of all-cause mortality. Additionally, compared with the lowest tertile (T1), a higher CDAI tertile (T3) was associated with a reduced risk (T3: HR, 0.96; 95% CI: 0.93 - 0.99; p for trend, 0.01).

Conclusion: Our study found that CDAI is inversely associated with all-cause mortality among patients with asthma, suggesting that higher antioxidant intake could potentially reduce mortality in this population. Future studies should explore the specific mechanisms by which dietary antioxidants influence asthma outcomes and evaluate the impact of targeted nutritional interventions in clinical practice.

Ethical compliance: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Background: Asthma is a chronic inflammatory disease of the airways with significant global disease burden. The relationship between Relative Fat Mass (RFM) - a novel obesity metric - and asthma exacerbation remains poorly characterized. This study aimed to determine whether RFM independently associates with exacerbation risk in asthma patients.

Methods: We conducted a cross-sectional study involving 1,770 adult participants from the National Health and Nutrition Examination Survey (NHANES). Participants were stratified by RFM tertiles (T1-T3). We used logistic regression models to assess the association between RFM and asthma exacerbation. Analyses were performed using both continuous and categorical RFM definitions, with progressive covariate adjustment across four models.

Results: Significant differences were observed between stable asthma and asthma exacerbation groups in terms of sex, education level and family history of asthma. After full covariate adjustment, RFM remained significantly associated with asthma exacerbation, confirming RFM as an independent predictor of asthma exacerbation (OR = 1.03, 95%CI: 1.01 ∼ 1.05, P=0.001), with higher RFM tertiles (T3:OR = 1.59, 95%CI: 1.09 ∼ 2.31, P=0.016) showing increased risk. Curve fitting confirmed a linear dose-response relationship (P=0.003).

Conclusion: This study revealed an independent positive association between RFM and asthma exacerbation risk, suggesting its potential utility for risk stratification.

Objective: Children from Latino backgrounds face unique challenges in managing asthma. Barriers are compounded when children live in urban settings and are exposed to urban stressors (e.g. barriers to medication use, neighborhood stress). Asthma management in schools is often directly implicated. This study aims to address these gaps in care by developing a 4-session, peer-facilitated, culturally tailored asthma self-management group intervention in urban public-school settings.

Methods: We developed and tested the ASMAS (Asthma Self-Management in Schools) intervention, utilizing an iterative process guided by previous work and theoretical models. Feedback from focus groups was used to further tailor ASMAS. We enrolled 81 middle school students in a cross-site pilot randomized controlled trial (RCT) to evaluate the efficacy of ASMAS compared both to Attention Control and No-Treatment Control conditions. Outcomes included asthma control, asthma-related sleep disruption, school absences, asthma self-efficacy, and availability of rescue inhaler and asthma action plan (AAP) at school.

Results: Compared to Attention Control participants, youth who received ASMAS had improved asthma outcomes over time (baseline to end-of-treatment) including asthma control (t = 2.1, p<.05, d = .4, M_diff = 1.5), asthma-related sleep disruptions (t = -0.24, p <.05, d = -0.4, M_diff = -3.6), school absences (d = -0.2), asthma management self-efficacy (t = 2.3, p <.05, d = .4, M_diff = 0.3) and rates of AAP (t = 1.8, p = .06; d = .3, M_diff = 20%) and rescue inhalers availability (t = 2.0, p <.01, d = .7, M_diff = 23%). Similar patterns were maintained at 4-month follow-up.

Conclusions: Results demonstrate ASMAS' feasibility and highlight the potential benefits of the tailored asthma intervention. A full-scale RCT to evaluate ASMAS' effectiveness, implementation, and sustainability is warranted.

Objective: To systematically evaluate the association between asthma and the risk of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT).

Data sources: PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies published up to May 2025.

Study selection: Observational studies (cohort, case-control, and cross-sectional) reporting the association between asthma and VTE, PE, or DVT with available odds ratios (ORs) or hazard ratios and 95% confidence intervals (or data to calculate them) were included.

Results: The meta-analysis revealed a significant association between asthma and increased risk of VTE. Patients with asthma had a 2.41-fold higher odds of PE (OR = 2.41, 95% CI: 1.77-3.27), 1.56-fold higher odds of DVT (OR = 1.56, 95% CI: 1.49-1.63), and 1.61-fold higher odds of overall VTE (OR = 1.61, 95%: CI 1.45-1.77). Cohort studies showed the strongest association (OR = 4.21, 95% CI 2.56-6.92). Subgroup analysis by region indicated the highest risk in Asia (OR =3.19, 95% CI: 2.06-4.96), followed by America (OR = 2.24, 95% CI: 1.55-3.24) and Europe (OR = 1.64, 95% CI: 1.49-1.81).

Conclusion: Asthma is significantly associated with an elevated risk of PE, DVT, and VTE, with particularly strong associations observed in cohort studies and Asian populations. These findings highlight the need for further research into underlying mechanisms and whether optimized asthma management can reduce thrombotic risk.

Background: Asthma is a chronic disease impacting millions globally, with rising prevalence linked to obesity. Body roundness index(BRI) is a novel measure of visceral fat istribution, but its association with asthma remains unexplored.

Objective: This study aimed to assess the relationship between body roundness index (BRI) and the prevalence of asthma using NHANES data from 2001 to 2018.

Date sources: www.cdc.gov/nchs/nhanes/.

Study selections: The association between BRI and asthma prevalence, as well as age at first asthma, was examined using NHANES data from 2001 to 2018. Subgroup analysis was conducted to evaluate sensitive populations. Nonlinear relationships between BRI and asthma prevalence and age at first asthma were assessed through smooth curve fitting and threshold effect analysis.

Results: Among the 44,426 participants, 6,057 self-reported having asthma. After adjusting for confounders, a positive association was observed between BRI and asthma prevalence (OR = 1.09, 95% CI: 1.08, 1.11). This association grew stronger as BRI increased (P for trend <0.01). Smooth curve fitting analysis indicated a linear relationship between BRI and asthma prevalence. Subgroup analysis revealed a positive association between BRI and all groups. Furthermore, there was a nonlinear positive relationship between BRI and age at first asthma (β = 0.46, 95% CI: 0.24, 0.68), with the saturation effect analysis indicating an important inflection point at 5.24.

Conclusions: Increased BRI showed a linearly positive association with higher asthma incidence, although causality cannot be determined. Greater caution is advised when considering higher BRI, particularly regarding the development of late-onset asthma.

Objective: To identify the most influential features of asthma control in children and to assess whether feature selection improves model performance.

Methods: Records of 890 patients (<18 years) from the Immunology, Asthma, and Allergy Research Institute, Children's Medical Center, Tehran (2013-2018) were analyzed. The binary outcome was asthma control (controlled vs uncontrolled). Eighty-three candidate features (demographics, comorbidities, history, triggers) were considered. Thirteen FS methods (filters, wrappers, embedded methods, plus PCA) were compared. For each method, the top 20 features were used to train an XGBoost classifier; the full 83-feature model served as the baseline. Performance was estimated with repeated holdout cross-validation (10 repeats, 90/10 splits) and summarized using Accuracy, Precision, Recall, F1, ROC-AUC, and PR-AUC.

Results: Relative to the all-features baseline model, the model trained on the SVM-selected subset showed consistent gains in key metrics: Recall increased from 86.12% to 90.32%, F1 from 77.37% to 82.84%, PR-AUC from 77.37% to 82.84%, and ROC-AUC from 52.18% to 64.21%. Features with high consensus across methods were primarily related to modifiable triggers (e.g., smoke exposure and climate-related factors) and medical history (e.g., allergic rhinitis and eczema).

Conclusions: Applying feature selection generally improved performance across multiple metrics, yielding compact, stable subsets that highlight modifiable factors - particularly triggers and allergic history - and support clinical interpretability. These findings are associative; therefore, external validation is recommended.

Background: Asthma and other allergic diseases, driven by immune dysregulation, pose a significant global health burden. While observational and experimental studies suggest a link between metabolites and allergies, causality remains unclear.

Methods: Genome-wide association study (GWAS) data for childhood allergies (CA; ncase = 6110, controls = 406,07) and typical allergic conditions included asthma, hay fever and eczema (ncase = 180,129, controls = 180,709) were used. Data on exposures were extracted from 136,016 Europeans for 233 circulating biomarkers and from 8,000 participants for 1400 plasma metabolites. The primary universal Mendelian randomization (UVMR) analysis used inverse variance weighting (IVW) and three supplementary methods for causal assessment. Sensitivity analyses included Cochran's Q test, MR-Egger intercept and MR-PRESSO to ensure robustness. Leave-one-out (LOO) analysis evaluated bias by sequentially removing SNPs. Bonferroni correction was applied, and significant metabolites underwent pathway enrichment analysis.

Results: We identified 24 metabolic pathways potentially involved in the biological mechanisms of typical allergic diseases and CA. MR analysis revealed 3 circulating biomarkers and 57 metabiotic traits potentially linked to CA, while 2 biomarkers and 56 metabolites were causally related to typical allergic diseases. After genetic correction, the ratio of omega-6 fatty acids to total fatty acids (IVW: p = 0.015, OR: 0.816, 95% CI: 0.693-0.961) and bilirubin (E, E) level (IVW: p = 8.23 × 10^-4, OR: 1.097, 95% CI: 1.039-1.578) remained significantly associated with CA. The significant roles of valine, leucine and isoleucine biosynthesis (p = 1.7 × 10^-3) and degradation (p = 0.041) in allergic diseases were also identified.

Conclusions: This study identified genetically determined metabolites and pathways significantly associated with asthma and other allergic diseases, offering novel insights into their pathogenesis.

Objective: The Mediterranean diet (MD) is known for its anti-inflammatory and antioxidant properties, yet its role in asthma pathophysiology remains underexplored. This study aimed to investigate the association between adherence to the MD and systemic markers of eosinophilic inflammation and oxidative stress in adult patients with bronchial asthma.

Methods: In this cross-sectional study, 86 adult asthma patients from a university outpatient clinic were assessed. Anthropometric measurements, Asthma Control Test (ACT) scores, and dietary habits (via the MedDiet score) were collected. Oxidative stress and antioxidant capacity were evaluated using the d-ROM (derivatives of reactive oxygen metabolites) test and PAT (plasma antioxidant test), respectively. Blood eosinophil percentage and absolute count were also measured.

Results: The majority of patients (83.7%) exhibited moderate adherence to the MD, while only 8.1% demonstrated high adherence. Higher MedDiet scores were significantly associated with lower eosinophil percentages (r = -0.322, p < 0.01) and counts (r = -0.254, p < 0.05), and greater antioxidant capacity (PAT) in patients with severe asthma (r = 0.339, p = 0.047). Full-fat dairy intake was positively associated with oxidative stress (d-ROM), while fruit and olive oil consumption were linked to enhanced antioxidant levels. No significant differences in oxidative stress were observed between asthma severity groups.

Conclusions: Greater adherence to the MD is associated with lower systemic eosinophilic inflammation and enhanced antioxidant capacity in asthma patients. The data indicate that dietary interventions could serve as complementary strategies in asthma care, particularly for severe cases, and that oxidative-stress associations were present and strongest among patients with severe asthma.

Objectives: This study aimed to examine the effectiveness of motivational interviewing (MI) in enhancing asthma self-efficacy among adults in a primary care setting in Northern Jordan.

Methods: A quality improvement project employing a quasi-experimental pre-post design was conducted using a convenience sample of adults diagnosed with asthma. The Asthma Self-Efficacy Scale (ASES) was administered at baseline and again eight weeks after implementation of the MI intervention. The sessions were guided by Bandura's self-efficacy framework, focusing on mastery experiences, social persuasion, and emotional regulation. Data were analyzed using paired t-tests at a significance level of 0.05.

Results: Participants demonstrated a significant improvement in asthma self-efficacy scores and symptom control following the intervention. The paired t-test indicated a statistically significant increase in self-efficacy (p < 0.001), confirming the intervention's effectiveness. Additionally, participants reported lower perceived stress and a 56% reduction in asthma symptom flare-ups.

Conclusions: Motivational interviewing proved effective in strengthening asthma self-management by enhancing patients' confidence and promoting behavioral change. The integration of MI into routine primary care is recommended to foster patient empowerment and improve clinical outcomes.