Exercise and Asthma

The Barriers to Shared Decision-making in Exercise Prescription for Children With Asthma: A Qualitative Study From Parents' Perspective

INTRODUCTION

The knowledge of barriers from the parental perspective is essential for facilitating shared decision-making in the field of pediatric asthma.

METHOD

Participants who were parents of children with a diagnosis of asthma were recruited, and in-depth, semistructured interviews were conducted. The interview transcripts were analyzed thematically using framework methods.

RESULTS

Seventeen participants undertook interviews. Three themes and nine subthemes emerged: (1) decision-making need level-limited understanding of decision-making knowledge, ambiguity regarding self-empowerment roles, and lack of family member support; (2) decision-making support level-insufficient ability to evaluate information, inefficient communication with health care professionals, and excessive use of professional terminology; and (3) decision-making outcome level-doubts about the final decision-making choices, time constraints on decision-making, and absence of mechanisms to track decisions made.

DISCUSSION

The findings would serve as crucial foundations for the development of decision-aid programs within the context of pediatric asthma.

Aquatic exercise for people with asthma: a systematic review with meta-analysis of randomized controlled trials

INTRODUCTION

Aquatic exercises are among the types of exercise most tolerated by people with asthma. Therefore, the objective of this study was to synthesize the evidence on the effects of aquatic exercise on lung function and quality of life in asthmatic patients.

DATA SOURCES

A systematic search encompassing the Medline, CINAHL, Cochrane Library, Embase, AMED, SPORTDiscus, and Physiotherapy Evidence Database databases was conducted to identify randomized controlled trials assessing the impact of aquatic exercise in comparison to control conditions or land-based exercise on lung function and quality of life in individuals diagnosed with asthma.

STUDY SELECTIONS

The stages of selection, data extraction and methodological evaluation, and level of evidence of the manuscripts were carried out independently by two authors.

RESULTS

Ten studies, comprising a total of 393 participants, were incorporated into this systematic review. Very low-quality evidence was found in favor of aquatic exercise in asthmatic patients for forced expiratory volume in 1 s (MD: 0.20 L, 95% CI: 0.02 L-0.38L N: 91) and for forced vital capacity (MD: 0.32 L, 95% CI: 0.08 L-0.56L N: 80). No effect of aquatic exercise was observed on the FEV1/FVC ratio (MD:1.11L, 95% CI: -1.28 L-3.49L N:80) compared with control. Only one study evaluated the effect of aquatic exercise on patients' quality of life.

CONCLUSIONS

Improvements in lung function and quality of life in asthmatic patients undergoing aquatic exercise are not supported by high-quality evidence. The present findings will need to be confirmed by new, methodologically more rigorous clinical trials.

Alleviation of allergic asthma by rosmarinic acid via gut-lung axis

BACKGROUND

Asthma affects 3% of the global population, leading to over 0.25 million deaths. Due to its complexity, asthma is difficult to cure or prevent, and current therapies have limitations. This has led to a growing demand for alternative asthma treatments. We found rosmarinic acid (RosA) as a potential new drug candidate from natural medicine. However, RosA has poor bioavailability and remains mainly in the gastrointestinal tract after oral administration, suggesting the involvement of gut microbiota in its bioactivity.

PURPOSE

To investigate the mechanism of RosA in alleviating allergic asthma by gut-lung axis.

METHODS

We used 16S rRNA gene sequencing and metabolites analysis to investigate RosA's modulation of gut microbiota. Techniques of molecular biology and metabolomics were employed to study the pharmacological mechanism of RosA. Cohousing was used to confirm the involvement of gut microbiota in RosA-induced improvement of allergic asthma.

RESULTS

RosA decreased cholate levels from spore-forming bacteria, leading to reduced 5-hydroxytryptamine (5-HT) synthesis, bronchoconstriction, vasodilation, and inflammatory cell infiltration. It also increased short-chain fatty acids (SCFAs) levels, facilitating the expression of intestinal tight junction proteins to promote intestinal integrity. SCFAs upregulated intestinal monocarboxylate transporters (MCTs), thereby improving their systemic delivery to reduce Th2/ILC2 mediated inflammatory response and suppress eosinophil influx and mucus production in lung. Additionally, RosA inhibited lipopolysaccharide (LPS) production and translocation, leading to reduced TLR4-NFκB mediated pulmonary inflammation and oxidative stress.

CONCLUSIONS

The anti-asthmatic mechanism of oral RosA is primarily driven by modulation of gut microbiota-derived 5-HT, SCFAs, and LPS, achieving a combined synergistic effect. RosA is a safe, effective, and reliable drug candidate that could potentially replace glucocorticoids for asthma treatment.

The causal relationship between risk of developing bronchial asthma and frailty: a bidirectional two-sample Mendelian randomization study

Background

A potential link between asthma and frailty has been suggested in previous studies. However, the nature of the causal relationship between these two conditions warrants further investigation. Therefore, this study assessed the bidirectional causality between asthma and frailty risk using two-sample Mendelian randomization (MR).

Methods

The study data were obtained from the genome-wide association study (GWAS) dataset, with 337,159 samples representing asthma data and 175,226 samples representing frailty. The causal relationship between the two disorders was assessed by selecting the single nucleotide polymorphisms (SNPs), significantly associated with both asthma and frailty. The inverse variance weighting (IVW) method was used as the main analytical method to estimate the possible influence of causality. Sensitivity analysis was also performed using Mr-Egger intercept, funnel plot, "leave-one-out," and Cochran Q test. In addition, potential mediators were investigated by risk factor analysis.

Result

The IVW method showed an increased risk of frailty due to increased genetic susceptibility factors and the number of to asthma (OR = 2.325, 95%CI:1.958-2.761; p = 6.527498e-22), while no horizontal pleiotropy was observed for the Mr-Egger intercept (p = 0.609) and the funnel plot. The Cochran Q value was 72.858, p = 0.024, and there was heterogeneity in the Cochran Q-value. No single SNP was observed for "leave-one-out" that had a biasing effect on the instrumental variables. In addition, genetic susceptibility to frailty was associated with asthma (OR = 1.088, 95%CI:1.058-1.119; p = 4.815589e-09). In the causal relationship described above, several risk factors for frailty are complex, with asthma leading to a significant reduction in physical activity endurance.

Conclusion

Our findings suggest a probable positive causal effect of asthma on the risk of developing frailty, potentially mediated by reduced physical activity endurance. At the same time, a causal relationship exists between frailty and asthma. Therefore, assessment strategies for frailty should include asthma and vice versa.

Exercise Reduces Airway Smooth Muscle Contraction in Asthmatic Rats via Inhibition of IL-4 Secretion and Store-Operated Ca2+ Entry Pathway

PURPOSE

Increased evidence has shown that aerobic exercise reduces airway hyperresponsiveness in asthmatic individuals. However, the underlying mechanisms of action remain elusive. This study aimed to investigate the effect of exercise on airway smooth muscle (ASM) contractile function in asthmatic rats, and uncover the possible involvement of interleukin 4 (IL-4) and the store-operated Ca²⁺ entry (SOCE) pathway.

METHODS

In this study, chicken ovalbumin was used to induce asthma in male Sprague-Dawley rats. The exercise group received moderate-intensity aerobic exercise training for 4 weeks. IL-4 concentrations in bronchoalveolar lavage fluid (BALF) samples were evaluated by enzyme linked immunosorbent assay. The contractile function of the ASM was investigated using tracheal ring tension experiments and intracellular Ca²⁺ imaging techniques. Western blot analysis was used to evaluate expression levels of calcium-release activated calcium (CRAC) channel protein (Orai) and stromal interaction molecule 1 (STIM1) in ASM.

RESULTS

Our data showed that the carbachol-stimulated, SOCE-mediated contraction of rat ASM was significantly increased in asthmatic rats, which could be abolished by exercise. Pharmacological studies revealed that GSK5498A and BTP-2, selective blockers of CRAC channels significantly inhibited SOCE-induced ASM contraction. In addition, exercise inhibited the up-regulation of IL-4 in BALF as well as STIM1 and Orai expression in the ASM of asthmatic rats. In line with these observations, we demonstrated that pretreatment of the ASM with IL-4 up-regulated the expression level of STIM1, Orai1 and Orai2, thereby promoting SOCE-mediated ASM contraction.

CONCLUSIONS

The data in this study reveal that aerobic exercise may improve the ASM contractile function in asthmatic rats by inhibiting IL-4 secretion and by down-regulating the expression of STIM1, Orai1 and Orai2, thus decreasing excessive SOCE-mediated ASM contraction in asthmatic rats.

Effects of Houpo Mahuang Decoction on serum metabolism and TRPV1/Ca2+/TJs in asthma

ETHNOPHARMACOLOGICAL RELEVANCE

Houpo Mahuang Decoction (HPMHD is one of the classic traditional Chinese prescriptions that has been used in the treatment of asthma. The therapeutic effects and mechanism of HPMHD in aggravated asthma remain to be explored, especially from the perspective of metabolomics and Transient Receptor Potential Vanilloid-1 (TRPV1)/Ca²⁺/Tight junction (TJ) regulation.

AIM OF THE STUDY

To investigate the therapeutic and metabolic regulatory effects and the underlying mechanism of HPMHD in asthmatic rats.

MATERIALS AND METHODS

The asthmatic rats were administered with the corresponding HPMHD (at dosages of 5.54, 11.07, 22.14 mg/kg). Then inflammatory cells in peripheral blood and bronchoalveolar lavage fluid (BALF) were counted, the levels of interleukin (IL)-4 and IL-13 in BALF were measured, and the changes in enhanced pause (Penh) and pathological damage of lung tissues were also detected to evaluate the protective effects of HPMHD. The serum metabolic profile of HPMHD in asthmatic rats was explored using Ultra-High-Performance Liquid Chromatography-mass spectrometer (UHPLC-MS), and the regulatory effects on TRPV1 and TJs of HPMHD in asthmatic rats were detected by Western blotting analysis. In vitro, 16HBE cells were stimulated with IL-4 plus SO₂ derivatives and then administered HPMHD. The intracellular Ca²⁺ regulated by TRPV1, and the expression levels of TRPV1 and TJ proteins (TJs) were then detected by calcium imaging and Western blotting. The effects were verified by inhibition of TRPV1 and in short hairpin RNA (shRNA)-mediated TRPV1 silencing cells.

RESULTS

HPMHD significantly attenuated the airway inflammation of asthmatic rats, and reduced the levels of inflammatory cells in peripheral blood and BALF as well as the levels of IL-4 plus IL-13 in BALF. In addition, the airway hyperresponsiveness and lung pathological damage were alleviated. Serum metabolomic analysis showed that 31 metabolites were differentially expressed among the normal saline-, model-, and HPMHD-treated rats. Pathway enrichment analysis showed that the metabolites were involved in 45 pathways, among which, TJs regulation-relevant pathway was associated with the Ca²⁺ concentration change mediated by the TRP Vanilloid channel. In vivo and in vitro experiments indicated that HPMHD reduced the concentration of intracellular Ca²⁺ via suppressing the expression and activation of TRPV1, increased the expression of ZO-1, Occludin, and Claudin-3, and protected the integrity of TJs.

CONCLUSION

The current study indicates that HPMHD alleviates rat asthma and participates in the regulation of serum metabolism. The anti-asthma effects of HPMHD might be related to the protection of TJs by inhibiting the intracellular Ca²⁺ concentration via TRPV1.

Mediator Effect of Cardiorespiratory Fitness on the Association between Physical Activity and Lung Function in Adults: Cross-Sectional Results from the Epimov Study

We investigated whether cardiorespiratory fitness (CRF) mediates the association between moderate-to-vigorous physical activity (MVPA) and lung function in asymptomatic adults. We examined the cross-sectional results of 1362 adults aged 18-80 years from the Epidemiology and Human Movement Study. Participants were submitted to spirometry to obtain forced vital capacity (FVC) and forced expiratory volume in 1s (FEV1). Additionally, we used cardiopulmonary exercise testing to obtain peak oxygen uptake (V˙O2) as a measure of CRF. Participants used a triaxial accelerometer for 4-7 days to obtain MVPA. Mediation analyses were performed considering the CRF as a mediator, MVPA as an independent variable, and FVC and FEV1 as dependent variables with adjustment for age, sex, and cardiovascular risk score. We aimed to investigate the total (path c) and direct (paths a, b, c') effects through the regression coefficients. We also examined the indirect effect, which was obtained from the product of the coefficients (path ab). Our sample was composed mainly of overweight and middle-aged women. MVPA was positively related to CRF (path a), as well as CRF and lung function (path b). MVPA also presented a significant positive total effect (path c) in the lung function. However, this relationship became non-significant when CRF was included in the model for both FVC and FEV1 (path c'). We did not observe a direct effect of MVPA on the lung function. In contrast, the indirect effect was significant (path ab). Lastly, CRF mediated 60% of the total effect of MVPA on FVC and 61.9% on FEV1. CRF mediates the relationship between lung function and MVPA in asymptomatic adults. Therefore, our results reinforce the need to include CRF assessment in practice clinical routine and suggest that strategies focusing on CRF might be more promising to prevent respiratory diseases in adults.

Effect of Routine Therapy Assisted by Physical Exercise on Pulmonary Function in Patients with Asthma in Stable Stage: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Objective

This study is aimed at investigating the efficacy of physical exercise-assisted routine therapy on the pulmonary function of patients with stable asthma to provide clinical evidence and data support to guide disease management.

Methods

Randomized controlled clinical trials of drug therapy and/or physical exercise for patients with stable asthma were retrieved from the China National Knowledge Infrastructure (CNKI), Wanfang database, Embase, PubMed, and Web of Science database. The studies published between January 2000 and June 2021 that met the criteria were included, and corresponding data were extracted. The meta-analysis was performed using the statistical software Stata 16.0. Statistical pooled effect sizes and 95% confidence intervals were calculated using a random-effects or fixed-effects model, as funnel plots were made with Begg's rank correlation method to evaluate publication bias.

Result

This meta-analysis included 14 randomized controlled studies. Physical exercise-assisted treatment (experiment group) or routine therapy was associated with significantly elevated levels of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) (P < 0.05). As for the peak expiratory flow (PEF) level (P < 0.05), its level was significantly increased with physical exercise-assisted therapy compared with the conventional approach (P > 0.05). Subgroup analysis indicated that the FVC level in the experimental group was higher than that in the control group (P < 0.05) regardless of the adoption of aerobic exercise/anaerobic exercise. In regard to the FEV1 and PEE levels, aerobic exercise was associated with elevated levels in the experimental group (P < 0.05), while no significant difference in anaerobic exercise between both groups was observed (P > 0.05). Further, FEV1, FVC, and PEF levels in the experimental group were higher than those receiving conventional treatment in the control group (P < 0.05).

Conclusion

Routine treatment combined with physical exercise could improve the levels of FEV1, FVC, and PEF in patients with bronchial asthma in the nonacute attack stage and enhance pulmonary functions. As a safe and efficient adjuvant therapy, physical exercise can contribute to an improved prognosis and quality of life for patients with asthma.

Effects of high intensity interval training and sprint interval training in patients with asthma: a systematic review

OBJECTIVE

The aim of this study is to review the effects of high-intensity interval training (HIIT)/sprint interval training (SIT) on asthma symptoms, cardiorespiratory functions, and other variables among asthmatic patients.

DATA SOURCES

Randomized controlled trials published between January 2000 and January 2021 were searched in PubMed/MEDLINE, Web of Science, and Cochrane Library databases.

STUDY SELECTIONS

Following pre-specified inclusion criteria, this review included 7 randomized controlled studies that compare HIIT/SIT as an intervention with any other intervention and/or control group.

RESULTS

Of the included studies only four reported the chronic phase effects of the HIIT/SIT protocols. HIIT and SIT protocols applied in studies differ. HIIT improved forced expiratory volume in 1 s (FEV₁) in the acute phase and maximal oxygen consumption (VO_2max) in the chronic phase in the asthmatic patients (p < 0.05).

CONCLUSION

To our knowledge, our systematic review is the first study evaluating the effects of HIIT/SIT protocols on asthma patients. HIIT/SIT protocols have beneficial effects on asthma patients. In order to better understand the results of these training procedures, studies that will be designed with high methodology are needed.

HDAC4 induces the development of asthma by increasing Slug-upregulated CXCL12 expression through KLF5 deacetylation

Background

Asthma is a frequently occurring respiratory disease with an increasing incidence around the world. Airway inflammation and remodeling are important contributors to the occurrence of asthma. We conducted this study aiming at exploring the effect of Histone deacetylase 4 (HDAC4)-mediated Kruppel-like factor 5 (KLF5)/Slug/CXC chemokine ligand-12 (CXCL12) axis on the development of asthma in regulation of airway inflammation and remodeling.

Methods

An asthmatic rat model was induced by ovalbumin (OVA) irrigation, and determined HDAC4, KLF5, Slug, and CXCL12 expression in the lung tissues by RT-qPCR and Western blot assay. OVA was also used to induce a cell model of asthma in human BEAS-2B and HBE135-E6E7bronchial epithelial cells. The airway hyperresponsiveness (AHR), and expression of inflammatory cytokines in model mice were examined using methacholine challenge test and ELISA. The biological behaviors were measured in asthma model bronchial smooth muscle cells (BSMCs) following loss- and gain- function approaches. The interactions between HDAC4, KLF5, Slug, and CXCL12 were also detected by IP assay, dual luciferase gene reporter assay, and ChIP.

Results

HDAC4 was upregulated in lung tissues of OVA-induced asthmatic mice, and inhibition of HDAC4 alleviated the airway inflammation and remodeling. HDAC4 increased KLF5 transcriptional activity through deacetylation; deacetylated KLF5 bound to the promoter of Slug and transcriptionally upregulated Slug expression, which in turn increased the expression of CXCL12 to promote the inflammation in bronchial epithelial cells and thus induce the proliferation and migration of BSMCs.

Conclusion

Collectively, HDAC4 deacetylates KLF5 to upregulate Slug and CXCL12, thereby causing airway remodeling and facilitating progression of asthma.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12967-021-02812-7.