Asthma Control In Children Research Articles

Characterising a Weight Loss Intervention in Obese Asthmatic Children.

The prevalence of obesity in asthmatic children is high and is associated with worse clinical outcomes. We have previously reported that weight loss leads to improvements in lung function and asthma control in obese asthmatic children. The objectives of this secondary analysis were to examine: (1) changes in diet quality and (2) associations between the baseline subject characteristics and the degree of weight loss following the intervention. Twenty-eight obese asthmatic children, aged 8–17 years, completed a 10-week diet-induced weight loss intervention. Dietary intake, nutritional biomarkers, anthropometry, lung function, asthma control, and clinical outcomes were analysed before and after the intervention. Following the intervention, the body mass index (BMI) z-score decreased (Δ = 0.18 ± 0.04; p < 0.001), %energy from protein increased (Δ = 4.3 ± 0.9%; p = 0.002), and sugar intake decreased (Δ = 23.2 ± 9.3 g; p= 0.025). Baseline lung function and physical activity level were inversely associated with Δ% fat mass. The ΔBMI z-score was negatively associated with physical activity duration at baseline. Dietary intervention is effective in achieving acute weight loss in obese asthmatic children, with significant improvements in diet quality and body composition. Lower lung function and physical engagement at baseline were associated with lesser weight loss, highlighting that subjects with these attributes may require greater support to achieve weight loss goals.

Application effect of Omaha system in the whole-path management of childhood asthma

Objective To explore the effect of Omaha system in the whole pathway management of childhood asthma. Methods A total of 120 children with asthma admitted to this hospital from January 2016 to March 2018 were selected and divided into study group and control group with 60 cases each by random number table method.The control group was given basic management, while the research group was given Omaha-based full-path management.The management effect of the two groups was compared. Results The total satisfaction rate of the two groups was significantly higher than that of the control group(P<0.05). The C-ACT score of the study group after intervention(25.82±2.06) was significantly higher than that of the control group, the levels of PEF(82.32±2.32)% and FEV1(87.66±1.74)% were significantly higher than those of the control group, and the difference between the two groups was statistically significant(P<0.05). After intervention, the C-ACT score(25.82±2.06) in the study group was significantly higher than that in the control group, and the levels of PEF(82.32±2.32)% and FEV1(87.66±1.74)% in the study group were significantly higher than those in the control group, with significant differences between the two groups(P<0.05). The scores of quality of life including emotional function(44.25±8.96), activity(25.68±4.17) and symptoms(40.43±9.29) in the study group were significantly higher than those in the control group, with a significant difference between the two groups(P<0.05). Conclusions The application of Omaha system in the whole-path management is beneficial to the control of asthma in children, significantly improve the respiratory function of children, and significantly improve their quality of life, and the management effect is good, worthy of recommendation. Key words: Childhood asthma; Full-path management; Omaha system

A randomized, double-blind, placebo-controlled, parallel-group study of once-daily inhaled fluticasone furoate on the hypothalamic\u2013pituitary\u2013adrenocortical axis of children with asthma

BackgroundTo evaluate the effects of fluticasone furoate on the hypothalamic–pituitary–adrenocortical axis, and the safety and tolerability of fluticasone furoate treatment in children with asthma.MethodsThis was a randomized, double-blind, placebo-controlled, multicenter, stratified, parallel-group, non-inferiority study of fluticasone furoate 50 µg inhalation powder administered once daily. The study enrolled children (aged 5–11 years inclusive) with a documented diagnosis of asthma for ≥ 6 months and a Childhood Asthma Control Test score of > 19. After a 7–14-day run-in period, eligible subjects were stratified by age and randomized to fluticasone furoate 50 µg once daily or placebo once daily via ELLIPTA for 6 weeks. The primary endpoint was the change from baseline (expressed as a ratio) in 0–24-h weighted mean serum cortisol at the end of the treatment period.ResultsFifty-six randomized subjects received fluticasone furoate 50 µg once daily and 55 received placebo. The primary analysis was performed in the serum cortisol population (n = 104) and demonstrated that fluticasone furoate 50 µg once daily was non-inferior to placebo (ratio = 0.93; 95% confidence interval 0.8096, 1.0620), as the lower limit of the 95% confidence interval for the geometric mean treatment ratio of fluticasone furoate 50 µg once daily versus placebo was greater than 0.80. Findings from the intent-to-treat population (n = 111) were similar.ConclusionsSix weeks of treatment with inhaled fluticasone furoate 50 µg once daily had no clinically relevant effect on the hypothalamic–pituitary–adrenocortical axis function of children, as measured by 24-h serum cortisol profiles. The primary analysis showed that fluticasone furoate 50 µg once daily was non-inferior to placebo. Fluticasone furoate 50 µg once daily was well tolerated and no new safety concerns emerged during the study.Trial registrationThis study is registered in ClinicalTrials.gov (NCT02483975). Date of submission: 25 June 2015.

Role of Impulse Oscillometry in Assessing Asthma Control in Children

Impulse oscillometry is an effort-independent technique of assessment of airway resistance and reactance, and can be performed in children unable to complete spirometry. To evaluate the utility of impulse oscillometry and spirometry for assessing asthma control in children. Prospective cohort study. Children aged 5-15 years, with mild to severe persistent asthma. On each 3-monthly follow-up visit, clinical assessment, classification of control of asthma, impulse oscillometry and spirometry were performed. Utility of impulse oscillometry parameters [impedance (Z5), resistance (R5), reactance (X5) at 5 Hz, and R5-20 (resistance at 20Hz -5Hz) (% predicted), and area of reactance (AX, actual values)] and FEV1 (% predicted) to discriminate between controlled and uncontrolled asthma was assessed by receiver operating characteristic (ROC) curve. Association of FEV1 and impulse oscillometry parameters over time with controlled asthma was evaluated by generalized estimating equation model. Number of visits in 256 children [mean (SD) age, 100 (41.6) mo; boys: 198 (77.3%)], where both impulse oscillometry and spirometry were performed was 2616; symptoms were controlled in 48.9% visits. Area under the curve for discrimination between controlled and uncontrolled asthma by FEV1, AX, R5-20, Z5, R5, and X5 were 0.58, 0.55, 0.55, 0.52, 0.52 and 0.52, respectively. FEV1 [OR (95% CI): 1.02 (1.01-1.03)] and AX [OR (95% CI): 0.88 (0.81-0.97)] measured over the duration of follow-up were significantly associated with controlled asthma. Spirometry and impulse oscillometry parameters are comparable in ascertaining controlled asthma. Impulse oscillometry being less effort-dependent may be performed for monitoring control of childhood asthma, especially in younger children.

Examining the Relationship Between Two Pediatric Asthma-Related Quality of Life Metrics

The Childhood Asthma Control Test (c-ACT) and the Pediatric Asthma Impact Scale (PAIS) are tools used to evaluate asthma control and asthma-related quality-of-life, respectively, in pediatric populations. The c-ACT is the gold-standard for asthma outcome measurements, whereas the PAIS is a newer tool that offers the benefit of being a patient-reported outcome measure (PROM). We aim to determine if the PAIS and the c-ACT measure similar outcomes, and could be used as proxies for each other. 39 pediatric patients (mean age 10, range 7 to 16) used the ASTHMAXcel mobile application to learn about asthma management through videos and games. At baseline, 4-month, and 6-month clinic visits, patients were administered the PAIS and the c-ACT. Scores on the tests were standardized to a 100-point scale, and the relationships of the scores at each visit and between visits were analyzed using the Pearson correlation. Significant correlations were found between scores on the PAIS and the c-ACT at the baseline, 4-month, and 6-month visits (r=0.05, p<0.01; r=0.52, p<0.01; r=0.55, p<0.01, respectively). Significant correlations were once again found when comparing changes between baseline and 4-month visits, baseline and 6-month visits, and 4-month and 6-month visits (r=0.57, p<0.01; r=0.47, p<0.01; r=0.40, p<0.01, respectively). A strong correlation exists between the outcome measurements of the PAIS and the c-ACT. These results indicate that there is potential to use the newer PAIS to measure similar outcomes as the c-ACT, particularly given its advantage as a PROM.

The effectiveness of omalizumab in the control of severe uncontrolled asthma in Latin America. An exploratory systematic review and meta-analysis

Omalizumab is effective in the treatment of severe persistent allergic asthma that is not controlled with long-acting beta-agonists/ high-dose inhaled corticosteroids. To conduct a systematic exploratory review and meta-analysis of studies with omalizumab in Latin America. A search of real-life studies on the effectiveness of omalizumab in asthma control conducted in Latin America was carried out. The average of the aggregate effectiveness of omalizumab in asthma control (Pooled Analysis) was estimated by using a random effects model. Nine open uncontrolled observational studies were identified; these studies included a total of 1 118 patients with severe uncontrolled asthma. The average of the estimated aggregate effectiveness of omalizumab in the good control of severe asthma was of 80.6 % in children and 78.9 % in adults. The average of the estimated aggregate effectiveness of omalizumab in the control of severe asthma in both children and adults in Latin America was over 78 %. Randomized controlled studies are required in order to establish the efficacy and effectiveness of omalizumab in the control of severe asthma and in the different subgroups by level of eosinophils.

Lung function and asthma control in school-age children managed in UK primary care: a cohort study

BackgroundSpirometry and fraction of exhaled nitric oxide (FeNO) are commonly used in specialist centres to monitor children with asthma. The National Institute for Health and Care Excellence recommends spirometry for...

Efeito de imunodulador glutamina e probiótico pool de Lactobacillus na atenuação dos sintomas e crises de asma em crianças

Introduction: Immunomodulator glutamine and probiotic Lactobacillus at certain doses have beneficial effects by modulation of the immune system and may assist in the integrity of therespiratory system. However, studies about the effects of glutamine or Lactobacillus pool on the prevention and control of asthma in children are still scarce. The aim of study was to evaluate the effect of the use of glutamine and Lactobacillus pool on the attenuation of clinical asthma symptoms in children. Methods: Longitudinal study, 45 children with medical diagnosis of asthma distributed in three groups: control group (C), glutamine group (G), Lactobacillus group (L). Group G was supplemented with L-glutamine powder (0.3 g/kg/day). Group L used a pool of Lactoba- cillus (Lactobacillus casei, paracasei, rhamnosus, acidophilus and Bifidobacterium lactis) (2 g/day). Group C received no glutamine or Lactobacillus pool. Clinical characteristics and symptoms of respiratory diseases were assessed by study-specific anamnesis and ISSAC Questionnaire (to obtain diagnostic scores and asthma symptoms) for 4 months. To test for differences between groups, the ANOVA test with Tukey post-hoc test was used. It was considered significant p &lt;0.05. Results: Initial ISSAC score was (C=8.67±1.77, L=7.80±1.52 and G=8.00 ± 1.46, p=0.31). At the first follow-up, the ISSAC score indicated that group G had improvement in the clinical characteristics of asthma (C=6.47±2.29, L = 5.07±2.28, G = 4.00±1.73, p &lt;0.05), as also occurred in the following months until the last follow-up (C=5.93±2.28, L=5.13±2.13, G=4.00±1.96, p&lt;0.05). After supplementation, group G presented lower mean duration of asthma attack (p=0.01), lower number of asthma attack (p&lt;0.05), lower prevalence of typical asthma symptoms, as cough and wheezing (p&lt;0.05). Conclusion: Glutamine supplementation attenuated the typical asthma symptoms, while the use of Lactobacillus pool did not attenuate the symptoms. Glutamine may be a new strategy for prevention and control of asthma in children.

A Study of Eosinophilia in Nasal Smear with severity and control of asthma in children

A Study of Eosinophilia in Nasal Smear with severity and control of asthma in children

Значение эндотелиального фактора роста в контроле бронхиальной астмы у детей

Значение эндотелиального фактора роста в контроле бронхиальной астмы у детей

Associated Factors for Asthma Severity in Korean Children: A Korean Childhood Asthma Study.

PurposeChildhood asthma has a considerable social impact and economic burden, especially in severe asthma. This study aimed to identify the proportion of childhood asthma severity and to evaluate associated factors for greater asthma severity.MethodsThis study was performed on 667 children aged 5–15 years with asthma from the nationwide 19 hospitals in the Korean childhood Asthma Study (KAS). Asthma was classified as mild intermittent, mild persistent, and moderate/severe persistent groups according to the National Asthma Education and Prevention Program recommendations. Multinomial logistic regression models were used to identify the associated factors for greater asthma severity.ResultsMild persistent asthma was most prevalent (39.0%), followed by mild intermittent (37.6%), moderate persistent (22.8%), and severe persistent asthma (0.6%). Onset later than 6 years of age (adjusted odds ratio [aOR], 1.69 for mild persistent asthma; aOR, 1.92 for moderate/severe persistent asthma) tended to increase asthma severity. Exposure to environmental tobacco smoke (aOR, 1.53 for mild persistent asthma; aOR, 1.85 for moderate/severe persistent asthma), and current dog ownership with sensitization to dog dander (aOR, 5.86 for mild persistent asthma; aOR, 6.90 for moderate/severe persistent asthma) showed increasing trends with greater asthma severity. Lower maternal education levels (aOR, 2.32) and no usage of an air purifier in exposure to high levels of outdoor air pollution (aOR, 1.76) were associated with moderate/severe persistent asthma.ConclusionsModification of identified environmental factors associated with greater asthma severity might help better control childhood asthma, thereby reducing the disease burden due to childhood asthma.

Effects of montelukast versus inhaled beclomethasone on asthma control and immunoglobulin-E levels in asthmatic children

Background: Beclomethasone dipropionate inhaler is a corticosteroid medication used as the controller of persistent asthma. Montelukast is a leukotriene receptor antagonist used as the second-line in controlling the symptoms of the asthmatic child. Objective: The objective of this study is to determine the comparison between the effects of beclomethasone dipropionate inhaler and montelukast on the total serum level of immunoglobulin E (IgE) and childhood asthma control test (C-ACT) in asthmatic children. Patients and Methods: A randomized clinical trial was done in Kerbala Teaching Hospital of pediatric from August 2014 to the end of October 2015, 97 patients were collected from asthma outpatient clinic aged 4 to 11 years with mild persistent asthma and randomly divided into beclomethasone group (51 patients) and montelukast group (46 patients), the total serum IgE was done before the initiation of treatment, and another reading was done after 3 months. The score of symptoms control was evaluated by C-ACT after 1 month of treatment, and another evaluation was done 2 months later. Results: There was a significant reduction in total serum IgE level (21% for montelukast group and 27% for beclomethasone group) after 3 months of treatment compared to baseline IgE, and there was significant improvement in childhood C-ACT scores (16% for montelukast group and 24% for beclomethasone group) after 3 months of treatment compared to the 1st month of treatment. There was a significant improvement in the beclomethasone group compared to the montelukast group after 3 months of treatment. Conclusions: Both beclomethasone and montelukast are effective controllers for asthma symptoms and reducing the total serum IgE level. Beclomethasone is better than montelukast in improving C-ACT scores.

The correlation between serum cholesterol, asthma control and therapeutic step in children with asthma and aero allergenic sensitization

The correlation between serum cholesterol, asthma control and therapeutic step in children with asthma and aero allergenic sensitization

Association between family management and asthma control in children with asthma.

The purpose of this study is to investigate the association between family management and asthma control in children with asthma. This cross-sectional descriptive study recruited 142 children with asthma and their parents. We used the Family Management Measure (FaMM), the Childhood Asthma Control Test (C-ACT), and fractional exhaled nitric oxide (FeNO) detectors to assess family management and asthma control. The McNemar's test was used to determine the proportional difference between C-ACT and FeNO in evaluating asthma control. Pearson correlation analysis and multiple linear regression analysis were used to assess the relationship between family management and asthma control in children with asthma. There was no significant difference in the proportion of C-ACT and FeNO in evaluating asthma control (McNemar's test p = .593). Child's Daily Life, Condition Management Ability, and Parental Mutuality were positively correlated with C-ACT (r = 0.398 to 0.655; all p < .05) and negatively correlated with FeNO (r = -0.245 to -0.402; all p < .05); Condition Management Effort, Family Life Difficulty, and View of Condition Impact were negatively correlated with C-ACT (r = -0.416 to -0.672; all p < .05) and positively with FeNO (r = 0.248 to 0.427; all p < 0.05). Child's Daily Life, Condition Management Effort, and View of Condition Impact dimensions significantly predicted the C-ACT results, and the Condition Management Effort and View of Condition Impact dimensions significantly predicted the FeNO results (p < .05). Pediatric nurses could provide family management education for parents to improve asthma control in children. In addition, pediatric nurses might assess asthma control condition of asthmatic children in combination with C-ACT and FeNO levels.

Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications.

Relationship between maternal communicative/critical health literacy and child’s asthma symptoms: Results from a population-based survey in metropolitan Japan

ObjectiveTo examine the association between maternal communicative/critical health literacy (CCHL) and child’s asthma symptoms. MethodsIn a population-based survey in greater Tokyo (N = 790 mother–child [aged 2–11 years] pairs), maternal CCHL was assessed with a validated questionnaire, and the presence of asthma symptoms in children was assessed by parent report using the International Study of Asthma and Allergies in Childhood score. Multiple logistic regression was conducted to analyze the association between child’s asthma and maternal health literacy, adjusting for potential confounders. ResultsThe prevalence of child’s asthma in the past year was significantly higher in the high maternal CCHL group than in the low CCHL group (18.0% vs 12.3%,p;0.035). High maternal CCHL was positively associated with the presence of child’s asthma symptoms after adjusting for the child’s clinical factors; household income; and maternal educational attainment, psychological distress, and employment status (coefficient = 0.494, 95% confidence interval: 0.012–0.976). ConclusionHigh maternal CCHL does not necessarily lead to appropriate asthma control in children. CCHL’s role in information overload environments requires further investigation. Practice ImplicationsHealth care practitioners should provide support even to parents with high CCHL to enable them to make appropriate decisions.

Sensitization to inhaled allergens in asthmatic children in southern Jordan: a cross-sectional study

BackgroundSensitization to inhaled allergens in children with bronchial asthma significantly affects asthma pathogenesis, severity and persistence into late childhood and adulthood. The present study determined the prevalence of sensitization to inhaled allergens in children with bronchial asthma and wheezing episodes in order to investigate the effect of positive sensitization on the severity and control of asthma symptoms and to screen for other associated allergic conditions.MethodsA cross-sectional study was conducted, including children between 6 months and 14 years of age attending the chest clinic of Al-Karak, south of Jordan, between November 2013 and February 2016. Skin prick tests (SPTs) using 11 standardized allergen extracts were conducted in 277 children. The severity of asthma was determined based on the Global Initiative for Asthma (GINA) assessment and the Childhood Asthma Control Test (C-ACT) in addition to the history of use of systemic steroids and hospital admissions within the past 12 months.ResultsSixty-seven percent of children with bronchial asthma reported sensitization to one or more of the inhaled allergens. The most common allergens were olive pollens (18%), cat fur (13.5%), and Dermatophagoides pteronyssinus (11.9%). There was a significant increase in allergen sensitization with age (p < 0.001). The most common concomitant allergic condition among children was allergic rhinitis (71.5%); however, allergic conjunctivitis was the only allergic condition that correlated with the skin test reactivity (p = 0.01). A family history of bronchial asthma was confirmed in 40.4% of children. Children with positive SPTs had lower ACT scores and reported more frequent use of systemic steroids and admissions to hospital within the past 12 months; however, this effect was not statistically significant (p > 0.05).ConclusionsSensitization to inhaled allergens is highly prevalent in children with asthma and wheezing episodes in southern Jordan and may be correlated with the severity of the disease. Therefore, appropriate measures to recognize and avoid these allergens are highly recommended. Most children in our study suffered from concomitant allergic rhinitis, indicating that an appropriate diagnosis and treatment of allergic rhinitis could significantly improve asthma control and thus the quality of life of these children.Trial registrationThis study is not a clinical trial.

Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study.

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management. Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression. Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001). Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications.

Vortex Whistle and Smart Phone Application for Peak Flow Recordings in Asthmatic Children: A Feasibility Study.

Introduction: Variable airflow obstruction that can be confirmed by diurnal variability of peak expiratory flow (PEF) >13% is an important characteristic of asthma. Home monitoring of PEF may be helpful to diagnose and monitor asthma. In this feasibility study, we aimed to study if asthmatic children can measure PEF at home twice daily during a 4-week period using a device designed as a “whistle” and a smart phone software application.Materials and Methods: Twice daily during 4 weeks, children aged 5–12 years with current asthma rated their asthma condition electronically on the smart phone application Blowfish before inhaling deeply then exhaling into the device to produce a high-pitched sound recorded by the application. Through mathematical algorithms, the sound was transferred to PEF, which was uploaded to a server. At inclusion, the Pediatric Asthma Quality of Life Questionnaire and the Childhood Asthma Control Test were answered. At the end, the parents graded the device and application.Results: One child did not manage to upload PEF. For the remaining 21 children, the median (quartiles) days with at least one measurement during the period were 27 (21–29.5), and on median 18 (9–24) days PEF was recorded twice daily. The median parental score (potential score 0–20) of the application was 18 (15–20).Discussion/Conclusion: The study shows promising results for home monitoring of PEF by an electronic device with automatic teletransmission. The high rate of successful recordings and parental satisfaction suggests that the clinical utility of the solution should be further studied.

Tai Chi Chuan Exercise Improves Lung Function and Asthma Control through Immune Regulation in Childhood Asthma.

Background Tai Chi Chuan (TCC) is an exercise of low to moderate intensity with key features of mindfulness, structural alignment, and flexibility to relax the body and mind in adults. Our previous study showed that TCC could improve the quality of life (QoL), pulmonary function, and fractional exhaled nitric oxide in asthmatic children. We further investigated whether the benefits induced by TCC were associated with immune regulation. Method Six- to twelve-year-old children diagnosed with mild to severe persistent asthma for at least one year according to the Global Initiative for Asthma guidelines were enrolled from a tertiary pediatric allergy center in Taiwan. Asthmatic children were divided into two groups based on their choice: (1) the TCC group had a 60-minute TCC exercise session once weekly led by an instructor and (2) the control group kept their original activity levels. All other exercises were encouraged as usual. Pulmonary function tests, laboratory tests, standardized pediatric asthma QoL questionnaire (PAQLQ(S)), and childhood asthma control test (C-ACT) were performed before and after the TCC program (12 weeks). Data on medications and exacerbations were collected from medical records. Results There were no differences between the TCC (n = 25) and control (n = 15) groups at baseline, except that the C-ACT showed significantly lower results in the TCC group (p=0.045). After 12 weeks, the number of leukocytes (p=0.041) and eosinophils (p=0.022) decreased, while regulatory T cells increased significantly (p=0.008) only in the TCC group. Lung functions (FEV1 and PEFR) were significantly improved in both the TCC (p < 0.001) and control (p=0.045 and 0.019, respectively) groups, while the PAQLQ(S) and C-ACT (p < 0.001) showed improvement only in the TCC group. Moreover, compared to the control group, the exacerbations within 12 weeks after the study were significantly decreased in the TCC group (p=0.031). After multiple regression by a conditional forward method, the factors that were significantly associated with exacerbation within 12 weeks after study is the practice of TCC and exacerbation within 24 weeks before study (p=0.013 and 0.015, respectively) after adjusting for age, sex, asthma severity, PEF, FEV1, C-ACT, PAQLQ(S), and medication score at baseline. Conclusion TCC exercise may improve pulmonary functions, asthma control, and QoL and prevent exacerbations in asthmatic children through immune regulation. Further research on detailed mechanisms is mandated.