A systematic review of the relationship between asthma, overweight, and the effects of physical activity in youth

Comparing the Effects of Bafa Wubu Tai Chi and Traditional He-Style Tai Chi Exercises on Physical Health Risk Factors in Overweight Male College Students: A Randomized Controlled Trial

The aim of this study was to evaluate the effects of Bafa Wubu Tai Chi (BW-TC) and traditional He-style Tai Chi (TH-TC) exercises on physical health risk factors in overweight male college students and to compare the effectiveness of the two Tai Chi exercise forms in improving these risk factors.

METHODS

Eighty-one overweight male university students between the ages of 18 and 23 were randomly assigned in a 1:1:1 ratio to the BW-TC group, TH-TC group, and control group (CG). The Tai Chi exercise training consisted of 12 weeks, three times a week, for 60 min per session. The CG attended three health lectures and maintained their normal study routine. The outcomes were body composition and blood lipids. Data were collected at baseline and post-intervention and analyzed using one-way ANOVA and mixed-design ANOVA.

RESULTS

At baseline, there were no significant differences in demographic characteristics and assessed parameters (p > 0.05) among the groups. The BW TC and TH TC groups both significantly decreased their body weight (2.69 kg, 2.04 kg, respectively), body mass index (0.90 kg/m², 0.67 kg/m², respectively), body fat percentage (1.46%, 1.10%, respectively), low-density lipoprotein cholesterol (8.82 mg/dL, 9.27 mg/dL, respectively), total cholesterol (8.57 mg/dL, 9.34 mg/dL, respectively) and triglycerides (10.14 mg/dL, 10.63 mg/dL, respectively); and increased their muscle mass (-0.56 kg, -1.13 kg, respectively) and high-density lipoprotein cholesterol (-5.77 mg/dL, -6.37 mg/dL, respectively). Multiple comparisons showed that both Tai Chi groups were significantly better than the CG in improving the evaluated parameters.

CONCLUSIONS

Two types of Tai Chi interventions were effective in improving body composition and blood lipids in overweight university students, without significant differences between the two.

Risk and Protective Factors for Physical Activity Engagement Among Adolescents With Comorbid Asthma and Obesity

OBJECTIVE

The current study identifies levels of physical activity (PA) engagement among adolescents with neither asthma nor overweight/obesity (OW/OB), one, or both conditions. Risk and protective factors are examined across groups.

METHODS

Data from 8th, 9th, and 11th graders were obtained from the 2019 Minnesota Student Survey (N = 125,164). One-way analysis of variance was used to assess PA levels across risk groups. Linear regressions were used to examine patterns of risk and protective factors for adolescent PA engagement across four groups (neither asthma nor OW/OB, asthma only, OW/OB only, and comorbid asthma + OW/OB). Results were stratified by race/ethnicity.

RESULTS

Adolescents with OW/OB only or asthma + OW/OB had significantly lower PA levels than youth with asthma only or neither condition (M = 3.65-3.67 days/week, SD = 2.20 vs M = 4.15-4.19 days/week, SD = 2.16-2.17, p < .001). The following variables were associated with adolescent PA (p < .001): Adult community care across all risk groups (β ranges = .13-.16), depressive symptoms among those with neither and both asthma + OW/OB (β's = -.10), and extracurriculars among those with asthma + OW/OB (β = .10). Extracurriculars and parent connectedness were protective for Hispanic adolescents.

CONCLUSIONS

Adolescents with OW/OB had significantly lower levels of PA compared to those without, regardless of asthma status. Individual and relational factors influenced adolescent PA. Future research investigating factors influencing adolescent PA should consider depressive symptoms, connectedness to adults in the community, non-sport-related extracurricular activity involvement, and address disparities among minoritized youth.

Weight management interventions that include dietary components for young people with chronic health care needs: A systematic review

AIMS

To identify and describe weight management interventions that include a dietary component for young people with chronic healthcare needs and overweight or obesity and their effect on body mass index (BMI) or weight.

METHODS

Six databases were searched in 2017 and 2020 for experimental studies in English: Ovid MEDLINE, Ovid Embase, Ovid AMED, EBSCO CINAHL, Scopus and Cochrane Central Register of Controlled Trials and Database of Systematic Reviews. Two independent reviewers conducted data extraction and quality assessment using the Cochrane Risk of Bias tool. Eligible studies included young people with chronic healthcare needs ≤18 years with overweight or obesity with an intervention that included a dietary component. Eligible outcomes were BMI or weight. Data were synthesised narratively.

RESULTS

The search identified 15 293 references, 12 studies were included (randomised controlled trials n = 5, before-after comparisons n = 7). Participant diagnoses were neurodevelopmental disabilities (n = 5) and mental illness (n = 1); survivors of cancers or tumours (n = 4); congenital heart disease (n = 1) and; migraine (n = 1). No studies addressed weight management in physical disabilities. Eight studies demonstrated a significant reduction in BMI or weight. Of these, most interventions used dietary counselling or an energy deficit, were family-focused, multicomponent and delivered by a multidisciplinary team including dietitians. A high risk of bias was detected across studies.

CONCLUSIONS

There is limited high-quality evidence about effective dietary solutions for the management of overweight and obesity for young people with chronic healthcare needs. While more research is required, dietary management appears to be important to manage weight in these populations.

Recommendations for Physical Activity in Asthma: A Work Group Report of the AAAAI Sports, Exercise, and Fitness Committee

Regular physical activity not only improves general health but also can positively impact asthma outcomes, such as control and quality of life. Despite this, many asthma patients do not engage in regular physical activity because they mistakenly believe that they should restrict exercise participation. Health care providers have an opportunity to influence the physical activity levels of their patients during regular office visits. Nonetheless, health care providers often overlook physical activity counseling as an adjunct to pharmacological therapy in asthma patients, and in particular, overlook physical activity counseling. Some providers who acknowledge the benefits of physical activity report being unaware how to approach a conversation with patients about this topic. To address these issues, members of the Sports, Exercise, and Fitness Committee of the American Academy of Allergy, Asthma, and Immunology (AAAAI) performed a focused literature search to identify and evaluate the effects of physical activity in patients with asthma. The purpose of this report is to summarize the evidence for physical activity's impact on asthma patients' disease control, pulmonary function, and overall well-being. Several subpopulations of patients with asthma, including children, adolescents, and older adults, are considered individually. In addition, this report offers practical recommendations for clinicians, including how to identify and overcome barriers to counseling, and methods to incorporate physical activity counseling into asthma treatment practice.

An Overview of the Obese-Asthma Phenotype in Children

Asthma is the most common chronic disease in childhood. Overweight and obesity are included among the comorbidities considered in patients with difficult-to-treat asthma, suggesting a specific phenotype of the disease. Therefore, the constant increase in obesity prevalence in children and adolescents raises concerns about the parallel increase of obesity-associated asthma. The possible correlation between obesity and asthma has been investigated over the last decade by different authors, who suggest a complex multifactorial relationship. Although the particular non-eosinophilic endotype of obesity-related asthma supports the concept that high body weight precedes asthma development, there is ongoing debate about the direct causality of these two entities. A number of mechanisms may be involved in asthma in combination with obesity disease in children, including reduced physical activity, abnormal ventilation, chronic systemic inflammation, hormonal influences, genetics and additional comorbidities, such as gastroesophageal reflux and dysfunctional breathing. The identification of the obesity-related asthma phenotype is crucial to initiate specific therapeutic management. Besides the cornerstones of asthma treatment, lifestyle should be optimized, with interventions aiming to promote physical exercise, healthy diet, and comorbidities. Future studies should clarify the exact association between asthma and obesity and the mechanisms underlying the pathogenesis of these two related conditions with the aim to define personalized therapeutic strategies for asthma management in this population.

Can the Childhood Physical Activity Questionnaire Be Used to Identify Physical Activity Levels in Children With Asthma?

Objective: Children with asthma who are physically active have a better quality of life, emphasizing the importance of activity monitoring and promotion in daily life. The validity of self-reported activity measurements has been questioned in pediatric populations. In this study, we aim to compare the Physical Activity Questionnaire for Children (PAQ-C) with objectively measured PA using accelerometry. Design: In this comparison study, the pooled dataset of two cross-sectional studies was used, which prospectively home-monitored PA using the alternative self-report PAQ-C questionnaire as well as with the criterion standard accelerometry (Actigraph wGT3X-BT and GT1M). Participants:Ninety children with pediatrician-diagnosed asthma participated in the study. Main Outcome Measures:Correlation coefficients were calculated to determine the relation between the PAQ-C and accelerometer data. The predictive value of the PAQ-C in differentiating between achieving and failing the recommended daily level of moderate-to-vigorous activity (MVPA) was evaluated with receiver operator characteristic (ROC) analysis. Results: The results showed weak to moderate correlations of the PAQ-C with the accelerometer data (r = 0.29-0.47). A PAQ-C cutoff of 3.09 showed the best performance on predicting whether the recommended level of MVPA was achieved. With this cutoff, 21 of the 39 children that did achieve their daily MVPA level (53.8% sensitivity) and 33 of the 46 children that did fail their daily MVPA level (71.7% specificity) were correctly classified. A PAQ-C score of 3.5 revealed a negative predictive value of 100% for assessing physical inactivity. Conclusion: This study revealed a weak relation between the PAQ-C and PA assessed with accelerometry. However, a PAQ-C score of 3.5 or higher might be used as a low-cost and easy-to-use PA screening tool for ruling out physical inactivity in a portion of the pediatric asthma population. Clinical Trial Registration: Netherlands Trial Register: Trial NL6087.

Association between Health-Related Physical Fitness and Respiratory Diseases in Adolescents: An Age- and Gender-Matched Study

The current study examined the differences in health-related physical fitness (HRPF), physical activity (PA), and sedentary behavior (SB) between adolescents with and without ongoing respiratory diseases (RD). This study's participants were from 12 to 15 years old (7th-10th grade) in South Korea. Adolescents with RD were selected through RD-related questions (i.e., asthma, rhinitis, sinusitis, and bronchitis) (n = 139); in contrast, adolescents without RD, randomly selected from the general group, responded to any health problem-related questions as "No" (n = 139). HRPF was measured based on the FITNESSGRAM and EURO FIT test batteries and the measurements of HRPF included cardiovascular endurance, muscular strength, muscular endurance, flexibility, and body composition. All statistical analyses were conducted by SPSS 25.0, and the independent t-test was used to compare the HRPF and PA between the two groups. Moreover, the measured HRPF was compared with a series of analyses of three-way ANOVAs (age × gender × group). Adolescents with RD had a positive association with less participation in PA (p < 0.05; RD: 3081.81 ± 4793.37; general: 2073.64 ± 3123.47) and with more time spent on SB (above 12 h per week: RD group (38.85%) and general group (33.09%)). Furthermore, adolescents in the RD group showed significant effects on all components of HRPF (p < 0.05). Our study confirmed that HRPF is an essential predictor of adolescents' health outcomes, especially for those with RD. We suggest that increased HRPF can be an effective treatment for respiratory diseases in adolescents, and health practitioners should pay more attention to helping adolescents with RD to gain or maintain high HRPF.

Levels of physical activity in children and adolescents with asthma: A systematic review and meta-analysis

BACKGROUND

In children and adolescents with asthma, the disease may reduce the perceived capability to participate in physical activity (PA) contributing to an increase in the sedentary lifestyle. The literature is unclear as to whether children and adolescents with asthma differ their PA levels from their healthy peers.

OBJECTIVE

Our objective was to describe the different methods and instruments used to measure PA and to compare the PA levels of children and adolescents with asthma with those of their healthy peers.

STUDY DESIGN

We conducted a systematic review of five databases. We included studies that compared the PA measured by objective and subjective instruments in children and adolescents with asthma versus controls. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence.

RESULTS

Of the 5966 reports returned by the initial search, 28 articles reporting on 3184 patients were included in the data synthesis. A forest plot showed that both groups had similar values of moderate to vigorous PA (MVPA; mean difference, -0.05 h/day; 95% confidence interval [CI], -0.11-0.01; p = .13), sedentary time (mean difference 0.00 h/day; 95% CI, -0.22-0.23 h/day; p = .99) and steps/day (mean difference 354 steps/day; 95% CI, -563-1270 steps/day; p = .45).

CONCLUSION

Children and adolescents with asthma have similar MVPA, steps/day, and sedentary time compared to the controls. The main instruments used were questionnaires and accelerometers.

Association between Physical Activity and Respiratory Diseases in Adolescents: An Age- and Gender-Matched Study

The purpose of the present cross-sectional study was to examine the impacts of allergic respiratory diseases on physical activity (PA), sedentary behaviors (SB), and body mass index (BMI) by matching age and gender with those adolescents without allergic respiratory diseases. This present study analyzed data from the 2019 Korea Youth Risk Behavior Web-based Survey (KYRBWS). Among 57,303 Korean adolescents who responded to the survey, the study divided adolescents into three different groups (i.e., general, asthma, and allergic rhinitis group). Asthma and allergic rhinitis groups included adolescents who checked on asthma- or allergic rhinitis-related questions as ‘yes’ (n = 259, n = 259), but the general group responded to any diseases-related question as ‘no’ (n = 259). The age and gender of participants among the three groups were matched. The results showed weight and BMI were significantly higher in asthma and allergic rhinitis groups compared to the general group (p < 0.001, p < 0.001). Furthermore, age, asthma, and allergic rhinitis were observed to be strong risk factors for predicting obesity in adolescents (BMI, >25.0 kg/m²). In addition, this study found allergic respiratory diseases strong impacts on BMI levels because adolescents with ongoing asthma, or allergic rhinitis symptoms were more likely to have the inevitability of further weight gain compared to the general adolescents. Therefore, not only national interest in adolescents with allergic respiratory disease is essential, but PA should be encouraged to prevent and alleviate these diseases due to obesity.

Helminthostachys zeylanica Water Extract Ameliorates Airway Hyperresponsiveness and Eosinophil Infiltration by Reducing Oxidative Stress and Th2 Cytokine Production in a Mouse Asthma Model

Helminthostachys zeylanica is a traditional folk herb used to improve inflammation and fever in Taiwan. Previous studies showed that H. zeylanica extract could ameliorate lipopolysaccharide-induced acute lung injury in mice. The aim of this study was to investigate whether H. zeylanica water (HZW) and ethyl acetate (HZE) extracts suppressed eosinophil infiltration and airway hyperresponsiveness (AHR) in asthmatic mice, and decreased the inflammatory response and oxidative stress in tracheal epithelial cells. Human tracheal epithelial cells (BEAS-2B cells) were pretreated with various doses of HZW or HZE (1 μg/ml-10 μg/ml), and cell inflammatory responses were induced with IL-4/TNF-α. In addition, female BALB/c mice sensitized with ovalbumin (OVA), to induce asthma, were orally administered with HZW or HZE. The result demonstrated that HZW significantly inhibited the levels of proinflammatory cytokines, chemokines, and reactive oxygen species in activated BEAS-2B cells. HZW also decreased ICAM-1 expression and blocked monocytic cells from adhering to inflammatory BEAS-2B cells in vitro. Surprisingly, HZW was more effective than HZE in suppressing the inflammatory response in BEAS-2B cells. Our results demonstrated that HZW significantly decreased AHR and eosinophil infiltration, and reduced goblet cell hyperplasia in the lungs of asthmatic mice. HZW also inhibited oxidative stress and reduced the levels of Th2 cytokines in bronchoalveolar lavage fluid. Our findings suggest that HZW attenuated the pathological changes and inflammatory response of asthma by suppressing Th2 cytokine production in OVA-sensitized asthmatic mice.

The impact of body mass index, central obesity and physical activity on lung function: results of the EpiHealth study

Study objectives

Obesity is often associated with lower lung function; however, the interaction of lung function with central obesity and physical inactivity is less clear. As such, we investigated the effect on lung function of body size (body mass index (BMI)), central obesity (waist circumference (WC)) and self-reported physical activity.

Methods

Lung function, height, weight and WC were measured in 22 743 participants (12 791 women), aged 45–75 years, from the EpiHealth cohort study. Physical activity, gender and educational level were assessed using a questionnaire.

Results

Obesity, central obesity and physical inactivity were all associated with lower forced expiratory volume in 1 s (FEV₁) and forced vital capacity (FVC). However, in participants without central obesity there was an increase in both FEV₁ and FVC by BMI (% predicted FVC increasing from median 98%, interquartile range (IQR) 89–110% in underweight participants (BMI <20) to 103%, IQR 94–113% in obese participants (BMI ≥30)). In contrast, there was a decrease in % predicted FVC in participants with central obesity (from 98%, IQR 89–109% in the normal weight group to 95%, IQR 85–105% in the obese weight group). We further found a negative association between physical activity and lung function among those with low and high levels of physical activity (% predicted FEV₁ 97%, IQR 86–107% versus 103%, IQR 94–113%, respectively and % predicted FVC 96%, IQR 85–106% versus 103%, IQR 94–113%, respectively). All results remained when calculated by z-scores.

Conclusions

The association between BMI and lung function is dependent on the presence of central obesity. Independent of obesity, there is an association between physical activity and lung function.

BMI and central obesity are related to lung function in the middle-aged and elderly. BMI association with lung function is dependent on the presence of central obesity, while the association of physical activity and lung function is independent of obesity.https://bit.ly/3eQl86C

Observational studies assessing the pharmacological treatment of obstructive lung disease: strengths, challenges and considerations for study design

Randomised controlled trials (RCTs) are the gold standard for evaluating treatment efficacy in patients with obstructive lung disease. However, due to strict inclusion criteria and the conditions required for ascertaining statistical significance, the patients included typically represent as little as 5% of the general obstructive lung disease population. Thus, studies in broader patient populations are becoming increasingly important. These can be randomised effectiveness trials or observational studies providing data on real-world treatment effectiveness and safety data that complement efficacy RCTs. In this review we describe the features associated with the diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in the real-world clinical practice setting. We also discuss how RCTs and observational studies have reported opposing outcomes with several treatments and inhaler devices due to differences in study design and the variations in patients recruited by different study types. Whilst observational studies are not without weaknesses, we outline recently developed tools for defining markers of quality of observational studies. We also examine how observational studies are capable of providing valuable insights into disease mechanisms and management and how they are a vital component of research into obstructive lung disease. As we move into an era of personalised medicine, recent observational studies, such as the NOVEL observational longiTudinal studY (NOVELTY), have the capacity to provide a greater understanding of the value of a personalised healthcare approach in patients in clinical practice by focussing on standardised outcome measures of patient-reported outcomes, physician assessments, airway physiology, and blood and airway biomarkers across both primary and specialist care.

Obesity is a risk factor for exercise-induced bronchospasm in asthmatic adolescents

INTRODUCTION

Exercise-induced bronchospasm (EIB) is common in young asthmatics and obesity is becoming an epidemic in this population. Both conditions can give rise to or worsen respiratory symptoms upon exercise and may interfere with recreational and sports activities.

OBJECTIVE

To investigate the association between obesity and the risk and severity of EIB in asthmatic children and adolescents.

METHODS

This study included data from asthmatic patients aged between 7 and 19 years undergoing treadmill running tests to evaluate EIB, defined as a reduction greater than or equal to 10% in forced expiratory volume in the first second (FEV₁ ) compared to baseline. Eutrophic, obese, and overweight individuals were categorized according to body mass index z-score (eutrophic, -0.5 < z ≤ 1; overweight, 1 < z < 2; and obese, z ≥ 2).

RESULTS

Of the 156 individuals studied (42% female), 58% were eutrophic, 22% overweight, and 19% obese. Seventy-three individuals (47%) presented with EIB, with higher risk among obese (OR, 2.86; 95% CI, 1.00-8.14; P = .05). Asthma severity was another independent risk factor for EIB (OR, 2.95; 95% CI, 1.36-6.42; P = .006). The number of patients in whom FEV₁ returned to baseline values (difference less than 10% from baseline) at the 13th minute after challenge was lower in obese individuals compared to eutrophic and overweight ones (P = .04). Baseline FEV₁ , gender, or age were not found to be risk factors for EIB in any of the groups.

CONCLUSION

Obese youngsters with asthma present a greater risk for EIB with slower recovery than their nonobese peers. Clinicians should be aware of this association, especially in those with more severe disease, for adequate recognition and treatment.

Low fitness and increased sedentary time are associated with worse asthma-The National Youth Fitness Survey

BACKGROUND

Asthma is the most common chronic illness in children and is independently impacted by obesity and by fitness. The National Youth Fitness Survey collected data on aerobic fitness, body composition, and health outcomes in children 6 to 11 years old. The goal of this study is to test hypotheses regarding relationships between asthma, aerobic fitness, and sedentary time in this uniquely studied cohort of young children.

METHODS

A total of 665 children (6-11 years old; 49% male) were included in analyses. We explored relationships between asthma outcomes and aerobic fitness (measured by endurance time), self-reported sedentary time, and body mass index categories. Fitness was categorized as unfit (lowest 25% of endurance times) or fit. Multivariate logistic regression models were created for asthma outcomes and adjusted for race, age, sex, poverty status, and overweight/obesity.

RESULTS

Among the participants, 17.9% had a previous history of asthma and 11.4% had current asthma. Additionally, 37.3% of participants were overweight or obese. Low fitness was significantly associated with increased odds of past asthma, current asthma, asthma attacks, wheeze with exercise, and wheeze with activity limitations in multivariate models. Increased sedentary time was significantly associated with increased odds of previous asthma, current asthma, asthma attacks, and wheeze with activity limitations.

CONCLUSION

Decreased aerobic fitness and increased sedentary time were associated with worse asthma outcomes in this group of children (6-11 years old). This data suggest that fitness and sedentary time, both modifiable factors, each have an independent effect on asthma and should be included in assessments and management of asthma health.

Association between Physician-Diagnosed Asthma and Weight Status among Chinese Children: The Roles of Lifestyle Factors

Childhood asthma and obesity have posed a parallel epidemic over the past few decades. However, whether asthma diagnosis is associated with obesity, and what the roles of lifestyle factors play in this relationship, remained unclarified. This study aimed to investigate the association between asthma and weight status in Chinese children and explore the potential mediating and/or modifying roles of lifestyle factors in the association. In this cross-sectional study, 16,837 children aged 6–12 years were recruited from Guangzhou, China. Participants’ information on physician-diagnosed asthma was collected from parents, and data on physical activity, screen time, and sleeping were reported in a validated questionnaire. Height and weight were objectively measured, and weight status was classified by body mass index (BMI). Multiple logistic regression analysis and mediation analysis were used. Results showed that asthmatic children were at significantly higher risk of obesity (odds ratio (OR) 1.51, 95% confidence interval (CI) 1.03, 2.21) compared with non-asthmatic children. More importantly, this increased risk was even greater in children with moderate-to-vigorous physical activity <60 min/d and children with screen time >2 h/d (both P_interaction < 0.05). Also, a positive relationship of asthma with overweight was found in children with screen time >2 h/d (OR 3.92, 95% CI 1.56, 9.88), while a negative association was observed between asthma and underweight in children aged 9–12 years (OR 0.23, 95% CI 0.06, 0.92). Mediation analysis indicated that these associations were not mediated by physical activity, screen time, or sleeping. The findings suggested that physician-diagnosed asthma was associated with higher risks of overweight and obesity, and these risks might be exacerbated by insufficient physical activity and prolonged screen time.

Perceptions of Asthma and Exercise, and Associations With Weight Status and Asthma Morbidity in Urban Children

BACKGROUND

Given the high prevalence of asthma and obesity in minority children, there is a need to identify targets for intervention to decrease the impact of these conditions on children's functioning in this high-risk group.

OBJECTIVE

To examine in urban children with persistent asthma, 1) differences in asthma indicators (eg, FEV1% predicted) by weight status, and by ethnic group/weight status, 2) caregivers' fears about their child's asthma by weight status, and by ethnic group/weight status, and 3) the proportion of children who qualified for exercise-induced bronchospasm (EIB) via exercise challenge test among those whose caregivers endorse exercise as a trigger for asthma.

METHODS

In this sample of urban children (aged 7-9; N = 147), subjective measures included child/caregiver daily report of asthma symptoms and caregiver fears about their child's asthma. Objective lung function was measured twice daily via handheld spirometer and EIB was confirmed via exercise challenge test.

RESULTS

In the overall sample, a greater proportion of normal-weight children reported asthma symptoms compared to overweight/obese children. Caregiver fears about asthma were more prevalent among Latino caregivers. Non-Latino White children whose caregivers were afraid their child may die when having asthma reported more days with asthma symptoms. Very few children had confirmed EIB compared to the proportion of caregivers who endorsed exercise as a dangerous trigger for asthma.

CONCLUSIONS

Caregiver fear about asthma and misperceptions of exercise as a dangerous trigger for asthma should be addressed during health care visits with families of children with asthma and interventions including urban children with asthma.

Exercise and lifestyle changes in pediatric asthma

PURPOSE OF REVIEW

The purpose of this review is to discuss the most recent studies on lifestyle interventions in pediatric asthma. We include studies on physical activity and exercise, sedentary time, nutrition, behavioral therapy and the role of schools.

RECENT FINDINGS

Several small studies in children with asthma suggest that exercise interventions can improve aerobic fitness, asthma symptoms or control and quality of life. Existing evidence supports recommending higher intake of fruits and vegetables for asthma risk and control. In contrast, the 'Western diet' - high in refined grains, highly processed foods, red meats and fried foods with low intake of fruits and vegetables - has a proinflammatory effect and may alter microbiota composition leading to worse asthma outcomes. Finally, there are opportunities to utilize schools to promote physical activity, though standardization of asthma management in the schools is needed.

SUMMARY

Assessing physical activity/fitness levels, sedentary time and nutritional status is important in the management of children with asthma, as they are modifiable factors. Larger rigorous studies evaluating lifestyle interventions are needed to better inform current asthma guidelines as well as to understand the underlying mechanism(s) related to physical activity and diet in asthma.

The Health Benefits of Exercise in Overweight and Obese Patients

More than 30% of U.S. adults are obese or overweight. A program of regular physical activity is recommended as part of an effective lifestyle intervention for weight loss and weight management. However, more than 40% of adults do not engage in sufficient physical activity to realize these beneficial effects on body weight. Physicians may encounter many barriers to counseling physical activity, such as lack of knowledge or self-efficacy for counseling patients about physical activity. Obese individuals may be reluctant to exercise because of weight stigma, physique anxiety, and other factors; therefore, referral to a weight management specialist or clinical exercise physiologist can be helpful in facilitating exercise and assisting in achieving a clinically meaningful weight loss. Exercise has many benefits on physical and mental health and well-being that go well beyond weight loss, and it is for these reasons that exercise is particularly important for overweight and obese individuals.

Modified Shuttle Test Distance Correlates With Peak Oxygen Uptake in Children and Adolescents With Severe Therapy-Resistant Asthma

Introduction

Several tests may be used to assess exercise intolerance in severe therapy-resistant asthma (STRA), including the gold standard cardiopulmonary exercise test (CPET) and the modified shuttle test (MST).

Objective

To correlate the distance achieved in the MST with peak oxygen uptake (VO₂peak) and to compare the maximal heart rate (HRmax) obtained in both tests in children and adolescents with STRA.

Methods

This is a cross-sectional study, with 19 children and adolescents with STRA. Demographic, anthropometric, clinical data, and spirometric values were collected. CPET and the MST were performed in two consecutive visits. HRmax, pulse oxygen saturation, and dyspnea were compared between tests. The distance achieved in the MST was correlated with VO₂peak.

Results

Nineteen patients with a mean age of 11.5 ± 2.5 years were included. The mean HRmax (bpm) achieved was 180.8 ± 12.10 for the MST and 187.6 ± 9.35 for CPET, whereas the mean HRmax as a percentage of predicted (HRmax%) was 90.7 ± 6.5 for the MST and 93.8 ± 4.5 for CPET. A difference of only 6 bpm was found for HRmax (p = 0.10) and of 3% for HRmax% (p = 0.06) between tests. A strong correlation was found between the MST (r = 0.79; p = 0.001) and VO₂peak measured through CPET. However, there were no correlations between the MST and both body mass index (r = -0.14; p = 0.564) and forced expiratory volume in the first second - FEV₁ (r = -0.02; p = 0.917).

Conclusion

The results demonstrate that the MST distance strongly correlates with VO₂peak, measured through CPET, and the main physiological variable responses were similar between both tests. Our results provide additional data for the use of the MST to assess exercise capacity in children and adolescents with STRA.

Childhood asthma in low and middle-income countries: Where are we now?

Pediatric asthma has been increasing in LMICs (Low Middle-Income Countries), leading to an important burden for both children and national health systems. Implementing measures to achieve control are influenced by the degree of organization health systems have, the availability and affordability of essential asthma medications, and the effective implementation of asthma programs and asthma guidelines. In this review authors give an updated view of the current situation of these components of asthma management in LMICs.

Associations between physical activity and asthma, eczema and obesity in children aged 12-16: an observational cohort study

OBJECTIVES

To compare the physical activity of adolescents with three common long-term conditions (asthma, eczema and obesity) with adolescents without these conditions.

DESIGN

Cross-sectional and longitudinal analyses of adolescents at ages 12, 14 and 16 in a large UK cohort study.

SETTING

The Avon Longitudinal Study of Parents and Children.

PARTICIPANTS

6473 adolescents with complete accelerometer data at at least one time point.

METHODS

Mean minutes of moderate to vigorous intensity physical activity (MVPA) and sedentary time per day were derived from accelerometer-based measurements at ages 12, 14 and 16. Obesity was defined at each time point from height and weight measurements. Parents reported doctor-assessed asthma or eczema. Cross-sectional and longitudinal regression models examined any differences in MVPA or sedentary time for adolescents with asthma, eczema or obesity compared with those without.

RESULTS

In longitudinal models, boys engaged in an average of 69.7 (95% CI 67.6 to 71.7) min MVPA at age 12, declining by 3.1 (95% CI 2.6 to 3.6) min/year while girls' average MVPA was 47.5 (95% CI 46.1 to 48.9) min at age 12, declining by 1.8 (95% CI 1.5 to 2.1) min/year. There was no strong evidence of differences in physical activity patterns of those with and without asthma or eczema. Obese boys engaged in 11.1 (95% CI 8.7 to 13.6) fewer minutes of MVPA, and obese girls in 5.0 (95% CI 3.3 to 6.8) fewer minutes than their non-obese counterparts. Cross-sectional models showed comparable findings.

CONCLUSIONS

Mean minutes of MVPA per day did not differ between adolescents with asthma or eczema and those without, but obese adolescents engaged in fewer minutes of MVPA. Findings reinforce the need for strategies to help obese adolescents be more active but suggest no need to develop bespoke physical activity strategies for adolescents with mild asthma or eczema.

Weight-management in children living with asthma: a qualitative study of the experiences of paediatric healthcare professionals

Objective: Weight loss has been found to improve the symptoms of asthma in children who are overweight. However, many paediatric weight management programmes do not address the challenges associated with living with asthma. The aim of this study was to explore the views and experiences of paediatric healthcare professionals concerning weight management advice and support offered to families of children living with asthma. Methods: In-depth individual interviews with 10 healthcare professionals who work with a paediatric asthma population (n = 4 Respiratory Consultants, 3 Respiratory Nurses, 3 General Paediatricians). Data were analysed using a Framework approach. Results: Healthcare professionals highlighted that families' perceptions of weight, their approach to physical activity and nutrition, the family's social context and perceptions of asthma and asthma treatment all influence weight management in children living with asthma. Initiating weight management conversations and referring to weight management support were perceived as challenging. It was thought that tailoring weight management to the needs of children living with asthma and locating support within the community were important to the success of a family-centred intervention. Conclusions: The results highlight the added complexity of responding to excessive weight in a paediatric population with asthma. Training and referral guidance for healthcare professionals may help overcome weight management support challenges. Addressing family beliefs about the factors influencing paediatric asthma and exploring families' motivations for behaviour change may enhance engagement with weight management.

Children with Obesity and Asthma: Which Are the Best Options for Their Management?

Obesity and asthma are complex disorders related to gene-environment interactions and various lifestyle factors. At present, they represent two of the most significant paediatric health problems worldwide, particularly in industrialized nations. The aim of this narrative review is to evaluate possible therapeutic strategies to manage asthma in children with overweight/obesity. PubMed was used to search for all of the studies published from January 2008 to June 2018 using the following key words: “asthma” and “overweight” or “obesity” or “obese” and “children” or “paediatric”. The literature review showed that growing evidence underlines the existence of an “obese asthma” phenotype characterised by difficult-to-control asthma with additional symptoms, worse control, more frequent and severe exacerbations, reduced response to inhaled corticosteroids, and lower quality of life than other phenotypes. Currently, therapeutic strategies centred on prevention are suggested and the development of resources to assist families with weight loss strategies seems useful for effective weight control and optimal asthma management. Studies on vitamin D supplementation and further knowledge are needed to better define the best therapeutic options to manage asthma in children with overweight/obesity and to reduce the onset and severity of this chronic respiratory disease through the design of a multifactorial intervention.

New-Onset Asthma and Combat Deployment: Findings From the Millennium Cohort Study

Recent reports suggest US military service members who deployed in support of the recent conflicts in Iraq and Afghanistan have higher rates of new-onset asthma than those who did not deploy. However, it is unknown whether combat experiences, in addition to deployment, contribute to new-onset asthma risk. This study aimed to longitudinally determine the risk factors for developing asthma, including combat deployment (categorized as deployed with combat experience, deployed without combat experience, or nondeployed), among participants in the Millennium Cohort Study from 2001 to 2013. A total of 75,770 participants completed a baseline survey and at least 1 triennial follow-up survey on deployment experiences, lifestyle characteristics, and health outcomes. Complementary log-log models stratified by sex were used to estimate the relative risk of developing asthma among participants who reported no history of asthma at baseline. In models with adjustments, those who deployed with combat experience were 24%-30% more likely to develop asthma than those who did not deploy. Deployed personnel without combat experience were not at a higher risk for new-onset asthma compared with nondeployers. Further research is needed to identify specific features of combat that are associated with greater asthma risk to inform prevention strategies.

The effect of obesity, weight gain, and weight loss on asthma inception and control

PURPOSE OF REVIEW

There is ample and growing evidence that obesity increases the risk of asthma and morbidity from asthma. Here, we review recent clinical evidence supporting a causal link between obesity and asthma, and the mechanisms that may lead to 'obese asthma'.

RECENT FINDINGS

Although in some children obesity and asthma simply co-occur, those with 'obese asthma' have increased asthma severity, lower quality of life, and reduced medication response. Underlying mechanistic pathways may include anatomical changes of the airways such as obstruction and dysanapsis, systemic inflammation, production of adipokines, impaired glucose-insulin metabolism, altered nutrient levels, genetic and epigenetic changes, and alterations in the airway and/or gut microbiome. A few small studies have shown that weight loss interventions may lead to improvements in asthma outcomes, but thus far research on therapeutic interventions for these children has been limited.

SUMMARY

Obesity increases the risk of asthma - and worsens asthma severity or control - via multiple mechanisms. 'Obese asthma' is a complex, multifactorial phenotype in children. Obesity and its complications must be managed as part of the treatment of asthma in obese children.

Phloretin Attenuates Allergic Airway Inflammation and Oxidative Stress in Asthmatic Mice

Phloretin (PT), isolated from the apple tree, was previously demonstrated to have antioxidative and anti-inflammatory effects in macrophages and anti-adiposity effects in adipocytes. Inflammatory immune cells generate high levels of reactive oxygen species (ROS) for stimulated severe airway hyperresponsiveness (AHR) and airway inflammation. In this study, we investigated whether PT could reduce oxidative stress, airway inflammation, and eosinophil infiltration in asthmatic mice, and ameliorate oxidative and inflammatory responses in tracheal epithelial cells. BALB/c mice were sensitized with ovalbumin (OVA) to induce asthma symptoms. Mice were randomly assigned to the five experimental groups: normal controls; OVA-induced asthmatic mice; and OVA-induced mice injected intraperitoneally with one of the three PT doses (5, 10, or 20 mg/kg). In addition, we treated inflammatory human tracheal epithelial cells (BEAS-2B cells) with PT to assess oxidative responses and the levels of proinflammatory cytokines and chemokines. We found that PT significantly reduced goblet cell hyperplasia and eosinophil infiltration, which decreased AHR, inflammation, and oxidative responses in the lungs of OVA-sensitized mice. PT also decreased malondialdehyde levels in the lung and reduced Th2 cytokine production in bronchoalveolar lavage fluids. Furthermore, PT reduced ROS, proinflammatory cytokines, and eotaxin production in BEAS-2B cells. PT also suppressed monocyte cell adherence to inflammatory BEAS-2B cells. These findings suggested that PT alleviated pathological changes, inflammation, and oxidative stress by inhibiting Th2 cytokine production in asthmatic mice. PT showed therapeutic potential for ameliorating asthma symptoms in the future.