Can training induce inflammatory control in asthma, or is it symptom control only?

Effects of physical activity on lung function and quality of life in asthmatic children: An updated systematic review and meta-analysis

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 (FEF_25-75) (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, FEF_25-75, 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.

Physical activity and childhood asthma control: Mediation and moderation role of body mass index

BACKGROUND

Physical activity (PA) may be associated with asthma management. Whether PA is associated with childhood asthma control is not well studied, and the role of body mass index (BMI) in this association remains unclarified. This study aimed to evaluate the association between PA and childhood asthma control and investigate the potential mediating and modifying role of BMI in the association.

METHODS

This cross-sectional study involved 303 asthmatic children aged 5-14 years. Information on PA was collected from children. Asthma control was assessed using a valid questionnaire by children and their parents. Height and weight were objectively measured and BMI was calculated and classified. Multiple linear regression, mediation, and moderation analyses were performed.

RESULTS

There was a positive association between PA and childhood asthma control with adjustment for variates (B = 0.144, p = .012). Mediation analysis indicated that BMI status negatively mediated the association (estimate = -0.656, 95% credit interval: -1.645, -0.006), and such indirect effect is lower than the direct effect (indirect effect/direct effect = 58.3%). No evidence of effect modification by BMI was observed (P_interaction = 0.516). Stratified analyses showed that the significant association was only observed in children with overweight/obesity (normal weight: B = 0.863, p = .189; overweight/obese: B = 1.494, p = .044).

CONCLUSIONS

Increased PA is associated with improved childhood asthma control, especially for children with higher BMI. BMI exhibited a negative effect but not effect modification in this association. PA should be encouraged to improve asthma control for asthmatic children. Besides, mechanisms other than weight loss may explain the association.

Evaluation of a nurse-supervised rehabilitation programme on clinical features and systemic inflammation in Chinese children with asthma: A propensity score-matched analysis

AIMS

To evaluate whether a nurse-supervised rehabilitation programmes could improve respiratory functions and systematic inflammation in children with asthma.

BACKGROUND

Children with asthma always suffer from poor life quality, and physical training and pulmonary rehabilitation could be beneficial to asthma.

DESIGN

A retrospective, observational, single-centre cohort analysis.

METHOD

Baseline characteristics between the nurse-supervised rehabilitation programme and usual-care groups were matched by propensity-score matching (PSM) in a 1:1 ratio. We compared the lung function and inflammatory markers between groups.

RESULTS

Among 52 pairs of children, differences in lung function were improved in the nurse-supervised rehabilitation group compared with those in usual-care group, including the oxygen saturation, forced expiratory volume in 1 second, forced expiratory flow of 25%-75% and peak expiratory flow (all P < 0.05). Two asthma-related inflammatory markers (hypersensitive C-reactive protein and immunoglobulin E) also significantly decreased in the nurse-supervised rehabilitation group (both P < 0.001).

CONCLUSIONS

The results indicate that the nurse-supervised rehabilitation programme might be effective in improving symptom control, respiratory functions and systemic inflammation in children with asthma. The study suggests that the NSR for asthma merits further research.

Moving more: physical activity and its positive effects on long term conditions in children and young people

While the benefits of regular participation in physical activity in children and young people are clear, misconceptions have developed about the possible negative effects and potential complications of exercise on long-term conditions such as epilepsy, asthma and diabetes. Over the last decade evidence has emerged supporting the positive impact that physical activity has on long-term conditions. Previous concerns were raised about the risks of hypoglycaemia in children with type 1 diabetes mellitus (T1DM) thus limiting participation in sports. Importantly, physical activity improves the metabolic profile, bone mineral density, cardiorespiratory fitness and insulin sensitivity while lowering mortality risk in children with T1DM. Children with asthma were prevented from doing exercise due to concerns about precipitating an acute asthmatic episode. To the contrary, physical activity interventions have consistently shown an increase in cardiovascular fitness, physical capacity, asthma-free days and quality of life in childhood asthmatics. Children with epilepsy are often excluded from sports due to concerns relating to increased seizure frequency, yet evidence suggests that this is not the case. The evidence supporting physical activity in childhood survivors of cancer is growing but still primarily confined to patients with acute lymphoblastic leukaemia. Participation in sports and physical activity also reduces mental health problems developing in adolescence. While further research is required to investigate benefits of physical activity on specific aspects of long-term conditions in children, in general this group should be advised to increase participation in sports and exercise as a means of improving long-term physical and mental health.

Patient perceived barriers to exercise and their clinical associations in difficult asthma

BACKGROUND

Exercise is recommended in guidelines for asthma management and has beneficial effects on symptom control, inflammation and lung function in patients with sub-optimally controlled asthma. Despite this, physical activity levels in patients with difficult asthma are often impaired. Understanding the barriers to exercise in people with difficult asthma is crucial for increasing their activity, and in implementing successful, disease modifying, and holistic approaches to improve their health.

METHODS

62 Patients within the WATCH Difficult Asthma Cohort (Southampton, UK) completed an Exercise Therapy Burden Questionnaire (ETBQ). The results were analyzed with contemporaneous asthma-related data to determine relationships between perceived exercise barriers and asthma and comorbidity characteristics.

RESULTS

Patients were reflective of a difficult asthma cohort, 66% were female, and 63% were atopic. They had a high BMI (median [inter-quartile range]) of 29.3 [25.5-36.2], age of 53.5 [38.75, 65.25], impaired spirometry with FEV1 73% predicted [59.5, 86.6%] and FEV/FVC ratio of 72 [56.5, 78.0] and poor symptom control, as defined by an Asthma Control Questionnaire (ACQ6) result of 2.4 [1.28, 3.2]. A high perceived barriers to exercise score was significantly correlated with increased asthma symptoms (r = 0.452, p < 0.0001), anxiety (r = 0.375, p = 0.005) and depression (r = 0.363, p = 0.008), poor quality of life (r = 0.345, p = 0.015) and number of rescue oral steroid courses in the past 12 months (r = 0.257, p = 0.048). Lung function, blood eosinophil count, FeNO, Njimegen and SNOT22 scores, BMI and hospitalisations in the previous year were not related to exercise perceptions.

CONCLUSION

In difficult asthma, perceived barriers to exercise are related to symptom burden and psychological morbidity. Therefore, exercise interventions combined with psychological input such as CBT to restructure thought processes around these perceived barriers may be useful in facilitating adoption of exercise.