Global Initiative For Asthma Guidelines Research Articles

DOES ASTHMA MANAGEMENT DIFFER BETWEEN INDIGENT AND PRIVATE CLINICS?

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Asthma is a reversible airway obstructive disorder characterized by airway inflammation and bronchoconstriction with symptoms such as intermittent cough, wheeze and shortness of breath. Global Initiative for Asthma (GINA) guidelines are published annually to help in decreasing the morbidity and mortality associated with asthma by guiding management. In this study, we compared management in two different population subsets, patients from the indigent clinic and from the private insured clinic, and determined if there was a disparity in asthma management. METHODS: After approval from the Institutional Review Board, a retrospective chart review was conducted among all patients with the diagnosis of asthma in two Internal Medicine resident-run community clinics from January 2016 to November 2019. Baseline demographics, asthma severity, number of exacerbations requiring hospital visits, and medication management were reviewed. RESULTS: Chart review of 128 patients between the indigent clinic (A), which included 94 patients, and private clinic (B), which included 34 patients, showed that there was no significant difference in management between the two clinics. Table 1, resulted below, shows whether asthma was managed appropriately between the two clinics based on the severity of asthma. If a patient is diagnosed with either cough variant or intermittent asthma, appropriate management would include the use of a SABA or as needed ICS, at minimum, for control of symptoms as per GINA guidelines. For patients diagnosed with persistent asthma, appropriate management included a stepwise approach with maintenance therapy and a rescue inhaler. 70 out of 80 patients (87.5%) at the indigent clinic (A) had appropriate management and 26 out of 33 patients (78.8%) at the private clinic (B) had appropriate management. CONCLUSIONS: Disparities in healthcare do exist but between the two internal medicine resident-run clinics, there was no difference in appropriate management of asthma. CLINICAL IMPLICATIONS: Although there was no difference in management of asthma between the two clinics, education will be needed on proper management since neither clinic had complete adherence to GINA guidelines for management. DISCLOSURES: No relevant relationships by Saiara Choudhury, source=Web Response no disclosure on file for Jack Davitt; No relevant relationships by Reema George, source=Web Response No relevant relationships by Salim Surani, source=Web Response

A cross sectional observational study about the relationship between body mass index and severity of asthma in children aged 6 to 14 years

Background: The effects of obesity on asthma severity, diagnosis and control are increasingly recognized. Primary objective of our study was to find out the relationship between BMI and severity of asthma in children. Secondary objectives were to study associated co-morbid conditions viz., atopic eczema and allergic rhinitis in children with asthma and the relationship between family history of asthma, atopy and allergic rhinitis with severity of asthma.Methods: This cross-sectional study was done in the tertiary care centre in Thrissur, Kerala. Children of age 6 to 14 years diagnosed as asthma according to Global Initiative for Asthma (GINA) guidelines were included. One hundred children qualified for the study during the stipulated time period. Children with symptoms and signs of asthma, were classified to intermittent and persistent based on GINA guidelines. BMI was calculated in all. Preliminary details and details on the risk factors were collected.Results: Mean age of the study population is 8.8 years. The study group had male predominance (57%). 39% had mild intermittent, 33% had mild persistent, 22% had moderate persistent and 6% had severe persistent asthma. Intermittent, mild persistent and moderate persistent were grouped as non-severe. 50% children had normal BMI, 28% were overweight and 22% underweight. Family history of asthma and atopic dermatitis was 47% and 38% respectively. Maximum children belonged to low socioeconomic status.Conclusion: Did not find any statistically significant association between severity and duration of asthma with obesity or overweight in children with asthma (p>0.05).

Impact of the COVID-19 pandemic in children with allergic asthma

Impact of the COVID-19 pandemic in children with allergic asthma

Atopy is predictive of a decreased need for hospitalization for coronavirus disease 2019

Atopy is predictive of a decreased need for hospitalization for coronavirus disease 2019

SARS-CoV-2 Pneumonia in Hospitalized Asthmatic Patients Did Not Induce Severe Exacerbation

BackgroundViral infections are known to exacerbate asthma in adults. Previous studies have found few patients with asthma among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia cases. However, the relationship between SARS-CoV-2 infection and severe asthma exacerbation is not known.ObjectiveTo assess the frequency of asthma exacerbation in patients with asthma hospitalized for SARS-CoV-2 pneumonia and compare symptoms and laboratory and radiological findings in patients with and without asthma with SARS-CoV-2 pneumonia.MethodsWe included 106 patients between March 4 and April 6, 2020, who were hospitalized in the Chest Diseases Department of Strasbourg University Hospital; 23 had asthma. To assess the patients' asthma status, 3 periods were defined: the last month before the onset of COVID-19 symptoms (p1), prehospitalization (p2), and during hospitalization (p3). Severe asthma exacerbations were defined according to Global INitiative for Asthma guidelines during p1 and p2. During p3, we defined severe asthma deterioration as the onset of breathlessness and wheezing requiring systemic corticosteroids and inhaled β2 agonist.ResultsWe found no significant difference between patients with and without asthma in terms of severity (length of stay, maximal oxygen flow needed, noninvasive ventilation requirement, and intensive care unit transfer); 52.2% of the patients with asthma had Global INitiative for Asthma step 1 asthma. One patient had a severe exacerbation during p1, 2 patients during p2, and 5 patients were treated with systemic corticosteroids and inhaled β2 agonist during p3.ConclusionsOur results demonstrate that patients with asthma appeared not to be at risk for severe SARS-CoV-2 pneumonia. Moreover, SARS-CoV-2 pneumonia did not induce severe asthma exacerbation.

Allergen Immunotherapy in Pediatric Asthma: A Pragmatic Point of View.

To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting effect after the end of the course. The recent clinical trials evidenced AIT effectiveness and safety in allergic asthma. Consequently, the current version of the GINA (Global Initiative for Asthma) guidelines recommend AIT as an add-on therapy for asthma. There is also evidence that AIT may exert preventive activity on the possible progression from allergic rhinitis to asthma in children and the onset of new sensitizations. The present review provides a pragmatic summary of the clinical indications of AIT in pediatric asthma, including the immunological mechanisms, the predictive biomarkers, and the safety issues in clinical practice.

Improving asthma care with Asthma-COPD Afterhours Respiratory Nurse at Emergency (A-CARE)

BackgroundEmergency departments (ED) are important providers of asthma care, particularly after-hours. We identified gaps for quality improvement such as suboptimal adherence rates to three key recommendations from the Global Initiative...

Hubungan Antagonis Leukotrien dengan Tingkat Kontrol Asma di Klinik Harum Melati

The level of asthma control is the extent to which the characteristics of asthma can be observed in patients with asthma and have been reduced or disappear with treatment. The Global Initiative for Asthma guidelines recommends leukotriene antagonists as the second-line add-on treatment. Leukotriene antagonists play a role in controlling the recurrence of asthma symptoms, so a well-controlled asthma patient will be achieved. This study conducted to find out the correlations between the use of leukotriene antagonists with the level of asthma control in patients with bronchial asthma at Harum Melati Clinic of Pringsewu in August 2018-August 2019. Methodology: This research using an analytic method with a retrospective approach. The population of this research was all of the medical records of patients with bronchial asthma at Harum Melati Clinic of Pringsewu on the period of August 2018-August 2019, amounting to 449, sampling using the total sampling technique with the total sample of 232 medical records that meet the inclusion criteria and exclusion criteria. Data were analyzed by the spearman test. 133 (57.3%) subjects had well-controlled asthma, 99 (42.7%) subjects having partly- controlled asthma, and there are no asthma patients have uncontrolled asthma (0%). And also got 125 (53.9%) subjects using leukotriene antagonists and 107 (46.1%) subjects did not use leukotriene antagonists. There is a correlation between the use of leukotriene antagonists with the level of asthma control in patients with bronchial asthma at Harum Melati Clinic of Pringsewu in August 2018-August 2019.

The beneficial role of FeNO in association with GINA guidelines for titration of inhaled corticosteroids in adult asthma: A randomized study

PurposeThis study aimed to demonstrate the role of fractional concentration of exhaled nitric oxide (FeNO) in association with Global Initiative for Asthma (GINA) guidelines for treatment of adult patients with asthma. MethodsIt was a prospective and randomized study. The symptomatic asthmatic patients were randomly divided into two groups: GINA group (followed GINA guidelines; N = 86) or GINA + FeNO group (followed GINA guidelines + FeNO for titration of inhaled corticosteroids - ICS; N = 90). They were followed-up for 9 months. ResultsIn GINA group, 37.2% patients had no treatment and 62.8% patients discontinued treatment vs. 40.0% and 60.0% in GINA + FeNO, respectively. After 3, 6 and 9 months of treatment, the percentage of mild, moderate and severe asthma showed no significant difference between the two groups. At 9th month, Δ moderate asthma (reduction) in GINA + FeNO group was significantly higher than in the GINA group (−22.0% vs. −11.6%; P = 0.018). The improvement of asthma control test (ACT) score was not different between the groups at 9th month (12 ± 6 vs. 10 ± 5; P > 0.05); the level of FeNO reduction in GINA + FeNO group was significantly higher than that in GINA group (−42 ± 11 vs. −35 ± 9; P = 0.022). The daily dose of ICS in GINA + FeNO group was significantly lower than that in GINA group (397 ± 171 vs. 482 ± 240 mcg and 375 ± 203 vs. 424 ± 221 mcg; respectively) at the end of 6 and 9 months. ConclusionThe use of FeNO in association with GINA guidelines has a beneficial role for accurate daily dose of ICS in adult patients with asthma.

Chronic rhinosinusitis with nasal polyps impact in severe asthma patients: Evidences from the Severe Asthma Network Italy (SANI) registry.

The clinical and laboratory features of patients enrolled in the Severe Asthma Network in Italy (SANI) registry, a web-based observatory collecting demographic, clinical, functional and inflammatory data of patients with severe asthma were evaluated, with a special emphasis to chronic rhinosinusitis with nasal polyposis (CRSwNP). For each eligible patients the following information has been collected: demographic data, clinical features, asthma control in the previous month according to the GINA (Global INitiative for Asthma) Guidelines and standardized questionnaires, concomitant regular and on demand treatments and inflammatory markers. 695 patients with severe asthma enrolled in 66 SANI centers were analyzed. The prevalence of chronic rhinosinusitis with nasal polyposis was 40.6%. Atopic dermatitis and bronchiectasis was significantly more frequent in patients with CRSwNP than in subjects without nasal polyposis; similarly, FeNO values are significantly higher in subject with CRSwNP than in patients without nasal polyposis. Finally, patients with CRSwNP had a significantly higher number of asthma exacerbations per year, more days on oral corticosteroids and were more likely to be OCS long term users. OCS sparing is needed in patients with severe asthma, mainly in subjects with CRSwNP, adopting adequate strategies such as a better adherence to the treatment with inhaled therapy according to the GINA recommendations, the use of biologic agents and a multidisciplinary approach of the patient.

Study of the beneficial role of exhaled nitric oxide in combination with GINA guidelines for titration of inhaled corticosteroids in children with asthma

Background. The use of FENO in association with current guidelines in the treatment of asthma has not been studied thoroughly. This study aimed to evaluate the beneficial role of FENO in combination with GINA (Global Initiative for Asthma) guidelines for titration of inhaled corticosteroids (ICS) in asthmatic children. Methods. It was a prospective and descriptive study. Uncontrolled asthmatic children were randomized to two groups: group 1 (followed GINA guidelines) or group 2 (followed GINA guidelines + FENO modification for ICS titration). The two groups were followed-up for 12 months. Results. The mean age of the patients in the study was 10 ± 4 years for group 1 (n = 116) and 11 ± 5 years for group 2 (n = 108). There were 87.9% patients in group 1 and 82.4% in group 2 that had a familial allergic history. There were 58.6% of moderate asthma and 41.4% of severe asthma in group 1, versus 56.4% and 43.6% in group 2, respectively. The percentage of moderate and severe asthma was also significantly modified after 6th and 12th month versus at inclusion (43.1% and 35.3% versus 58.6%, P < 0.01 and P < 0.005; 23.2% and 12.9% versus 41.4%, P < 0.005 and P < 0.001, respectively). The total daily dose of ICS in group 2 at 12th months was significantly lower than that in group 1 (3515 ± 1175 versus 4785 ± 1235 mcg; P < 0.005). The daily cost of ICS treatment in group 2 was also lower than that of group 1 (18 ± 4 versus 27 ± 3 USD; P < 0.05). Conclusion. The use of FENO in combination with GINA guidelines for ICS titration is useful in reducing the daily ICS dose and treatment cost.

Single and Synergistic Effects of Type 2 Cytokines on Eosinophils and Asthma Hallmarks.

The type 2 cytokines IL-5, IL-13, and IL-4 play an important role in the induction and progression of asthma. According to the Global Initiative for Asthma guidelines, blood eosinophil numbers are one marker that helps to guide treatment decisions in patients suffering from severe forms of asthma. Effects of type 2 cytokines were analyzed, alone or in combination, on eosinophils in blood and other compartments and on the development of asthma symptoms. C57BL/6 mice received a single intranasal application of equimolar amounts of IL-5, IL-13, and IL-4, alone or in combination. Numbers, activation state, and migratory behavior of eosinophils in bone marrow (BM), blood, lung, and bronchoalveolar lavage as well as airway hyperresponsiveness and goblet cell metaplasia were evaluated. Only IL-13 was associated with airway eosinophilia, development of airway hyperresponsiveness, and goblet cell metaplasia, without any synergistic effects. IL-5 increased the number of eosinophils in BM and lung tissue but failed to affect structural changes. IL-4 had similar, but weaker, effects to IL-13. Cytokine combinations synergistically affected eosinophils but failed to enhance IL-13-driven effects on lung function or goblet cell metaplasia. IL-5 and IL-13 markedly increased eosinophil numbers locally in lung and airways and distally in blood and BM, whereas IL-5 and IL-4 only increased eosinophils in lung and BM. IL-13 together with IL-4 failed to demonstrate any synergistic effect. These insights into single and combined effects of type 2 cytokines on disease-driving mechanisms could improve understanding of the impact and effectiveness of new therapies in asthma.

Nebulized budesonide in the patients with acute asthma exacerbation: A randomized clinical trial

Background: The management of asthma currently focuses on the Global Initiative for Asthma (GINA) guideline. This randomized clinical trial aimed to find whether the addition of nebulized budesonide to basic treatment would further improve the peak expiratory flow (PEF) rates and decrease the hospitalization days in patients through asthma exacerbation. Methods: Eligible patients with a definitive diagnosis of asthma exacerbation in the emergency department of Masih Daneshvari hospital were entered into this study. Patients were divided into the intervention and the control groups based on random numbers. To follow the GINA guidelines, both the groups received hydrocortisone (3 mg/kg slow IV stat) at the arrival, oxygen and nebulizer containing salbutamol and ipratropium bromide three times every 30 min and then every 8 h during the first 24 h. Nebulized budesonide (0.5 mg/2 ml) was added to the regimen of the intervention group and nebulized saline as the placebo in the control group. PEF of all eligible cases was measured on arrival and then at 1, 6, and 24 h after the ending of the first session of inhalation. Results: Hospitalization days decreased significantly in the intervention group (P ≤ 0.001). There was no median ± standard deviation of PEF in the intervention group after 1 h (P = 0.019) and stayed higher than the control group on 6 and 24 h, respectively (P = 0.015 and P = 0.050). Conclusion: Adding nebulized budesonide to the main treatment regimen of an acute asthma attack helps the patients gaining better respiratory flow and reduces the hospitalization time.

Exploring the effect of presence and type of allergen sensitization on fractional exhaled nitric oxide, immunoglobulin E, and interleukins 4, 5, and 13 among asthmatics.

Objective:Asthma is associated with airway inflammation. Allergen sensitization (atopy) is common in asthma. This study explored the effect of food and/or aeroallergen sensitization; on airway and systemic inflammation using fractional exhaled nitric oxide (FENO) and interleukins (ILs) 4, 5, and 13.Methods:The study enrolled asthmatics (diagnosed using Global Initiative for Asthma guidelines). Atopy was diagnosed using skin-prick testing (SPT). All subjects underwent testing for FENO, blood absolute eosinophil count (AEC), and serum levels of immunoglobulin E (IgE), and ILs 4, 5, and 13. Asthmatics (BA) were classified as atopic (BA-A) and nonatopic (BA-N). Atopic-asthmatics were subclassified as exclusively food allergen (AtAA) or aeroallergen (AtAA); or dually (AtFAA) sensitized.Results:The study enrolled 203 asthmatics (BA) and 50 controls. Among BA, 169 were BA-A and 34 were BA-N. Mean values of AEC, serum IgE and FENO, and ILs 4 and 13 were significantly higher in BA-A than BA-N (659 vs. 218/mm3, 638 vs. 217 IU/ml, 39.2 vs. 20.0 ppb, 14.96 vs. 8.04 pg/ml, and 22.12 vs. 11.64 pg/ml, respectively). Meanwhile, mean IL-5 was higher in BA-A (11.01 vs. 8.76 pg/ml; P = 0.22), but not statistically significant. Subgroup analysis of atopic asthmatics (i.e., AtFA, AtAA, and AtFAA), revealed similar mean values for FENO (31.99 vs. 40.16 vs. 39.46 ppb), AEC (691.00 vs. 653.07 vs. 659.88/mm3), IgE (635.60 vs. 630.32 vs. 646.39 IU/ml), IL-4 (12.63 vs. 14.74 vs. 15.44 pg/ml), and IL-13 (18.38 vs. 19.87 vs. 24.57 pg/ml). No difference was observed among subgroups of atopic-asthmatics.Conclusion:Subgroups of atopic-asthmatics did not show any consistent difference across all the studied parameters.

The global initiative for asthma guidelines (2019): change in the recommendation for the management of mild asthma based on the SYGMA-2 trial - A critical appraisal.

The Global Initiative for Asthma (GINA) recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The pocket guide for practicing clinicians states that “the 2019 GINA strategy report represents the most important change in asthma management in 30 years.” An important recommendation is the change in treatment strategy for the management of mild asthma where the guideline recommends that” all adults and adolescents with asthma should receive either symptom driven (in mild asthma) or daily low dose inhaled corticosteroid (ICS) containing controller treatment to reduce the risk of serious exacerbations.” Our study critically appraises the SYGMA-2 trial, a key trial that largely formed the basis of this recommendation and discusses the potential consequences of using only long-acting beta-2-agonist + ICS as needed as against regular, daily low-dose ICS with as-needed short-acting beta-2-agonist. Our critique covers airway inflammation, disease heterogeneity, understanding the noninferiority margin and its consequences, the Hawthorne effect, and conflict of interest. It is our view that statement of this magnitude will have far-reaching implications for clinical practice which will be in the interests of some patients but also against the interests of others.

Clinical Profile of Episodic Wheezing and Multiple Trigger Wheezing in Preschool Children: A Cross-Sectional Study

AbstractThe objectives of our study were to identify the relative frequency of episodic viral wheeze (EVW) and multiple trigger wheeze (MTW) in preschool children of 1 to 5 years of age with recurrent wheezing and to compare the relevant clinical and sociodemographic parameters in the above phenotypes. This cross-sectional study included 165 children aged 1 to 5 years with recurrent wheeze. Participants were categorized into EVW and MTW based on history according to European Respiratory Society Task Force recommendations 2008. Symptom control was assessed by Global Initiative for Asthma guidelines 2015. Of the total participants, EVW was seen in 55% and MTW in 45%. Children with MTW were significantly older than those with EVW, more atopic, and had higher eosinophil counts. The dominant phenotype seen in our study was EVW. The absence of ocular/nasal allergy and exclusive breastfeeding predicted well-controlled symptoms in EVW and in all preschool wheezers, respectively.

Allergen immunotherapy in children and adolescents with respiratory diseases.

To date, the only disease-modifying treatment strategy for allergic rhinitis and asthma is allergen immunotherapy (AIT). There is evidence that AIT improves allergic rhinitis and asthma, such as reducing symptom severity and medication use and improving of quality of life, with a long-lasting effect after the end of the course. The recent clinical trials evidenced AIT effectiveness and safety in allergic asthma. Consequently, the current version of the GINA (Global Initiative for Asthma) guidelines recommend AIT as an add-on therapy for asthma. There is also evidence that AIT may exert preventive activity on the possible progression from allergic rhinitis to asthma in children and the onset of new sensitizations. (www.actabiomedica.it)

Outpatient Management of Bronchial Asthma: A Comparative Analysis Between Guideline-Directed Management and Usual Management.

BackgroundBronchial asthma is a common controllable disease that causes a serious economic and social burden. The Global Initiative for Asthma (GINA) was developed to help guide clinicians in appropriate management of asthma. Despite the existence of published guidelines, common practice in many primary care clinics follows usual care based on clinical gestalt. This study aims to determine if there is a statistically significant difference in outcomes between patients receiving guideline-directed therapy when compared to those receiving usual clinician therapy.MethodsA total of 300 patients were included in this study. Among them, 139 patients received guideline-directed medical therapy (GDMT group) and 161 received usual medical therapy (UMT group). Logistic regression models were utilized to determine if there was a significant difference in outcomes for patients comparing number of exacerbations and number of hospitalizations.ResultsMore patients in GDMT group suffered from recorded exacerbations in the prior year with 43.9% having one, 3.6% having two, and 0.7% having three, compared to the frequencies of exacerbations in the UMT group (29.2%, 1.9%, and 1.2%, respectively) (P < 0.05). Cumulative number of hospitalizations due to asthma exacerbations in the prior year was also higher in GDMT group compared to the UMT group (one in 5.8% GDMT vs. 3.1% UMT; two in 0.0% GDMT vs. 0.6% UMT) without statistically significant difference (P = 0.349).ConclusionsPrimary care providers’ adherence to the 2018 GINA guidelines for asthma treatment did not offer benefit to patient outcomes, such as number of exacerbations or hospitalizations, compared to the usual medical care of bronchial asthma. Patient-tailored care may offer reduction in the rates of exacerbations and hospitalization.

Chronic asthma in adults

There are around 5.4 million people in the UK with asthma. Poorly controlled asthma places a particular burden on the NHS, and diminishes patients’ quality of life. More significantly, there are an estimated 1400 deaths from asthma each year in the UK, many of which are preventable. This is unacceptably high for a treatable condition. General practice carries much of the responsibility for diagnosis and management of asthma, and there is potential to improve the mortality and morbidity rates from asthma by improving knowledge transfer between GPs and their patients and the use of guidelines on compliance with agreed treatment paths. There are three separate sets of guidelines for the diagnosis and treatment of asthma: The British Thoracic Society and Scottish Intercollegiate Guidelines Network guidelines, The National Institute for Health and Care Excellence guidelines, and Global Initiative for Asthma guidelines. These will be reviewed throughout this article.

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.