Clinical Diagnosis Of Asthma Research Articles

RELATIONSHIP BETWEEN SCHOOLCHILDREN'S LEVELS OF PHYSICAL ACTIVITY, ANTHROPOMETRIC INDICES AND PULMONARY FUNCTION.

ABSTRACTObjective: To evaluate and to correlate levels of physical activity with the pulmonary function of children with and without a diagnosis of asthma.Methods: This study was conducted in two phases with schoolchildren aged between eight and 16 years old in Porto Alegre/RS. In the first phase (cross sectional), the sample was classified as asthmatic if a physician had ever diagnosed them with asthma and if they reported symptoms and treatment for the disease in the past 12 months. In the second phase (control-case), the following were measured: anthropometry, physical activity levels, time spent in front of screens, and lung function (spirometry). Data are presented in mean and standard deviation or median and interquartile interval and by absolute and relative values. Chi-square, Student’s t-test or Mann-Whitney test and Spearman correlation were applied, with p<0.05 being significant.Results: 605 students participated in the study, 290 children with a clinical diagnosis of asthma and 315 classified as a control. 280 (47.3%) were male children, with an average age of 11.0±2.3 years old. The spirometric values showed differences in the classifications of airway obstruction levels between the asthma and control groups (p=0.005), as well as in the response to bronchodilator use for FEV1/FVC (p=0.023). In the correlation assessment, there was no correlation between physical activity with anthropometric values, nor with pulmonary function, pre-and post-bronchodilator.Conclusions: The study demonstrates that there is no relationship between either anthropometric values or physical activity levels with pulmonary function of asthmatic children.

Development of Automatic Wheeze Detection Algorithm for Children With Asthma

Asthma is a symptom of tracheal obstruction caused by bronchospasm, and it is among the most prevalent chronic obstructive pulmonary diseases. Auscultation is the most commonly used approach for the clinical diagnosis of asthma. However, recognizing wheezes through auscultation requires experienced physicians, and this approach is not sufficiently objective. Therefore, developing a method for recognizing wheezes objectively is crucial. Most studies have used the spectral features of lung sounds to detect wheezes; however, they have not achieved sufficiently high performance owing to the poor discrimination of spectral features. Several studies have attempted to extract wheezing features from lung sound spectrograms; however, their approaches were easily affected by variations in the wheezing frequency and background noise. The present study proposes a novel automatic wheeze detection algorithm for extracting lung sound features in the time–frequency domain and automatically detecting wheezes. The proposed algorithm applies canonical correlation analysis to successfully detect wheezing features in a lung sound spectrogram. Moreover, a neural network technique is used to effectively classify healthy and wheezing sounds. The experimental results indicated that the proposed algorithm showed excellent performance in detecting wheezing.

Evaluation of Post-Bronchodilator Reversibility in Patient with Chronic Obstructive Pulmonary Disease and Asthma

Obstructive lung disease is a group of disorders comprising Chronic Obstructive Pulmonary Disease (COPD) and asthma. It is one of the most common causes of morbidity and mortality worldwide. COPD is a preventable and treatable disease characterized by persistent respiratory symptoms and airflow limitation, whereas asthma is reversible episodes of recurrent wheezing, cough, breathlessness, and chest tightness. It is sometimes difficult to distinguish COPD from asthma when COPD patients present with significant post-bronchodilator reversibility. Spirometry is the gold standard test to diagnose obstructive airway disease. We carried out a hospital-based cross-sectional study in Nepal Medical College Teaching Hospital from January 2018 to December 2018. One hundred and ninety eight patients who met the inclusion criteria underwent spirometry. Basal and post-bronchodilator FEV1, FVC, FEV1/FVC, and reversibility of FEV1 were measured. The majority of the patients enrolled in the study were males (n=100). The mean age of the patients was 49.3±17.0 years. Most of the patients were above 60 years of age (n=68). Clinical diagnosis of asthma was made in 113 (57%) and COPD in 85 (43%) patients. Post-bronchodilator reversibility was observed in 48 (42%) asthmatic and 19 (22%) COPD patients. Post-bronchodilator reversibility was statistically significant in asthmatic patients (p=0.032). Post-bronchodilator reversibility was observed in COPD patients as well. Therefore, post-bronchodilator reversibility alone may have a limited role in differentiating COPD from bronchial asthma. However, spirometry is mandatory to diagnose a patient with obstructive lung disease.

A model-based approach for assessing bronchodilator responsiveness in children: The conventional cutoff revisited

A model-based approach is developed to establish clinically relevant cut-offs for bronchodilator response in children. A dynamic nomogram is proposed for predicting the probability of asthma in childhood clinical practice.

The Clinical Role of Changes of Maximum Expiratory Flow at 25% and 50% of Vital Capacity before and after Bronchodilator Reversibility Test in Diagnosing Asthma.

Changes of maximum expiratory flow at 25% and 50% of vital capacity (MEF25 and MEF50, respectively), and predominant parameters indicating small airways function in asthmatics before and after bronchodilator (BD) reversibility test have been less interpreted. Our study aimed to investigate the clinical role of changes of MEF25 and MEF50 before and after BD reversibility test in diagnosing asthma. Forced expiratory volume in the first second (FEV1), MEF25, and MEF50 were measured before and after BD reversibility test in 207 asthmatic patients using standard process. Forty healthy individuals were enrolled as controls. Receiver operating characteristic (ROC) curve was used to assess the diagnostic accuracy of reversibility of MEF25 and MEF50 before and after BD reversibility test (ΔMEF25% and ΔMEF50%, respectively) in diagnosing asthma. Among these functional criteria, ΔMEF25% and ΔMEF50% ≥ 25% performed the best diagnostic performance. The sensitivity, specificity, and accuracy of ΔMEF25% ≥ 25% as an objective diagnostic test for asthma were 63.29%, 87.50%, and 67.21%, and of ΔMEF50% ≥ 25% were 79.23%, 85.00%, and 80.16%, respectively. The area under the ROC curve of the indicators was 0.8203 and 0.9104, respectively. By contrast, an increase in FEV1 ≥ 12% and 200 mL demonstrated a sensitivity of 62.32%, specificity of 82.50%, and accuracy of 65.59% in diagnosing asthma. The changes of MEF25 and MEF50 before and after BD reversibility test may be of additional value in the clinical diagnosis of asthma, with cutoff values of 25% being the most.

Immune network dysregulation precedes clinical diagnosis of asthma

Allergic asthma is a chronic disease beginning in childhood that is characterized by dominant T-helper 2 cell activation without adequate counter-regulation by T-helper 1 cell and regulatory T cell activity. Prior transcriptomic studies of childhood asthma have primarily investigated subjects who already have a disease diagnosis, and have generally taken an approach of differential gene expression as opposed to differential gene interactions. The immune states that predispose towards allergic sensitization and disease development remain ill defined. We thus characterize immune networks of asthmatic predisposition in children at the age of 2, prior to the diagnosis of allergic asthma, who are subsequently diagnosed with asthma at the age of 7. We show extensive differences of gene expression networks and gene regulatory networks in children who develop asthma versus those who do not using transcriptomic data from stimulated peripheral blood mononuclear cells. Moreover, transcription factors that bind proximally to one another share patterns of dysregulation, suggesting that network differences prior to asthma diagnosis result from altered accessibility of gene targets. In summary, we demonstrate non-allergen-specific immune network dysregulation in individuals long before clinical asthma diagnosis.

Statins for asthma.

Asthma is a common chronic respiratory disease. People with asthma have inflammation of their airways that causes recurrent episodes of wheezing, breathlessness and chest tightness, with or without a cough. Statins possess multiple therapeutic effects, including lowering lipid levels in the blood. Statins are reported to have a potential role as an adjunct treatment in asthma. However, comprehensive evidence of the benefits and harms of using statins is required to facilitate decision making. To assess the benefits and harms of statins as an adjunct therapy for asthma in adults and children. We searched for studies in the Cochrane Airways Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid SP and Embase Ovid SP, from their inception dates We handsearched the proceedings of major respiratory conferences. We also searched clinical trials registries for completed, ongoing and unpublished studies, and scanned the reference lists of included studies and relevant reviews to identify additional studies. The search is current to 7 February 2020. We included randomised controlled trials (RCTs) with a parallel-group design that assessed statins for at least 12 weeks' duration. We considered all participants with a clinical diagnosis of asthma to be eligible, regardless of age, sex, disease severity and previous or current treatment. We planned to include studies reported as full text, those published as abstract only, and unpublished data. Two review authors independently screened and selected the studies, extracted outcome data and intervention characteristics from included studies, and assessed risk of bias according to standard Cochrane methodological procedures. We resolved any disagreement through discussion. We found only one trial involving a total of 60 people living with asthma. The trial compared the effect of atorvastatin with a placebo (dummy treatment containing lactose) in treating people with chronic asthma. The trial did not report data for the primary outcomes or adverse events. There was uncertainty about the relative effect on forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) in the atorvastatin group compared with the placebo group. The study did not report serious adverse effects for the interventions. The included study had internal discrepancies in its reported data. The evidence was of very low certainty, so we are unable to draw conclusions about the effectiveness and safety of statins to treat asthma. High-quality RCTs are needed to assess the effect of statins on people with asthma. Well-designed multicentre trials with larger samples and longer duration of treatment are required, which assess outcomes such as adverse events, hospital utilisation and costs, to provide better quality evidence. Future studies that include subgroups of obese people with asthma are also required.

Correlation between levels of adipokines and inflammatory mediators with spirometric parameters in individuals with obesity and symptoms of asthma: Cross-sectional study

IntroductionThe adipose tissue secretes adipokines and influences the release of inflammatory mediators contributing to a state of low-grade systemic inflammation that may change lung function. ObjectiveTo correlate levels of adipokines and inflammatory mediators with lung function in individuals with obesity and bronchial asthma symptoms. Materials and methodsA cross-sectional study, including women with obesity (grade II and III) with symptoms and clinical diagnosis of asthma. Anthropometric measurements (weight, height, BMI), pulmonary function test (spirometry), asthma control test questionnaire, collection of systemic inflammatory markers (blood collection) and pulmonary markers (sputum collection) were collected and were analyzed: IL-6, IL-8, TNF-α, adiponectin, resistin, leptin and C-reactive protein (CRP). The patients were stratified into two groups according to asthma control. Results80 women were analyzed and 40% had an ACT score greater than or equal to 18 and were classified as “controlled asthma”. More than half of the patients of ACT<18 score obtaining measures of FEV1, PEF and FEF25–75% below and 80% of predicted. There was a significant and negative correlation between IL-6 in the sputum with FVC and FEF25–75% in the group ACT<18 and with FVC and FEV1 in the group ACT≥18. ConclusionsTherefore, we concluded that the increase of interleukin-6 in the sputum is related to worse pulmonary function even in patients with controlled asthma, especially in the translate airway permeability measures.

Psychometric evaluation of the Brazilian version of the pediatric asthma control and communication instrument

There is a lack of questionnaires capable of evaluating the clinical control of Brazilian children and adolescents with asthma over a wide age range. The Pediatric Asthma Control and Communication Instrument (PACCI) has been validated, but only with English- and Spanish-speaking children in the United States. To evaluate the psychometric properties of the Brazilian version of the PACCI questionnaire. A cross-sectional psychometric study conducted with children and adolescents aged 01 to 19 years with a clinical diagnosis of asthma, and their respective parents/guardians. The following assessments were conducted: socioeconomic status; clinical control using the Childhood Asthma Control Test (c-ACT), Asthma Control Test (ACT); caregiver quality of life using the Pediatric Asthma Caregivers Quality of Life Questionnaire (PACQLQ); and pulmonary function test (spirometry). Validity was evaluated as follows: exploratory and confirmatory factor analysis; Cronbach's alpha analysis (α); floor and ceiling effects; receiver operator characteristic curve analysis. A total of 128 participants were included, most of them male (54.7%). The Brazilian version of PACCI had adequate internal consistency (α = .76) and moderate floor and ceiling effects. The internal structure presented acceptable adjustment indices, considering the extraction of four factors. The factors presented adequate α values. Asthma control factor 1 correlated with c-ACT/ACT and PACQLQ. Control domain scores greater than four points (sum of score) and above 1 point (problem index) were indicative of uncontrolled asthma. The Brazilian version of PACCI was able to provide valid and reliable measures in evaluating the clinical control of asthma in Brazilian children and adolescents.

Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases

Background: Capnovolumetry is of interest as a method for the diagnosis of obstructive airway diseases, requiring little cooperation from the patient. Objective: To help in the interpretation of capnovolumetric parameters, we aimed to identify their correspondence to conventional lung function indices. Methods: We studied 978 patients from a diagnostic study with complete functional data and the clinical diagnosis of asthma, chronic obstructive pulmonary disease (COPD), or no respiratory disease. Using path analysis, four capnovolumetric parameters (slope of expiratory phase 3, ratio of slopes of phases 3 and 2, volume of phase 2, and the ratio area/volume of phase 3) previously identified as predictors of airway obstruction in terms of spirometry and body ple­thysmography, were analyzed regarding their relationship to each other and the diagnostic categories of asthma or COPD versus control, or obstruction versus no obstruction. We then identified four lung function parameters showing relationships as much as possible isomorphic to those between capnovolumetric parameters. Results: The four capnovolumetric parameters were related to COPD and obstruction via both direct and indirect influences, but only two of them to asthma. Regarding the correspondence to lung function parameters, the slope of expiratory phase 3 corresponded best to the ratio of residual volume to total lung capacity, the ratio of slopes of phases 3 and 2 to forced expiratory volume in 1 s, the volume of phase 2 to forced expired flow at 50% of vital capacity, and the ratio area/volume of phase 3 to forced vital capacity. Conclusions: Our results indicated an intricate relationship of capnovolumetric parameters to each other and to airway obstruction, asthma, or COPD. The correspondence to conventional lung function measures seemed to reflect the entities lung hyperinflation, overall ventilatory impairment, bronchoconstriction, and ventilated lung volume, in that order. These findings might be helpful for clinicians in the interpretation of capnovolumetry.

Performance Characteristics of Spirometry With Negative Bronchodilator Response and Methacholine Challenge Testing and Implications for Asthma Diagnosis

In patients with a history suggestive of asthma, diagnosis is usually confirmed by spirometry with bronchodilator response (BDR) or confirmatory methacholine challenge testing (MCT). We examined the proportion of participants with negative BDR testing who had a positive MCT (and its predictors) result and characteristics of MCT, including effects of controller medication tapering and temporal variability (and predictors of MCT result change), and concordance between MCT and pulmonologist asthma diagnosis. Adults with self-reported physician-diagnosed asthma were recruited by random-digit dialing across Canada. Subjects performed spirometry with BDR testing and returned for MCT if testing was nondiagnostic for asthma. Subjects on controllers underwent medication tapering with serial MCTs over 3 to 6weeks. Subjects with a negative MCT (the provocative concentration of methacholine that results in a 20%drop in FEV1 [PC20] > 8mg/mL) off medications were examined by a pulmonologist and had serial MCTs after 6 and 12months. Of 500 subjects (50.5 ± 16.6 years old, 68.0%female) with a negative BDR test for asthma, 215 (43.0%) had a positive MCT. Subjects with prebronchodilator airflow limitation were more likely to have a positive MCT (OR, 1.90; 95%CI, 1.17-3.04). MCT converted from negative to positive, with medication tapering in 18 of 94 (19.1%) participants, and spontaneously over time in 25 of 165 (15.2%) participants. Of 231 subjects with negative MCT, 28 (12.1%) subsequently received an asthma diagnosis from a pulmonologist. In subjects with a self-reported physician diagnosis of asthma, absence of bronchodilator reversibility had a negative predictive value of only 57%to exclude asthma. A finding of spirometric airflow limitation significantly increased chances of asthma. MCT results varied with medication taper and over time, and pulmonologists were sometimes prepared to give a clinical diagnosis of asthma despite negative MCT. Correspondingly, in patients for whom a high clinical suspicion of asthma exists, repeat testing appears to be warranted.

Urinary 1-Hydroxypyrene levels among children with asthma in Chennai, South India

Aim: To explore the potential relationship between exposure to Polycyclic Aromatic Hydrocarbons (PAHs) and asthma exacerbation among children and also to explore the potential exposure sources of PAHs at the household level. Methods: Case-control study was conducted at a tertiary care hospital in Chennai among 60 participants after obtaining approval from the Institutional Ethics Committee. The study was conducted from March till May 2018. Informed consent was obtained from the participants. The participants were included based on their clinical diagnosis of asthma and few participants were as used as control based on no documented history of wheeze and PEFR levels. All the participants were male children aged between 9-12 years and exclusion was done if they were reported to having congenital heart disease, surgery or chronic lung disease. They were interviewed with a standardized questionnaire to ascertain their exposure to PAHs sources. Urinary 1-OHP levels were analyzed using HPLC to determine their exposure. Results: Participants with asthma showed a higher concentration of 1-OHP (7.56mg/g) in their urine. Second-hand exposure to tobacco smoke, consumption of charred or grilled foods, use of indoor air pollutants and exposure to traffic fumes were identified as contributive factors to elevated 1-OHP levels. Conclusion: Exposure sources at household levels may play a major role in exacerbating asthma. Significant PAHs exposure was contributed through dietary habits. Further exposure monitoring studies are needed to quantify the impact of PAH exposure on respiratory health. Keywords: Polycylic Aromatic Hydrocarbons; Asthma; 1-Hydroxypyrene

The health care utilization and out-of-pocket expenditure associated with asthma amongst a sample of Australian women aged over 45 years: analysis from the ‘45 and up’ study

Objective This study aims to describe the prevalence of health care utilization (including conventional medicine, self-care and complementary medicine treatments) for the management of asthma by women aged 45 years and over and their associated out-of-pocket expenditure. Methods A self-reported mail survey of 375 Australian women, a cohort of the national 45 and Up Study, reporting a clinical diagnosis of asthma. The women were asked about their use of health care resources including conventional medicine, complementary medicine, and self-prescribed treatments for asthma and their associated out-of-pocket spending. Spearman’s correlation coefficient, student’s t-test and chi-square test were used as appropriate. Population level costs were created by extrapolating the costs reported by participants by available national prevalence data. Results Survey respondents (N = 375; response rate, 46.9%) were, on average, 67.0 years old (min 53, max 91). The majority (69.1%; n = 259) consulted at least one health care practitioner in the previous 12 months for their asthma. Most of the participants (n = 247; 65.9%) reported using at least one prescription medication for asthma in the previous 12 months. The total out-of-pocket expenditure on asthma treatment for Australian women aged 50 years and over is estimated to be AU$159 million per annum. Conclusions The breadth of conventional and complementary medicine health care services reported in this study, as well as the range of treatments that patients self-prescribe, highlights the challenges of coordinating care for individuals living with asthma.

Serum allergen-specific IgE reactivity: is there an association with clinical severity and airway eosinophilia in asthmatic cats?

The aim of this study was to evaluate the results of serum allergen-specific IgE testing in cats with a clinical diagnosis of asthma and to determine if the number of allergens with positive IgE reactivity and magnitude of positive IgE responses would be associated with the severity of clinical signs or airway eosinophilia. Medical records from 2008 to 2018 were retrospectively reviewed. Inclusion required a diagnosis of feline asthma based on consistent clinicopathologic features and bronchoalveolar lavage (BAL) cytology with >10% eosinophils; additionally, cats needed to have the results of serum allergen-specific IgE tests. Eighteen cases satisfied the inclusion criteria. Median age was 5 years and the most common presenting clinical sign was cough (n = 10/18). Most cats lived exclusively indoors (n = 13/18). The median percentage of BAL eosinophils was 47%. Serum allergen-specific IgE testing supported an underlying allergic etiology in 14/18 (78%) cats, with all but one having polysensitization. The severity of clinical signs and magnitude of airway eosinophilia did not correlate with the degree of positive IgE reactivity. This study identified a strong association between the identification of allergen-specific IgE and cats with asthma, and the majority of these cats were polysensitized. However, larger numbers of allergens with positive IgE reactivity or magnitude of IgE reactivity were not significantly associated with clinical severity or airway eosinophilia. Knowledge of positive allergen-specific IgE results could guide allergen avoidance, regardless of the magnitude of IgE reactivity.

Role of Montelukast in Asthma and Allergic rhinitis patients.

Objectives:Our objective was to evaluate the effect of Montelukast on the symptoms of asthma and allergic rhinitis (AR), assess its effect on the individual quality of life (QoL), and estimate the proportion of participants having adverse effects.Methods:This prospective, open-label study conducted at Dow University of Health Sciences, Ankle Saria Hospital and Sindh Government Hospital Liaquatabad, Karachi, from August 2018 to September 2019, included patients aged >18 years with a clinical diagnosis of Asthma, AR, or both. Patients were given a 10 mg Montelukast tablet each day and then called for follow-up in the fourth week, where the questions related to the improvement in the symptoms of asthma or AR were asked. Patients were also asked about the improvement in QoL and any adverse effects.Results:A total of 694 patients were registered of which 138(19.8%) had AR, 294(42.4%) had asthma, while 273(39.3%) had both. Mean age was 41.1±14.63 years and 352 (50.7%) were male and 342(49.3%) were females. On a follow-up visit, there was a sufficient improvement in 351 asthmatics (63.9%), and 288 patients with AR (70.1%) overall, strong or marked improvement in the day (n=342,62.3%) and night time (n=331,60.3%) asthma symptoms. Overall improvements in QoL were very good or good in 419 patients. Montelukast was well-tolerated here with adverse effects (like abdominal discomfort, fever, fatigue, headache, rash, and upper respiratory tract symptoms) seen in 125 patients (18.01%).Conclusion:Montelukast was very effective in improving the symptoms and QoL of the individuals suffering from asthma and/or AR.

The environmental health catastrophe in Urmia Lake and asthma disease: a cohort study

Background:Urmia Lake of Iran used to be the largest saltwater lake in the world. It has now disastrously shrunk to 10 percent of its previous size. This study aims to investigate the impact of this environmental catastrophe on the occurrence of asthma.Methods:The whole population of ten districts in the area were investigated in this retrospective cohort study: “Exposed group” in the neighbouring areas of the lake, “Not exposed group 1” with medium distance (65 km) from the lake, and “Not exposed group 2” with more than 160 km from the lake. Clinical diagnosis of asthma was performed by the family physicians in the whole population.Results:The occurrence risk of asthma in “Exposed group” was 1.85 times higher (CI95%: 1.1- 3.0) than of “Not exposed group 1”. The risk of disease, similarly, in “Exposed group” was 1.44 times more (CI95%: 0.9-2.3) when compared to “Not exposed group 2”.Conclusion:The country and provincial authorities should consider this hazardous climate change in the region seriously before it becomes a harmful event for millions of people living in the area.

Exploring the relevance and extent of small airways dysfunction in asthma (ATLANTIS): baseline data from a prospective cohort study

Small airways dysfunction (SAD) is well recognised in asthma, yet its role in the severity and control of asthma is unclear. This study aimed to assess which combination of biomarkers, physiological tests, and imaging markers best measure the presence and extent of SAD in patients with asthma. In this baseline assessment of a multinational prospective cohort study (the Assessment of Small Airways Involvement in Asthma [ATLANTIS] study), we recruited participants with and without asthma (defined as Global Initiative for Asthma severity stages 1-5) from general practices, the databases of chest physicians, and advertisements at 29 centres across nine countries (Brazil, China, Germany, Italy, Spain, the Netherlands, the UK, the USA, and Canada). All participants were aged 18-65 years, and participants with asthma had received a clinical diagnosis of asthma more than 6 months ago that had been confirmed by a chest physician. This diagnosis required support by objective evidence at baseline or during the past 5 years, which could be: positive airway hyperresponsiveness to methacholine, positive reversibility (a change in FEV1 ≥12% and ≥200 mL within 30 min) after treatment with 400 μg of salbutamol in a metered-dose inhaler with or without a spacer, variability in peak expiratory flow of more than 20% (measured over 7 days), or documented reversibility after a cycle (eg, 4 weeks) of maintenance anti-asthma treatment. The inclusion criteria also required that patients had stable asthma on any previous regular asthma treatment (including so-called rescue β2-agonists alone) at a stable dose for more than 8 weeks before baseline and had smoked for a maximum of 10 pack-years in their lifetime. Control group participants were recruited by advertisements; these participants were aged 18-65 years, had no respiratory symptoms compatible with asthma or chronic obstructive pulmonary disease, normal spirometry, and normal airways responsiveness, and had smoked for a maximum of 10 pack-years. We assessed all participants with spirometry, body plethysmography, impulse oscillometry, multiple breath nitrogen washout, CT (in selected participants), and questionnaires about asthma control, asthma-related quality of life (both in participants with asthma only), and health status. We applied structural equation modelling in participants with asthma to assess the contribution of all physiological and CT variables to SAD, from which we defined clinical SAD and CT SAD scores. We then classified patients with asthma into SAD groups with model-based clustering, and we compared asthma severity, control, and health-care use during the past year by SAD score and by SAD group. This trial is registered with ClinicalTrials.gov, number NCT02123667. Between June 30, 2014, and March 3, 2017, we recruited and evaluated 773 participants with asthma and 99 control participants. All physiological measures contributed to the clinical SAD model with the structural equation modelling analysis. The prevalence of SAD in asthma was dependent on the measure used; we found the lowest prevalence of SAD associated with acinar airway ventilation heterogeneity (Sacin), an outcome determined by multiple breath nitrogen washout that reflects ventilation heterogeneity in the most peripheral, pre-acinar or acinar airways. Impulse oscillometry and spirometry results, which were used to assess dysfunction of small-sized to mid-sized airways, contributed most to the clinical SAD score and differed between the two SAD groups. Participants in clinical SAD group 1 (n=452) had milder SAD than group 2 and comparable multiple breath nitrogen washout Sacin to control participants. Participants in clinical SAD group 2 (n=312) had abnormal physiological SAD results relative to group 1, particularly their impulse oscillometry and spirometry measurements, and group 2 participants also had more severe asthma (with regard to asthma control, treatments, exacerbations, and quality of life) than group 1. Clinical SAD scores were higher (indicating more severe SAD) in group 2 than group 1, and we found that these scores were related to asthma control, severity, and exacerbations. We found no correlation between clinical SAD and CT SAD scores. SAD is a complex and silent signature of asthma that is likely to be directly or indirectly captured by combinations of physiological tests, such as spirometry, body plethysmography, impulse oscillometry, and multiple breath nitrogen washout. SAD is present across patients with all severities of asthma, but it is particularly prevalent in severe disease. The clinical classification of SAD into two groups (a milder and a more severe group) by use of impulse oscillometry and spirometry, which are easy to use, is meaningful given its association with GINA severity stages, asthma control, quality of life, and exacerbations. Chiesi Farmaceutici SpA.

Growth Pattern of School Going Children with Asthma: A Case Control Study

Background: To compare growth pattern of children with asthma against healthy controls and to assess the quality of life score in children with asthma. Subjects and Methods: The study was conducted in the outpatient and inpatient departments of Department of Pediatrics amongChildren between 5-15 years with clinical diagnosis of asthma were enrolled in this study. It was a cross sectional study. Results: Our study included 100 children between 5 – 10 years age group which had 50 children having asthma and rest were normal children. Out of 50 asthma children, 5 (10%)had obesity and study was significant (p=0.028). And 20 of the 50 asthma children(40%) had stunting.(p=0.015). In11 to 15 years age group 4 (8%) had obesity(p=0.072) and 24%had stunting and the study was significant(p=0.029). Conclusion: Stunting and obesity are more seen in children with asthma compared to normal children. Children with severe forms of asthma and children were whose asthma was poorly controlled were more prone for stunting and obesity.

Pediatric Asthma Control and Communication Instrument: translation into Portuguese and cross-cultural adaptation for use in Brazil.

ABSTRACTObjective:To translate the Pediatric Asthma Control and Communication Instrument (PACCI) to Portuguese and adapt it for use in Brazil, ensuring the cultural validity of the content and semantic equivalence of the target version. Methods:The Brazilian Portuguese-language version of the PACCI was developed according to the most commonly used methodology, which included the following steps: translation; synthesis of the translation; review by the author of the original questionnaire; back-translation; synthesis of the back-translation; review by a native external researcher who is a native speaker of English; approval of the author of the original questionnaire; review by a specialist in Portuguese; review by a multidisciplinary committee of experts to determine the agreement of the items, considering the clarity of each and its appropriateness in the cultural context; cognitive debriefing; and development of the final version. The cognitive debriefing involved 31 parents/legal guardians of children 1-21 years of age with a clinical diagnosis of asthma, as defined by the Global Initiative for Asthma, with the objective of determining the comprehensibility and clarity of the items for the target population. Results:The multidisciplinary committee of experts indicated that the items on the questionnaire were clear and comprehensible, with kappa values above 0.61, indicating substantial agreement. In the cognitive debriefing, the parents/legal guardians presented no difficulties in understanding any of the items (agreement > 0.90); therefore, no further changes were needed.Conclusions:The translation and cross-cultural adaptation of the PACCI for use in Brazil were successful.

A study on correlation of serum IgE levels with diagnosis and severity of asthma in children

Background: Asthma is a chronic inflammatory airway disorder which increases bronchial hyperreactivity to various allergens and irritants characterized by narrowing of airways. Immunoglobulin E (Ig E) plays major role in the pathogenesis of asthma which is produced due to dysregulation of type 2 T helper lymphocytes (Th2) induced cytokines in genetically susceptible individual after exposing to allergens or irritants. The aim of this study was to estimate serum Ig E level in children between 3-12 years of age and to correlate it with the clinical diagnosis and severity of asthma.Methods: A prospective interventional study was done over a period of one year, enrolling 81 children aged between 3-12 years, who were newly diagnosed cases of asthma attending asthma clinic in a tertiary care pediatric government hospital. Serum IgE level was estimated and its correlation with the severity of asthma was assessed.Results: The mean Absolute Eosinophil Count (AEC) of the study was 305.85±188.40 cells /mm3. Mean Ig E level was increased in asthmatic children (874.59±287 IU/ml). Mean serum Ig E level in mild intermittent asthma was 247.92 ± 89.50 IU/ml, in mild persistent asthma was 742.95±306.78 IU/ml, in moderate persistent asthma was 1142±196.88 IU/ml and in severe persistent asthma was 1790±121.50 IU/ml. The increasing level of serum Ig E was found to be statistically significant (p &lt;0.05) with increasing grading of asthma.Conclusions: Elevated serum IgE levels support clinical diagnosis of asthma in children and can predict severity of asthma and can be used to counsel parents for better compliance in the management of bronchial asthma.