Asthma Exacerbations In Adults Research Articles

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children

Increased vs Stable Doses of Inhaled Corticosteroids for Exacerbations of Chronic Asthma in Adults and Children

Increased vs Stable Doses of Inhaled Corticosteroids for Exacerbations of Chronic Asthma in Adults and Children

Adult asthma exacerbations and environmental triggers: a retrospective review of ED visits using an electronic medical record

Background Despite familiarity with triggers for asthma, there is little recent study on the association of triggers with the emergency department (ED) presentation of adult asthma exacerbation. Methods Retrospective electronic chart review of adult patients treated in an urban teaching hospital ED with chief complaint and diagnostic coding related to asthma and upper respiratory tract infection (URI) was conducted. Monthly aeroallergen data and environmental conditions were obtained from a local allergen extract laboratory and local government sources. Data analysis was performed using Newey-West time series regression modeling with adjustment for autocorrelation or ordinary least squares linear regression modeling using outcome variables of asthma visits and admissions. Results There were 56 747 visits, with 554 asthma visits and 1 514 URI visits. Asthma visits ( R 2 = 0.631) were positively correlated with tree pollen counts (correlation coefficient = 0.458 [0.152-0.765]) and average humidity (correlation coefficient = 1.528 [0.296-2.760]). Asthma admissions ( R 2 = 0.480) were negatively correlated with average temperature (correlation coefficient = −0.557 [−1.052 to −0.061]) when adjusting for confounding by fine particulate matter. Conclusions The ED acute asthma exacerbation presentation is positively correlated with tree pollen and humidity, whereas need for admission is associated with dropping temperatures. These results reinforce the need for vigilance during periods of increased risk and perhaps focused preventative strategies.

Five-day course of budesonide inhalation suspension is as effective as oral prednisolone in the treatment of mild to severe acute asthma exacerbations in adults

Background Limited evidence is available on the use of budesonide inhalation suspension (BIS) for the treatment of mild to severe acute asthma exacerbations (AAE) in adults in an inpatient setting. This study was conducted to evaluate the efficacy of a five-day course of BIS compared with oral prednisolone (OP) in the management of adults with AAE. Methods A retrospective study examined the response of 28 patients hospitalized with mild to severe acute asthma exacerbation from January 2003 to December 2003. These patients, who were steroid free ≥1 yr, were administered a five-day course of BIS (2 × 2 mg bid) or OP (2 × 15 mg bid). PEF, FEV 1 and asthma symptom scores were recorded daily. Results The BIS ( n = 13) and OP ( n = 15) treatment groups were comparable at baseline for demographic characteristics and prebronchodilator (fenoterol) FEV 1 of 52.4% predicted normal value and 54.6% predicted normal value, respectively. Mean change of morning PEF was 152 L/min during BIS treatment and 130 L/min for OP treatment; the mean changes of morning forced expiratory volumes in 1 s (FEV 1) were 1.0 and 0.7 L, respectively. The mean change in daytime symptom scores were −1.6 and −1.3 in the BIS and the OP groups, respectively. Improvements in PEF, FEV 1 and daytime symptom scores were significantly different between baseline and after treatment in each treatment group ( p < 0.05). However, improvements in both BIS and OP groups were similar. Conclusion Budesonide inhalation suspension may be an alternative treatment of acute asthma exacerbation in adults who are at risk for systemic corticosteroids.

Association of Indoor Air Pollution with Rhinitis Symptoms, Atopy and Nitric Oxide Levels in Exhaled Air

Background: Exposure to particulate matter (PM) outdoors can induce airway inflammation and exacerbation of asthma in adults. However, there is limited knowledge about the effects of exposure to indoor PM. The aim of this study was to investigate the association of exposure to indoor sources of PM with rhinitis symptoms, atopy and nitric oxide in exhaled air (FeNO) as a measure of airway inflammation. Methods: We conducted a population-based cross-sectional study of 3,471 persons aged 18–69 years. Exposure to indoor sources of PM and prevalence of rhinitis symptoms were assessed by a self-administered questionnaire. Atopy was defined as at least 1 positive test (≧0.35 kU/l) for serum-specific IgE against grass, birch, cat or Dermatophagoides pteronyssinus. Regression analyses were used to adjust for confounders. Results: Self-reported exposure to the use of woodstoves, candles or gas kitchen cookers was not significantly associated with either increased prevalence of rhinitis symptoms or atopy or increased levels of FeNO. The prevalence of atopy and allergic rhinitis and the levels of FeNO were significantly decreased among current and previous smokers. Exposure to environmental tobacco smoke (ETS) for 0.5–5 h, but not above 5 h, was significantly associated with a slightly increased prevalence of rhinitis symptoms. Conclusion: Self-reported exposure to the use of woodstoves, candles or gas cookers was not significantly associated with an increased risk of rhinitis symptoms or atopy, nor increased FeNO. Self-reported exposure to ETS was associated with a slightly higher prevalence of self-reported rhinitis symptoms without any clear dose-response relationship.

The relationship of short-term air pollution and weather to ED visits for asthma in Japan

Introduction The incidence of asthma exacerbation has been increasing in many countries. Environmental factors may play an important role in this trend. We aimed to investigate the relationship of weather conditions and air pollution to significant exacerbation of asthma. Methods The daily number of emergency department (ED) visits by ambulance for asthma was collected through records of the Tokyo Fire Department from January 1 to December 31, 2005. We also collected daily air pollution levels and meteorological data for Tokyo during the same period. Meteorological data included minimum temperature, maximum barometric pressure, maximum relative humidity, and precipitation. Measured air pollutants included sulfur dioxide, nitrogen monoxide, nitrogen oxides, suspended particulate matter, and carbon monoxide. We performed a time series analysis using multivariable-adjusted autoregressive integrated moving average model. The analysis was conducted separately among adults and among children (<15 years old). Results Of a total of 643 849 patients who were transported to the ED by ambulance, there were 6447 patients with exacerbation of asthma. Among adults, lower minimum temperature was significantly associated with increased transport. Among children, there were no significant associations between exacerbation of asthmas requiring emergency transport and air pollutants or meteorological factors. The highest number of transports was found on October 11, the day after the National Sports Day in Japan. Conclusions Cold temperature is related to an increased risk of significant exacerbation of asthma in adults. Air pollution does not seem to play a major role in significant exacerbation of asthma requiring ambulance transports to ED.

Infections, Immunity &amp; their Effects on Asthma

Infections, Immunity &amp; their Effects on Asthma

How Viral Infections Cause Exacerbation of Airway Diseases

Exacerbations of asthma and COPD are major causes of morbidity, mortality, and health-care costs. Over the last decade, studies using new molecular diagnostic techniques have established that respiratory viruses are a major cause of exacerbations of both asthma and COPD. The most prevalent viruses detected during exacerbations are the rhinoviruses. Despite the burden of disease associated with exacerbations, little is known about the mechanisms of virus-induced exacerbations of airway diseases. Exacerbations are associated with increased airway inflammation in patients with both asthma and COPD, but many questions remain unanswered regarding the key inflammatory cells and mediators involved. Identifying the key inflammatory mediators involved in exacerbations holds the promise of developing diagnostic and prognostic markers of exacerbation. In addition, such studies can identify new therapeutic targets for the development of novel drugs for the prevention and treatment of exacerbations.

Papel del rinovirus en las infecciones respiratorias en niños hospitalizados

AntecedentesEl rinovirus se considera un agente causal de cuadros catarrales banales, sin embargo se ha descrito como un agente inductor de exacerbaciones asmáticas en adultos y niños mayores. En nuestro medio no se ha descrito el papel del rinovirus en infecciones respiratorias de niños hospitalizados.ObjetivosDescribir las infecciones confirmadas por rinovirus en niños hospitalizados por infección respiratoria en un hospital de segundo nivel.Pacientes y métodosEstudio descriptivo prospectivo de las infecciones confirmadas por rinovirus en niños hospitalizados por fiebre o infección respiratoria en la temporada 2004-2005. Para el diagnóstico virológico se realizó inmunofluorescencia y reacción en cadena de la polimerasa (PCR) en aspirado nasofaríngeo. Se describen las características clínicas de los pacientes.ResultadosSe describen un total de 76 niños hospitalizados con infección por rinovirus, lo que supuso el 25 % de los pacientes hospitalizados por procesos respiratorios o fiebre. El rinovirus fue el segundo agente viral identificado tras el virus respiratorio sincitial (29,9% de los hospitalizados). El 71,1 % de los pacientes fueron menores de 2 años. Los diagnósticos más frecuentes fueron sibilancias recurrentes en el 60,5 %, bronquiolitis en 23,7 %, neumonía en el 7,9 % e infección respiratoria de vías altas en el 5,3%. Presentaron fiebre de más de 38 °C el 57,9 % de los niños e infiltrado radiológico el 23,7%. Presentaron hipoxia el 43,4% de los niños. En niños mayores de 2 años el diagnóstico fue crisis asmática en 21 de los 22 casos.ConclusionesLos rinovirus se detectaron en un importante porcentaje de los niños hospitalizados a consecuencia de infección respiratoria, siendo precedidos en frecuencia sólo por el virus respiratorio sincitial. En nuestra serie es el agente viral más frecuentemente asociado con episodios de sibilancias recurrentes en niños mayores de 2 años, y el segundo en los más pequeños.

Pharmacological strategies for self-management of asthma exacerbations: Table 1—

Written action plans are effective within asthma self-management, but there are few guidelines about the specific medication adjustments which can be recommended for self-treatment of exacerbations. This review examines pharmacological strategies for self-management of asthma exacerbations in adults, including those for inhaled corticosteroid/long-acting beta2-agonist (ICS/LABA) users. Oral corticosteroids are well-established in clinical practice and clinical trials for the treatment of severe exacerbations, including during combination therapy. Evidence supports 7-10 days treatment, with no need to taper except to reduce side-effects. Doubling the dose of ICS is not effective. Several studies have shown benefit from high-dose ICS (2,400-4,000 microg beclomethasone equivalent) for 1-2 weeks. This may be achieved by adding a high-dose ICS inhaler to maintenance ICS or ICS/LABA therapy. There is inconclusive evidence about acutely increasing the dose of maintenance budesonide/formoterol for exacerbations, and no studies of this approach with fluticasone/salmeterol. For patients taking maintenance budesonide/formoterol, use of the same medication as-needed reduces exacerbations. Short-acting beta2-agonists are still effective in producing bronchodilation during combination therapy; however, a higher dose may be required. There is a need for further studies to clarify remaining issues about self-management of asthma exacerbations, particularly with regard to side-effects of treatment and patient acceptability.

Formoterol via Turbuhaler is as effective as salbutamol via pMDI* with spacer in the treatment of acute asthma exacerbations in adults,

Formoterol via Turbuhaler is as effective as salbutamol via pMDI* with spacer in the treatment of acute asthma exacerbations in adults,

A comparison of levalbuterol with racemic albuterol in the treatment of acute severe asthma exacerbations in adults

This multicenter, randomized, double-blind trial compared nebulized levalbuterol (Lev) and racemic albuterol (Rac) in the treatment of acute asthma. Methods Adults with acute asthma exacerbations (FEV 1 20%-55% predicted) received prednisone and either Lev (1.25 mg, n = 315) or Rac (2.5 mg, n = 312). Nebulized treatments were administered every 20 minutes in the first hour, then every 40 minutes for 3 additional doses, then as necessary for up to 24 hours. The primary end point was time to meet discharge criteria. Secondary end points included changes in lung function and hospitalization rates. A subset of 160 patients had plasma ( S)-albuterol concentrations determined at study entry. Results Time to meet discharge criteria did not differ between the 2 treatments. FEV 1 improvement was greater following Lev compared with Rac, both after dose 1 and cumulatively over the entire treatment period (dose 1 in intent to treat [ITT] group: Lev 0.50 ± 0.43 L, Rac 0.43 ± 0.37 L; P = .02), particularly among the 60% of patients not on recent steroid therapy (dose 1: Lev 0.58 ± 0.47 L, Rac 0.44 ± 0.37 L; P < .01), and patients whose entry ( S)-albuterol concentrations were in the highest quartile of those measured. A small and similar proportion of Lev-treated (7.0%) and Rac-treated (9.3%) patients required hospitalization ( P = .28). Among patients not on steroids, fewer Lev- than Rac-treated patients required admission (3.8% vs 9.3%, P = .03), as was also the case for patients with high plasma ( S)-albuterol concentrations. Asthma relapses (5% in 30 days) were lower than in previous reports and did not differ between groups. Conclusions This study suggests that early, regular nebulized β 2-agonist and systemic corticosteroid therapy may reduce hospitalization and relapse rates in patients with acute severe asthma. Lev was well tolerated and compared favorably with Rac in improving airway function, particularly in those who were not on inhaled or oral corticosteroids and in those who had high plasma ( S)-albuterol concentrations at presentation.

Rhinovirus chemotherapy

Human rhinoviruses (HRV), members of the Picornaviridae family, are comprised of over 100 different virus serotypes. HRV represent the single most important etiological agents of the common cold [Arruda, E., Pitkaranta, A., Witek Jr., T.J., Doyle, C.A., Hayden, F.G., 1997. Frequency and natural history of rhinovirus infections in adults during autumn. J. Clin. Microbiol. 35, 2864–2868; Couch, R.B., 1990. Rhinoviruses. In: Fields, B.N., Knipe, D.M. (Eds.), Virology. Raven Press, New York, pp. 607–629; Turner, R.B., 2001. The treatment of rhinovirus infections: progress and potential. Antivir. Res. 49 (1), 1–14]. Although HRV-induced upper respiratory illness is often mild and self-limiting, the socioeconomic impact caused by missed school or work is enormous and the degree of inappropriate antibiotic use is significant. It has been estimated that upper respiratory disease accounts for at least 25 million absences from work and 23 million absences of school annually in the United States [Anzueto, A., Niederman, M.S., 2003. Diagnosis and treatment of rhinovirus respiratory infections. Chest 123 (5), 1664–1672; Rotbart, H.A., 2002. Treatment of picornavirus infections. Antivir. Res. 53, 83–98]. Increasing evidences also describe the link between HRV infection and more serious medical complications. HRV-induced colds are the important predisposing factors to acute otitis media, sinusitis, and are the major factors in the induction of exacerbations of asthma in adults and children. HRV infections are also associated with lower respiratory tract syndromes in individuals with cystic fibrosis, bronchitis, and other underlying respiratory disorders [Anzueto, A., Niederman, M.S., 2003. Diagnosis and treatment of rhinovirus respiratory infections. Chest 123 (5), 1664–1672; Gern, J.E., Busse, W.W., 1999. Association of rhinovirus infections with asthma. Clin. Microbiol. Rev. 12 (1), 9–18; Pitkaranta, A., Arruda, E., Malmberg, H., Hayden, F.G., 1997. Detection of rhinovirus in sinus brushings of patients with acute community-acquired sinusitis by reverse transcription-PCR. J. Clin. Microbiol. 35, 1791–1793; Pitkaranta, A., Virolainen, A., Jero, J., Arruda, E., Hayden, F.G., 1998. Detection of rhinovirus, respiratory syncytial virus, and coronavirus infections in acute otitis media by reverse transcriptase polymerase chain reaction. Pediatrics 102, 291–295; Rotbart, H.A., 2002. Treatment of picornavirus infections. Antivir. Res. 53, 83–98]. To date, no effective antiviral therapies have been approved for either the prevention or treatment of diseases caused by HRV infection. Thus, there still exists a significant unmet medical need to find agents that can shorten the duration of HRV-induced illness, lessen the severity of symptoms, minimize secondary bacterial infections and exacerbations of underlying disease and reduce virus transmission. Although effective over-the-counter products have been described that alleviate symptoms associated with the common cold [Anzueto, A., Niederman, M.S., 2003. Diagnosis and treatment of rhinovirus respiratory infections. Chest 123 (5), 1664–1672; Gwaltney, J.M., 2002a. Viral respiratory infection therapy: historical perspectives and current trials. Am. J. Med. 22 (112 Suppl. 6A), 33S–41S; Turner, R.B., 2001. The treatment of rhinovirus infections: progress and potential. Antivir. Res. 49 (1), 1–14; Sperber, S.J., Hayden, F.G., 1988. Chemotherapy of rhinovirus colds. Antimicrob. Agents Chemother. 32, 409–419], this review will primarily focus on the discovery and development of those agents that directly or indirectly impact virus replication specifically highlighting new advances and/or specific challenges with their development.

Lack of insurance coverage and urgent care use for asthma: A retrospective cohort study

BackgroundAsthma is a common chronic disease with profound impacts upon individuals and the US health care system. Inadequate health care coverage has been associated with more frequent and severe exacerbations of the disease. We examined the relationship between adequacy of health care coverage and use of emergent care of adults with asthma.MethodsThe 2001 Behavioral Risk Factor Surveillance System was the source of data on adults with current asthma. Bivariate and multiple logistic regression analysis modeled identifiable factors in predicting urgent or emergent care.ResultsKey variables included demographics and information on self-reported gaps in health care coverage. The primary outcome was emergency room or urgent care visits for worsening of asthma symptoms. Of 16,234 subjects nationally with current asthma, 2,195 from eight states had valid responses to a supplemental module asking about emergency room use or urgent care visits because of asthma. Thirty four percent of these individuals required such care in the previous year. Having an interruption in health care coverage in the past year was associated with an increased risk of needed urgent or emergent care (crude Odds Ratio [OR] 1.48, 95% confidence intervals [CI]1.03, 2.1). The association was not statistically significant in the adjusted multivariate model including race/ethnicity, employment status, gender, age, education and the ability to identify a primary physician (adjusted OR 1.2, 95% CI 0.8, 1.8).ConclusionThis study provides population-level, generalizable evidence of increased risk of exacerbations of asthma in adults and (1) their demographic characteristics, and (2) continuous adequate health care coverage.

Beyond Our Pages

Beyond Our Pages

Doubling daily inhaled corticosteroid dose is ineffective in mild to moderately severe attacks of asthma in adults

Asthma guidelines recommend increasing or doubling inhaled corticosteroid (ICS) dose to treat mild and moderate exacerbations of asthma in adults. To: (i) compare the effectiveness of doubling existing daily ICS dose (fluticasone) with maintaining usual ICS dose and usual daily ICS dose accompanied by oral steroids (OS) (dexamethasone) during mild and moderately severe exacerbations of asthma in adults; (ii) examine determinants of success and failure; and (iii) compare side-effect profiles. A randomized, double-blind, placebo-controlled (double-dummy), triple crossover trial. Participants acted as their own control. Outcome measures included treatment success/failure, peak expiratory flow (PEF) after 7 days therapy or at treatment failure, and side-effects. From 22 participants (nine males and 13 females), 18 pairs of data were available for maintaining usual ICS versus doubling ICS and doubling ICS versus OS, and 19 for maintaining usual ICS versus OS. Median (fifth-95th percentile) age was 46.5 (32-64) years and forced expiratory volume in one second (FEV(1)) 73% (29-97%) predicted. The outcome after doubling ICS was not superior to maintaining usual ICS, with 11 (61%) failures in both arms (P = 0.66). OS, with only 5 (26%) failures, was superior to maintaining usual ICS with 12 (63%) failures (P = 0.04), and to doubling ICS with 5 (28%) versus 11 (61%) failures (P = 0.07). Median PEF (as percentage of run-in best) at end-points were 90.5% (57.1-177.1) for OS, 78.3% (39.5-103.1) for maintaining usual ICS and 77.9 (27.7-110.3) for doubling ICS. Neither gender nor PEF at exacerbation were predictive of failure. Although doubling ICS was not an effective therapy overall, ICS dose at exacerbation were predictive of success in the doubling ICS arm (P = 0.04). Treatment failures when doubling daily ICS dose were more common if achieved fluticasone dose was less than 2000 microg (three of 11, 73%) compared to 2000 microg or greater (eight of eight, 37.5%). Increasing age and the presence of an upper respiratory tract infection (URTI) were predictive of failure with OS. Side-effects were more commonly reported with OS (52.6%) than doubling ICS (42.1%) or maintaining usual ICS (19.1%) with the most common being mood changes (36.8%), sleep disturbance (31.6%) and changes in appetite (26.3%). Doubling daily ICS dose per se is not effective for the treatment of mild to moderately severe exacerbations of asthma in adults. Success may depend on achieved ICS dose. Oral steroids are effective, but side-effects are common. A review of current guidelines may be warranted.

Naturally Occurring Parainfluenza Virus 3 Infection in Adults Induces Mild Exacerbation of Asthma Associated with Increased Sputum Concentrations of Cysteinyl Leukotrienes

Background:Viral respiratory tract infections represent the most frequent cause of asthma exacerbation in both children and adults, but the precise mechanism of such exacerbation remains unknown. Objectives: To determine the critical mediator of naturally occurring parainfluenza virus (PIV) 3-induced mild asthma exacerbations in adults. Methods: The study subjects were 19 adult asthmatics with mild asthma exacerbation (peak expiratory flow = 60–80% of predicted before bronchodilator use and >80% of predicted after initial bronchodilator treatment). Differential cell counts and concentrations of inflammatory markers including eosinophil cationic protein (ECP), cysteinyl leukotrienes (cysLTs), interleukin (IL)-5, IL-10 and IL-12 were measured in the induced sputum obtained from adults with PIV3- (n = 9) and non-cold-induced (n = 10) exacerbation of asthma during both acute and convalescent phases. Results: PIV3 infection was confirmed by the presence of viral RNA in nasopharyngeal aspirates. Mild exacerbation of asthma was not associated with significant changes in sputum differential cell counts. Concentrations of sputum ECP and cytokines were comparable between PIV3 and non-cold-induced patients. In contrast, PIV3 infection was associated with a significant increase in sputum cysLTs during the acute phase of mild asthma exacerbation. Conclusions: Our results identified cysLTs as a critical mediator of PIV3-induced acute asthma exacerbation.

The Tottori-Ken Seibu earthquake and exacerbation of asthma in adults

The aim of the study was to characterize patients at risk for exacerbations of their asthma as a result of the Tottori-Ken Seibu earthquake and to identify factors that predict exacerbation of asthma after an earthquake. A retrospective cohort study-analysis was conducted of 156 asthmatic patients, aged 18 to 89 years, who were out-patients of Tottori University Hospital and who had completely recorded their asthmatic symptoms and measured their peak expiratory flow (PEF) rates for more than one year prior to the earthquake. Seventeen (11%) patients who experienced the earthquake were identified as having an exacerbation within one month after the earthquake. Diurnal variability of PEF during the month after the earthquake was compared to values during a matched month one year previously. When factors associated with exacerbation were identified by a review of the medical case notes and the contribution of these factors to the exacerbation was determined using multivariate analysis, airflow limitation was shown to be independently associated with exacerbation after the earthquake. Acute asthma attacks are more likely to occur within the first week after the earthquake event without diurnal PEF variability. Asthma is likely to worsen after an earthquake.

Mechanisms of viral impact on asthma exacerbations

Rationale Respiratory viruses are a frequent cause of wheezing in infants and children. 60 - 85% of asthma exacerbations in children and up to 50% of asthma exacerbations in adults are attributed to respiratory viruses. Previous studies investigated the role of rhinoviruses, RS-viruses and adenoviruses in development of asthma exacerbations in children hospitalized in the clinic of the Institute of Immunology (Moscow, Russia). Rhinovirus was the most frequently detected – 33 samples (24.8% of all tested samples), adenovirus – 5 samples (3.8%), RSV– 4 samples (3.0%), and mixed infections (rhinovirus and RSV) – 1 sample (0.7%). Among positive samples rhinovirus accounted for 76.7%, adenovirus - 11.6%, RSV - 9.3%, and mixed infection - 2.3%. Methods Primers for PCR diagnostics of Parainfluenza viruses of 1, 2 and 3 type and coronaviruses OC43 and 229E were developed. Investigation of HLA-alleles and genotypes was conducted in patients with virus-induced bronchial asthma to reveal HLA-associated markers of susceptibility to viral-induced asthma. Results An increased frequency of HLA-DRB1 ∗13 specificity and reduced frequencies of HLA-DRB1 ∗04 and HLA-DRB1 ∗11 specificities were noted in the viral-induced asthmatics compared to the healthy control group. A minimal increase of HLA-DRB1 homozygotes - 21% was also noted in comparison with the control group - 14%. Conclusions Investigation of HLA-haplotype in patients with viral-induced outbreaks of asthma via HLA-genotyping may reveal more evident associations between HLA-haplotypes and individual respiratory viral infections.

The pH of exhaled breath condensate (EBC): A non invasive tool for evaluation of asthma in childhood

Rationale Recent studies show that the pH of EBC could be predictive of asthma exacerbation in adults. However no data are available in children. The aim of our study was to establish if EBC pH could be used as a non-invasive mean of monitoring asthma in childhood. Methods Between April and July 2002, a total of 104 consecutive patients with mild persistent asthma (72 M, median age 9.9 years) were enrolled. Thirty healthy children were used as controls (11 M, median age 7 years). All children performed skin prick tests, lung function tests and EBC pH measurements, using a hand-made device. Patients with asthma exacerbation received steroid and β2-agonist treatment for one week, and then the EBC pH determination was repeated. Results Out of 104 patients, 34 (32.7%) showed evidences of acute exacerbation of asthma (AA) and 70 (67.3%) had stable asthma (SA). We found that the pH of EBC in patients with AA was significantly lower than that of patients with SA (7.25 vs 7.32; p<0.05) and that the latter was significantly lower than that of controls (7.32 vs 7.78; p<0.0001). After treatment, the EBC pH of patients with AA was significantly higher than before therapy (7.75 vs 7.25; p<0.0001). Finally, among patients with AA we found a positive correlation between pH and FEV 1, FEF 25, FEF 50 and FEF 75 (p=0.02, p=0.01, p=0.01, p=0.02; respectively). Conclusions Our study shows for the first time in children that the pH of EBC is a reliable non invasive marker for assessing ongoing airway inflammation and response to treatment.