Decreased Asthma Symptoms Research Articles

Effectiveness of fruit and vegetable consumption with asthmatic symptoms and episodes: A systematic review

Introduction: Asthma is a chronic disease, so it is essential to adhere to good treatment and follow the recommendations appropriatel, Objective: to determine the effectiveness of recommending the consumption of fruits and vegetables (FV) on the reduction of asthma attacks, including Asthma Control Questionnaire (ACQ) and Interleukin-6 (IL-6) scores, Methods: The search was performed in the electronic databases: Pubmed, Web of Science, Scopus and Cochrane Library. Studies were included that applied at least one intervention or recommendation for FV consumption in patients with asthma, airway inflammation and other associated problems. Two independent reviewers assessed the selected studies and measured risk of bias. Relevant information was summarized and combined with random effect meta-analysis (DerSimonian-Laird). RevMan 5,4 was applied. Finally, the degree of recommendation was evaluated with GRADE-pro, Results: Three randomized clinical trials (RCTs) totaling 197 subjects were identified. A decrease in asthma symptoms was observed according to the ACQ, but not statistically significant (-0,20; 95 % CI: -0.59, 0,19). Furthermore, interleukin-6 also did not present significance 0,20 (95 % CI: -0,06, 0,46). The nature of the design of the meta-analyzed studies allows a high and moderate degree of recommendation to be scored, respectively. The findings in general suggest that FV intake can generate favorable changes in asthma and its prevention. However, this study failed to demonstrate this statistically, Conclusion: It is necessary that more RCTs be carried out to increase the power of the evidence and update the available information

Serum 25-hydroxyvitamin D deficiency is associated with atopy, and sex may be an effect modifier of its association with asthma in teenagers from northeast Brazil.

Sufficient vitamin D (25-hydroxyvitamin D [25(OH)D]) serum levels are associated with decreased asthma symptoms. Our aim was to investigate associations between vitamin D and atopy, asthma, asthma severity, and asthma phenotypes in Brazilian teenagers. This cross-sectional study involved 942 individuals (11-19 years old) engaged in an asthma cohort. The ISAAC questionnaire was employed to diagnosis asthma and asthma severity. Serum allergen-specific immunoglobulin E (sIgE) was measured by ImmunoCap and serum 25(OH)D was measured by ELISA. We calculated the correlation between sIgE and 25(OH)D. We used multivariate logistic regression analysis to assess associations of interest. We found that 25(OH)D deficiency was positively associated with atopy (OR 1.45, confidence interval [CI] 1.05-2.00) and high levels of this vitamin negatively correlated with sIgE to Dermatophagoides pteronyssinus (r = -0.11, p = 0.019). The average 25(OH)D serum level was 27.0 ± 9.5 ng/ml; 366 individuals (38.8%) had a sufficient level. There was no association between 25(OH)D and asthma, asthma severity or asthma phenotypes in the population. However, sex was a possible effect modifier of the association between vitamin D and asthma: insufficiency in asthmatic women (86%) was higher than in asthmatic men (42%), and there was an association between insufficient vitamin D levels and greater asthma risk only in women (OR = 3.06, 95% CI 1.16-8.07). We have shown that vitamin D deficiency was associated with greater risk of atopy in both sexes and vitamin D insufficiency was associated with asthma only in women. There was no association between vitamin D levels and asthma phenotypes or asthma severity.

Personalized target therapy for severe bronchial asthma in combination with polypous rhinosinusitis

Bronchial asthma is a current problem of health care in connection with high prevalence and heterogeneity of a disease. Development and deployment in clinical practice of genetically engineered biological medicines for treatment of patients with severe eosinophilic bronchial asthma allowed to change cardinally the course of a disease and to considerably improve quality of life of such patients. The presented clinical case focuses on the experience of using benralizumab, an interleukin-5 receptor antagonist in a patient with T2-endotype of severe bronchial asthma in combination with polypous rhinosinusitis. The diagnosis of bronchial asthma was established to the patient in 36 years. The patient had the burdened allergological personal and family anamnesis, intolerance of nonsteroid anti-inflammatory medicines, polyps in a nose were revealed later. It is known that the clinical phenotype of a combination of bronchial asthma to a polypous rhinosinusitis is difficult for treatment in connection with the inflammation which was more expressed, difficult giving in to control in airways. Over time the course of a disease was made heavier, control of symptoms was lost and, despite the therapy volume corresponding to the 5th step on GINA, including reception of system glucocorticosteroids, an exception of all factors interfering achievement of control regular symptoms and frequent aggravations remained. In accordance with the Federal Guidelines, the patient was prescribed targeted therapy with benralizumab, which suppresses eosinophilic inflammation in the respiratory tract. During the treatment, a rapid significant improvement in the patient’s condition was noted in the form of a decrease in asthma symptoms, normalization of spirography indicators, and cessation of exacerbations. The persistent clinical effect allowed to abandon the use of systemic glucocorticosteroids without losing control of the disease. There were no adverse reactions to the drug administration. Thus, therapy with benralizumab in patients with the T2-endotype of severe bronchial asthma in combination with polypous rhinosinusitis is safe and highly effective and allows it to be recommended for widespread use in clinical practice.

An enhanced care package to improve asthma management in Malawian children: a randomised controlled trial

BackgroundShortages of clinical staff make chronic asthma care challenging in low-income countries. We evaluated an outpatient asthma care package for children, including task-shifting of asthma management roles.MethodsWe conducted a non-blinded...

Effects of Androgen Receptor (AR) Signaling on Airway inflammation in an Obesity-Associated Asthma Model

Obese women are disproportionately affected by severe asthma. Androgen receptor signaling attenuated neutrophilic and eosinophilic airway inflammation in asthma, and administration of dehydroepiandrosterone (DHEA-S), an androgen upstream of testosterone and estrogen that is increased in males, decreased asthma symptom scores and increased lung function in women with moderate to severe asthma. However, it remains unknown how AR signaling affects airway inflammation during an obese state. We hypothesized that AR signaling decreases eosinophilic and neutrophilic airway inflammation by decreasing T cell metabolism and differentiation of Th2 and Th17 cells.

Design of a home-based intervention for Houston-area African-American adults with asthma: Methods and lessons learned from a pragmatic randomized trial

A growing body of evidence demonstrates that home-based, multicomponent interventions can effectively reduce exposures to asthma triggers and decrease asthma symptoms. However, few of these studies have targeted adults. To address this and other research gaps, we designed and implemented a pragmatic randomized clinical trial, the Houston Home-based Integrated Intervention Targeting Better Asthma Control (HIITBAC) for African Americans, to assess the effectiveness of a home-based intervention to improve asthma control and quality of life in African-American adults—a population disproportionately affected by asthma. The primary goals were to help participants reduce allergens and irritants in their homes and better manage their disease through knowledge, improved medication use, and behavior change. HIITBAC had two groups: clinic-only and home-visit groups. Both groups received enhanced clinical care, but the home-visit group also received a detailed home assessment and four additional home visits spaced over roughly one year. We recruited 263 participants. Of these, 152 (57.8%) were recruited through electronic health record data, 51 (19.4%) through Emergency Medical Services data, and 60 (22.8%) through other efforts (e.g., emergency departments, community events, outreach). Seventy participants (26.6%) were lost to follow up, substantially more in the home-visit than in the clinic-only group. We describe the HIITBAC methodology and cohort, discuss lessons learned about recruitment and retention, and highlight adaptations we implemented to address these lessons.

Risk factors for the development of asthma symptoms in children with allergic rhinitis

Purpose: Both allergic rhinitis and asthma are considered one airway disease, which interacts with each other in disease onset and symptom worsening. We evaluated factors developing new or persistent asthma symptoms in elementary school children with al lergic rhinitis. Methods: We selected 343 children aged 6 to 7 years who had rhinitis symptoms within 12 months and allergic sensitization on skin prick tests among 2,491 elementary school children. The questionnaires on symptoms, medical history and environments, blood eosinophils, serum total IgE, pulmonary function test, and bronchial provocation tests were obtained. Using multiple regression analysis, we evaluated factors for later asthma symptoms during a follow-up period of 4 years. Results: The independent risk factors for later asthma symptoms among children with allergic rhinitis were higher body mass index (adjusted odds ratio [aOR], 1.29; 95% confidence interval [CI], 1.06-1.56; P=0.012), a parental diagnosis of asthma (aOR, 6.19; 95% CI, 1.59-24.06; P=0.008), residence in the rural area (aOR, 5.37; 95% CI, 1.34-21.42; P=0.017), and a history of bronchiolitis in the first 2 years (aOR, 5.82; 95% CI, 1.42-23.80; P=0.014). However, pulmonary functions, the levels of bronchial hyper-responsiveness, and the patterns of sensitization showed not significant factors. Children whose allergic rhinitis was treated in the follow-up period were less likely to have asthma symptoms later (aOR, 0.30; 95% CI, 0.10-0.93; P=0.036). Conclusion: In the school-aged children with allergic rhinitis, body mass index and asthma-related risk factors are crucial for devel oping asthma symptoms. The appropriate treatment of rhinitis may decrease asthma symptoms. (Allergy Asthma Respir Dis 2020;8:191-198)

Effectiveness of Fish Oil Containing Omega-3 in Improving Symptoms and Lung Function in Asthma Outpatient in Surabaya, Indonesia

Indonesia as a potential maritime country in fish production, can be processed into fish oil containing omega-3. Based on previous libraries, omega-3 fish oils can be used to improve asthma control and improve lung function. The effects of a drug are individualized depending on genetic and environmental factors. The aim of the study was to investigate the effect of fish oil containing omega-3 on improving asthma symptoms and improving lung function. The research method used is pre-post test design, using data collection technique with asthma control test questionnaire to see clinical symptoms of asthma and measure lung function with peak flow meter. Intervention given is a fish oil product with once daily doses,then follow up every week for 4 weeks. The subject of research is adult age. Pulmonary function data and asthma symptoms will be tested for normality with shapiro-wilk test and followed by anova one way. The research was conducted in 2016-2017 in Surabaya and the data obtained 28 respondents. At the control level of asthma and total ACT score (P less than 0.05) it can be concluded that there was significant difference between before and after omega-3 fish oil therapy for 4 weeks. In the improvement of lung function there is a significant improvement of lung function starting from before therapy until the increase every week until the 4th week. Fish oil containing omega 3 for 4 weeks may decrease asthma symptoms in the asthma control level category and total ACT score. In addition, fish oil can also improve lung function significantly in every week

House Dust Mite Sublingual Immunotherapy for Pediatric Patients With Allergic Asthma.

To review the published literature evaluating administration of house dust mite (HDM) sublingual immunotherapy (SLIT) in pediatric patients with allergic asthma. PubMed database search (1966 to November 2017) using the search terms allergy, allergic rhinitis, asthma, allergic asthma, house dust mite, allergen immunotherapy, subcutaneous immunotherapy, sublingual immunotherapy, MK-8237, children, and pediatric. Package labeling and references from identified articles were also reviewed. Studies published in English evaluating the efficacy of HDM SLIT in children <18 years of age were included. Patients with allergic asthma who fail to improve with pharmacotherapy may require disease-modifying, HDM-specific immunotherapy. Acceptance of subcutaneous immunotherapy (SCIT) in the pediatric population is limited by the need for weekly injections and the risk of systemic adverse effects. Trials in pediatric patients with allergic rhinitis and asthma monosensitized to HDM demonstrated mixed results, likely because of variability in methodologies. SLIT reduced asthma symptoms in 8 placebo-controlled studies; however, asthma medication use was reduced in just 4 trials. Compared with pharmacotherapy alone, SLIT and SCIT decreased asthma symptom scores similarly for up to 3 years. Sequential SCIT/SLIT decreased both asthma symptoms and medication scores and was more effective than SLIT alone. Sublingual HDM immunotherapy reduces symptom scores in pediatric patients with allergic asthma but may be slower in onset and less effective than SCIT in reducing asthma medication use.

Flexibility and strength training in asthma: A pilot study

ABSTRACTObjective: Although less is known about musculoskeletal factors that may contribute to asthma symptoms, body-based treatments addressing movement restrictions of the chest and shoulders may be a useful adjunct to asthma pharmacotherapy. In this pilot study, we compared asthma symptoms, pulmonary function tests, and medication use before and after a course of resistance flexibility and strength training (RFST) treatments in human subjects with asthma. Methods: Patients with asthma (n = 10; mean age 23 years) completed questionnaires (Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Test (ACT)), spirometry, chest wall excursion, and shoulder range of motion (ROM) before and after a series of four RFST treatments over 47 ± 21 days. Each treatment consisted of a one-hour session involving eccentric stretching of the arm, shoulder, and chest while lying in a supine position. Results: Significant clinical improvement was observed for mean ACQ scores from pre- to post-treatment (mean decrease 0.73, 95% CI 0.26–1.09, Cohen d = 2.25, p =.0014). No significant improvement was observed in the ACT, AQLQ, or spirometry, although inhaler use decreased for half of the subjects and did not change for the remaining subjects (i.e. none increased). Chest wall excursion and all ROM tests trended toward improvement, but was only statistically significant (p <.05) for the arm raise in the frontal plane. Conclusion: RFST may be a beneficial, nonpharmacological method to decrease asthma symptoms. Future studies should be conducted involving a larger sample size, longer intervention time, control group, and blood collection to test inflammatory mediators.

Regulation of Eosinophil and Group 2 Innate Lymphoid Cell Trafficking in Asthma.

Asthma is an inflammatory disease usually characterized by increased Type 2 cytokines and by an infiltration of eosinophils to the airways. While the production of Type 2 cytokines has been associated with TH2 lymphocytes, increasing evidence indicates that group 2 innate lymphoid cells (ILC2) play an important role in the production of the Type 2 cytokines interleukin (IL)-5 and IL-13, which likely amplifies the recruitment of eosinophils from the blood to the airways. In that regard, recent asthma treatments have been focusing on blocking Type 2 cytokines, notably IL-4, IL-5, and IL-13. These treatments mainly result in decreased blood or sputum eosinophil counts as well as decreased asthma symptoms. This supports that therapies blocking eosinophil recruitment and activation are valuable tools in the management of asthma and its severity. Herein, we review the mechanisms involved in eosinophil and ILC2 recruitment to the airways, with an emphasis on eotaxins, other chemokines as well as their receptors. We also discuss the involvement of other chemoattractants, notably the bioactive lipids 5-oxo-eicosatetraenoic acid, prostaglandin D2, and 2-arachidonoyl-glycerol. Given that eosinophil biology differs between human and mice, we also highlight and discuss their responsiveness toward the different eosinophil chemoattractants.

Asthma Risk Factors and Prevention Behaviour Relate to Asthma Level of Control

Introduction : Asthma’s symptoms are commonly persistent in each asthmatic client, but they could be controlled. This control directly refers to asthma level of control. It could be affected by asthma risk factors and preventive behavior to exposures, but the correlation between them is still unclear because the development of asthma is not fully understood and very complex. The objective of this study was to explain the correlation between asthma risk factors and preventive behavior to exposures to asthma level of control.Method : This study used cross-sectional design and involved 41 respondents which are taken by simple random sampling. Data were collected using questionnaires and then analyzed by using Spearman Rho correlation with level of significance ≤0.05.Result : Result showed that asthma risk factors had correlation with asthma level of control (p=0,032), but preventive behavior to exposures had no correlation with asthma level of control (p=0,095).Conclusion : It can be concluded that asthma level of control has correlation with asthma risk factors. Preventive behavior has no correlation with asthma level of control could be caused by the differences between the respondents preventive behavior and the recommended one. It indicates possible errors or unsuitability in preventive behavior to asthma risk factor exposures. However, preventive behavior to asthma risk factors exposures is still necessary in order to decrease asthma symptoms.

The Detroit Young Adult Asthma Project: Pilot of a Technology-Based Medication Adherence Intervention for African-American Emerging Adults

PurposeTo conduct a randomized controlled pilot of a multicomponent, technology-based intervention promoting adherence to controller medication in African-American emerging adults with asthma. The intervention consisted of two computer-delivered sessions based on motivational interviewing combined with text messaged reminders between sessions. MethodsParticipants (N = 49) were 18–29 years old, African-American, with persistent asthma requiring controller medication. Participants had to report poor medication adherence and asthma control. Youth were randomized to receive the intervention or an attention control. Data were collected through computer-delivered self-report questionnaires at baseline, 1, and 3 months. Ecological Momentary Assessment via two-way text messaging was also used to collect “real-time” data on medication use and asthma control. ResultsThe intervention was feasible and acceptable to the target population, as evidenced by high retention rates and satisfaction scores. Changes in study outcomes from pre- to postintervention favored the intervention, particularly for decrease in asthma symptoms, t (42) = 2.22, p < .05 (Cohen's d = .071). ConclusionsResults suggest that the intervention is feasible and effective. However, findings are preliminary and should be replicated with a larger sample and more sophisticated data analyses.

Long-term CPAP treatment improves asthma control in patients with asthma and obstructive sleep apnoea

Both asthma and obstructive sleep apnoea cause sleep disturbance, daytime sleepiness and diminished quality of life. Continuous positive airway pressure (CPAP) is efficient in reducing symptoms related to sleep apnoea. Here we report the impact of long-term use of CPAP on asthma symptoms. A survey questionnaire was distributed to all of our obstructive sleep apnoea patients with CPAP therapy in 2013. We used the Finnish version of the Asthma Control Test™ (ACT) and a visual analogue scale (0=no symptoms, 100=severe asthma symptoms). Asthma was defined as self-reported physician-diagnosed disease and a special reimbursement for asthma medication by the Social Insurance Institution. We sent 2577 questionnaires and received 1586 answers (61%). One hundred ninety-seven patients were asthmatics with a prevalence of asthma among CPAP users of 13%. We studied 152 patients (58 females) whose CPAP therapy was initiated after starting asthma medication. Their mean (SD) age was 62 (10) years, duration of CPAP 5.7 (4.7) years and their CPAP daily use was 6.3 (2.4) h. Self-reported asthma severity decreased significantly from 48.3 (29.6) to 33.1 (27.4) (p<0.001), and ACT score increased significantly from 15.35 (5.3) to 19.8 (4.6) (p<0.001) without a significant change in the body mass index (BMI). The percentage of patients using rescue medication daily reduced from 36 to 8% with CPAP (P<0.001). We noticed a significant decrease in asthma symptoms with long-term use of CPAP in patients with both asthma and obstructive sleep apnoea.

Sleep medicine.

To reflect the recent advances in the field of pediatric sleep medicine. The pediatrician will be able to define which children to refer for a sleep study and what to expect from the sleep specialist in 2015. In the first study that compared adeno tonsillectomy (TA) to watchful waiting, TA reduced symptoms and improved children's behavior, quality of life, and polysomnographic results. Anti-inflammatory therapy for mild obstructive sleep apnea was effective and well tolerated according to a double-blind study. A retrospective study showed that it is beneficial for 80% of the patients. TA is associated with a decrease in asthma symptoms and medication utilization. Pediatricians need to be aware of the clear benefits of tonsillectomy (including better asthma control), although anti-inflammatory therapy may improve symptoms and polysomnographic findings in children with nonsevere obstructive sleep apnea.

Sublingual Immunotherapy for Asthmatic Children Sensitized to House Dust Mite: A Meta-Analysis.

The house dust mite is one of the most common allergens worldwide. There is good evidence that house dust mite subcutaneous immunotherapy is efficacious and has long-term benefit in children. However, the evidence of the benefit of house dust mite sublingual immunotherapy (SLIT) is less convincing. The purpose of this meta-analysis was to evaluate that efficacy and safety of dust mite SLIT in children with asthma.Medical Literature Analysis and Retrieval System Online, ISI Web of Knowledge, and Cochrane Central Register of Controlled Trials databases until February 2014 were searched. The primary outcome was mean change in asthma symptom score. Secondary outcomes included mean change in serum immunoglobulin G4 (sIgG4), specific Dermatophagoides pteronyssinus, immunoglobulin E (IgE) levels, and medication score. Safety was also assessed.We found that SLIT significantly decreased asthma symptom score (P = 0.007) and increased sIgG4 levels (P = 0.011) greater than control in children (<18 years of age) with asthma. There was no difference between SLIT and control groups in specific D pteronyssinus IgE levels (P = 0.076) and medication score (P = 0.408). The safety profile was similar between groups.Our study indicates that dust mite SLIT therapy was effective in reducing asthma symptoms and in increasing sIgG4 but did not significantly reduce medication scores or specific D pteronyssinus IgE levels. Our findings are not enough to support the use of dust mite SLIT in children with asthma.

Do asthmatics benefit from music therapy? A systematic review

To determine the effectiveness of music therapy in asthma. Searches for experimental and observational studies published between 01.01.92 and 31.12.13 were conducted through electronic databases: Medline/PubMed, Embase, SportDiscus, Cochrane Library, Teacher Reference Centre, Web of Science, Academic Search Complete, PsycINFO, PsycARTICLES, PEDro and Scopus. The selection criteria included any method of music therapy applied to patients with asthma, with respect to asthma symptoms and lung function. Two reviewers screened the records independently. The risk of bias was assessed using the Cochrane Collaboration's tool. Strength of recommendation was graded according to GRADE recommendation. The literature search identified 867 citations, from which 8 (three RCTs and five nRCTs) low and high risk of bias studies were included in the review. All RCTs used music listening as a form of complementary treatment. One RCT of the low risk of bias indicated positive effects on lung function in mild asthma. In two others, despite the decrease in asthma symptoms, music was not more effective than the control condition. In two nRCTs a decrease in asthma symptoms was reported as an effect of playing a brass or wind instrument; in two nRCTs the same effect was observed after music assisted vocal breathing exercises and singing. Mood improvement, decrease of depression and anxiety were also observed. The paucity, heterogeneity, and significant methodological limitations of available studies allow for only a weak recommendation for music therapy in asthma. This study highlights the need for further research of mixed methodology.

β-2 adrenergic receptor gene methylation is associated with decreased asthma severity in inner-city schoolchildren: asthma and rhinitis.

Genetic variation in the β-2 adrenergic receptor gene (ADRB2) has been implicated in asthma severity and control with conflicting results. Epigenetic variation in the ADRB2 may play an important role in asthma phenotype. We aimed to evaluate whether DNA methylation of ADRB2 is associated with asthma phenotypes in inner-city school-aged children. Multiple CpG sites in the promoter region of ADRB2 gene were analysed in 177 children enrolled in the School Inner-City Asthma Study. Blood- or saliva-derived DNA was measured by bisulphite-polymerase chain reaction pyrosequencing assay. Average percentage DNA methylation across the sites was evaluated for association with asthma severity (report of dyspnoea, night-time symptoms, rescue medication use, and baseline spirometry) and morbidity (school absences and unscheduled healthcare visits). Three clades composed of highly correlated methylation sites within the methylated segment of ADRB2 were further analysed. Methylation of individual sites generally ranged from 0% to 6% with average percentage methylation across sites of 2.4%. Univariate analyses strongly favoured the association of higher percentage methylation with lower asthma severity measured by report of dyspnoea. Furthermore, there was a non-significant trend towards less rescue medication use, night-time symptoms, school absences, activity limitation due to asthma, and improved lung function measurements with increased methylation. Multivariate analysis demonstrated methylation of ADRB2 gene significantly associated with less dyspnoea (odds ratio (OR) 0.2, 95% confidence interval (CI), 0.1-0.6, P=0.002). Each of the three clades of methylation sites showed a strong, but not statistically significant, effect on decreased dyspnoea. DNA methylation in the ADRB2 gene is associated with decreased asthma symptom severity, suggesting a role for methylation in asthma phenotypes.

Multiple microbial exposures in the home may protect against asthma or allergy in childhood

Experimental animal data on the gram-negative bacterial (GNB) biomarker endotoxin suggest that persistence, dose, and timing of exposure are likely to influence its effects on allergy and wheeze. In epidemiologic studies, endotoxin may be a sentinel marker for a microbial milieu, including gram-positive bacteria (GPB) as well as GNB, that may influence allergy and asthma through components (pathogen-associated molecular patterns) that signal through innate Toll-like receptor pathways. To determine the influence of current GNB and GPB exposures on asthma and allergic sensitization in school-aged children. We examined the relationship between bacterial biomarkers and current asthma and allergic sensitization in 377 school-aged children in a birth cohort study. We then evaluated the effects of school-aged endotoxin, after controlling for exposure in early life. Exposure to GNB was inversely associated with asthma and allergic sensitization at school age [for >median endotoxin: prevalence odds ratio (POR)=0.34, 95% CI=0.2-0.7, for current asthma and prevalence ratio=0.77, 95% CI=0.6-0.97, for allergic sensitization]. In contrast, elevated GPB in the bed was inversely associated with current asthma (POR=0.41, 95% CI=0.2-0.9) but not with allergic sensitization (POR=1.07, 95% CI=0.8-1.4). School-aged endotoxin exposure remained protective in models for allergic disease adjusted for early-life endotoxin. Both GNB and GPB exposures are associated with decreased asthma symptoms, but may act through different mechanisms to confer protection. Endotoxin exposure in later childhood is not simply a surrogate of early-life exposure; it has independent protective effects on allergic disease.

Community Health Workers and Environmental Interventions for Children with Asthma: A Systematic Review

Community health worker (CHW)–delivered, home-based environmental interventions for pediatric asthma were systematically reviewed. Seven PubMed/MEDLINE listed randomized controlled trials that encompassed the following intervention criteria were identified: (1) home-based; () delivered by a CHW; () delivered to families with children with asthma; and () addressed multiple environmental triggers for asthma. Details of research design, intervention type, and setting, interventionist, population served, and the evaluated outcomes were abstracted. Outcome assessment was broad and non-uniform. Categories included direct mediators of improved health outcomes, such as trigger-related knowledge, trigger reduction behaviors and allergen or exposure levels, and asthma-related health outcomes: change in lung function, medication use, asthma symptoms, activity limitations, and health care utilization. Indirect mediators of health outcomes, or psychosocial influences on health, were measured in few studies.Overall, the studies consistently identified positive outcomes associated with CHW-delivered interventions, including decreased asthma symptoms, daytime activity limitations, and emergency and urgent care use. However, improvements in trigger reduction behaviors and allergen levels, hypothesized mediators of these outcomes, were inconsistent. Trigger reduction behaviors appeared to be tied to study-based resource provision. To better understand the mechanism through which CHW-led environmental interventions cause a change in asthma-related health outcomes, information on the theoretical concepts that mediate behavior change in trigger control (self-efficacy, social support) is needed. In addition, evaluating the influence of CHWs as clinic liaisons that enhance access to health professionals, complement clinic-based teaching, and improve appropriate use of asthma medications should be considered, alongside their effect on environmental management. A conceptual model identifying pathways for future investigation is presented.