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Burge AT, Lee AL. Get a move on: physical (in)activity in people with obstructive airway disease. ERJ Open Res 2024; 10:00305-2024. [PMID: 39040589 PMCID: PMC11261376 DOI: 10.1183/23120541.00305-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 07/24/2024] Open
Abstract
A study extended the "can do, do do" concept in people with obstructive airways disease to demonstrate different clinical and movement behaviour characteristics based on quadrant classification, and proposed a treatable traits approach to management https://bit.ly/4cOGlN5.
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Affiliation(s)
- Angela T. Burge
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, VIC, Australia
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
| | - Annemarie L. Lee
- Institute for Breathing and Sleep, Heidelberg, VIC, Australia
- Department of Physiotherapy, Monash University, Frankston, VIC, Australia
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2
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Born CDC, Bhadra R, D’Souza G, Kremers SPJ, Sambashivaiah S, Schols AMWJ, Crutzen R, Beijers RJHCG. Combined Lifestyle Interventions in the Prevention and Management of Asthma and COPD: A Systematic Review. Nutrients 2024; 16:1515. [PMID: 38794757 PMCID: PMC11124109 DOI: 10.3390/nu16101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
(1) Background: A healthy lifestyle has a protective role against the onset and management of asthma and chronic obstructive pulmonary disease (COPD). Therefore, combined lifestyle interventions (CLIs) are a potentially valuable prevention approach. This review aims to provide an overview of existing CLIs for the prevention and management of asthma or COPD. (2) Methods: A systematic literature search was conducted using PubMed, EMBASE, and PsycInfo. Studies were included if CLIs targeted at least two lifestyle factors. (3) Results: Among the 56 included studies, 9 addressed asthma and 47 addressed COPD management, with no studies focusing on prevention. For both conditions, the most prevalent combination of lifestyle targets was diet and physical activity (PA), often combined with smoking cessation in COPD. The studied CLIs led to improvements in quality of life, respiratory symptoms, body mass index/weight, and exercise capacity. Behavioural changes were only measured in a limited number of studies and mainly showed improvements in dietary intake and PA level. (4) Conclusions: CLIs are effective within asthma and COPD management. Next to optimising the content and implementation of CLIs, these positive results warrant paying more attention to CLIs for persons with an increased risk profile for these chronic respiratory diseases.
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Affiliation(s)
- Charlotte D. C. Born
- Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Rohini Bhadra
- Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
- Division of Clinical Physiology, St John’s Medical College & St John’s Research Institute, Bengaluru 560034, India
| | - George D’Souza
- Department of Pulmonary Medicine, St John’s Medical College Hospital, Bengaluru 560034, India
| | - Stef P. J. Kremers
- Department of Health Promotion, NUTRIM Institute of Nutrition and Translational Research in Metabolism, 6229 ER Maastricht, The Netherlands
| | - Sucharita Sambashivaiah
- Division of Clinical Physiology, St John’s Medical College & St John’s Research Institute, Bengaluru 560034, India
- Department of Physiology, St John’s Medical College, Bengaluru 560034, India
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 HX Maastricht, The Netherlands
| | - Rosanne J. H. C. G. Beijers
- Department of Respiratory Medicine, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
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3
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De-Miguel-Diez J, Llamas-Saez C, Vaquero TS, Jiménez-García R, López-de-Andrés A, Carabantes-Alarcón D, Carricondo F, Romero-Gómez B, Pérez-Farinos N. Association between Asthma and Lower Levels of Physical Activity: Results of a Population-Based Case-Control Study in Spain. J Clin Med 2024; 13:591. [PMID: 38276097 PMCID: PMC10816609 DOI: 10.3390/jcm13020591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
(1) Background: Our aim was to determine changes in the prevalence of physical activity (PA) in adults with asthma between 2014 and 2020 in Spain, investigate sex differences and the effect of other variables on adherence to PA, and compare the prevalence of PA between individuals with and without asthma. (2) Methods: This study was a cross-sectional, population-based, matched, case-control study using European Health Interview Surveys for Spain (EHISS) for 2014 and 2020. (3) Results: We identified 1262 and 1103 patients with asthma in the 2014 and 2020 EHISS, respectively. The prevalence of PA remained stable (57.2% vs. 55.7%, respectively), while the percentage of persons who reported walking continuously for at least 2 days a week increased from 73.9% to 82.2% (p < 0.001). Male sex, younger age, better self-rated health, and lower body mass index (BMI) were significantly associated with greater PA. From 2014 to 2020, the number of walking days ≥2 increased by 64% (OR1.64 95%CI 1.34-2.00). Asthma was associated with less PA (OR0.87 95%CI 0.47-0.72) and a lower number of walking days ≥2 (OR0.84 95%0.72-0.97). (4) Conclusions: Walking frequency improved over time among people with asthma. Differences in PA were detected by age, sex, self-rated health status, and BMI. Asthma was associated with less LTPA and a lower number of walking days ≥2.
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Affiliation(s)
- Javier De-Miguel-Diez
- Respiratory Care Department, Gregorio Marañón General University Hospital, 28007 Madrid, Spain;
| | - Carlos Llamas-Saez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (C.L.-S.); (A.L.-d.-A.); (D.C.-A.)
| | | | - Rodrigo Jiménez-García
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (C.L.-S.); (A.L.-d.-A.); (D.C.-A.)
| | - Ana López-de-Andrés
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (C.L.-S.); (A.L.-d.-A.); (D.C.-A.)
| | - David Carabantes-Alarcón
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (C.L.-S.); (A.L.-d.-A.); (D.C.-A.)
| | - Francisco Carricondo
- Department of Immunology, Laboratory of Neurobiology of Hearing (UCM 910915), Ophthalmology and Otorhinolaryngology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.C.); (B.R.-G.)
| | - Barbara Romero-Gómez
- Department of Immunology, Laboratory of Neurobiology of Hearing (UCM 910915), Ophthalmology and Otorhinolaryngology, Faculty of Medicine, Complutense University of Madrid, 28040 Madrid, Spain; (F.C.); (B.R.-G.)
| | - Napoleón Pérez-Farinos
- Epi-PHAAN Research Group, School of Medicine, Universidad de Malaga, 29071 Malaga, Spain;
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Welsner M, Gruber W, Blosch C, Olivier M, Mellies U, Dillenhoefer S, Brinkmann F, Koerner-Rettberg C, Sutharsan S, Taube C, Stehling F. Impact of habitual physical activity and exercise capacity on quality of life in adolescents and adults with cystic fibrosis. Pediatr Pulmonol 2024. [PMID: 38214406 DOI: 10.1002/ppul.26855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 12/04/2023] [Accepted: 12/30/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The influence of habitual physical activity and exercise capacity on health-related quality of life (HRQoL) in people with cystic fibrosis (pwCF) is poorly characterized. This study investigated the influence of habitual physical activity, exercise capacity, lung function, and body mass index (BMI) on HRQoL in adolescent and adult pwCF. METHOD Subjects were fitted with an accelerometer to determine habitual physical activity (steps/day), including time spent at different intensities, for up to 4 weeks. Then bicycle ergometry (maximal exercise capacity; Wpeak), lung function (percent predicted forced expiratory volume in 1 s, ppFEV1 ), BMI, and response to the Cystic Fibrosis Questionnaire-Revised (CFQ-R) were determined. RESULTS Sixty-five pwCF participated in the study. Physically active pwCF had significantly higher ppFEV1 (p < .001) and exercise capacity (p < .001) than inactive pwCF, and had significantly higher scores on the CFQ-R physical (p = .006), emotional (p = .015), role (p = .008), health (p = .006), and weight (p = .004) subscales. On multiple linear regression analysis, ppFEV1 and, to a lesser extent, exercise capacity, were the most important determinants of HRQoL in pwCF. Time spent in moderate-to-vigorous intensity physical activity did not influence any of the CFQ-R subscales, whereas time spent in vigorous-intensity influenced CFQ-R scores for role (p = .007), body (p = .001), health (p = .009), and weight (p = .01). CONCLUSION HRQoL in adolescent and adult pwCF was influenced by several factors. Avoiding sedentary behavior and spending time in vigorous-intensity levels positively influenced HRQoL, whereas the total number of steps per day played only a minor role in determining HRQoL. Both ppFEV1 and exercise capacity markedly influenced HRQoL.
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Affiliation(s)
- Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Wolfgang Gruber
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
- Institute of Human Nutrition and Food Science, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Christopher Blosch
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
- Department of Pediatric Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
| | - Margarete Olivier
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Uwe Mellies
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
| | - Stefanie Dillenhoefer
- Department of Pediatric Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
| | - Folke Brinkmann
- Department of Pediatric Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
| | - Cordula Koerner-Rettberg
- Department of Pediatric Pulmonology, University Children's Hospital, Ruhr University, Bochum, Germany
- Children's Hospital, Marienhospital Wesel, Wesel, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Adult Cystic Fibrosis Center, University of Duisburg-Essen, Essen, Germany
| | - Florian Stehling
- Pediatric Pulmonology and Sleep Medicine, Cystic Fibrosis Center, Children's Hospital, University of Duisburg-Essen, Essen, Germany
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Price OJ, Del Giacco S, Gawlik R, Janson C, Odemyr M, Papadopoulos NG, Bonini M. Exercise and physical activity for asthma management: The European Academy of Allergy and Clinical Immunology perspective. Allergy 2023; 78:2823-2825. [PMID: 37340667 DOI: 10.1111/all.15789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/19/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
- Department of Respiratory Medicine, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health and Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
| | | | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Mikaela Odemyr
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
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Clemente-Suárez VJ, Mielgo-Ayuso J, Ramos-Campo DJ, Beltran-Velasco AI, Martínez-Guardado I, Navarro Jimenez E, Redondo-Flórez L, Yáñez-Sepúlveda R, Tornero-Aguilera JF. Basis of preventive and non-pharmacological interventions in asthma. Front Public Health 2023; 11:1172391. [PMID: 37920579 PMCID: PMC10619920 DOI: 10.3389/fpubh.2023.1172391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
Asthma is one of the most common atopic disorders in all stages of life. Its etiology is likely due to a complex interaction between genetic, environmental, and lifestyle factors. Due to this, different non-pharmacological interventions can be implemented to reduce or alleviate the symptoms caused by this disease. Thus, the present narrative review aimed to analyze the preventive and non-pharmacological interventions such as physical exercise, physiotherapy, nutritional, ergonutritional, and psychological strategies in asthma treatment. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Asthma is an immune-mediated inflammatory condition characterized by increased responsiveness to bronchoconstrictor stimuli. Different factors have been shown to play an important role in the pathogenesis of asthma, however, the treatments used to reduce its incidence are more controversial. Physical activity is focused on the benefits that aerobic training can provide, while physiotherapy interventions recommend breathing exercises to improve the quality of life of patients. Nutritional interventions are targeted on implement diets that prioritize the consumption of fruits and vegetables and supplementation with antioxidants. Psychological interventions have been proposed as an essential non-pharmacological tool to reduce the emotional problems associated with asthma.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain
- Studies Centre in Applied Combat (CESCA), Toledo, Spain
| | - Juan Mielgo-Ayuso
- Department of Health Sciences, Faculty of Health Sciences, University of Burgos, Burgos, Spain
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Ismael Martínez-Guardado
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, Universidad Camilo José Cela, Madrid, Spain
| | | | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | | | - Jose Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain
- Studies Centre in Applied Combat (CESCA), Toledo, Spain
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Urroz Guerrero PD, Oliveira JM, Lewthwaite H, Gibson PG, McDonald VM. Key Considerations When Addressing Physical Inactivity and Sedentary Behaviour in People with Asthma. J Clin Med 2023; 12:5998. [PMID: 37762938 PMCID: PMC10531510 DOI: 10.3390/jcm12185998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
People with asthma tend to be less physically active and more sedentary than people without asthma. This narrative review aimed to present key considerations when addressing physical inactivity and sedentary behaviour in people with asthma by identifying barriers and facilitators, determinants and correlates, and intervention approaches. Using a search strategy, electronic databases were searched for relevant studies. Data extracted from studies were qualitatively synthesised. A total of 26 studies were included in the review. Six studies reported asthma symptoms as a barrier to physical activity, while four studies reported having a supportive network as a physical activity facilitator. Across studies, physical activity correlates/determinants were pulmonary function, exercise capacity, body mass index, dyspnoea, psychological health, and asthma control. Interventions that effectively improved physical activity in the short term were a step-based prescription programme, a weight loss programme incorporating aerobic and resistance training, and a weight loss lifestyle intervention, while a high-intensity interval training pulmonary rehabilitation program was effective in the long term. The collective findings suggest that a personalised physical activity programme incorporating different strategies is needed. There was minimal evidence to provide recommendations to optimise sedentary behaviour in asthma, and more research is needed on the topic.
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Affiliation(s)
- Paola D. Urroz Guerrero
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, NSW 2305, Australia; (P.D.U.G.); (H.L.); (P.G.G.)
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia;
- School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Joice M. Oliveira
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia;
- School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW 2308, Australia
- Graduate Program in Rehabilitation Sciences, Pitagoras Unopar University, Londrina 86041-140, PR, Brazil
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Londrina 86038-350, PR, Brazil
| | - Hayley Lewthwaite
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, NSW 2305, Australia; (P.D.U.G.); (H.L.); (P.G.G.)
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia;
- School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Peter G. Gibson
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, NSW 2305, Australia; (P.D.U.G.); (H.L.); (P.G.G.)
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia;
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia
| | - Vanessa M. McDonald
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, NSW 2305, Australia; (P.D.U.G.); (H.L.); (P.G.G.)
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, NSW 2305, Australia;
- School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW 2308, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia
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Khan J, Moran B, McCarthy C, Butler MW, Franciosi AN. Management of comorbidities in difficult and severe asthma. Breathe (Sheff) 2023; 19:230133. [PMID: 38020342 PMCID: PMC10644109 DOI: 10.1183/20734735.0133-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Difficult-to-treat and severe asthma are challenging clinical entities. In the face of suboptimal asthma control, the temptation for clinicians is to reflexively escalate asthma-directed therapy, including increasing exposure to corticosteroids and commencement of costly but potent biologic therapies. However, asthma control is objectively and subjectively assessed based on measurable parameters (such as exacerbations or variability in pulmonary physiology), symptoms and patient histories. Crucially, these features can be confounded by common untreated comorbidities, affecting clinicians' assessment of asthma treatment efficacy.
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Affiliation(s)
- Jehangir Khan
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Barry Moran
- St Vincent's University Hospital, Dublin, Ireland
- Shared first authorship
| | - Cormac McCarthy
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Marcus W. Butler
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
| | - Alessandro N. Franciosi
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- Shared senior authorship
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Jin G, Jiang Y, Shao H, Zhu J. The effect of pulmonary rehabilitation on childhood asthma: a systematic review and meta-analysis. Minerva Pediatr (Torino) 2023; 75:604-613. [PMID: 37466066 DOI: 10.23736/s2724-5276.21.06656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is a comprehensive nursing intervention for lung function improvement in patients with respiratory diseases. This systematic review focused on further exploration of the unclear impacts of PR on childhood asthma. EVIDENCE ACQUISITION Web of Science, Cochrane Library, Embase, PubMed, and other databases were searched until May 2021. Randomized controlled trials (RCTs) comparing the effects of PR (including exercise training and education) and routine care on childhood asthma were included. Study selection, data extraction, and bias risk assessment were performed independently by two investigators. EVIDENCE SYNTHESIS Fourteen RCTs involving 1401 patients were included. Relative to the control group, the total scores of the asthma quality of life questionnaire were evidently improved in the experimental group, including motor domain scores (MD=0.88, 95% CI: 0.67-1.09), symptom domain scores (MD=1.23, 95% CI: 0.61-1.85), and affective domain scores (MD=1.38, 95% CI: 0.63-2.14). Besides, 6-min walk distance (MD=2.01, 95% CI: 0.86-3.15) and asthma control test (MD=0.31, 95% CI: 0.02-0.60) were prominently improved. However, the maximum oxygen uptake (MD=0.81, 95% CI: -0.2 to 1.82) was not markedly improved. The forced expiratory volume in 1 s (MD=0.42, 95% CI: -0.29 to 1.13), and forced vital capacity (MD=0.07, 95% CI: -0.14 to 0.28) were not remarkably improved. There was an evident improvement in the peak expiratory flow (MD=1.22, 95% CI: 0.15-2.30). CONCLUSIONS PR improves some lung functions, exercise tolerance and the quality of life of children with asthma, and it might work as a supplementary therapy for the treatment of childhood asthma. Moreover, more RCTs of high quality and in large sample size are needed for further confirmation.
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Affiliation(s)
- Guoping Jin
- Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Jiang
- Department of Respiratory, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hanqing Shao
- Department of Respiratory, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jihua Zhu
- Department of Nursing, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China -
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Gill R, Rojas‐Ruiz A, Boucher M, Henry C, Bossé Y. More airway smooth muscle in males versus females in a mouse model of asthma: A blessing in disguise? Exp Physiol 2023; 108:1080-1091. [PMID: 37341687 PMCID: PMC10988431 DOI: 10.1113/ep091236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
NEW FINDINGS What is the central question of this study? The lung response to inhaled methacholine is reputed to be greater in male than in female mice. The underpinnings of this sex disparity are ill defined. What is the main finding and its importance? We demonstrated that male airways exhibit a greater content of airway smooth muscle than female airways. We also found that, although a more muscular airway tree in males might contribute to their greater responsiveness to inhaled methacholine than females, it might also curb the heterogeneity in small airway narrowing. ABSTRACT Mouse models are helpful in unveiling the mechanisms underlying sex disparities in asthma. In comparison to their female counterparts, male mice are hyperresponsive to inhaled methacholine, a cardinal feature of asthma that contributes to its symptoms. The physiological details and the structural underpinnings of this hyperresponsiveness in males are currently unknown. Herein, BALB/c mice were exposed intranasally to either saline or house dust mite once daily for 10 consecutive days to induce experimental asthma. Twenty-four hours after the last exposure, respiratory mechanics were measured at baseline and after a single dose of inhaled methacholine that was adjusted to trigger the same degree of bronchoconstriction in both sexes (it was twice as high in females). Bronchoalveolar lavages were then collected, and the lungs were processed for histology. House dust mite increased the number of inflammatory cells in bronchoalveolar lavages to the same extent in both sexes (asthma, P = 0.0005; sex, P = 0.96). The methacholine response was also markedly increased by asthma in both sexes (e.g., P = 0.0002 for asthma on the methacholine-induced bronchoconstriction). However, for a well-matched bronchoconstriction between sexes, the increase in hysteresivity, an indicator of airway narrowing heterogeneity, was attenuated in males for both control and asthmatic mice (sex, P = 0.002). The content of airway smooth muscle was not affected by asthma but was greater in males (asthma, P = 0.31; sex, P < 0.0001). These results provide further insights regarding an important sex disparity in mouse models of asthma. The increased amount of airway smooth muscle in males might contribute functionally to their greater methacholine response and, possibly, to their decreased propensity for airway narrowing heterogeneity.
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Affiliation(s)
- Rebecka Gill
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
| | - Andrés Rojas‐Ruiz
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
| | - Magali Boucher
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
| | - Cyndi Henry
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
| | - Ynuk Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université LavalDépartement de médecineQuébecCanada
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Price OJ, Simpson AJ. Exercise and asthma - Trigger or treatment? Respir Med 2023; 213:107247. [PMID: 37086818 DOI: 10.1016/j.rmed.2023.107247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 04/24/2023]
Abstract
Exercise is one of the most commonly reported symptom triggers for people with asthma. However, a growing body of evidence indicates that regular exercise and physical activity are associated with improved clinical and patient reported outcomes. In this article, we summarise and consolidate recent original studies evaluating exercise and physical activity profiles in people with asthma and provide an up-to-date perspective concerning the role of exercise training and physical activity promotion in the context of asthma management. To conclude, we identify key unmet needs and provide directions for future research.
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Affiliation(s)
- Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, UK; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK; Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Andrew J Simpson
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, UK
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12
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D'Agostino EM, Zhang S, Day SE, Konty KJ, Armstrong S, Skinner A, Neshteruk CD. The longitudinal association between asthma severity and physical fitness among new York City public school youth. Prev Med 2023; 170:107486. [PMID: 36931475 DOI: 10.1016/j.ypmed.2023.107486] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 01/20/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
Severe persistent childhood asthma is associated with low physical activity and may be associated with poor physical fitness. Research on the asthma severity-fitness association longitudinally and across sociodemographic subgroups is needed to inform fitness interventions targeting youth with asthma. We evaluated the relationship between asthma severity (categorized as severe, mild, or no asthma) and subsequent fitness in New York City (NYC) public school youth enrolled in grades 4-12 using the NYC Fitnessgram dataset (2010-2018). Longitudinal mixed models with random intercepts were fit to test the association between asthma severity and one-year lagged fitness z-scores by clustering repeated annual observations at the student level. Models were adjusted for sex, race/ethnicity, grade level, poverty status, time, and stratified by sociodemographic factors. The analytic sample included 663,137 students (51% male; 31% non-Hispanic Black, 40% Hispanic; 55% in grades 4-8, 70% high poverty; 87%, 11% and 1% with no, mild, and severe asthma, respectively). Students with severe asthma and mild asthma demonstrated -0.19 (95% CI, -0.20 to -0.17) and - 0.10 (95% CI, -0.11 to -0.10), respectively, lower fitness z-scores in the subsequent year relative to students without asthma. After stratifying by demographics, the magnitude of the asthma severity-fitness relationship was highest for non-Hispanic white vs. all other racial/ethnic subgroups, and was similar across sex, grade level, and household poverty status. Overall, we observed an inverse longitudinal relationship between asthma severity and subsequent fitness among urban youth, particularly non-Hispanic Whites. Future research should examine how neighborhood-level factors impact the asthma severity-fitness relationship across racial/ethnic subgroups.
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Affiliation(s)
- Emily M D'Agostino
- Department of Orthopaedic Surgery, Duke University Medical School, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America.
| | - Sue Zhang
- Trinity College of Arts and Sciences, Duke University, Durham, NC, United States of America
| | - Sophia E Day
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Kevin J Konty
- New York City Department of Health and Mental Hygiene, Office of School Health, NY, New York, United States of America
| | - Sarah Armstrong
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Pediatrics, Duke University Medical School, Durham, NC, United States of America; Duke Global Health Institute, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Asheley Skinner
- Duke Clinical Research Institute, Duke University, Durham, NC, United States of America; Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University Medical School, Durham, NC, United States of America
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13
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Endrigue TC, Lunardi AC, Freitas PD, Silva RA, Mendes FAR, França-Pinto A, Carvalho-Pinto RM, Carvalho CRF. Characteristics of individuals with moderate to severe asthma who better respond to aerobic training: a cluster analysis. J Bras Pneumol 2023; 49:e20220225. [PMID: 36753210 PMCID: PMC9970378 DOI: 10.36416/1806-3756/e20220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/31/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To determine the characteristics of individuals with asthma who are responsive to aerobic training. METHODS This post hoc analysis of pooled data from previous randomized controlled trials involved 101 individuals with moderate to severe asthma who underwent aerobic training. Participants underwent a maximal cardiopulmonary exercise test and completed the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire before and after a 24-session aerobic training program. Better and worse responders to aerobic training were identified by cluster analysis. RESULTS Two clusters were identified according to the improvement in peak VO2 after aerobic training (better and worse responders). Characteristics of the better responder group were being older, being female, having higher BMI, and having higher cardiac reserve at baseline when compared with the worse responder group. Also, better responders had worse clinical control, worse quality of life, and lower physical capacity at baseline. After training, worse responders, in comparison with better responders, showed half the improvement in Δpeak VO2 (7.4% vs. 13.6%; 95% CI, -12.1 to -0.92%; p < 0.05) and worse asthma control. A weak, negative, but significant association (r = -0.35; p < 0.05) was observed between clinical control and aerobic fitness only in the better responder group. Both groups showed significant improvement in quality of life. CONCLUSIONS Obese individuals with worse exercise capacity, clinical control, and quality of life showed improvement with aerobic training. Moreover, worse responders also improved with training, but to a lesser extent.
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Affiliation(s)
- Tiago C Endrigue
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Adriana C Lunardi
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Patrícia D Freitas
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Ronaldo A Silva
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Felipe A R Mendes
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Andrezza França-Pinto
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Regina M Carvalho-Pinto
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Celso R F Carvalho
- . Departamento de Fisioterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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Ödling M, Andersson N, Janson C, Melén E, Bergström A, Kull I. Health-related quality of life decreases in young people with asthma during the transition from adolescence to young adulthood: a birth cohort study. BMC Pulm Med 2023; 23:34. [PMID: 36694146 PMCID: PMC9872377 DOI: 10.1186/s12890-022-02259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/23/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND During the transition from paediatric to adult healthcare there is a gap between asthma guidelines and actual management with decreased healthcare consultations and dispensations of asthma medications after the transition to adult healthcare among young people with asthma. How health-related quality of life (HRQoL) develops during the transition from adolescence to young adulthood is unclear. Our aim was therefore to investigate HRQoL among young people with asthma during the transition to adulthood. Further, to assess if level of asthma control and physical activity influence any potential association between asthma and HRQoL. METHODS The study population consisted of 2268 participants from the ongoing Swedish population-based prospective birth cohort BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology). HRQoL was measured using the instrument EQ-5D-3 L and three general questions. The EQ-5D-3 L consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The EQ-5D-3 L instrument and questions on general health, symptoms and treatment of asthma, and lifestyle factors were based on data from follow-ups at 16 and 24 years. Cross-sectional analyses were made. RESULTS At the 24-year follow-up, the adjusted median values of EQ VAS were lower compared with at the 16-year follow-up; among both participants with asthma (80 vs. 85, p < 0.01) and those without asthma (80 vs. 87, p < 0.01). At the 24-year follow-up, participants with uncontrolled asthma had a lower adjusted median EQ VAS score than peers with controlled/partly controlled asthma (75 vs. 80, p = 0.03). Further, young adults with asthma who did not fulfil the WHO recommendations on physical activity had lower EQ VAS scores than peers who did (70 vs. 80, p < 0.01). CONCLUSION HRQoL is lower in young adulthood than in adolescence. Young adults with asthma having uncontrolled disease or who are physically inactive appear to be particularly vulnerable.
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Affiliation(s)
- Maria Ödling
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Andersson
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christer Janson
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Erik Melén
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.416452.0Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Anna Bergström
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.425979.40000 0001 2326 2191Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Inger Kull
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden ,grid.416452.0Sachs’ Children and Youth Hospital, Stockholm, Sweden
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15
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Lee H, Ryu J, Chung SJ, Park DW, Park TS, Moon JY, Kim TH, Sohn JW, Yoon HJ, Kim SH. Overall and respiratory mortality reduction with physical activity in subjects with and without asthma. Allergy 2023. [PMID: 36602280 DOI: 10.1111/all.15638] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/06/2023]
Affiliation(s)
- Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jiin Ryu
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Jun Chung
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Dong Won Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tai Sun Park
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ji-Yong Moon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Tae-Hyung Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jang Won Sohn
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Joo Yoon
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sang-Heon Kim
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Guo Q, Zhao Y, Zhao J, Bian M, Qian L, Xue T, Zhang JJ, Duan X. Acute change of lung function to short-term exposure to ambient air pollutants with and without physical activity: A real-world crossover study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 316:120481. [PMID: 36341821 DOI: 10.1016/j.envpol.2022.120481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
Physical activity (PA) would increase the inhalation rate and thereby inhaled dose of air pollutants. However, it's still uncertain whether the effects of air pollutants on lung function are attenuated by PA, especially in the high-polluted areas. We aimed to disentangle the interaction between air pollution and PA on lung function among healthy adults. In this study, a real-world crossover study was conducted among 74 healthy adults. Each participant underwent both rest and 15-min intermittent moderate PA exposure scenarios (consisting of 15min stationary bike riding alternating with 15min of rest), which lasted for 2 h. On the same day, the participants among active and inactive group were exposed to the same air pollution. We have monitored the fine particulate matter (PM2.5), particulate matter less than 10 μm (PM10), particulate matter less than 1 μm (PM1), black carbon (BC), nitrogen dioxide (NO2), and ozone (O3) continuously during 2-h exposure. Lung function were measured at five times points for each visit (before, immediately, 3 h, 5 h, and 24 h after the 2-h exposure scenario). Mixed-effects models were applied to explore the effects of air pollution, PA, and their interaction on lung function. The participants had a mean (standard deviation (SD)) age of 19.9 (0.9) years. The average concentration [mean ± SD] of PM2.5, PM10, PM1, BC, NO2, and O3 were 59.4 ± 45.1 μg/m3, 122.8 ± 109.0 μg/m3, 38.8 ± 29.2 μg/m3, 1.94 ± 1.17 μg/m3, 59.5 ± 26.6 μg/m3, and 74.0 ± 30.3 μg/m3, respectively. Overall, greater increasement in lung function were observed among active group compared with inactive group at all timepoints. In fully adjusted models, we observed the benefits of PA and detrimental effects of air pollutants on lung function. Our results suggested that PA, compared to rest, alleviated the detrimental effects of air pollutants on lung function. We also stressed the importance of timing of measurements for capturing association. In conclusion, our observations suggested that PA might alleviate the associations between various pollutant exposures and lung function, which would drive further research towards potential pathway.
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Affiliation(s)
- Qian Guo
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Yuchen Zhao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Jiahao Zhao
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Mengyao Bian
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Liqianxin Qian
- School of Civil and Resource Engineering, University of Science and Technology Beijing, Beijing 100083, China
| | - Tao Xue
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100083, China
| | - Junfeng Jim Zhang
- Nicholas School of the Environment and Global Health Institute, Duke University, Durham, NC, USA; Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Xiaoli Duan
- School of Energy and Environmental Engineering, University of Science and Technology Beijing, Beijing 100083, China.
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17
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Jing Z, Wang X, Zhang P, Huang J, Jia Y, Zhang J, Wu H, Sun X. Effects of physical activity on lung function and quality of life in asthmatic children: An updated systematic review and meta-analysis. Front Pediatr 2023; 11:1074429. [PMID: 36846162 PMCID: PMC9944457 DOI: 10.3389/fped.2023.1074429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The benefits of physical activity (PA) for asthmatic children were increasingly recognized, and as the design of studies on PA and asthma has become more refined in recent years, the latest evidence needed to be updated. We performed this meta-analysis to synthesize the evidence available from the last 10 years to update the effects of PA in asthmatic children. METHODS A systematic search was conducted in three databases, PubMed, Web of Science, and Cochrane Library. Randomized controlled trials were included, and two reviewers independently conducted the inclusion screening, data extraction, and bias assessment. RESULTS A total of 9 studies were included in this review after 3,919 articles screened. PA significantly improved the forced vital capacity (FVC) (MD 7.62; 95% CI: 3.46 to 11.78; p < 0.001), and forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75) (MD 10.39; 95% CI: 2.96 to 17.82; p = 0.006) in lung function. There was no significant difference in forced expiratory volume in the first second (FEV1) (MD 3.17; 95% CI: -2.82 to 9.15; p = 0.30) and fractional exhaled nitric oxide (FeNO) (MD -1.74; 95% CI: -11.36 to 7.88; p = 0.72). Also, PA significantly improved the quality of life as assessed by the Pediatric Asthma Quality of Life Questionnaire (all items p < 0.05). CONCLUSIONS This review suggested that PA could improve FVC, FEF25-75, and quality of life in asthmatic children, but there was insufficient evidence of improvement in FEV1 and airway inflammation. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022338984.
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Affiliation(s)
- Zenghui Jing
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xingzhi Wang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Panpan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jinli Huang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yuanyuan Jia
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Juan Zhang
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Huajie Wu
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Xin Sun
- Department of Pediatrics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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de Lima FF, Pinheiro DHA, de Carvalho CRF. Physical training in adults with asthma: An integrative approach on strategies, mechanisms, and benefits. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1115352. [PMID: 36873818 PMCID: PMC9982132 DOI: 10.3389/fresc.2023.1115352] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023]
Abstract
Asthma is a chronic airway disease characterized by airflow limitation and respiratory symptoms associated with chronic airway and systemic inflammation, bronchial hyperreactivity (BHR), and exercise-induced bronchoconstriction (EIB). Asthma is a heterogeneous disease classified according to distinct airway and systemic inflammation. Patients commonly present with several comorbidities, including anxiety, depression, poor sleep quality, and reduced physical activity levels. Individuals with moderate to severe asthma often have more symptoms and difficulty achieving adequate clinical control, which is associated with poor quality of life, despite proper pharmacological treatment. Physical training has been proposed as an adjunctive therapy for asthma. Initially, it was suggested that the effect of physical training might be attributed to the improved oxidative capacity and reduced production of exercise metabolites. However, in the last decade, there has been evidence that aerobic physical training promotes anti-inflammatory effects in asthma patients. Physical training improves BHR and EIB, asthma symptoms, clinical control, anxiety, and depression levels, sleep quality, lung function, exercise capacity, and dyspnea perception. Furthermore, physical training reduces medication consumption. The most commonly used exercise strategies are moderate aerobic and breathing exercises; however, other techniques, such as high-intensity interval training, have shown promising effects. In the present study, we reviewed the strategies and beneficial effects of exercise on clinical and pathophysiological asthma outcomes.
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19
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Jiang J, Zhang D, Huang Y, Wu Z, Zhang W. Exercise rehabilitation in pediatric asthma: A systematic review and network meta-analysis. Pediatr Pulmonol 2022; 57:2915-2927. [PMID: 36103241 DOI: 10.1002/ppul.26134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This systematic review delineates various exercise-based pulmonary rehabilitation (PR) designs and quantifies how they may be optimized in pediatric asthma treatment. DESIGN Comprehensive systematic review, network meta-analysis, and quality analyses using PubMed, Embase, Cochrane Library, Web of Science Core Collection, and Medline searches. INTERVENTIONS Discrete and combined endurance, respiratory, resistance, strength, and interval training. MAIN OUTCOME MEASURES Forced expiratory volume at 1 s to predicted value ratio (FEV1 % pred), forced vital capacity to predicted value ratio (FVC% pred), forced expiratory flow between 25% and 75% of vital capacity ratio (FEF25%-75%), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and the 6-min walk test (6MWT). RESULTS Twenty-four randomized controlled trials (RCTs) involving a combined 1031 patients were included. Endurance training was the most common form of PR (58.3%), typically conducted through outpatient clinics (29.2%). Network meta-analysis showed that compared with other PR, interval training significantly improved PAQLQ total scores, and activity, symptom, and emotional domains. Interval training also had a significant effect on the 6MWT. No adverse events were reported. Exercise training did not have a significant effect on FEV1 % pred; however, combined endurance and respiratory training significantly improved both FVC% pred and FEF25%-75%. CONCLUSIONS Exercise-based PR is safe and effective in childhood asthma treatment. Interval training may be a core component for improving quality of life and exercise capacity in this patient population, while combined respiratory and endurance training may significantly affect lung function. The clinical efficacy of these results should be confirmed through high-quality RCTs.
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Affiliation(s)
- Jing Jiang
- School of pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Department of Pediatric Respiratory Diseases, Nanyang Zhang Zhongjing Hospital, Nanyang, China
| | - Dong Zhang
- School of pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Yapan Huang
- Department of Pediatric Respiratory Diseases, Nanyang Zhang Zhongjing Hospital, Nanyang, China
| | - Zhenguo Wu
- School of pediatrics, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Department of Pediatric Respiratory Diseases, Nanyang Zhang Zhongjing Hospital, Nanyang, China
| | - Wei Zhang
- Department of Pediatric Respiratory Diseases, Nanyang Zhang Zhongjing Hospital, Nanyang, China
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20
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McLoughlin RF, Clark VL, Urroz PD, Gibson PG, McDonald VM. Increasing physical activity in severe asthma: a systematic review and meta-analysis. Eur Respir J 2022; 60:2200546. [PMID: 35896208 PMCID: PMC9753478 DOI: 10.1183/13993003.00546-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Physical inactivity is common in asthma and is recognised as an important modifiable risk for poor clinical outcomes such as impaired asthma control and health-related quality of life (HRQoL). Despite evidence supporting the role of physical activity in reducing the risk of these outcomes, little is known about optimal interventions for increasing physical activity in those with severe disease. This systematic review and meta-analysis evaluates the effectiveness of interventions in increasing physical activity in severe asthma. METHODS MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, Informit, SPORTDiscus and Cochrane databases were searched up to September 2021 for physical activity-based intervention studies that assessed physical activity outcomes (e.g. steps per day, time spent undertaking physical activity) in adults with severe asthma. Data on asthma-related (e.g. asthma control) and health-related outcomes (e.g. HRQoL) were assessed as secondary outcomes. The revised Cochrane Risk of Bias tool was used to assess risk of bias. Random-effects meta-analyses synthesised data where possible. RESULTS Four randomised controlled trials (all 12 weeks in duration) including 176 adults with moderate-to-severe asthma were included. An increase in physical activity was reported with a moderate-vigorous intensity aerobic and resistance training intervention (steps per day and time spent undertaking physical activity), and an unsupervised pedometer-based intervention (steps per day). Meta-analyses showed that physical activity interventions had an overall positive effect on steps per day (mean difference (MD) 1588, 95% CI 399-2778; p=0.009, I2=23), asthma control (MD -0.65, 95% CI -0.95--0.35; p<0.0001, I2=0%) and HRQoL (MD 0.56, 95% CI 0.10-1.01; p=0.02, I2=16%) compared to control. CONCLUSION While there is some evidence supporting the effectiveness of interventions in improving physical activity in adults with severe asthma, higher-quality, large-scale studies of longer duration are needed to determine the optimal intervention.
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Affiliation(s)
- Rebecca F McLoughlin
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Vanessa L Clark
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Paola D Urroz
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Peter G Gibson
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
- Dept of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
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21
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Kahwash BM, Nyenhuis SM. Exercising with Asthma: A Slow Burn or a Quick HIIT? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2605-2606. [DOI: 10.1016/j.jaip.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/07/2022]
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22
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Satar S, Sahin ME, Ergun P. Factors Affecting the Success of Pulmonary Rehabilitation in Asthma. J Asthma 2022; 60:912-919. [PMID: 35930532 DOI: 10.1080/02770903.2022.2109163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: The majority of patients with asthma limit their physical activity due to the fear of exercise dyspnea. Regular exercise, on the other hand, is currently suggested as one of the non-pharmaceutical treatment alternatives for patients with asthma since it improves their quality of life and symptom control. This study aimed to investigate the indicators of success in patients with asthma receiving pulmonary rehabilitation (PR). Methods: A total of 131 patients with the diagnosis of asthma were included in the study. All patients attended an 8-week comprehensive, multidisciplinary, outpatient and individualized PR program. Results: The factors related to the gains in dyspnea perception, exercise capacity, peripheral muscle strength, respiratory muscle strength and quality of life were evaluated. In the multivariate linear regression analysis, the gain in dyspnea perception is related to baseline dyspnea. The gain in exercise capacity is related to baseline exercise capacity and the amount of smoking. The gain in peripheral muscle strength is related to gender. The gain in respiratory muscle strength is related to age, and finally the gain in quality of life is related to baseline dyspnea and anxiety levels. Conclusion: Especially men, young people, heavy smokers, and those with low initial exercise capacity, high perception of dyspnea, and high anxiety are more likely to benefit from PR.
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Affiliation(s)
- Seher Satar
- Health Sciences University Ankara Atatürk Sanatorium Training and Research Hospital, Chronic Respiratory Disease Clinic - Pulmonary Rehabilitation Center, Ankara, TURKEY
| | - Mustafa Engin Sahin
- Health Sciences University Ankara Atatürk Sanatorium Training and Research Hospital, Chronic Respiratory Disease Clinic - Pulmonary Rehabilitation Center, Ankara, TURKEY
| | - Pinar Ergun
- Health Sciences University Ankara Atatürk Sanatorium Training and Research Hospital, Chronic Respiratory Disease Clinic - Pulmonary Rehabilitation Center, Ankara, TURKEY
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23
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Kahwash BM, Gregory KL, Sharp LK, Nyenhuis SM. Results From a National Survey of Asthma Provider Beliefs and Practices Regarding Exercise and Asthma: A Work Group Report of the AAAAI Committee on Sports, Exercise, and Fitness. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1778-1783. [PMID: 35606306 DOI: 10.1016/j.jaip.2022.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND National Heart, Lung, and Blood Institute guidelines recommend regular physical activity (PA) for patients with asthma. Health care provider (HCP) counseling represents an effective approach to optimizing patient PA. However, current exercise rates among asthma patients are suboptimal, which suggests that counseling may be improved. OBJECTIVE To understand PA counseling behaviors among HCPs who manage asthma. METHODS A voluntary 36-item survey assessing self-reported awareness of PA recommendations and current clinical practices was sent to 979 randomly selected HCP members of the American Academy of Allergy, Asthma & Immunology (AAAAI). RESULTS The overall response rate was 9.3% (91 of 979). Respondents were physicians (100%) and allergists/immunologists (96%) who reported an average of 18.1 ± 12.3 years in independent practice. Over half (58%) reported personally engaging in 150 min/wk or more of moderate to strenuous PA. Eighty percent of participants were unaware of specific PA guidelines for patients with asthma, yet 66% acknowledged evidence for improved asthma outcomes with moderate exercise. A large majority of respondents believed that patients with asthma (97%) and severe asthma (84%) should pursue exercise. Whereas 90% of respondents support incorporating exercise counseling into asthma care, only 69% regularly counsel asthma patients about PA. Barriers cited included limited time, lack of knowledge regarding how and where to refer patients for exercise, and other medical priorities. Potential facilitators of PA included increasing practitioner education and patient-directed posters in waiting areas. CONCLUSIONS Health care providers recognized PA as an important component of asthma care but were often unaware of specific guidelines. Promoting PA counseling may require using a time-efficient approach to implement counseling at each asthma patient encounter.
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Affiliation(s)
- Basil M Kahwash
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
| | - Karen L Gregory
- Oklahoma Allergy and Asthma Clinic, Oklahoma City, Okla; School of Nursing and Health Studies, Georgetown University, Washington, DC
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois at Chicago, Chicago, Ill
| | - Sharmilee M Nyenhuis
- Division of Pulmonary, Critical Care, Sleep, and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, Ill
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24
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McLoughlin RF, McDonald VM. The Management of Extrapulmonary Comorbidities and Treatable Traits; Obesity, Physical Inactivity, Anxiety, and Depression, in Adults With Asthma. FRONTIERS IN ALLERGY 2022; 2:735030. [PMID: 35387051 PMCID: PMC8974714 DOI: 10.3389/falgy.2021.735030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/19/2021] [Indexed: 12/31/2022] Open
Abstract
Asthma is a complex and heterogenous disease characterized by variability in disease expression and severity. Multiple extrapulmonary comorbidities and treatable traits are common in people with asthma, and there is an increasing appreciation of how these may complicate asthma management. This review will discuss the prevalence and impact of extrapulmonary comorbidities/risk factors or "traits," which have been found to co-exist in asthma (obesity, symptoms of depression and/or anxiety and physical inactivity), the impact these traits have on future outcomes (including exacerbation risk and quality of life) and asthma management, and how we should target treatment in asthma when these extrapulmonary traits are present.
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Affiliation(s)
- Rebecca F McLoughlin
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa M McDonald
- National Health and Medical Research Council, Centre of Excellence in Treatable Traits, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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25
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Gholamnezhad Z, Safarian B, Esparham A, Mirzaei M, Esmaeilzadeh M, Boskabady MH. The modulatory effects of exercise on lipopolysaccharide-induced lung inflammation and injury: A systemic review. Life Sci 2022; 293:120306. [PMID: 35016883 DOI: 10.1016/j.lfs.2022.120306] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
Recent studies have shown that proper exercise significantly restricts inflammatory responses through regulation of the immune system. This review discusses mechanisms of protective effects of exercise in lipopolysaccharide (LPS)-induced lung injury. We performed a systematic search in PubMed, Scopus, and Web of Sciences using the search components "physical exercise", "lung" and "LPS" to identify preclinical studies, which assessed physical activity effects on LPS-induced pulmonary injury. Articles (n = 1240) were screened and those that had the eligibility criteria were selected for data extraction and critical appraisal. In all of the 21 rodent-model studies included, pulmonary inflammation was induced by LPS. Exercise protocols included low and moderate intensity treadmill training and swimming. The results showed that aerobic exercise would prevent LPS-induced oxidative stress and inflammation as well as airways resistance, exhaled nitric oxide, protein leakage, increase in total WBC, macrophage and neutrophil population, levels of interleukin (IL)-6, IL-1β, IL-17, tumor necrosis factor-α, granulocyte-macrophage colony-stimulating factor and CXCL1/KC, and improved IL-10 and IL-ra in lung tissue, bronchoalveolar lavage fluid (BALF) and serum. In addition, in trained animals, the expression of some anti-inflammatory factors such as heat shock protein72, IL-10, triggering receptor expressed on myeloid cells-2 and irisin was increased, thus ameliorating lung injury complications. Aerobic exercise was shown to alleviate the LPS-induced lung injury in rodent models by suppressing oxidative stress and lowering the ratio of pro-inflammatory to anti-inflammatory cytokines.
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Affiliation(s)
- Zahra Gholamnezhad
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Bahare Safarian
- Student Research Committee, Arak University of Medical Sciences, Arak, Iran
| | - Ali Esparham
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Mirzaei
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahla Esmaeilzadeh
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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26
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Vassilopoulou E, Skypala I, Feketea G, Gawlik R, Dunn Galvin A, Meyer R, Pitsios C, Maria Pop R, Ryan D, Said M, Schiere S, Vlieg-Boerstra B, Kull I. A multi-disciplinary approach to the diagnosis and management of allergic diseases: An EAACI Task Force. Pediatr Allergy Immunol 2022; 33:e13692. [PMID: 34724234 DOI: 10.1111/pai.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Guidelines for management of patients with allergic conditions are available, but the added value of nurses, allied healthcare professionals (AHPs), and general practitioners (GPs), in the management of allergic disease, has not been fully clarified. The European Academy of Allergy and Clinical Immunology (EAACI) appointed a task force to explore this issue. AIM To investigate the added value of nurses, AHPs, and GPs in management of allergic diseases, in an integrated model of care. METHODS A search was made of peer-reviewed literature published between 2010 and December 2020 (Cochrane Library, PubMed, and CINAHL) on the involvement of the various specific healthcare providers (HCPs) in the management of allergic diseases. RESULTS Facilitative models of care for patients with allergies can be achieved if HCP collaborates in the diagnosis and management. Working in multi-disciplinary teams (MDT) can increase patients' understanding of the disease, adherence to treatment, self-care capabilities, and ultimately improve quality of life. The MDT competencies and procedures can be improved and enhanced in a climate of mutual respect and shared values, and with inclusion of patients in the planning of care. Patient-centered communication among HCPs and emphasis on the added value of each profession can create an effective integrated model of care for patients with allergic diseases. CONCLUSION Nurses, AHPs, and GPs, both individually and in collaboration, can contribute to the improvement of the management of patients with allergic disease. The interaction between the HCPs and the patients themselves can ensure maximum support for people with allergies.
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Affiliation(s)
- Emilia Vassilopoulou
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
| | - Isabel Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield NHS Foundation Trust, London, and Imperial College, London, UK
| | - Gavriela Feketea
- Iuliu Hatieganu, University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Pediatrics, Pediatric Allergy Outpatient Clinic, "Karamandaneio", Children Hospital, Patras, Greece
| | | | | | - Rosan Meyer
- Department of Paediatrics, Imperial College London, London, UK
| | | | - Raluca Maria Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dermot Ryan
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Maria Said
- Allergy & Anaphylaxis Australia, Sydney, Australia.,EAACI Patient Organisation Committee, Zurich, Switzerland
| | - Sophie Schiere
- Department of Pharmacology, Gent University, Gent, Belgium
| | | | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
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