Childhood asthma and physical activity: a systematic review with meta-analysis and Graphic Appraisal Tool for Epidemiology assessment

Asthma and Participation: A Scoping Review

Asthma is a widespread pediatric chronic disease, but there is limited understanding of its impact on participation (other than physical activity) and the conceptualization of participation. We conducted a scoping review to explore the evidence on the relationship between pediatric asthma and participation in several domains of occupation outlined in the Occupational Therapy Practice Framework 4th Edition. A structured literature search was implemented in PubMed/MEDLINE, Elsevier EMBASE, CINAHL, SCOPUS, Clarivate Web of Science Core Collection, and APA PsycINFO. Data were extracted by occupational domain and analyzed using a stoplight categorization. Of the 3444 identified articles, 10 met inclusion criteria, five of which were categorized as green (addressing specific occupational activities). No article explicitly defined participation. Asthma's influence on nonphysical activity occupations remains unclear. Future research must clarify both the meaning and measures that best capture participation, and further explore the relationship between asthma and participation.

Frequency of Severe Asthma and Its Clinical Phenotypes at the Asthma Clinic in One of the Largest Sudanese Tertiary Pediatric Hospitals: A Cross-Sectional Hospital-Outpatient-Based Study

Background

Asthma is one of the most common non-communicable diseases. Childhood asthma has been increasing in Sudan, with a 13-16% prevalence among Khartoum school children. To achieve and maintain good asthma control, proper diagnosis, assessment of severity, and appropriate medication administration are crucial, with phenotyping being a key factor in determining patients' specific treatment.

Objective

To study the frequency of severe asthma and the distribution of its different phenotypes and to investigate associations between age and gender and different phenotypes of asthma.

Methodology

This descriptive cross-sectional hospital-based study was conducted in the Asthma Clinic of Mohamed Al-Amin Hamid Pediatrics Hospital. It included 229 patients who were presented to the clinic from September 2021 to April 2022. Data were collected from the patients and/or their caregivers using a modified validated standard questionnaire and were analyzed using SPSS version 26.0. A p-value of 0.05 or less was considered statistically significant.

Results

In this study of 229 participants, 14.4% had severe asthma, with 44.5% and 41% exhibiting mild and moderate asthma, respectively. Most were effectively managed in steps 2 or 3. The cohort, primarily aged 5 or younger (40.2%) with a male majority (62%), showed a mean diagnosis age of 2.9 ± 2.8 years. Impressively, 90% maintained well-controlled asthma. Within severe asthma cases (87% atopic), 39.4% represented a severe allergic asthma phenotype. Elevated eosinophil counts were noted in 45.5% (serum) and 78.8% (sputum cytology), while 57.6% had normal serum IgE levels. The predominant symptom pattern in severe asthma was episodic multi-trigger wheezing (48.5%). Age and gender displayed no significant association with severe asthma phenotype.

Conclusion

This study reveals a concerning rise in childhood asthma prevalence in Sudan, emphasizing the importance of tailored treatment strategies. Severe asthma, characterized by atopic eosinophilic involvement, necessitates targeted interventions in pediatric asthma care for specific phenotypes.

Current Approaches in the Multimodal Management of Asthma in Adolescents-From Pharmacology to Personalized Therapy

Asthma and adolescence are two sensitive points and are difficult to manage when they coexist. The first is a chronic respiratory condition, with frequent onset in early childhood (between 3 and 5 years), which can improve or worsen with age. Adolescence is the period between childhood and adulthood (12-19 years), marked by various internal and external conflicts and a limited capacity to understand and accept any aspect that is delimited by the pattern of the social circle (of the entourage) frequented by the individual. Therefore, the clinician is faced with multiple attempts regarding the management of asthma encountered during the adolescent period, starting from the individualization of the therapy to the control of compliance (which depends equally on the adverse reactions, quality of life offered and support of the close circle) and the social integration of the subject, communication probably having a more important role in the monitoring and evolution of the condition than the preference for a certain therapeutic scheme. Current statistics draw attention to the increase in morbidity and mortality among children with bronchial asthma, an aspect demonstrated by the numerous hospitalizations recorded, due either to an escalation in the severity of this pathology or to faulty management. The purpose of this article is to review the delicate aspects in terms of controlling symptoms and maintaining a high quality of life among teenagers.

Environmental exposures in early-life and general health in childhood

BACKGROUND

Early-life environmental exposures are suspected to be involved in the development of chronic diseases later in life. Most studies conducted so far considered single or few exposures and single-health parameter. Our study aimed to identify a childhood general health score and assess its association with a wide range of pre- and post-natal environmental exposures.

METHODS

The analysis is based on 870 children (6-12 years) from six European birth cohorts participating in the Human Early-Life Exposome project. A total of 53 prenatal and 105 childhood environmental factors were considered, including lifestyle, social, urban and chemical exposures. We built a general health score by averaging three sub-scores (cardiometabolic, respiratory/allergy and mental) built from 15 health parameters. By construct, a child with a low score has a low general health status. Penalized multivariable regression through Least Absolute Shrinkage and Selection Operator (LASSO) was fitted in order to identify exposures associated with the general health score.

FINDINGS

The results of LASSO show that a lower general health score was associated with maternal passive and active smoking during pregnancy and postnatal exposure to methylparaben, copper, indoor air pollutants, high intake of caffeinated drinks and few contacts with friends and family. Higher child's general health score was associated with prenatal exposure to a bluespace near residency and postnatal exposures to pets, cobalt, high intakes of vegetables and more physical activity. Against our hypotheses, postnatal exposure to organochlorine compounds and perfluorooctanoate were associated with a higher child's general health score.

CONCLUSION

By using a general health score summarizing the child cardiometabolic, respiratory/allergy and mental health, this study reinforced previously suspected environmental factors associated with various child health parameters (e.g. tobacco, air pollutants) and identified new factors (e.g. pets, bluespace) warranting further investigations.

Asthma-related lung function and physical activity patterns among children living in urban neighborhoods

OBJECTIVE

Black and Latino American children residing in urban environments are at increased risk for comorbid asthma and obesity. Physical activity (PA) is a modifiable behavior known to contribute to the asthma-obesity phenotype. While research has indicated links between optimal asthma status and high PA among children, little is documented about whether this group may display other asthma and PA patterns that warrant clinical attention and tailored interventions.

METHODS

Children with persistent asthma (N = 97) ages 7-9 and their caregivers from urban neighborhoods completed daily measures of asthma status and moderate-to-vigorous physical activity (MVPA) and questionnaires about health and sociodemographic characteristics. Clinical asthma guidelines (e.g. FEV1 ≥ 80%) and sample means were used to categorize children into high or low lung function and MVPA patterns. Individual, family, and contextual differences across lung function and MVPA patterns were investigated.

RESULTS

Twenty-nine percent of participants displayed optimal lung function and high MVPA. The remainder of the sample exhibited various less optimal patterns (e.g. poorer lung function and high MVPA). Caregivers of children displaying poorer lung function and high MVPA levels were more likely to report asthma related fears than caregivers of children with low MVPA levels regardless of lung function status.

CONCLUSIONS

Asthma and PA interventions can be tailored to better address each child's unique clinical and behavioral patterns. An enhanced understanding of risk factors for suboptimal patterns of asthma status and PA may aid in multicomponent intervention efforts.

Changes in physical activity and sedentary time among children with asthma during the COVID-19 pandemic and influencing factors

OBJECTIVE

Regular physical activity is essential for asthma control in children, but it remains understudied within the context of COVID-19. Physical activity and sedentary time levels before and during the COVID-19 pandemic among children with asthma were documented and differences by characteristics were explored.

METHODS

This was a cross-sectional self-administered online survey study of 5- to 17-year-old children with asthma from the United States between December 2020 and April 2021.

RESULTS

This study included 68 children with asthma. Although only 4.6% of the children were fully inactive before the pandemic, this number increased to 24.6% during the survey period (p < 0.001). Children spent significantly less time outdoors and more time in front of screens during the pandemic versus before (p < 0.001). The variety of activities in which children with asthma engaged in during the pandemic was lower than what they used to do prior to the COVID-19 crisis. Boys, Hispanic children, those of low-income households, and those not attending school in-person were significantly associated with less participation in physical activity during the pandemic. Ethnicity remained significantly associated after adjusting for multiple comparisons.

CONCLUSIONS

During the COVID-19 pandemic, children with asthma were less active and spent more time in front of screens and less time outdoors. Subgroup analyses revealed individual, parental, and organizational characteristics being associated with differential participation in physical activity, highlighting disparities in opportunities for children with asthma of different circumstances to remain active and healthy during the pandemic. Additional, more robust longitudinal studies are needed to confirm these results.

Prevalence of Asthma in East Azerbaijan Adult Population and Its Determinants Factors: A Cross-Sectional Study from the Northwest of Iran

Background

Asthma is one of the most common chronic respiratory diseases. It is estimated that more than 400 million people will suffer from it by 2025. This study aims to determine the prevalence of asthma in East Azerbaijan and investigate the association between asthma and some environmental and demographic factors.

Materials and Methods

This is a cross-sectional study based on a major Lifestyle Promotion Project (LPP) conducted in the districts of East Azerbaijan, including 2641 participants aged 15 to 65 years of the general population selected through probability proportional to size (PPS) multistage stratified cluster sampling. We used the World Health Survey questionnaire about doctor-diagnosed asthma to determine the prevalence of asthma. Age, smoking status, physical activity level, socioeconomic variables such as job and education level, and body mass index (BMI) were used as covariates in regression models. A questionnaire was used to obtain socio-demographic information and smoking status. The short form of the International Physical Activity Questionnaire was used to estimate the level of physical activity (IPAQ).

Results

The mean age of participants was 40.9 ± 12.05 years including 1242 (47 %) males and 1399 (53 %) females. The prevalence of asthma was 3.3 %. The frequency of smokers was significantly higher in the asthmatic group compared with the non-asthmatic group (OR=2.33 [1.76-3.31]; p=0.03). There was no significant association between asthma and other demographic and lifestyle characteristics. Obesity has also played a significant role in the development of asthma.

Conclusion

According to the results of this study, obesity and smoking have played a significant role in the development of asthma but there is no statistically significant relationship between socioeconomic and demographic factors.

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 Frequency and Health-Related Quality of Life in Spanish Children and Adolescents with Asthma: A Cross-Sectional Study

Asthma is considered the most prevalent chronic childhood disease worldwide. Physical activity (PA) represents a tool to improve patients with respiratory diseases' health-related quality of life (HRQoL). A cross-sectional study examining data from the Spanish National Health Survey (ENSE 2017) was carried out to investigate the associations between the PAF (physical activity frequency) and health-related quality of life (HRQoL) in asthmatic children and adolescents from 8 to 14 years old (total 11.29 years ± 1.91, boys 11.28 ± 1.90 and 11.29 ± 1.95 girls). Data were obtained from the Children Questionnaire, which was completed by their families or legal guardians, achieving a final sample composed of 240 participants with asthma. Data were taken from Survey 2017 (ENSE 2017), the last one before the COVID-19 pandemic. The results revealed significant associations between the PAF and the HRQoL, finding no significant differences between genders.

Parental Education Moderates the Relation between Physical Activity, Dietary Patterns and Atopic Diseases in Adolescents

Background: Atopic diseases, particularly asthma, eczema, and rhinitis, are among the most common chronic diseases in childhood, with several factors implicated in their pathogenesis. Our study examined the role of parental education in the association between diet, physical activity, and atopy in adolescents. Methods: 1934 adolescents (47.5% boys) aged 13−14 years old reported information about their diet and physical activity and their parents reported their highest educational level. The moderating role of parental education level (primary/secondary vs. tertiary) in the relation between lifestyle patterns and atopic diseases was examined with logistic regression analyses. Results: High consumption of dairy products was inversely associated to adolescents’ asthma and rhinitis symptoms overall, but this relation was almost 50% stronger for the adolescents with high parental education level background. The same pattern of reduction of the odds was noticed also regarding the association among the high intake of fruits, vegetables, pulses, with all three atopic diseases and the adherence to a physically active lifestyle only with current asthma and eczema (all p < 0.05). Conclusion: Adolescents who are physically active and consume a higher intake of fruits, vegetables, and pulses and a lower intake of fast-food and sweets, and their parents/guardians having higher education, are less likely to have any current symptoms of asthma, eczema, and rhinitis than the ones who have low educated parents.

Personalized Treatment of Asthma: The Importance of Sex and Gender Differences

An individual's sex (nominally male or female, based on biological attributes) and gender (a complex term referring to socially constructed roles, behaviors, and expressions of identity) influence the clinical course of asthma in several ways. The physiologic development of the lungs and effects of sex hormones may explain why more boys than girls have asthma, and after puberty, more women than men have asthma. Female sex hormones have an impact throughout the life span and are associated with poor asthma control. Gender may influence exposure to asthma triggers, and sex and gender can influence the prevalence of comorbidities and interactions with health care professionals. Despite widely reported sex- and gender-based differences in asthma and asthma management, these issues frequently are not considered by health care professionals. There is also inconsistency regarding the use of "sex" and "gender" in scientific discourse; research is needed to define sex- and gender-based differences better and how they might interact to influence asthma outcomes. This review outlines the impact an individual's sex and gender can have on the pathogenesis, clinical course, diagnosis, treatment, and management of asthma.

Association between Land Use Mix and Respiratory Symptoms and Asthma in Children from the Generation XXI Birth Cohort

Land use mix (LUM) in the neighbourhoods has been associated with healthier lifestyles. However, less is known about the association between LUM and health outcomes, namely during childhood. The objective of this study was to evaluate the association between different LUM indexes for Porto Metropolitan Area and asthma and respiratory symptoms in children. A cross-sectional analysis was performed involving 6260 children enrolled in Generation XXI. Land use around the child's residence was assessed with the Portuguese official map of land cover using a GIS. Generalized linear mixed-effects models were fitted to estimate the association between LUM and respiratory symptoms and asthma at 7 years of age. Adjusted associations were quantified using odds ratio (OR) and 95% confidence interval (95% CI). After adjustment, LUM was associated with a lower odds of wheezing in the last 12 months [OR (95% CI) = 0.37 (0.15; 0.93) using Shannon's Evenness Index within 500 m; and OR = 0.93 (0.89; 0.98) using the number of different land use types within 250 m]. Living in neighbourhoods with high LUM has a protective effect on current wheezing symptoms. Our results highlight the association between LUM and respiratory symptoms among children, suggesting that public health considerations should be incorporated in land use decision-making.

The modifiable biopsychosocial drivers of psychological distress for adolescents with asthma: Implications for Clinical Care

PURPOSE

Overwhelming distress exceeds the capacity of healthy coping strategies to feel better using healthy coping strategies alone, resulting in the use of unhealthy coping strategies. Unhealthy coping strategies may exacerbate asthma symptoms and asthma can contribute to overwhelming distress. This study aimed to review the modifiable drivers of overwhelming distress in adolescents with asthma.

METHODS

The biopsychosocial drivers of psychological distress for adolescents with asthma were explored within the domains of the modifiable biopsychosocial model of health and wellbeing.

RESULTS

Asthma in adolescents is associated with problems in the domains of environment, developmental outcomes, sense of belonging, health behaviours, coping, and treatment of illness.

CONCLUSIONS

The relationship between asthma and psychological distress highlights the need for holistic treatment of asthma. Further research is needed to establish causation between variables and to investigate whether interventions that address either asthma symptoms or biopsychosocial drivers of distress can improve both factors.

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.

Clinical Utility and Validity of Exercise Vital Sign in Children

ABSTRACT

We reviewed charts of 14,446 sports medicine patients, children aged 5 to 18 years, over a 3-year period to determine the discriminant validity of Exercise Vital Sign (EVS) questions. A logistic regression analyzed factors related to any moderate to vigorous physical activity (MVPA). A linear regression analyzed factors related to amount of MVPA for those who participated in any weekly MVPA. Overall, 48% of children reported meeting physical activity guidelines for 420 min·wk-1. Overall, children reported 400.36 ± 280.04 min·wk-1 of MVPA. Those with depression had significantly less MVPA than those without (95% confidence interval [CI], -96.65 to -26.31). Girls had significantly less MVPA than boys (95% CI, -59.15 to -40.31). Overweight and obese children reported less MVPA compared with normal weight children (95% CIs, -42.65 to -17.29 and -91.61 to -65.50, respectively). EVS demonstrates strong discriminant validity to detect differences between groups as a function of sex, body mass index, and depression.

Analysis of the association between exercise induced bronchospasm, cardiorespiratory fitness, and physical activity levels of adolescents

ABSTRACT This study aims to verify the association between exercise-induced bronchospasm (EIB), cardiorespiratory fitness, and physical activity levels in adolescents. To do so, we evaluated 202 healthy adolescents aged from 13 to 18 years, out of which 94 (46.5%) were females and 108 (53.5%) males. Participants performed a bronchial challenge test in a treadmill (Master Super ATL, Inbramed®) to evaluate bronchial hyper-responsiveness; a spirometric test (Microquark, Cosmed®) to evaluate lung function; answered the Baecke’s Questionnaire of Habitual Physical Activity; and performed the progressive aerobic cardiovascular endurance run test. Data were analyzed using Spearman’s correlation, chi-square test, and odds ratio. The significance level adopted was p<0.05. No statistically significant correlations were found between the decrease of the forced expiratory volume in the first second (FEV1), cardiorespiratory fitness, and physical activity levels. Likewise, the chi-squared test revealed no significant differences between classifications of cardiorespiratory fitness (low or adequate) and EIB (presence or absence) (χ2=0.155; p=0.694). Finally, odds ratio showed no increased chances of the presence of EIB in participants who presented low cardiorespiratory fitness (OR=1.130; CI: 0.616-2.073). We concluded that cardiorespiratory fitness and physical activity levels are not associated with the decrease of FEV1 and that there is no relation between the presence of EIB and the classification of cardiorespiratory fitness of adolescents.

Self-Reported Physical Activity and Asthma Risk in Children

BACKGROUND

Increased physical activity (PA) may protect against asthma but PA can trigger asthma symptoms.

OBJECTIVE

To investigate relationships between moderate-to-vigorous PA (MVPA) assessed during routine care visits and incident asthma.

METHODS

For this retrospective cohort, 542,486 children between 2 and 17 years from 2010 to 2017 were included who had an MVPA assessment (exercise vital sign) during routine care visits. The association of MVPA and asthma was analyzed using Cox proportional hazards regression models as a function of age, with MVPA and body mass index (BMI) being time-varying factors, adjusted for race and ethnicity, socioeconomic status, and air pollution.

RESULTS

The mean MVPA was 5.4 (standard deviation: 4.4) hours/week. Crude asthma incidence density rate (IDR) was highest in children with <1 hour/week of MVPA (IDR: 9.07, 95% confidence interval [CI]: 8.79, 9.36) and lowest in children engaging in 4 to 7 hours/week of MVPA (IDR: 6.55, 95% CI: 6.33, 6.77). In adjusted models, an increase in MVPA was associated with lower asthma risk in children reporting 0 hour/week of MVPA (hazard ratio: 0.981, 95% CI: 0.973, 0.990). In children with ≥8 hours/week of MVPA, an increase in MVPA was associated with higher asthma risk (1.005, 95% CI: 1.002, 1.009). There was no significant BMI by MVPA interaction.

CONCLUSION

Increasing MVPA in children with low activity levels is associated with lower asthma risk; children reporting high levels of activity may experience greater asthma risk as their activity levels increase further. Understanding the role of PA in the development of asthma and assessing MVPA during routine care visits in children may help to develop targeted interventions and guide asthma management.

New Technologies for Promoting Physical Activity in Healthy Children and in Children with Chronic Respiratory Diseases: A Narrative Review

Physical activity (PA) is proven to benefit children and adolescents in several ways. New technologies may provide children with stimulating modalities for organizing their leisure time, accessing fitness programs, and obtaining daily goal reminders and peer support. Due to the current COVID-19 pandemic, following WHO recommendations for PA is difficult for many children, especially for those living in urban areas. Therefore, the use of digital tools to support and maintain PA could be useful in healthy children, as well as in those with chronic respiratory diseases (CRDs). This narrative review aims to summarize the most recent evidence about the role of new technologies in promoting PA in healthy children and in those with CRDs, in supporting PA during the COVID-19 pandemic, and in enhancing psychological wellbeing in this age group. The use of technological devices for promoting PA, such as web/mobile apps and games, has been proven to be effective both in healthy children and in those with CRDs. In conclusion, new technologies are very promising in terms of feasibility, acceptability, and efficacy in promoting PA. Further studies are required to evaluate the long-term health benefits of using these technologies.

Physical activity, lung function, and sleep outcomes in urban children with asthma

OBJECTIVES

To examine (1) whether daily declines in physical activity (PA) level and/or in lung function (FEV1) predict an asthma exacerbation in a sample of urban children with asthma, and (2) the association between number of sleep awakenings and decline in daytime PA in this group.

METHODS

In this sample of urban children aged 7-9 years with persistent asthma (N = 147), objective methods assessing lung function via a handheld spirometer and moderate-to-vigorous physical activity (MVPA) via accelerometry were measured over a 4-week period during the fall and early winter of each year as part of a larger 5-year study.

RESULTS

In the entire sample, a significant association between PA and lung function was noted such that a greater decline in daily MVPA was associated with lower odds of exacerbation. Ethnic group differences showed that this association was also significant only among Latino children (odds ratio [OR] = 0.98; 95% confidence interval [CI]:0.97-0.99). A greater number of sleep awakenings were associated with greater declines in daily MVPA among Latinos only (p = .05).

CONCLUSIONS

Results suggest that declining MVPA may contribute to lower risk for an exacerbation. Reasons for declining MVPA need to be further explored in this group. Children with asthma may avoid or be fearful of engaging in PA or may face early symptoms which influence patterns of PA, and this may minimize risk for an exacerbation. Results also suggest reasons for night-time disruptions may need to be targeted in further research or interventions as they can contribute to PA avoidance in this high-risk group.

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.

Developing and validating a school-based screening tool of Fundamental Movement Skills (FUNMOVES) using Rasch analysis

BACKGROUND

A large proportion of children are not able to perform age-appropriate fundamental movement skills (FMS). Thus, it is important to assess FMS so that children needing additional support can be identified in a timely fashion. There is great potential for universal screening of FMS in schools, but research has established that current assessment tools are not fit for purpose.

OBJECTIVE

To develop and validate the psychometric properties of a FMS assessment tool designed specifically to meet the demands of universal screening in schools.

METHODS

A working group consisting of academics from developmental psychology, public health and behavioural epidemiology developed an assessment tool (FUNMOVES) based on theory and prior evidence. Over three studies, 814 children aged 4 to 11 years were assessed in school using FUNMOVES. Rasch analysis was used to evaluate structural validity and modifications were then made to FUNMOVES activities after each study based on Rasch results and implementation fidelity.

RESULTS

The initial Rasch analysis found numerous psychometric problems including multidimensionality, disordered thresholds, local dependency, and misfitting items. Study 2 showed a unidimensional measure, with acceptable internal consistency and no local dependency, but that did not fit the Rasch model. Performance on a jumping task was misfitting, and there were issues with disordered thresholds (for jumping, hopping and balance tasks). Study 3 revealed a unidimensional assessment tool with good fit to the Rasch model, and no further issues, once jumping and hopping scoring were modified.

IMPLICATIONS

The finalised version of FUNMOVES (after three iterations) meets standards for accurate measurement, is free and able to assess a whole class in under an hour using resources available in schools. Thus FUNMOVES has the potential to allow schools to efficiently screen FMS to ensure that targeted support can be provided and disability barriers removed.

Effect of 8 Weeks of Incremental Aerobic Training on Inflammatory Mediators, Cardiorespiratory Indices, and Functional Capacity in Obese Children With Bronchial Asthma

PURPOSE

To appraise the effects of incremental aerobic training (IAT) on systemic inflammatory mediators, cardiorespiratory indices, and functional capacity in obese children with bronchial asthma.

METHODS

This study included 30 children with asthma (age = 8-16 y) allocated randomly into either the control group (n = 15; received the traditional pulmonary rehabilitation program) or IAT group (n = 15; engaged in 8 weeks of IAT in addition to the traditional pulmonary rehabilitation program). The systemic inflammatory mediators (high-sensitivity C-reactive protein and interleukin-6), cardiorespiratory indices (peak oxygen uptake, minute ventilation, maximum heart rate, heart rate recovery at 1 min after exercises, and oxygen pulse), and functional capacity (represented by 6-min walk test) were analyzed pretreatment and posttreatment.

RESULTS

A significant reduction in the level of high-sensitivity C-reactive protein and interleukin-6 and increase in peak oxygen uptake, minute ventilation, maximum heart rate, and heart rate recovery at 1 minute after exercises was observed among the IAT group as compared with the control group. In addition, the IAT group covered a longer distance in the 6-minute walk test than the control group, suggesting favorable functional capacity.

CONCLUSION

The study results imply that IAT has the potential to improve the inflammatory profile, cardiorespiratory fitness, and functional capacity of obese children with bronchial asthma.

Asthma and Physical Activity in Urban Children

OBJECTIVES 

Asthma and obesity disproportionately affect urban minority children. Avoidance of physical activity contributes to obesity, and urban children with asthma are at risk for lower levels of physical activity. We examined associations between lung function and moderate to vigorous physical activity (MVPA) and moderators of this association in a diverse sample of children with asthma.

METHODS 

Urban children (N = 142) ages 7-9 with persistent asthma and their caregivers completed a study of asthma and physical activity. Longitudinal mixed effects models examining daily-level asthma and physical activity evaluated the association between asthma and MVPA, and the moderating effect of weight, and cultural/contextual factors on this association.

RESULTS 

Average daily MVPA was below recommended guidelines. Differences in MVPA were found by racial/ethnic group (p = .04) and weight (p = .001). Poorer asthma status was associated with lower MVPA in Latino and Black participants (p's < .05), and in normal weight youth (p = .01). Body mass index (BMI) moderated the association between asthma and MVPA. Those with lower BMI had more optimal asthma status and higher MVPA levels, whereas associations attenuated for participants with higher BMI (p = .04). Caregivers' perceptions of neighborhood safety and fear of asthma were marginally associated with children's symptoms and MVPA: as perceptions of safety decreased and fear increased, associations between asthma and MVPA weakened (p's = .09 and .07, respectively).

CONCLUSIONS 

Suboptimal asthma status is associated with less MVPA in urban children. Weight status and cultural/contextual factors play a role in the association and are worthy targets for future research and intervention.

The Role of Nutritional Factors in Asthma: Challenges and Opportunities for Epidemiological Research

The prevalence of asthma has nearly doubled over the last decades. Twentieth century changes in environmental and lifestyle factors, including changes in dietary habits, physical activity and the obesity epidemic, have been suggested to play a role in the increase of asthma prevalence and uncontrolled asthma worldwide. A large body of evidence has suggested that obesity is a likely risk factor for asthma, but mechanisms are still unclear. Regarding diet and physical activity, the literature remains inconclusive. Although the investigation of nutritional factors as a whole (i.e., the “diet, physical activity and body composition” triad) is highly relevant in terms of understanding underlying mechanisms, as well as designing effective public health interventions, their combined effects across the life course has not received a lot of attention. In this review, we discuss the state of the art regarding the role of nutritional factors in asthma, for each window of exposure. We focus on the methodological and conceptual challenges encountered in the investigation of the complex time-dependent interrelations between nutritional factors and asthma and its control, and their interaction with other determinants of asthma. Lastly, we provide guidance on how to address these challenges, as well as suggestions for future research.

Physical Activity in Children and Adolescents With Chronic Respiratory Diseases: A Systematic Review and Meta-Analysis

BACKGROUND

The literature is unclear as to whether children and adolescents with chronic respiratory diseases (CRDs) differ from their healthy peers in physical activity (PA).

OBJECTIVE

To determine the PA levels measured through accelerometers in children and adolescents with CRDs.

METHODS

The authors conducted a systematic review using five databases. The authors included studies that assessed the PA measured by accelerometers in children and adolescents with CRDs. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence.

RESULTS

From 11,497 reports returned by the initial search, 29 articles reporting on 4381 patients were included. In the sensitivity analysis, the authors found that children and adolescents with CRDs had a moderate-to-vigorous PA (MVPA) of -0.08 hours per day (95% confidence interval [CI], -0.12 to -0.03 h/d; P = .001), which was lower than the healthy controls; the values for sedentary time (mean difference -0.47 h/d; 95% CI, -1.29 to 0.36 h/d; P = .27) and steps/d (mean difference 361 steps/d; 95% CI -385 to 1707 steps/d; P = .45) were similar for both.

CONCLUSION

Children and adolescents with CRDs have a slight reduction in MVPA in comparison with healthy controls, but sedentary time and steps/d were similar for both.

Diagnosis in children with exercise-induced respiratory symptoms: A multi-center study

OBJECTIVE

Exercise-induced respiratory symptoms (EIS) are common in childhood and reflect different diseases that can be difficult to diagnose. In children referred to respiratory outpatient clinics for EIS, we compared the diagnosis proposed by the primary care physician with the final diagnosis from the outpatient clinic and described diagnostic tests and treatments.

DESIGN

An observational study of respiratory outpatients aged 0-16 years nested in the Swiss Paediatric Airway Cohort (SPAC).

PATIENTS

We included children with EIS as the main reason for referral. Information about diagnostic investigations, final diagnosis, and treatment prescribed came from outpatient records. We included 214 children (mean age 12 years, range 2-17, 54% males) referred for EIS.

RESULTS

The final diagnosis was asthma in 115 (54%), extrathoracic dysfunctional breathing (DB) in 35 (16%), thoracic DB in 22 (10%), asthma plus DB in 23 (11%), insufficient fitness in 10 (5%), chronic cough in 6 (3%), and other diagnoses in 3 (1%). Final diagnosis differed from referral diagnosis in 115 (54%, 95%-CI 46%-60%). Spirometry, body plethysmography, and exhaled nitric oxide were performed in almost all, exercise-challenge tests in a third, and laryngoscopy in none. 91% of the children with a final diagnosis of asthma were prescribed inhaled medication and 50% of children with DB were referred to physiotherapy.

CONCLUSIONS

Diagnosis given at the outpatient clinic often differed from the diagnosis proposed by the referring physician. Diagnostic evaluations, management, and follow-up differed between clinics and diagnostic groups highlighting the need for evidence-based diagnostic guidelines and harmonized procedures for children seen for EIS.

Effect of age on exercise-induced bronchoconstriction in children and adolescents with asthma

OBJECTIVE

The relationship between exercise-induced bronchoconstriction (EIB) and exertional dyspnea in children and adolescents is yet to be fully established. This study examined whether indicators of fractional exhaled nitric oxide (FeNO), forced expiratory volume in 1 s (FEV₁) percent predicted at baseline, and dyspnea are useful for predicting children and adolescents with EIB.

METHODS

We enrolled 184 children and adolescents diagnosed with asthma (mean age 11.2 years); participants were divided into two groups according to age (12 years) and were subjected to a 6-min exercise challenge test. Lung function tests and modified Borg scale scores were used to examine perceptions of dyspnea at 0, 5 and 15 min after exercise.

RESULTS

Among children, the maximum percentage drop in FEV₁ after exercise correlated significantly with FeNO (adjusted β = 2.3, P < 0.001) and with the perception of dyspnea at 5 min after exercise (adjusted β = 1.9, P < 0.001). Among adolescents, the maximum percentage drop in FEV₁ correlated with FeNO (adjusted β = 2.7, P = 0.007) and with lung function (FEV₁, percent predicted; adjusted β = -0.28, P = 0.006). Children with EIB had significantly stronger dyspnea after exercise than did children without EIB. Adolescents even without EIB may experience more exertional dyspnea than children without EIB.

CONCLUSIONS

Overall, our findings indicated that EIB was associated with FeNO and exertional dyspnea in asthmatic children. By contrast, EIB was associated with FEV₁ percent predicted at baseline and FeNO but not with exertional dyspnea in asthmatic adolescents.

PEDIATRIC ASTHMA: IMPACT OF THE DISEASE IN CHILDREN RECEIVING OUTPATIENT TREATMENT IN SOUTHERN BRAZIL

OBJECTIVE

To evaluate the impact of pediatric asthma on patients of a specialized outpatient clinic in Southern Brazil.

METHODS

The study included children aged 8 to 17 years old with asthma diagnosis (mild, moderate and severe) under treatment at the asthma clinic of Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil. Measurements of spirometry, quality of life, disease control and atopy tests were applied.

RESULTS

A total of 66 children were included in the study and divided into groups, according to the severity of the disease: mild, moderate or severe asthma. The results showed similarities in both the treatment and the impact of asthma between groups, except for adherence to treatment: the group with mild asthma showed least adherence to treatment, and the group with severe asthma, greater adherence (p=0.011). As to school absenteeism, the group with severe asthma showed higher frequency (p=0.012), with over 10 days per year (p=0.043). Spirometry showed lower volume/capacity for the group with moderate asthma, followed by the groups with severe and mild asthma. All groups had a high prevalence of allergic asthma, with mites as the main allergens. For quality of life (QOL), and health-related quality of life (HRQOL) levels, there were no differences between groups. In addition, the values were close to the acceptable levels for the total score and for each one of the six domains. The same occurred for the HRQOL-asthma module.

CONCLUSIONS

QOL and HRQOL present acceptable levels regardless of the severity of the disease.

Improving Asthma Conditions for Children and Adolescents by Expanding the Statewide Learning Collaborative Model Through Health Homes

BACKGROUND AND OBJECTIVES

Asthma is one of the most common diseases among children in the United States. Increasing provider adherence to national asthma guidelines and connecting patients to Health Homes can increase optimal asthma care. The objectives of this article are to report the results of an asthma learning collaborative and explore the role of Health Homes in contributing to its success.

METHODS

Quantitative and qualitative data were collected regarding the experiences of 14 pediatric primary care practices and 6 Health Homes participating in a 9-month learning collaborative.

RESULTS

Practices exceeded process aims of 80% compliance with optimal asthma care and the use of an Asthma Action Plan among patients aged 2 to 21 years. Health Home care coordinators also reported improvements in self-management strategies for asthma conditions, including the presence of an Asthma Action Plan, medications, spacers, and proper spacing techniques. Providers and Health Home care coordinators identified role clarity, mitigation of environmental triggers, and management of asthma conditions as benefits of the experience.

CONCLUSIONS

The results of this asthma learning collaborative increased provider adherence to national guidelines and significantly improved optimal asthma care for patients. This multipronged, holistic approach to asthma care proved successful for controlling and maintaining asthma conditions among patients.

Physical activity and asthma development in childhood: Prospective birth cohort study

BACKGROUND

Sedentary behavior and decreased physical activity are possible risk factors for developing asthma. This longitudinal study investigates the association between physical activity and subsequent asthma. We hypothesize that children with decreased physical activity at early school age, have higher risk of developing asthma.

METHODS

One thousand eight hundred thirty-eight children from the KOALA Birth Cohort Study were analyzed. Children who were born prematurely or with congenital defects/diseases with possible influence on either physical activity or respiratory symptoms were excluded. Physical activity, sedentary behavior, and screen time were measured at age 4 to 5 years by questionnaire and accelerometry in a subgroup (n = 301). Primary outcome was asthma, assessed by repeated ISAAC questionnaires between age 6 and 10. Secondary outcome was lung function measured by spirometry in a subgroup (n = 485, accelerometry subgroup n = 62) (forced expiratory volume in 1 second [FEV1], forced vital capacity [FVC] and FEV1/FVC ratio) at age 6 to 7 years.

RESULTS

Reported physical activity was not associated with reported asthma nor lung function. Accelerometry data showed that daily being 1 hour less physically active was associated with a lower FEV1/FVC (z score β, -0.65; 95% confidence interval, -1.06 to -0.24).

CONCLUSIONS

Physical activity at early school age was not associated with reported asthma development later in life. However, lung function results showed that sedentary activity time was associated with lower FEV1/FVC later in childhood. As this is the first longitudinal study with objectively measured physical activity and lung function, and because the subgroup sample size was small, this result needs replication.

Exercise and Asthma

Asthma is a chronic lower respiratory disease that is very common worldwide, and its incidence is increasing year by year. Since the 1970s, asthma has become widespread, with approximately 300 million people affected worldwide and about 250,000 people have lost their lives. Asthma seriously affects people's physical and mental health, resulting in reduced learning efficiency, limited physical activities, and decreased quality of life. Therefore, raising awareness of the risk of asthma and how to effectively treat asthma have become important targets for the prevention and management of asthma in recent years. For patients with asthma, exercise training is a widely accepted adjunct to drug-based and non-pharmacological treatment. It has been recommended abroad that exercise prescriptions are an important part of asthma management.

Asthma control and management among schoolchildren in urban Uganda: results from a cross-sectional study

Background: Children from low- and middle-income countries have poor asthma control, mainly because of poor management. The extent of this problem in Uganda is not well known, but such information would be useful to guide policy and practice. We therefore conducted a cross-sectional study among schoolchildren with asthma in urban Uganda, to assess the level of asthma control and management.

Methods: Schoolchildren aged 5-17 years were enrolled, asthma was diagnosed by the study medical team. Asthma control was assessed using the Asthma Control Test and the childhood Asthma Control Test. Data on previous asthma management was obtained using interviewer-led questionnaires. Data were analysed using multiple linear and multiple logistic regression.

Results: We enrolled 561 children with asthma, of whom only 56% had ever had an asthma diagnosis. We categorised asthma as well-controlled (55.5%), partly-controlled (29.5%) and poorly-controlled (15.0%). Poor asthma control was associated with increasing age (adjusted regression coefficient [95% confidence interval], p-value: -1.07 [-1.20, -0.94], p<0.0001), concurrent allergic rhinitis (-1.33 [-2.28, -0.38], p=0.006), and city residence in early life (-1.99 [-3.69, -0.29], p=0.06). Regular use of inhaled asthma medication in the last 12 months was very low; 18.1% for salbutamol and 6.7% for inhaled corticosteroids. The main barriers to inhaled asthma medication use were lack of prescription (47.6%) and inaccurate diagnosis (38.8%). Increased inhaler use was associated with tertiary education of the fathers (adjusted odds ratio [95% confidence interval], p-value: 5.19 [2.39-11.28], p<0.0001), city residence in early life (4.66 [1.79-12.43], 0.002) and an asthma diagnosis prior to enrolment (11.39 [6.35-20.43], p<0.0001).

Conclusions: This study confirms that children with asthma in Uganda generally have inadequate asthma control, which is attributable to poor asthma management. This could be improved through re-training of medical workers and patient education, and by increasing availability and affordability of essential asthma medications.

Does physical activity strengthen lungs and protect against asthma in childhood? A systematic review

BACKGROUND

Physical activity may be a potentially modifiable risk factor for asthma and driver of lung function development. This systematic review aimed to summarize the available evidence concerning the longitudinal effect of physical activity on the development of asthma, the persistence of asthma symptoms and lung function outcomes in children and adolescents.

METHODS

PubMed and Embase electronic databases were searched for all original articles that investigated the longitudinal association between physical activity and asthma outcomes or lung function outcomes in children and adolescents. The search and data extraction were conducted by two independent researchers. The methodological quality of the included studies was assessed using two critical assessment tools.

RESULTS

The literature search retrieved 2298 publications from the electronic databases. All articles were screened, and 2289 were subsequently excluded, resulting in nine longitudinal studies eligible for inclusion in this review. Two studies found no association with incident wheeze, and two of four found no association with various asthma outcomes. Three studies investigated the effect on lung function: one observed an association in boys only, one observed an association in girls only, and one found no associations.

CONCLUSION

The evidence was highly inconsistent for the relationship between physical activity and asthma and lung function outcomes. Hence, we conclude that there is insufficient evidence to suggest that physical activity has a long-term effect on the risk of asthma development in youth. Furthermore, there is insufficient evidence to determine the longitudinal effects of physical activity on lung function in children.

Asthma, exercise and metabolic dysregulation in paediatrics

Asthma is the most frequent chronic disease in childhood. Chest tightness, cough, wheezing and dyspnoea during or after exercise may be unique manifestations of asthma in up to 90% of subjects. Physical activity may be reduced by uncontrolled asthma symptoms and parental beliefs, impairing physical fitness of asthmatic children. Clinicians working in the field of allergy are aware of evidence supporting the benefits of physical activity for patients with asthma. Treatment of asthma is required in order to obtain its control and to avoid any limitation in sports and active play participation. As exercise performance in children with controlled asthma is not different from that of healthy controls, any exercise limitation cannot be accepted. Overweight and obesity may interfere with asthma and exercise, leading to dyspnoea symptoms. Evidences on the effect of insulin resistance on airway smooth muscle and on bronchial hyperactivity are presented. CONCLUSION: Exercise is part of the strategy to obtain the best control of asthma in childhood, but we have to optimise the asthma control therapy before starting exercise programming. Furthermore, it is crucial to give best attention on the effects of obesity and insulin resistance, because they could in turn influence patients' symptoms.

Effects of physical therapy on lung function in children with asthma: Study protocol for a systematic review and meta-analysis

BACKGROUND

Morbidity of asthma in children is increasing, which is significantly affecting children's life quality. Despite the medication therapy, physical therapies, including breathing exercises, inspiratory muscle training and physical training, are widely used to improve children's condition. However, the effectiveness of physical therapy remains unclear. This systematic review and meta-analysis is aiming to evaluate the effects of physical therapy on lung function in children with asthma and to assess which physical therapy is more effective.

METHODS

Three main databases (PubMed, Embase, and the Cochrane Library) will be searched from inception to November 30, 2018 for randomized controlled trials investigating the effects of physical therapy on lung function in children (age < 18 years old) with asthma published in English. In addition, a manual search of the references of relevant published studies in English will also be considered.Two independent reviewers will conduct studies selection, data extraction, and risk of bias assessment. Outcome measures will be the Peak Expiratory Flow (PEF), the Forced Expiratory Volume in the first second (FEV1), and the Forced Vital Capacity (FVC). Subgroup analyses will be performed according to the physical therapy (breathing exercises, inspiratory muscle training, and physical training) and the outcome (PEF, FEV1, FVC).

RESULTS

The results will provide useful information about the effect of physical therapy on lung function in children with asthma and demonstrate which physical therapy is more effective.

CONCLUSION

The findings of this study will be published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42019121627.

Association between asthma, obesity, and health behaviors in African American youth

Background: There is a clear relationship between obesity and asthma, with obesity recognized as a risk factor for asthma. There is mounting evidence, however, that asthma may predict obesity risk via behavioral pathways. Objectives: The purpose of this study was to assess the cross-sectional relationships between asthma, body mass index (BMI) percentile, and behavioral factors including caloric intake, dietary inflammatory index, moderate-vigorous physical activity (MVPA), and sedentary time (SED) among African American adolescents. Methods: A community-based sample of 195 African American youth (ages 11-18 years) were included in this analysis. Asthma status was based on self-report using the International Study of Asthma and Allergies in Children's Phase Three questionnaire. MVPA and SED were measured via accelerometry, and caloric intake and dietary inflammatory index were evaluated with the Food Frequency Questionnaire. Weight status was assessed via BMI percentile using measured weight, height, and CDC growth charts. Results: Adolescents with a history of asthma were significantly more overweight (62% vs. 43%, p = 0.04) and consumed a higher inflammatory diet (1.6 ± 0.3 vs. 1.0 ± 0.2, p = 0.02) than their peers who never had asthma. After adjusting for all covariates, activity and dietary variables, odds ratio analysis revealed adolescents who reported ever having asthma were 3.1 ± 1.5 times as likely to be overweight or obese than adolescents with no asthma history (p = 0.02). Conclusions: Presence of asthma history was associated with increased obesity risk in African American adolescents, independent of behavioral factors. Longitudinal studies are needed to better understand the relationship between asthma and obesity in African American adolescents.

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.

Asthma and youth soccer: an investigation into the level of asthma awareness and training among youth soccer coaches

Purpose

Asthma is the most common chronic disease among children. Exercise-induced bronchoconstriction which is common in asthmatic patients also occurs in individuals with no prior asthma diagnosis. Despite this and the fact that soccer is a high ventilation sport, there are no validated asthma management protocols in place for soccer coaches. This study aims to address 1) soccer coaches’ current knowledge on asthma, 2) whether there is a need for asthma-related training, and 3) any barriers to administration of such training.

Patients and methods

A total of 2,300 volunteer youth soccer coaches from the Edmonton Minor Soccer Association (EMSA) were invited to participate in completing a 22-question online survey. The survey was open for 1 month from June 8, 2018, to July 8, 2018.

Results

There was a response rate of 22% (513 of 2,300). Respondents were on average, inexperienced coaches, coached younger age groups, and approximately one-third of respondents had personal experience with asthma (either themselves or their child had asthma). 93% of respondents had not received any asthma-related training at any coaching level, whether it be from EMSA or the Alberta Soccer Association. Coaches had strong knowledge on how to treat asthma attacks, but mixed levels of knowledge on asthma attack prevention. Experienced coaches were better at identifying the number of players with asthma on their team and the number of asthma-related incidents they had encountered as coaches. Coaches demonstrated a receptive attitude toward receiving asthma-related training, with 91% of respondents saying training would be beneficial and 69% of respondents saying training should be mandatory.

Conclusion

The results of this study indicate that soccer coaches have limited knowledge regarding asthma management, acknowledge a need for asthma-related training, and are willing to participate in and could benefit from educational interventions as it pertains to their roles as coaches.

Sex-Specific Association between Childhood BMI Trajectories and Asthma Phenotypes

BACKGROUND

Asthma and obesity are two common health problems in the pediatric population. Obesity is associated with several comorbidities which are of great consequence. Excess adipose tissue has been linked to asthma in a number of studies. However, little is known about childhood body mass index (BMI) trajectories and the development of asthma phenotypes.

OBJECTIVE

The current study aims to investigate the significance of BMI trajectories over childhood and the risk of asthma phenotypes.

METHODS

The current study is a prospective cohort of children aged 0-2 years who were followed every two years for eight years through cycles one to five in the National Longitudinal Survey of Children and Youths (NLSCY). Statistical analysis: a latent class growth modelling (LCGM) method was used to identify BMI trajectory patterns from cycles one to five. Multiple imputation (number of imputations=5) was carried out to impute children with missing values on height or weight information. Sampling weights and 1,000 bootstrap weights were used in SAS PROC SURVEYLOGISTIC to examine the association between BMI trajectory and asthma phenotypes (persistent or transient asthma) in a multivariate analysis.

RESULTS

The study consisted of 571,790 males and 549,230 females. Among them, 46% of children showed an increasing trajectory in terms of change in BMI percentile during childhood, followed by the stable-trajectory group (41%) and decreasing-trajectory group (13%). After controlling for confounding factors, females in the increasing BMI trajectory group were four times more likely to be associated with persistent asthma (OR = 4.09; 95% CI:1.04-16.15; p = 0.0442) than females in the stable BMI trajectory group. No such relationship was found in males. The BMI trajectory was not significantly associated with risk of transient asthma for either sex.

CONCLUSION

We report a female-specific association between increasing adiposity, measured by BMI, and persistent asthma.

Environmental risk factors for asthma in 13-14 year old African children

Background Asthma prevalence in African children is high. Factors driving the prevalence or disease severity are poorly understood. This study aims to investigate environmental factors associated with asthma and severity in African children. Methods Population based cross-sectional study of children aged 13-14 years from 10 African centers who participated in ISAAC III. Self-reported environmental exposures included engaging in physical exercise, television watching, various biomass and ETS exposure, consumption of paracetamol, large family sizes and having pets in the home. Univariable and multivariable analyses were done adjusting for center variations. Prevalences, odds ratio and 95% confidence intervals (CI) were calculated. Results There were 258 267 children recruited among the 13-14-year-old participants. Of these, 28,391 respondents from 232 schools completed both the written questionnaire (WQ) and environmental questionnaire (EQ). The prevalence of asthma and severe asthma were 12.8% (CI 12.4-13.2), and 8.7% (CI 8.4-8.0) respectively. Factors strongly associated with asthma were maternal smoking (OR = 1.41; 95%CI: 1.23-1.64), open fire heating (OR = 1.28; 95%CI: 1.08-1.51) electric heating (OR = 1.13; 95%CI: 1.01-1.28), physical exercise (OR = 1.29; 95%CI: 1.11-1.50), monthly paracetamol use (OR 1.23; 95%CI 1.13-1.33), having an elder sibling (OR = 0.87; 95%CI 0.77-0.98). Factors associated with severe asthma were maternal smoking (OR = 1.61; 95%CI: 1.38-1.89), cat pet (OR = 1.14; 95%CI: 1.04-1.25), frequent physical exercise (OR = 1.42; 95%CI: 1.23-1.64) and monthly paracetamol use (OR = 1.20; 95%CI 1.07, 1.34). Conclusion Several environmental exposures were associated with asthma and severe disease.

Causal relationships between adiposity and childhood asthma: bi-directional Mendelian Randomization analysis

BACKGROUND/OBJECTIVES

Obesity and asthma are common chronic diseases and have been reported to be mutually causative. We investigated the causal direction of the relationship between adiposity and asthma using genetic markers as instrumental variables (IVs) in bi-directional Mendelian randomization (MR) analysis.

SUBJECTS/METHODS

We used data from the Taiwan Children Health Study with 24 body mass index (BMI)-single-nucleotide polymorphisms (SNPs, combined into a weighted allelic score) and 16 asthma-SNPs (combined into two weighted allelic scores, separately for asthma inflammatory and antioxidative genes) to yield genetic IVs for adiposity and asthma, respectively.

RESULTS

The weighted allele score for BMI was strongly associated with adiposity (p = 2 × 10^-16) and active asthma (p = 0.03). The two-stage least square regression risk ratio (RR) for the effect of BMI on asthma was 1.04 (95% confidence interval: 1.00-1.07, p = 0.03). Although the weighted asthma genetic scores were significantly associated with asthma (p = 8.4 × 10^-3), no association was seen for genetically instrumented asthma with BMI using MR. Central obesity was the most accurate predictor of asthma. Adiposity showed higher causal effects on asthma in boys and children with non-atopic asthma. Sensitivity analysis for MR revealed no directional genetic pleiotropy effects. The causal effect RRs of BMI on asthma were 1.04, 1.08, and 1.03 for inverse-variance weighted, MR-Egger regression (slope), and weighted median methods, respectively, all in accordance with the MR estimates.

CONCLUSIONS

High adiposity may lead to asthma, whereas the effects of asthma on adiposity accumulation are likely to be small.

Prevalence of asthma among male 16 to 18-year-old adolescents in the Northern Borders Region of Saudi Arabia

Background

Asthma is a common chronic disease in adolescents, and has led to a significant morbidity and disability. Few studies have estimated the prevalence of asthma in the Northern Borders Region of Saudi Arabia. Only limited data has been available about prevalence of asthma in adolescents’ age.

Objectives

The objectives of this study were to assess the prevalence of asthma and associated symptoms in 16 to 18-year-old adolescents, and to assess the level of asthma control among students with physician-diagnosed asthma, in the Northern Borders Region of Saudi Arabia.

Methods

A cross-sectional study was carried out on 511 male 16 to 18-year-old students in the Northern Borders Region of Saudi Arabia during the academic year 2017–2018. An International Study of Asthma and Allergies in Children (ISAAC) questionnaire and Asthma Control Test (ACT) were used as the measurement tool. The data were analyzed by SPSS version 20, using descriptive statistics and Chi-square test. A p-value of 0.05 or less was considered, statistically significant.

Results

Among the 511 students, the prevalence of physician-diagnosed asthma was 11.4%. The prevalence of lifetime wheeze, and exercise-induced wheeze were 30.3% and 19% respectively. The prevalence of night cough and wheezing attack in the past 12 months were 17% and 16.8% respectively. A total of 51.8% of asthmatic students have poor asthma control.

Conclusions

The prevalence of asthma and associated symptoms in 16 to18-year-old students is high in the Northern Borders Region. Uncontrolled asthma was observed in half of asthmatic students.

The impact of modifiable risk factor reduction on childhood asthma development

Childhood asthma is responsible for significant morbidity and health care expenditures in the United States. The incidence of asthma is greatest in early childhood, and the prevalence is projected to continue rising in the absence of prevention and intervention measures. The prevention of asthma will likely require a multifaceted intervention strategy; however, few randomized controlled trials have assessed such approaches. The purpose of this review was to use previous meta-analyses to identify the most impactful risk factors for asthma development and evaluate the effect of risk factor reduction on future childhood asthma prevalence. Common and modifiable risk factors with large effects included acute viral respiratory infections, antibiotic use, birth by cesarean section, nutritional disorders (overweight, obesity), second hand smoke exposure, allergen sensitization, breastfeeding, and sufficient prenatal vitamin D level. Evaluation and estimates of risk factor modification on populations at risk should guide scientists and policymakers toward high impact areas that are apt for additional study and intervention.

Investigating Youth Sport Coach Perspectives of an Asthma Education Module

Physical activity can reduce symptoms and improve wellbeing in people who have asthma, and organized sport is one way for children and youth with asthma to engage in exercise. While asthmatic youth may experience a number of barriers to sport participation, healthy physical and social sport environments supported by coaches can help asthmatic youth athletes maintain long-term engagement in activity. This paper reports results of an assessment of an online coach education tool related to air quality, physical activity, and allergic disease (e.g., asthma). Focus groups with youth team sport coaches in southern Ontario (n = 12 participants) were conducted to explore how users experience the module and short- and medium-term outcomes of implementation. Although coaches perceive the module as relevant, it is considered less valuable in certain contexts (e.g., indoor environments) or when compared with other coach education (e.g., tactical). Although broad asthma management behaviours (e.g., athlete medical forms) were recognized, specific module-identified prevention and management techniques (e.g., the Air Quality Health Index) were less frequently described. Ensuring environment and health coach education emphasizes athlete performance while reducing risk is critical to promoting module application and providing safe and enjoyable youth team sport spaces.

Physical activity and asthma: cause or consequence? A bidirectional longitudinal analysis

BACKGROUND

There is increasing interest in the role physical activity (PA) can play in the development and management of asthma. Understanding whether PA can have a positive effect is hindered by the potential influence of asthma on PA and a lack of relevant longitudinal data, leading to a debate on the existence and direction of these links. The aim of this study was to explore whether having asthma results in lower PA levels, and/or whether lower PA levels lead to more asthma in children and adolescents.

METHODS

In a population-based study of 4983 children, data on asthma and PA were collected via questionnaires and time use diaries biennially, between the ages of 6 and 14. Current asthma was defined as use of asthma medications or wheeze in the past year, and incident asthma was defined as doctor's diagnosis since the previous wave. PA was time spent doing moderate-to-vigorous physical activities in a day. Bidirectionality of this relationship was investigated using cross-lagged structural equational models.

RESULTS

PA was not longitudinally associated with incident or current asthma. Similarly, there was no evidence that incident or current asthma predicted PA at any of the ages.

CONCLUSIONS

Using a novel strategy to investigate bidirectionality between PA and asthma, our results suggest that asthma and PA participation are not longitudinally associated in either direction. Our findings suggest that PA does not play an important role in the development or persistence of asthma.

Effect of the leukotriene receptor antagonist montelukast on orthodontic tooth movement

Asthma is a chronic inflammatory disease, and its prevalence is relatively high among children. Optimal management of asthma often requires long-term pharmacotherapy; however, the effects of these medications on orthodontic treatment is uncertain. We evaluated the effects of the leukotriene LTD₄ receptor antagonist montelukast on orthodontic tooth movement in an animal model. Eight mongrel dogs were given montelukast for periods up to 4 weeks. An orthodontic force of 150-200 g was applied to move the second and fourth premolars toward the site of the extracted third premolar. The distance between premolars was measured at baseline and at weeks 1, 2, and 4. Histological examination with hematoxylin-eosin staining was used to evaluate osteoclast activity. A slight delay in orthodontic movement and decreased osteoclast activity were observed in the montelukast-treated group, as compared with untreated controls. However, the differences were not statistically significant (P > 0.05). Our findings suggest that montelukast use will not interfere with orthodontic treatment of asthma patients. However, these findings require confirmation in clinical studies.

Associations of physical activity with childhood asthma, a population study based on the WHO - health behaviour in school-aged children survey

Background

Asthma in paediatric populations is one of the highest public health concerns. In this study of children and adolescents, we hypothesized that low levels of physical activity (PA) would show associations with asthma that vary by asthma outcome. The objective was to assess whether PA was associated with ever asthma and/or current asthma.

Methods

Analyses were based on 4824 Danish schoolchildren aged 11–15 years old (48.7% boys) participating in the HBSC survey. The study variables were (1) physician-diagnosed asthma (ever asthma) and (2) physician-diagnosed asthma plus wheezing and/or physician or hospital consultation for wheezing (current asthma). Associations with PA by gender were analysed with multivariate logistic regression using the “variance covariance (vce) cluster” method.

Results

The prevalence of ever asthma was 14.3% (boys) and 12.8% (girls), and that of current asthma was 6.8% (boys) and 7.0% (girls). Boys with current asthma showed important differences in low and high PA. We found inverse associations between low PA and ever asthma, odds ratio [95% confidence interval] male: .55 [.30; .99] and female: .47 [.24; .93], and current asthma, male: .27 [.12; .60] (P linear trend = .007) and female: .32 [.11; .94].

Conclusions

The lowest activity levels showed significant inverse associations with asthma, regardless of the definition. For boys, the more stringent (current asthma) of the two paediatric asthma definitions revealed a significant trend with PA, and the direction of associations shifted to positive as weekly PA increased.

Electronic supplementary material

The online version of this article (10.1186/s40733-018-0042-9) contains supplementary material, which is available to authorized users.

Association of self-efficacy of parents/caregivers with childhood asthma control parameters

Objective To verify the association between the self-efficacy of parents/caregivers and control parameters of childhood asthma. Method Cross-sectional study with parents/caregivers of asthmatic children. Data were collected through a sociodemographic questionnaire and the Self-efficacy and their child's level of asthma control scale: Brazilian version. Results Participation of 216 parents/caregivers in the study. There was a statistically significant association between self-efficacy scores and the following variables: unscheduled physician visit (p=0.001), visit to emergency department (p<0.001), hospital stays in the previous 12 months (p=0.005), physical activity limitation (p=0.003), school days missed (p<0.001), impaired sleep (p<0.001), ability to differentiate crisis medication from control medication (p=0.024), use of spacer (p=0.001), performing oral hygiene after use of inhaled corticosteroids (p=0.003), and knowledge of medication gratuity (p=0.004). Conclusion A significant relationship of the self-efficacy of parents/caregivers of asthmatic children with control parameters and training on the necessary skills to reach this control was demonstrated in the study.

Screen Time Engagement Is Increased in Urban Children With Asthma

Physical activity in children has been shown to play a role in its relationship to asthma, both in terms of prevalence and incidence. One measure of physical activity in children is sedentary behavior, which might be measured by the degree of engagement with media electronic screens. We found that children with asthma, as compared with children without asthma, engage in significantly more hours of screen time (median 35 vs 26 h/wk, P = .004). In this birth cohort, those who developed a diagnosis of asthma at 8 years of age were significantly more engaged in electronic screen time than their peers. No other clinical or lifestyle behaviors were significantly associated with a diagnosis of asthma. Further study will be needed to determine directionality of this finding.