OBJECTIVE: To assess the effectiveness of a non-pharmacological intervention in patients with asthma on conventional therapy including inhaled corticosteroid. DESIGN: A randomised controlled trial of the Buteyko technique in a group of adults with asthma. The control group was trained by a physiotherapist in breathing and relaxation techniques. SETTING: A single centre associated with a University-based asthma programme. MAIN OUTCOME MEASURE: Asthma control, defined by a composite score based on the Canadian asthma consensus report 6 months after completion of the intervention. RESULTS: Both groups showed substantial and similar improvement and a high proportion with asthma control 6 months after completion of the intervention. In the Buteyko group the proportion with asthma control increased from 40% to 79% and in the control group from 44% to 72%. In addition the Buteyko group had significantly reduced their inhaled corticosteroid therapy compared with the control group (p=0.02). None of the other differences between the groups at 6 months were significant. CONCLUSIONS: Six months after completion of the interventions, a large majority of subjects in each group displayed control of their asthma with the additional benefit of reduction in inhaled corticosteroid use in the Buteyko group. The Buteyko technique, an established and widely recognised intervention, or an intensive programme delivered by a chest physiotherapist appear to provide additional benefit for adult patients with asthma who are being treated with inhaled corticosteroid.

BACKGROUND:Art therapy has been used to help children cope with chronic illness but has not been specifically tested with children who have asthma.

OBJECTIVE:To test an art therapy intervention in a randomized controlled trial in children with asthma.

METHODS:Twenty-two children with asthma were randomized to an active art therapy or wait-list control group. Those in the active art therapy group participated in 60-minute art therapy sessions once a week for 7 weeks. Sessions included specific art therapy tasks designed to encourage expression, discussion, and problem-solving in response to the emotional burden of chronic illness. Measures taken at baseline, immediately after, and 6 months after the final art therapy session included the Formal Elements Art Therapy Scale applied to the Person Picking an Apple from a Tree assessment, the parent and child versions of the Pediatric Quality of Life Asthma Module, and the Beck Youth Inventories. Those children assigned to the wait-list control group completed all evaluations at the same intervals as the children receiving art therapy but did not receive the art therapy interventions.

RESULTS:Score changes from baseline to completion of art therapy indicated (1) improved problem-solving and affect drawing scores; (2) improved worry, communication, and total quality of life scores; and (3) improved Beck anxiety and self concept scores in the active group relative to the control group. At 6 months, the active group maintained some positive changes relative to the control group including (1) drawing affect scores, (2) the worry and quality of life scores, and (3) the Beck anxiety score. Frequency of asthma exacerbations before and after the 6-month study interval did not differ between the 2 groups.

CONCLUSION:This was the first randomized trial demonstrating that children with asthma receive benefit from art therapy that includes decreased anxiety and increased quality of life.

OBJECTIVE: To observe the effect of acupoint sticking on clinical symptoms and life quality in patients with bronchial asthma. METHODS: Multicenter randomized double-blind clinical trial was done, one hundred and eighty-eight cases were divided into a medication acupoint sticking group (125 cases) and a placebo group (63 cases). Dazhui (GV 14), Feishu (BL 13), Tiantu (CV 22), etc. were selected in both groups. The medication cakes were made of grinding pepper, brassica alba seeds, asarum, etc. into fine powder mixed with ginger oil and ginger juice, applied on acupoints in the acupoint sticking group. While another compound cakes made of powder of red rice, black rice, maize mixed with small amount of ginger juice, were used in the placebo group. Asthma Quality of Life Questionnaire(AQLQ), symptom scores during the day and night, scores of self effect, and the value of lung function were observed. RESULTS: The value of daily behavior and environmental factors of AQLQ, total scores of AQLQ, daytime symptoms and scores of self effect in the medication acupoint sticking group, were significantly improved compared to those of placebo group (all P<0.05). The lung function of forced expiratory volume in one second (FEV1) and the percentage of forced expiratory volume in one second in predicted value (FEV1/FVC) had no significant diffrence between two groups (both P>0.05). CONCLUSION: The acupoint sticking therapy can significantly improve clinical symptoms of patients with bronchial asthma, and can improve life quality of the patients.

OBJECTIVE: To observe the effect of acupoint sticking on clinical symptoms and life quality in patients with bronchial asthma. METHODS: Multicenter randomized double-blind clinical trial was done, one hundred and eighty-eight cases were divided into a medication acupoint sticking group (125 cases) and a placebo group (63 cases). Dazhui (GV 14), Feishu (BL 13), Tiantu (CV 22), etc. were selected in both groups. The medication cakes were made of grinding pepper, brassica alba seeds, asarum, etc. into fine powder mixed with ginger oil and ginger juice, applied on acupoints in the acupoint sticking group. While another compound cakes made of powder of red rice, black rice, maize mixed with small amount of ginger juice, were used in the placebo group. Asthma Quality of Life Questionnaire(AQLQ), symptom scores during the day and night, scores of self effect, and the value of lung function were observed. RESULTS: The value of daily behavior and environmental factors of AQLQ, total scores of AQLQ, daytime symptoms and scores of self effect in the medication acupoint sticking group, were significantly improved compared to those of placebo group (all P<0.05). The lung function of forced expiratory volume in one second (FEV1) and the percentage of forced expiratory volume in one second in predicted value (FEV1/FVC) had no significant diffrence between two groups (both P>0.05). CONCLUSION: The acupoint sticking therapy can significantly improve clinical symptoms of patients with bronchial asthma, and can improve life quality of the patients.

OBJECTIVE:To evaluate the involvement of different CD4T cell subtypes in the anti-asthmatic effects of acupuncture in asthmatic mice.

METHODS:BALB/c mice were challenged by ovalbumin (OVA) for the establishment of experimental asthma model. Mice were divided into 4 groups by a random number table including the normal control, asthma model, acupuncture and sham acupuncture groups (14 per group). Acupoints Dazhui (GV 14), bilateral Fengmen (BL 12) and Feishu (BL 13) were selected for manual acupuncture treatment every other day for 4 weeks and Huantiao (GB 30) was selected for sham acupuncture. Airway hyperresponsiveness was examined by Buxco Pulmonary System. Pulmonary histopathology analysis was performed for inflammatory cell infiltration and mucus hypersecretion by haematoxylin eosin staining and periodic acid-Schiffstaining. Inflammatory mediators assays of serum were investigated by enzyme-linked immunosorbent assay and Bio-Plex. CD4T cell subpopulations including the expression levels of important factors in T lymphocyte polarization in lung tissue were examined by flow cytometric and Western blot analyses. Related pathways were detected by Western blot assay.

RESULTS:Compared with the OVA-induced asthma model group, acupuncture could attenuate airway hyperresponsiveness, inhibit inflammatory cell infiltration and mucus hypersecretion (P<0.05 or P<0.01). Furthermore, acupuncture increased the expressions of T-bet and Foxp3, the cell numbers of CD4interferon gamma (IFN-γ)and CD4Foxp3in lung tissue and the level of Treg type cytokine interleukin (IL)-10 in serum (P<0.05 or P<0.01). Meanwhile, acupuncture reduced the RAR-related orphan receptor gamma t (RORγt) level, the cell numbers of CD4IL-17Aas well as the levels of IL-5, IL-13 and IL-17A in serum (P<0.05 or P<0.01). In addition, both acupuncture and sham acupuncture could inhibit the phosphorylation of p38 and p44/42 (P<0.01).

CONCLUSION:Acupuncture could alleviate allergic airway inflammation by strengthening the activities of Th1 and Treg, thus regulating the balance of CD4T cell subtypes in experimental asthmatic mice.

Aerobic exercise (AE) reduces lung function decline and risk of exacerbations in asthmatic patients. However, the inflammatory lung response involved in exercise during the sensitization remains unclear. Therefore, we evaluated the effects of exercise for 2 weeks in an experimental model of sensitization and single ovalbumin-challenge. Mice were divided into 4 groups: mice non-sensitized and not submitted to exercise (Sedentary, n=10); mice non-sensitized and submitted to exercise (Exercise, n=10); mice sensitized and exposed to ovalbumin (OVA, n=10); and mice sensitized, submitted to exercise and exposed to OVA (OVA+Exercise, n=10). 24 h after the OVA/saline exposure, we counted inflammatory cells from bronchoalveolar fluid (BALF), lung levels of total IgE, IL-4, IL-5, IL-10 and IL-1ra, measurements of OVA-specific IgG1 and IgE, and VEGF and NOS-2 expression via western blotting. AE reduced cell counts from BALF in the OVA group (p<0.05), total IgE, IL-4 and IL-5 lung levels and OVA-specific IgE and IgG1 titers (p<0.05). There was an increase of NOS-2 expression, IL-10 and IL-1ra lung levels in the OVA groups (p<0.05). Our results showed that AE attenuated the acute lung inflammation, suggesting immunomodulatory properties on the sensitization process in the early phases of antigen presentation in asthma.

OBJECTIVES: To study the anti-asthmatic and anti-anaphylactic activities of Blatta orientalis mother tincture (B. orientalis MT), a homeopathic medicine, in experimental animal models. METHODS: The anti-asthmatic activity of B. orientalis MT was studied in the bronchial hyperactivity models, acetylcholine and histamine induced bronchospasm, in guinea pigs. Anti-anaphylactic activity was tested by active and passive anaphylaxis models in rats, anti-eosinophilic activity was tested by milk-induced eosinophilia in mice. RESULTS: Significant protection against acetylcholine and histamine aerosol-induced bronchospasm in B. orientalis MT treated guinea pigs was seen. In active and passive anaphylaxis albino rat models significant reduction in mesenteric mast cells degranulation, serum IgE level and eosinophil cell count was observed in the B. orientalis MT treated rat group when compared with the sensitized control rat group. CONCLUSION: These results reveal broad activity of B. orientalis MT. It may have nonselective anti-asthmatic activity. The anti-anaphylactic activity of B. orientalis MT may be due to mast cell stabilization, suppression of IgE and eosinophil cell count.

BACKGROUND: The effect of breathing techniques on asthma symptoms and disease control is uncertain. AIM: To investigate whether physiotherapist-taught breathing exercises can improve asthma control and reduce the condition's impact on patients' quality of life. METHOD: A randomised controlled trial comparing breathing training with asthma education (control for non-specific effects of healthcare professionals' attention) was carried out. RESULTS: One month after the intervention, both groups showed similar improvements in asthma quality-of-life questionnaire scores but, at six months, there was a significant difference between groups in favour of breathing training. There was also a significant difference in anxiety and depression scores in favour of breathing training at six months. DISCUSSION AND CONCLUSION: This study found that adult patients with asthma who were taught breathing exercises showed improvements in quality of life, symptoms and psychological well-being after six months. Breathing exercises may have a role in helping the many people treated for asthma in general practice who have symptoms despite inhaled treatment.

Objectives:Breastfeeding might be associated with respiratory allergy and asthma subtypes(i.e., allergic asthma), but such relations have never been examined yet in the US. Therefore, the aims of the study were: To examined the association between breastfeeding and respiratory allergy in children aged six years.To examined the association between breastfeeding and asthma including asthma subtypes (allergic) in children aged six yearsOur hypothesis was that exclusively breastfeeding for 3 months would reduce the risk of developing childhood respiratory allergy and allergic asthma.

Methods:A longitudinal study was used, utilizing data from mother-infant pairs that participated in the infant Feeding Practices Study-II(IFPS-II) and the Year-6-Follow-Up Study(Y6FU) in the United-States(US). The data included mother-reported breastfeeding practices in IFPS-II, childhood allergies in Y6FU, and covariates as demographic variables, siblings, wheezing, RSV, history of family allergies, maternal smoking status, and introduction to complementary foods. Multiple logistic regressions were used to examine the study aims.

Results:Overall, 1,177 questionnaires were completed in IFPS-II and Y6FU. Until 3 months, 35.9%(n = 423) of the children were exclusively breastfed, and 24.6%(n = 290) were exclusively formula-fed. Based on mothers' reports, 20.8%(n = 245) of the children had been diagnosed by a physician as having had a respiratory allergy, and 10.2% (n = 120)with asthma, and of these, 105 cases had allergic asthma(8.7%). The results of the multivariable analyses showed that children who were exclusively breastfed for 3 months were significantly less likely by 37% to have respiratory allergy(AOR = 0.63 CI 95%:0.42-0.93) compared with children who were exclusively formula fed for 3 months afteradjusting for associated covariates. There were no significant differences in the odds of having asthma across the different feeding practices. Allergic asthma, however, was significantly associated with exclusive breastfeeding for 3 months (AOR = 0.54 CI 95%:0.30-0.96), after adjusting for associated covariates.

Conclusions:Exclusive breastfeeding for the first 3 months reduce the risk for respiratory allergies and allergic asthma in children.

Funding Sources:There is no funding source to declare.

The worldwide prevalence of childhood asthma has been increasing considerably, and the protection afforded by breastfeeding in its development has been the subject of controversy for more than 80 years. Previous systematic reviews have generally found a protective effect of breastfeeding on allergic outcomes, although many studies have methodological limitations. Although breastfeeding is protective against lower respiratory tract infection during infancy, such protection has not been demonstrated for asthma in all studies. Breastfeeding has health benefits for the mother and child. Exclusive breastfeeding for the first 6 months of an infant's life, with continued breastfeeding for up to 2 years or longer, is recognized as the"gold"standard for infant feeding because human milk is uniquely suited to the human infant, and its nutritional content and bioactivity promote a healthy development. There is increasing concern that the practice of delaying complementary foods until 6 months may exacerbate the risk of allergic disease. Breast milk contains immunological components that protect against infections and allergic disease in infancy. The composition of human breast milk is complex, containing factors that interact with the infant immune system and intestinal milieu including allergens, cytokines, immunoglobulins, polyunsaturated fatty acids, and chemokines. Transforming growth factorβ is a cytokine in human milk involved in maintaining intestinal homeostasis, inflammation regulation, and oral tolerance development. Modern day society, with increased standards of hygiene, has changed the gut flora of Western infants, potentially impacting the risk of developing immune-mediateddiseases including allergic disease and asthma. Microbial diversity is intrinsic to healthy immune maturation and function. Compared to breastfed infants, formula-fed infants had lower bacterial diversity and an altered intestinal microbiota in the first few weeks of life associated with an increased risk of eczema and asthma. Favorable gut colonization through continued breastfeeding may promote tolerance as well as protection when complementary feeding is initiated.

OBJECTIVE:To provide a review of the literature and rate the quality of published studies regarding chiropractic care, including spinal manipulation, for asthmatic patients.

METHODS:A multimodal search strategy was conducted, including multiple database searches, along with reference and journal hand-searching. Studies were limited to those published in English and in peer-reviewed journals or conference proceedings between January 1980 and March 2009. All study designs were considered except personal narratives or reviews. Retrieved articles that met the inclusion criteria were rated for quality by using the Downs and Black checklist. A brief summary was also written for each retrieved study.

RESULTS:Eight articles met the inclusion criteria of this review in the form of one case series, one case study, one survey, two randomized controlled trials (RCTs), one randomized patient and observer blinded cross-over trial, one single blind cross study design, and one self-reported impairment questionnaire. Their quality scores ranged from 5 to 22 out of 27.

CONCLUSION:Results of the eight retrieved studies indicated that chiropractic care showed improvements in subjective measures and, to a lesser degree objective measures, none of which were statistically significant. It is evident that some asthmatic patients may benefit from this treatment approach; however, at this time, the evidence suggests chiropractic care should be used as an adjunct, not a replacement, to traditional medical therapy.

Asthma and atopic dermatitis are common allergic diseases, and their prevalence has increased in urban children. Recently, it is becoming understood that forest environment has favorable health effects in patients with chronic diseases. To investigate favorable clinical and immunologic effects of forest, we examined changes in clinical symptoms, indirect airway inflammatory marker, and serum chemokines before and after a short-term forest trip. The forest trips were performed with 21 children with asthma and 27 children with atopic dermatitis. All participating children were living in air polluted urban inner-city. We measured spirometry and fractional exhaled nitric oxide (FeNO) in children with asthma and measured scoring atopic dermatitis (SCORAD) index and Thymus and Activation-Regulated Chemokine (TARC)/CCL17 and Macrophage-Derived Chemokine (MDC)/CCL22 levels in children with atopic dermatitis before and after the forest trip. Indoor air pollutants such as indoor mold, particulate matter 10 (PM10) and total volatile organic compounds (TVOCs) of each child's home and the accommodations within forest were measured. A significant increase in forced vital capacity (FVC) and a significant decrease in FeNO were observed after the forest trip in children with asthma. SCORAD indices and MDC/CCL22 levels were significantly decreased after the forest trip in children with atopic dermatitis. Airborne mold and PM10 levels in indoor were significantly lower in the forest accommodations than those of children's homes; however, TVOC levels were not different between the two measured sites. Short-term exposure to forest environment may have clinical and immunological effects in children with allergic diseases who were living in the urban community.

Adult asthmatics, ranging from 19 to 52 years from an asthma and allergy clinic in a university setting volunteered to participate in the study. The 17 students were randomly divided into yoga (9 subjects) and nonyoga control (8 subjects) groups. The yoga group was taught a set of breathing and relaxation techniques including breath slowing exercises (pranayama), physical postures (yogasanas), and meditation. Yoga techniques were taught at the university health center, three times a week for 16 weeks. All the subjects in both groups maintained daily symptom and medication diaries, collected A.M. and P.M. peak flow readings, and completed weekly questionnaires. Spirometry was performed on each subject every week. Analysis of the data showed that the subjects in the yoga group reported a significant degree of relaxation, positive attitude, and better yoga exercise tolerance. There was also a tendency toward lesser usage of beta adrenergic inhalers. The pulmonary functions did not vary significantly between yoga and control groups. Yoga techniques seem beneficial as an adjunct to the medical management of asthma.

Adult asthmatics, ranging from 19 to 52 years from an asthma and allergy clinic in a university setting volunteered to participate in the study. The 17 students were randomly divided into yoga (9 subjects) and nonyoga control (8 subjects) groups. The yoga group was taught a set of breathing and relaxation techniques including breath slowing exercises (pranayama), physical postures (yogasanas), and meditation. Yoga techniques were taught at the university health center, three times a week for 16 weeks. All the subjects in both groups maintained daily symptom and medication diaries, collected A.M. and P.M. peak flow readings, and completed weekly questionnaires. Spirometry was performed on each subject every week. Analysis of the data showed that the subjects in the yoga group reported a significant degree of relaxation, positive attitude, and better yoga exercise tolerance. There was also a tendency toward lesser usage of beta adrenergic inhalers. The pulmonary functions did not vary significantly between yoga and control groups. Yoga techniques seem beneficial as an adjunct to the medical management of asthma.

OBJECTIVE: This article discusses the role of diet in the management of asthma. Readers will gain an understanding of how evolution of the western diet has contributed to increased asthma prevalence and how dietary modification that includes management of dietary lipids may reduce symptoms of asthma.

DATA SOURCES: Relevant studies published in English were reviewed.

STUDY SELECTION: Medline search to identify peer-reviewed abstracts and journal articles.

RESULTS: Asthma and obesity, which often occur together, have increased in prevalence in recent years. Studies suggest adaption of a western diet has not only contributed to obesity, but that increased intake of specific nutrients can cause changes in the frequency and severity of asthma. Increased asthma prevalence has also been proposed to arise from increased exposure to diesel particles or lack of exposure to infectious agents or endotoxins during childhood, generating a biased Th2 immune response, and increased cytokine and leukotriene production. Antagonists directed against these pro-inflammatory mediators include anticytokines and antileukotrienes. A reduction in the levels of inflammatory mediators associated with asthma has also been seen with dietary interventions, such as the administration of oils containing gamma-linolenic acid and eicosapentaenoic acid.

CONCLUSIONS: Evidence suggests elevated body mass index and dietary patterns, especially intake of dietary lipids, contribute to symptoms of asthma. Dietary modification may help patients manage their asthma as well as contribute to their overall health.

Many studies have been done to evaluate the effect of various natural products in controlling asthma symptoms. Virgin coconut oil (VCO) is known to contain active compounds that have beneficial effects on human health and diseases. The objective of this study was to evaluate the effect of VCO inhalation on airway remodelling in a rabbit model of allergic asthma. The effects of VCO inhalation on infiltration of airway inflammatory cells, airway structures, goblet cell hyperplasia, and cell proliferation following ovalbumin induction were evaluated. Allergic asthma was induced by a combination of ovalbumin and alum injection and/or followed by ovalbumin inhalation. The effect of VCO inhalation was then evaluated via the rescue or the preventive route. Percentage of inflammatory cells infiltration, thickness of epithelium and mucosa regions, and the numbers of goblet and proliferative cells were reduced in the rescue group but not in preventive group. Analysis using a gas chromatography-mass spectrometry found that lauric acid and capric acid were among the most abundant fatty acids present in the sample. Significant improvement was observed in rescue route in alleviating the asthma symptoms, which indicates the VCO was able to relieve asthma-related symptoms more than preventing the onset of asthma.

BACKGROUND: Previous studies have shown that breathing techniques reduce short acting beta(2) agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non-specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. METHODS: After a 2 week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30 weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12. RESULTS: Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p = 0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p<0.0001) and ICS dose was reduced by 50% (p<0.0001; p>0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes. CONCLUSION: Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non-specific upper body exercises.