Journal of Asthma最新文献

Objective: To observe the clinical efficacy of medical education combined with extended care in patients with bronchial asthma and its effect on adherence to inhaled glucocorticoids.

Methods: Ninety-eight patients with bronchial asthma were divided into the control group and the experimental group, n = 49, by utilizing the random number table method. The control group was given routine education and care as well as routine out-of-hospital instructions, and the experimental group was given medical education and extended care based on the control group. Asthma disease knowledge mastery, asthma control, quality of life, medication adherence and lung function were compared between both groups, and the number of asthma attacks and re-hospitalizations were recorded.

Results: The experimental group performed higher scores of health knowledge, asthma control test and quality of life, rate of complete adherence, forced expiratory volume in one second (FEV₁), peak expiratory flow rate, and FEV₁/forced vital capacity. The number of asthma attacks and the times of re-hospitalizations were lower in the experimental group (all p < 0.05).

Conclusion: Medical education combined with extended care can improve bronchial asthma patients' mastery of asthma disease knowledge, effectively control patients' conditions, enhance patients' quality of life and lung function, increase patients' adherence to inhaled glucocorticoids, and reduce the recurrence of bronchial asthma patients.

Objective: This review aims to present existing evidence on the impact of pioglitazone, a thiazolidinedione class anti-diabetic drug, on asthma control and lung function, providing a comprehensive understanding of its potential as a treatment for asthma.

Data sources: The review draws upon data from preclinical animal studies and clinical trials investigating the effects of pioglitazone on asthma, focusing on its role in reducing airway inflammation, hyperreactivity, and remodeling, and its impact on pulmonary function.

Study selections: Relevant studies were selected based on their examination of pioglitazone's therapeutic effects in asthma, including both animal models and clinical trials involving human asthma patients.

Results: Animal studies have suggested that pioglitazone could alleviate inflammation, airway hyperreactivity, and airway remodeling, thereby improving pulmonary function in asthma. However, clinical trials have not demonstrated significant therapeutic benefits, with minimal improvements observed in asthma control and lung function, and the presence of notable side effects.

Conclusion: Despite promising preclinical data, the efficacy of pioglitazone in treating human asthma remains unproven, with safety concerns and limited clinical benefits observed in trials. Further research is needed to assess the safety and effectiveness of pioglitazone in asthma treatment and to explore its impact on other inflammatory mechanisms.

Background: Asthma is a common chronic condition with increasing prevalence. Diet, including dried fruit consumption, has been linked to asthma risk, but the mechanisms remain unclear. This study investigates how dried fruit consumption affects asthma risk, focusing on acetate as a potential mediator.

Methods: We used Mendelian Randomization (MR) to analyze the relationships between dried fruit intake, acetate levels, and asthma. We applied three MR methods-Inverse-Variance Weighted (IVW), Weighted Median (WM), and MR-Egger-to determine causal effects.

Results: Dried fruit intake was inversely associated with asthma risk (IVW: β = -0.506, p = 0.0135) and positively associated with acetate levels (IVW: β = 0.269, p < 0.0001). Higher acetate levels were also linked to lower asthma risk (IVW: β=-0.361, p < 0.0001). Mediation analysis showed that acetate mediates approximately 19.22% of the effect of dried fruit on asthma risk.

Conclusion: Dried fruit consumption reduces asthma risk, partly through increasing acetate levels. This acetate-mediated pathway accounts for about 20% of the effect, suggesting potential for dietary strategies in asthma prevention and management. Further research could enhance the understanding and applicability of these findings.

Background: Recurrent respiratory tract infections (RRTIs) in children represent a significant clinical challenge. Although some studies have identified potential risk factors, a comprehensive and systematic overview is lacking.

Objective: This analysis is carried out to provide more advanced evidence to guide future prevention and health care.

Methods: This study (PROSPERO: CRD42024576464) was conducted in accordance with PRISMA guidelines. PubMed, Embase, Web of Science, and the Cochrane Library were searched for relevant studies published in English. Subgroup analysis, sensitivity analysis, and publication bias assessments were performed. Data analysis was conducted using Stata 17, and GRADE was employed to assess the quality of evidence. The risk factors identified in the positive results were discussed qualitatively.

Results: A total of 29 studies covering 639,078 children were included. Some risk factors: asthma (OR = 3.08, 2.06-4.62), breastfeeding <6 months (OR = 1.26, 1.04-1.52), DCC: day care center (OR = 1.50, 1.16-1.93), have siblings (OR = 1.26, 1.00-1.59), ETS: Environmental tobacco smoke (OR = 1.13, 1.00-1.27), snoring (OR = 1.49, 1.16-1.93) got positive result.

Conclusion: This analysis identifies several key risk factors for RRTIs in children, providing enhanced evidence for prevention and management strategies. In particular, asthma warrants closer attention, given its strong association with respiratory infections in pediatrics.

Objectives: Current variations in asthma prevalence and clinical characteristics suggest that lifestyle choices including dietary habits, may affect the pathogenesis and/or clinical expression of the disease. The purpose of this study is to evaluate the association between adherence to Mediterranean diet (MD) and asthma control, considering disease severity.

Methods: Adherence to MD was assessed through a questionnaire, the MD Adherence Screener (MEDAS), previously validated in Mediterranean populations. Each participant received a score ranging from 0 to 14. A score higher than 10 indicates high MD adherence. The level of asthma control was assessed by the Asthma Control Test and two groups were formed (controlled vs. partly controlled/uncontrolled).

Results: The study sample included 105 participants (34% males). About 45% of participants were severe asthmatics. Adherence to MD was associated with 14% higher, though not statistically significant, probability of controlled asthma in the overall study sample (OR = 1.14; 95% CI = 0.46-2.81) and 60% higher probability of controlled asthma among severe asthmatics (OR = 1.60, 95% CI = 0.46-5.59).

Conclusions: These results indicate a possible association between adherence to MD and asthma control, but findings are restricted by the study's small sample size which does not allow asserting the inference.

Objective: To evaluate the impact of peak expiratory flow (PEF) monitoring using a smart peak flow (SPF) device on the quality of life (QoL) and satisfaction among children with asthma.

Methods: This 3-month prospective cohort study enrolled 71 children aged 7 to 17 years with physician-diagnosed asthma. Participants used the SPF device twice daily, with measurements recorded automatically. Quality of life was assessed using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and asthma control was assessed using the Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT). Adherence to PEF measurements and satisfaction with the device were evaluated.

Results: Seventy-one children (mean age 11.4 years) completed the study. Adherence to twice-daily PEF measurements decreased significantly over three months (from 50.0% at 1 month to 39.9% at 3 months, p < 0.001). Children with good adherence (38.0%) showed significant improvements in PAQLQ scores, while those with poor adherence (62.0%) did not. COVID-19 infection resulted in a significant decrease in %PEF rate and increased peak flow variability. Despite device-related issues, overall satisfaction was high (85.19% for good adherence users vs. 88.64% for poor adherence users, p = 0.671).

Conclusion: Regular PEF monitoring improves QoL in children with asthma by enabling early detection of symptom changes and better management. However, maintaining adherence to regular PEF monitoring is challenging. Further research with control groups is needed to validate these findings.

Background: Previous studies have suggested a potential link between pediatric asthma and psychiatric disorders. However, the causal relationship between pediatric asthma and psychiatric disorders is unclear. Therefore, we used Mendelian randomization to explore causal relationships between pediatric asthma and depression, anxiety disorders, and attention deficit and hyperactivity disorder (ADHD).

Methods: Genome-wide association studies (GWAS) meta-analyses with the largest possible sample size and independent individuals from European ancestry were selected. The genetic data for depression and anxiety are from FinnGen consortium, while the genetic data for ADHD is from the Psychiatric Genomics Consortium. Inverse variance weighted (IVW) was the main analysis method. The heterogeneity of the instrumental variables (IVs) was assessed using IVW, and the horizontal pleiotropy of the IVs was assessed using MR-Egger.

Result: The IVW results showed a significant causal relationship between pediatric asthma and depression (OR = 1.08, 95% CI = 1.02-1.15; p = 0.013). However, there is no evidence to suggest a causal relationship between pediatric asthma, anxiety, and ADHD. Reverse MR suggests a significant causal relationship (OR = 1.27, 95% CI [1.14-1.41], p = 9.64E - 06) between ADHD and pediatric asthma using the IVW method.

Conclusions: Our findings suggest a causal relationship between pediatric asthma and an increased risk of depression. Additionally, we found that ADHD is significantly associated with a higher risk of pediatric asthma.

Background: There is limited information on the discrepancy between the spirometric values calculated with diverse spirometric prediction equations in normal children.

Objective: To determine the differences in percentage predicted (PP) values calculated through thirteen prediction equations (PEs) in healthy Chilean children.

Methods: We compared the PP values for FVC, FEV1, FEF25-75% and FEV1/FVC obtained by applying thirteen PEs, using GLI-2012 as a gold standard reference equation and including race neutral GLI-2022 in the analysis; PP values are from a group of 208 healthy Chilean children aged 7 to 17 years.

Results: In boys, the range of differences for FVC between PEs compared to the reference group went from -5.47% to 20.82% and from -6.4% to 19.74% in girls. For FEV1, in girls, the range of differences went from -5.96% to 18.01% and from -5,04% to 20.67% in boys. Significant differences between GLI-2012 PPs and the other PEs were observed more frequently in girls than in boys (p < 0.001).

Conclusions: There is a wide difference between the spirometric PPs values by different PEs, including race neutral GLI-2022. Our findings, especially given the potential interpretative and clinical implications, might suggest the need for conducting standardized, multicenter studies in Latin America to determine which PEs would better fit pediatric populations in this region.

Background and aims: To construct a set of scientific and effective quality evaluation indicators of continuing care for children with asthma, and to promote the development of continuing care for children with asthma toward a more specialized and standardized direction.

Methods: Through literature research and semi-structured interview, the item pool of evaluation index was drawn up, and the first draft of expert inquiry questionnaire was formed based on the three-dimensional quality theoretical model of structure-process-result, and the construction of quality evaluation index was completed through two rounds of expert inquiry and analytic hierarchy process.

Results: The effective recovery rate was 94.44% in the first round and 100.00% in the second round, the expert authority coefficient was 0.852 and 0.863, and the Kendal coordination coefficient was 0.129 and 0.126, respectively (p < 0.01). Finally, the evaluation index of continuing care quality for children with asthma was formed, including 3 first-level indicators, 9 s-level indicators and 36 third-level indicators, and then the weight and combination weight of each index were obtained by AHP.

Conclusions: The evaluation index of continuing care quality for children with asthma is scientific and specific, which is of great significance to the improvement of continuing care quality for children with asthma.

Introduction: Personalized Asthma Action Plans (AAPs) are a cornerstone of pediatric asthma management. We aimed to assess parental knowledge and perceptions of the use of AAPs in managing their child's asthma.

Methods: In 2023 we conducted a cross-sectional survey to assess knowledge and perceptions of AAPs in parents/caregivers of children aged 0-17 years with asthma who had an AAP and attended respiratory clinics at Sydney Children's Hospital, Randwick. The questionnaire included parental perceptions on the utility of AAPs, parental asthma management self-efficacy (PAMSE), and an adapted version of the Asthma Action Plan Knowledge Interview tool (AAPKI). Descriptive statistics and regression analyses were used to assess associations between AAPKI, PAMSE and other outcomes.

Results: Seventy-one parents completed the survey. Mean PAMSE score was 4.2/5 (SD 0.5). Median AAPKI score was 70.2% out of 100% (IQR 20.4%). Most parents (80.0%, n = 56) were satisfied/very satisfied with using AAPs to manage their child's asthma. Most agreed/strongly agreed that AAPs were helpful in knowing when to seek medical attention for their child's asthma (81.7%, n = 58), helped their understanding of asthma severity (81.7%, n = 58), and increased their confidence in asthma management (76.0%, n = 54). Over half of parents (55.7%, n = 39) would prefer AAPs digitally and majority (78.6%, n = 55) would like color-coded AAPs.

Conclusion: High levels of AAP knowledge and self-efficacy scores were demonstrated. Most parents expressed understanding of the benefits of AAPs. Our findings suggest parents of children with asthma prefer AAPs in color and in digital version which may help guide standardization of AAPs across Australia.