Asthma Symptoms Research Articles

The association between ibuprofen administration in children and the risk of developing or exacerbating asthma: a systematic review and meta-analysis

BackgroundIbuprofen is one of the most commonly used analgesic and antipyretic drugs in children. However, its potential causal role in childhood asthma pathogenesis remains uncertain. In this systematic review, we assessed the association between ibuprofen administration in children and the risk of developing or exacerbating asthma.MethodsWe searched MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, and Scopus from inception to May 2022, with no language limits; searched relevant reviews; and performed citation searching. We included studies of any design that were primary empirical peer-reviewed publications, where ibuprofen use in children 0–18 years was reported. Screening was performed in duplicate by blinded review. In total, 24 studies met our criteria. Data were extracted according to PRISMA guidelines, and the risk of bias was assessed using RoB2 and NOS tools. Quantitative data were pooled using fixed effect models, and qualitative data were pooled using narrative synthesis. Primary outcomes were asthma or asthma-like symptoms. The results were grouped according to population (general, asthmatic, and ibuprofen-hypersensitive), comparator type (active and non-active) and follow-up duration (short- and long-term).ResultsComparing ibuprofen with active comparators, there was no evidence of a higher risk associated with ibuprofen over both the short and long term in either the general or asthmatic population. Comparing ibuprofen use with no active alternative over a short-term follow-up, ibuprofen may provide protection against asthma-like symptoms in the general population when used to ease symptoms of fever or bronchiolitis. In contrast, it may cause asthma exacerbation for those with pre-existing asthma. However, in both populations, there were no clear long-term follow-up effects.ConclusionsIbuprofen use in children had no elevated risk relative to active comparators. However, use in children with asthma may lead to asthma exacerbation. The results are driven by a very small number of influential studies, and research in several key clinical contexts is limited to single studies. Both clinical trials and observational studies are needed to understand the potential role of ibuprofen in childhood asthma pathogenesis.

Asthma and Hyperglycemia: Exploring the Interconnected Pathways.

The interplay between asthma and glucose metabolism disorders, such as hyperglycemia, has gained increasing attention due to the potential exacerbation of asthma symptoms and severity. This review explores the complex relationship between hyperglycemia and asthma, emphasizing the pathophysiological links, the impact of glucose metabolism disorders on asthma, and the effects of asthma medications on glucose levels. Hyperglycemia, often induced by asthma treatments like corticosteroids, has been associated with an increased risk of asthma exacerbations. This review delves into the pathophysiology underlying this association, highlighting the role of insulin resistance, metabolic syndrome, and obesity in both the development and management of asthma. Metabolic syndrome, characterized by abdominal obesity and hyperglycemia, independently increases the risk of worsening respiratory symptoms and asthma. Furthermore, this review examines the influence of various antidiabetic medications on asthma outcomes. Biguanides, like metformin, have shown promise in improving asthma outcomes in patients with type 2 diabetes mellitus and asthma. However, other medications have mixed results regarding their impact on asthma control and lung function. Considering these findings, this review advocates for further research into the role of metabolic pathways in asthma management. It calls for comparative studies and the inclusion of asthma-related outcomes in clinical trials of antidiabetic drugs to better understand their potential benefits for individuals with obesity and concurrent asthma.

The effect of wet cupping therapy on the clinical symptoms of adult-onset asthma: a randomized clinical trial.

Asthma is an inflammatory disease of the lungs. Cupping therapy is a traditional method used in Persian medicine for treating various ailments. This study aimed to evaluate the anti-asthmatic effects of wet cupping therapy (WCT) in patients with mild to moderate asthma. This is a randomized clinical trial conducted on 103 asthma patients who were referred to Loghman Hakim Hospital, Tehran, Iran. The diagnosis of the disease was confirmed by a pulmonologist based on the patient's history and clinical examinations. The patients who were treated with common asthma medications were assigned to intervention and control groups. The intervention group underwent one session of WCT in the region between two shoulders on one of the 17th, 19th, and 21st days of the lunar month. The clinical signs of all patients were gathered based on the asthma control test questionnaire before the intervention and in the first, second, fourth, sixth, and eighth weeks after the intervention. The scores of the five questionnaire items and the mean total treatment score (MTTS) were compared between the two groups. Additionally, the satisfaction scores of the participants in the two groups were compared. Of 103 patients, 82 patients completed the study. The mean total treatment score (MTTS) was not significantly different between the control and intervention groups at the beginning of the study (p = 0.06). In the intervention group, the MTTS was 11.44 before WCT, while it was significantly increased (24.24) eighth week after the intervention (p < 0.001). However, the MTTS in the intervention group was significantly higher than the control group in the first week (p <0.001). In addition, at the end of the trial, the subjects' satisfaction scores in the WCT and control groups were 7.48 and 4.53, respectively (p < 0.001). Wet cupping therapy can be an efficient therapeutic method to ameliorate respiratory complications of asthma patients.

Refining Children's exposure assessment to NO2, SO2, and O3: Incorporating indoor-to-outdoor concentration ratios and individual daily routine

Exposure to air pollutants like sulfur dioxide (SO2), nitrogen oxides (NOx), and ozone (O3) is associated with adverse health effects, particularly with exacerbations of asthma symptoms and new asthma cases in both children and adults. While fixed-site monitoring (FSM) stations are commonly used in air pollutant exposure studies, they may not fully capture personal exposures due to limitations such as inadequate consideration of daily routines and indoor/outdoor concentration variations. In this study, to enhance the accuracy of personal exposure calculated by using FSM data, individual's daily activity routine, encompassing both indoor and outdoor environments, were incorporated by using indoor-to-outdoor concentration ratios. Three methodologies were compared to assess the accuracy of exposure calculations: (i) direct exposure determination employing passive samplers (PS), (ii) personal exposure calculated using FSM data alone, and (iii) personal exposure calculated using FSM data refined by integrating local average individual daily activity routines and indoor-to-outdoor ratios. The results demonstrate that the refined method (iii) yields substantial improvements in estimated exposure levels, reducing the average error from 1.4% to 0.4% for NO2, from 72.1% to 12.7% for SO2, and from 323.4% to 24.9% for O3.

Integrated Multi-Omics Analysis Reveals Mountain-Cultivated Ginseng Ameliorates Cold-Stimulated Steroid-Resistant Asthma by Regulating Interactions among Microbiota, Genes, and Metabolites.

Steroid-resistant asthma (SRA), resisting glucocorticoids such as dexamethasone (DEX), is a bottleneck in the treatment of asthma. It is characterized by a predominantly neutrophilic inflammatory subtype and is prone to developing into severe refractory asthma and fatal asthma. Currently, there is a lack of universally effective treatments for SRA. Moreover, since cold stimulation does increase the risk of asthma development and exacerbate asthma symptoms, the treatment of cold-stimulated SRA (CSRA) will face greater challenges. To find effective new methods to ameliorate CSRA, this study established a CSRA mouse model of allergic airway inflammation mimicking human asthma for the first time and evaluated the alleviating effects of 80% ethanol extract of mountain-cultivated ginseng (MCG) based on multi-omics analysis. The results indicate that cold stimulation indeed exacerbated the SRA-related symptoms in mice; the DEX individual treatment did not show a satisfactory effect; while the combination treatment of DEX and MCG could dose-dependently significantly enhance the lung function; reduce neutrophil aggregation; decrease the levels of LPS, IFN-γ, IL-1β, CXCL8, and IL-17; increase the level of IL-10; alleviate the inflammatory infiltration; and decrease the mucus secretion and the expression of MUC5AC. Moreover, the combination of DEX and high-dose (200 mg/kg) MCG could significantly increase the levels of tight junction proteins (TJs), regulate the disordered intestinal flora, increase the content of short-chain fatty acids (SCFAs), and regulate the abnormal gene profile and metabolic profile. Multi-omics integrated analysis showed that 7 gut microbes, 34 genes, 6 metabolites, and the involved 15 metabolic/signaling pathways were closely related to the pharmacological effects of combination therapy. In conclusion, integrated multi-omics profiling highlighted the benefits of MCG for CSRA mice by modulating the interactions of microbiota, genes, and metabolites. MCG shows great potential as a functional food in the adjuvant treatment of CSRA.

Respiratory, cardio-metabolic and neurodevelopmental long-term outcomes of moderate to late preterm birth: not just a near term-population. A follow-up study.

Moderate-to-late preterm infants constitute the majority within the preterm infant population. Most research on preterm infants has focused on very preterm children, often treating moderate-to-late preterm infants as similar to full-term infants. Our objective was to compare clinical, respiratory, cardio-metabolic and neurodevelopmental outcomes in adolescents aged 12-15 years born moderate and late preterm with a control group of the same age born full-term. Observational cross-sectional study, comparing moderate-to-late preterm (32-36+6 weeks' gestational age) with full-term adolescents (37-41+6 weeks' gestational age; 75 each group). Perinatal and neonatal history were collected as well as data on respiratory evolution (ISAAC questionnaire for asthma symptoms for adolescents 13-14 years), anthropometric values, learning difficulties, behavioral test (screening questionnaire for high-performance autism spectrum disorder and evaluation test for attention deficit hyperactivity disorder), skin prick test, pulmonary function test, echocardiogram and blood pressure. A blood test with metabolic profile was conducted. Moderate-to-late preterm adolescents had more current asthma [p = 0.008, OR3 (95% CI 1.26-7.14)] and longer duration of combined treatments to control asthma (inhaled corticosteroids and anti-leukotrienes; p = 0.048). Forced vital capacity <80% was detected more often in moderate-to-late preterm patients (p = 0.013). When assessing right ventricle, moderate-to-late preterm adolescents showed better tricuspid annular plane systolic excursion z-score (p = 0.003), shortening fraction (p < 0.001) and E/A ratio z-score (p = 0.002). Regarding left ventricular assessment, moderate-to-late preterm group had smaller ventricle diastolic diameter (p = 0.04) and lower posterior wall z-score values (p = 0.037). They also showed a better S'wave z-score (p = 0.027), E wave (p = 0.005), E/A ratio (p = 0.003) and a higher septal myocardial performance index z-score (p = 0.025). Moderate-to-late preterm adolescents presented lower weight z-score (p = 0.039), body mass index z-score (p = 0.013), Waterlow weight index (p = 0.006) and higher undernutrition index [p = 0.04; OR 1.4 (95% CI 1-1.9)]. Although there were no differences in neurodevelopmental survey or behavioral tests. Our findings underscore the importance of extended follow-up for this predominant group of premature infants to identify potential respiratory, cardiac and anthropometric issues that may emerge in the future.

Genetic polymorphisms (FTO rs9939609 and TMEM18 rs6548238), adipokines (leptin and adiponectin) and adiposity in children and adolescents with asthma

ObjectiveTo describe independent factors related to the interaction of FTO rs9939609, TMEM18 rs6548238, leptin, and adiponectin in children/adolescents with asthma, under the influence of obesity. MethodsThe authors performed a cross-sectional study with 57 children/adolescents, ages 8–19 years, at a tertiary hospital, from 2017 to 2018. Participants were classified by nutritional status, performed spirometry with a bronchodilator test and completed an asthma questionnaire, higher scores indicated more asthma symptoms. Two asthma groups were formed: Group 1(G1)-normal-weight; Group 2(G2)-overweight/obese. Serum was collected for adipokines (n = 32) and genetic polymorphisms (n = 53) dosages. ResultsAge and body mass index (BMI) correlated directly in normal-weight (p = 0.009) and obese participants (p = 0.004). Girls reported more asthma complaints (p = 0.044). Participants with negative bronchodilator responses presented lower BMI (14.55–17.16) than responders (19.4–26.84) (p = 0.049). Leptin dosages are related directly to BMI (5,34–40 ng/ml in obese × 0,54–42 ng/ml in nonobese) (p = 0.003). Levels were high in girls (4.78–17.55 µg/ml) (p = 0.029) and low in nonobese boys (0.54–6.92 µg/ml) (p = 0.006). In obese, low leptin levels (< 10 ng/ml) were found in small airway dysfunction carriers (p = 0.025); elevated adiponectin (> 5 µg/ml) correlated with FEV1/FVC > 80 % (p = 0.035) and positive bronchodilator tests (8.84–13 µg/ml) (p = 0.039); and FTO A allele correlated with low adiponectin 0–8.84 µg/ml (p = 0.021) and low FEV1/FVC (46 %-88 %) (p = 0.023). ConclusionBMI correlated directly with age and leptin levels. Obese participants presented high serum levels of leptin and FTO A allele correlated with low FEV1/FVC. Larger cohorts are necessary for better elucidation of the role of adipokines and polymorphisms in the pathophysiology of asthma and obesity.

Association between prenatal and childhood exposure to particulate matter and asthmatic symptoms in the children of the Cyprus MEDEA Cohort

Association between prenatal and childhood exposure to particulate matter and asthmatic symptoms in the children of the Cyprus MEDEA Cohort

Associations between greenness exposure and asthma symptom score in the Constances cohort

Associations between greenness exposure and asthma symptom score in the Constances cohort

Pollen effects in a changing climate: Ragweed pollen exposure and sleepiness in immunotherapy patients of a Southeastern Michigan allergy clinic.

Allergic rhino-conjunctivitis (AR) is a globally relevant health disorder characterized by sneezing, rhinorrhea and sleep disturbance. Ragweed (Ambrosia artemisiifolia) is a plant common to North America and an important allergen. Coarse methods of measuring airborne pollen counts are used to predict seasonal allergy symptoms. This research used a longitudinal study design with a novel, model-based raster of predicted pollen counts to test associations with self-reported symptoms of AR collected from patients receiving immunotherapy for pollen allergies at an allergy clinic. Researchers visited a clinic six times over three weeks. Immunotherapy patients were asked to fill out a brief intake survey on allergic and symptomatic profiles, daytime sleepiness, housing quality, and demographics. Participants responded to a daily, emailed survey on sleepiness and asthma symptoms for 21 days. Using the date and location of responses, ragweed pollen counts were extracted from a prognostic, model based raster (25km pixels). Lag associations of pollen counts with sleepiness were tested using a logistic regression model , adjusted for housing and demographic characteristics, in a distributed lag non-linear model (DLNM) framework. 49 people participated in the study. 26 (52%) were female. The mean age was 37.9 years. Asthma/allergy symptoms were not associated with ragweed pollen but sleepiness was highest two days after exposure (Estimate: 0.33 [0.04,0.62]). Subjects traveled widely during the study period. Intense exposures to ragweed pollen may be associated with daytime sleepiness within small exposure windows. Model-based predicted pollen counts could be used to study health impacts of pollen in people with disease severe enough to receive immunotherapy. Daytime sleepiness can affect productivity and injury risk, and pollen season length and allergenicity may be increasing with climate change. Thus our results may have important implications for population health.

Seasonal variations of size-classified aerosol-bound elements in school environments and risk factors for the prevalence of atopic diseases among pupils

Five-stage Sioutas impactors were used to collect particulate matter (PM) in 4 classrooms and the playground of a school with various educational levels near the largest industrial chemical complex in Portugal. Monitoring was carried out over a total period of 8 weeks split equally between winter and spring. Samples were analysed for its elemental composition by PIXE. The prevalence of respiratory symptoms in schoolchildren was assessed by applying the International Study of Asthma and Allergies in Childhood (ISAAC) standardised questionnaire. The mass concentration of quasi-ultrafine particles (PM0.25) was higher in winter, but lower than those reported in other studies. Elements accounted for 15.3–17.3 % and 25.6–34.1 % of the total PM10 mass in winter and spring, respectively. Elements such as K, S, Zn, Cu and Br presented a dominant mode in PM0.25, while Al, Mg, Ca, Fe and Si peaked at 2.5 μm. Throughout the campaign, Cl was the main component of the mass of PM greater than 0.5 μm in the schoolyard, while in classrooms Ca constituted the most abundant element of PM2.5-10. The results indicate that soil dust, cleaning products, biomass burning, traffic, the chemical complex and railway affected PM levels at the school. Taking paracetamol and living near roads with intense traffic of heavy vehicles were found to be statistically significant predictors of asthma symptoms, while the frequent consumption of antibiotics and children exposure to parental smoking during the first year of their life were found to increase the odds of developing symptoms of rhinitis.

Efficacy and safety of subcutaneous and sublingual allergen immunotherapy in the treatment of asthma in children: a systematic review and meta-analysis.

Asthma is a common chronic condition in children globally. Allergen-specific immunotherapy, such as subcutaneous (SCIT) and sublingual (SLIT) therapies, are promising by increasing allergen tolerance. This meta-analysis compares the efficacy and safety of SLIT and SCIT in pediatric asthma. We searched PubMed, Cochrane Library, and Embase for randomized controlled trials and case-control studies comparing SLIT and SCIT in asthmatic children. Meta-analysis was conducted using random-effects models with calculations via R software version 4.3.2 and RevMan version 5.4. Study quality and bias risk were assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. The literature search yielded a total of 1787 records, with 7 studies meeting the inclusion criteria after screening and assessments. There was no significant difference in the Total Asthma Symptoms Score between SLIT and SCIT (mean difference -0.05 [95% CI: -0.21; 0.10]). However, asthma improvement rates were higher in the SLIT group (risk ratio 0.77 [95% CI: 0.64; 0.93]). FEV1 improvement showed no significant difference (mean difference -1.60 [95% CI: -6.27; 3.08]). Adverse events were similar between the treatments (risk ratio 0.56 [95% CI: 0.11; 2.82]). SLIT and SCIT were generally similarly effective and safe for treating pediatric asthma. SLIT may be preferred due to its noninvasive administration. More research is needed on long-term effects and tailored treatment approaches.

Research Progress in Integrated Chinese and Western Medicine Health Management for School-Age Children with Asthma

Objective: The purpose of this study is to investigate the application of Chinese and Western medicine in the health management of school-age children with asthma and its research progress, with a view to providing a more comprehensive and effective management strategy for the clinic. Methods: Using the method of literature review, this study systematically searched and analyzed the relevant studies on the combination of Chinese and Western medicine in the health management of school-aged children with asthma in recent years, focusing on Chinese medicine treatment, Western medicine treatment, and the combined health management of Chinese and Western medicine. Results: Chinese medicine treatment, Western medicine treatment, and the health management mode of combining Chinese and Western medicine showed unique advantages in school-age asthmatic children. Through the comprehensive use of Chinese medicine’s diagnosis and treatment, Chinese medicine conditioning, Chinese medicine characteristic therapy, and Western medicine’s modern medical methods, it not only effectively relieved asthma symptoms but also significantly improved the quality of life of the children. At the same time, this management mode also focuses on the psychological guidance and family care of the children, forming an all-round and multi-level health management system. Conclusion: The health management strategy of combining Chinese and Western medicine has a broad application prospect in school-age asthmatic children, and its specific interventions and mechanisms of action should be further studied to provide more scientific and systematic guidance for clinical practice.

Longitudinal association of exclusive and dual use of cigarettes and cigars with asthma exacerbation among US adults: a cohort study

BackgroundCigar use among adults in the United States has remained relatively stable in the past decade and occupies a growing part of the tobacco marketplace as cigarette use has declined. While studies have established the detrimental respiratory health effects of cigarette use, the effects of cigar use need further characterization. In this study, we evaluate the prospective association between cigar use, with or without cigarettes, and asthma exacerbation.MethodsWe used data from Waves 1–5 (2013–2019) of the Population Assessment of Tobacco and Health Study to run generalized estimating equation models examining the association between time-varying, one-wave-lagged cigarette and cigar use and self-reported asthma exacerbation among US adults (18+). We defined our exposure as non-established (reference), former, exclusive cigarette, exclusive cigar, and dual use. We defined an asthma exacerbation event as a reported asthma attack in the past 12 months necessitating oral or injected steroid medication or asthma symptoms disrupting sleep at least once a week in the past 30 days. We adjusted for age, sex, race and ethnicity, household income, health insurance, established electronic nicotine delivery systems use, cigarette pack-years, secondhand smoke exposure, obesity, and baseline asthma exacerbation.ResultsExclusive cigarette use (incidence rate ratio (IRR): 1.26, 95% confidence interval (CI): 1.03–1.54) and dual use (IRR: 1.41, 95% CI: 1.08–1.85) were associated with a higher rate of asthma exacerbation compared to non-established use, while former use (IRR: 1.01, 95% CI: 0.80–1.28) and exclusive cigar use (IRR: 0.70, 95% CI: 0.42–1.17) were not.ConclusionWe found no association between exclusive cigar use and self-reported asthma exacerbation. However, exclusive cigarette use and dual cigarette and cigar use were associated with higher incidence rates of self-reported asthma exacerbation compared to non-established use. Studies should evaluate strategies to improve cigarette and cigar smoking cessation among adults with asthma who continue to smoke.

The complicated relationship between asthma and swimming

Introduction: Apart from pharmacological treatment, non-pharmacological strategies including physical activity play a significant role in the management of asthma. The aim of this paper is to examine various topics related to swimming and asthma. They include the detailed effect of swimming on asthma control,the potential role of swimming in early childhood asthma development, exercise induced asthma in swimmers as well as the relationship between asthma and cold water swimming. Review methods: This article is based on the literature found in the PubMed Database from the period of 1971-2024 with the use of keywords such as “asthma”, “swimming”, “cold water swimming”, “exercise induced asthma”, “childhood asthma” Description of the state of knowledge: Swimming is a safe form of physical activity for asthma patients.Swimming training enhances aerobic capacity, reduces exercise-induced bronchoconstriction and improves lung function in both pediatric and adult patients. However, there is a concern regarding indoor swimming pools that chlorine can potentially induce airway inflammation. There is research suggesting that early life swimming pool exposure may contribute to the asthma development in atopic children. There is some premise to the thought that cold water swimming may help alleviate asthma symptoms, but it also carries many risks.Swimming is a major cause of exercise induced asthma in professional athletes. Conclusions: Alongside appropriate pharmacological treatment, swimming is a valuable strategy in asthma management in both pediatric and adult asthma patients. The risks of chlorinating pools are still not known to outweigh the benefits of swimming for asthmatics. Further research should be carried out on safety of early swimming in atopic children. Cold water swimming should also be evaluated in terms of safety and potential benefits for asthma patients.

In utero exposure to antihistamines and risk of hepatocellular carcinoma in a multigenerational cohort.

Growing evidence suggests that liver disease originates in early life. Antihistamines cross the placenta and are frequently prescribed to pregnant women to treat nausea and vomiting, as well as allergy and asthma symptoms. Exposure to antihistamines in utero may impact the developing liver by reprogramming or inducing epigenetic changes in fetal hepatocytes. We examined in utero exposure to antihistamines and the risk of HCC in the Child Health and Development Studies, a multigenerational cohort that enrolled pregnant women in the East Bay, CA, between 1959 and 1966 (n=14,507 mothers and 18,751 liveborn offspring). We reviewed mothers' medical records to identify those prescribed antihistamines during pregnancy, and diagnoses of HCC in adult (age ≥18 y) offspring were identified by linkage with a population-based cancer registry. Cox proportional hazard models were used to estimate adjusted hazard ratios, with follow-up accrued from birth through cancer diagnosis, death, or last contact. About 15% of offspring (n=2759 of 18,751) were exposed in utero to antihistamines. Chlorpheniramine (51.8%) and diphenhydramine (15.4%) were the 2 most commonly prescribed antihistamines. Any in utero exposure was not associated with HCC (adjusted hazard ratio: 2.76, 95% CI: 0.70, 10.89), but the association differed by timing of exposure. Offspring exposed to antihistamines in the first or second trimester had a higher risk of HCC compared to offspring not exposed (adjusted hazard ratio: 4.64, 95% CI: 1.21, 17.78). Similarly, incidence rates were 4.3 per 100,000 (95% CI: 0.9, 12.6) for offspring exposed in the first or second trimester compared to 1.0 per 100,000 (95% CI: 0.3, 2.1) for offspring not exposed. In utero exposure to antihistamines in early pregnancy may increase the risk of HCC in adulthood.

A Review of the Latest Guidelines for Diagnosing and Managing Asthma in Children in the United States and Canada.

Globally, asthma remains the most widespread chronic respiratory condition in children, with a larger proportion of children being affected by the condition. Regardless of the higher prevalence rates, the outcomes of pediatric asthma have remained inadequate, even as there are numerous preventable deaths (approximately 300 children in the United States and 250 children in Canada, annually). The characteristic symptoms of pediatric asthma include wheezing, cough, and shortness of breath that are characteristically triggered by several potential stimuli. However, several diagnostic challenges exist and have resulted in either overdiagnosis or underdiagnosis, making pediatric asthma diagnosis and management problematic. Effective management of asthma in children entails a holistic approach that encompasses non-pharmacological and pharmacological management, alongside self-management and educational aspects. Working with pediatric asthma patients and their families/caregivers is vital to promoting and realizing better asthma diagnosis and management outcomes. Educational guidelines regarding the best ways for effective treatment, avoidance of triggers, modifiable risk factors, and the actions that should be taken during chronic asthma attacks through individualized action plans are vital. Thus, the objective of this systematic review is to provide an overview of the latest guidelines on pediatric asthma diagnosis and management. In this regard, this review presents several similarities in existing pediatric asthma diagnosis and management guidelines in the United States and Canada. For instance, most guidelines and studies reviewed have proposed the use of objective tests for confirmation of asthma diagnosis, particularly in symptomatic individuals. The peak flow variability measurement, bronchodilator reversibility testing, and spirometry have also been proposed by the guidelines and studies, even as the recommendations regarding the timing and hierarchy of the objective test substantially vary between the guidelines and studies. We hope that the present review will be helpful to physicians and healthcare service providers working within pediatric health contexts.

Occupational asthma in the salmon processing industry: a case series

ObjectivesExposure to bioaerosols in salmon processing workers is associated with occupational asthma. IgE-mediated allergy and other disease mechanisms may be involved in airway inflammation and obstruction. Knowledge about disease burden,...

Oral and inhaled corticosteroid dose reductions with tezepelumab versus placebo in patients with severe, uncontrolled asthma from DESTINATION

The Global Initiative for Asthma recommends gradually stepping down treatments to the lowest oral/inhaled corticosteroid doses that control symptoms and exacerbations. Tezepelumab treatment enabled reductions in oral/inhaled corticosteroid doses versus placebo, while preserving asthma symptom control and lung function.

Evaluation of a Primary Care-Integrated Mobile Health Intervention to Monitor between-Visit Asthma Symptoms.

This study aimed to evaluate implementation of a digital remote symptom monitoring intervention that delivered weekly symptom questionnaires and included the option to receive nurse callbacks via a mobile app for asthma patients in primary care. Research questions were structured by the NASSS (Nonadoption, Abandonment, Scale-up Spread, and Sustainability) framework. Quantitative and qualitative methods assessed scalability of the electronic health record (EHR)-integrated app intervention implemented in a 12-month randomized controlled trial. Data sources included patient asthma control questionnaires; app usage logs; EHRs; and interviews and discussions with patients, primary care providers (PCPs), and nurses. We included app usage data from 190 patients and interview data from 21 patients and several clinician participants. Among 190 patients, average questionnaire completion rate was 72.3% and retention was 78.9% (i.e., 150 patients continued to use the app at the end of the trial period). App use was lower among Hispanic and younger patients and those with fewer years of education. Of 1,185 nurse callback requests offered to patients. Thirty-three (2.8%) were requested. Of 84 PCP participants, 14 (16.7%) accessed the patient-reported data in the EHR. Analyses showed that the intervention was appropriate for all levels of asthma control; had no major technical barriers; was desirable and useful for patient treatment; involved achievable tasks for patients; required modest role changes for clinicians; and was a minimal burden on the organization. A clinically integrated symptom monitoring intervention has strong potential for sustained adoption. Inequitable adoption remains a concern. PCP use of patient-reported data during visits could improve intervention adoption but may not be required for patient benefits.