(Correcting) misdiagnoses of asthma: a cost effectiveness analysis Benefits and problems of a physical training programme for asthmatic patients. Exercise is associated with improved asthma control in adults Short term effects of aerobic training in the clinical management of moderate to severe asthma in children The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial Physical training does not increase allergic inflammation in asthmatic children A comparison of obese and nonobese people with asthma: exploring an asthma-obesity interaction. Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. High-intensity physical training in adults with asthma. A 10-week rehabilitation program. Exercise training on disease control and quality of life in asthmatic children. Effect of continuing or finishing high-level sports on airway inflammation, bronchial hyperresponsiveness, and asthma: a 5-year prospective follow-up study of 42 highly trained swimmers. Bronchial inflammation in corticosteroid‐sensitive and corticosteroid‐resistant asthma at baseline and on oral corticosteroid treatment Increased level of bronchial responsiveness in inactive children with asthma. Overdiagnosis of asthma in obese and nonobese adults Training Improves Physical Fitness and Decreases CRP Also in Asthmatic Conscripts The relationship between obesity and asthma severity and control in adults. Effects of aerobic training on airway inflammation in asthmatic patients. Physical Activity/Exercise and Type 2 Diabetes Effects of swimming training on aerobic capacity and exercise induced bronchoconstriction in children with bronchial asthma High-intensity physical training in adults with asthma. A comparison between training on land and in water. Effects of Home-Based Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease Effects of exercise training and montelukast in children with mild asthma. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer.
Background The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common . Objective : to determine whether a secondary -screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective . Method R and omly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in , or rule-out , a correct diagnosis of asthma . Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained . Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects . Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars . Results Of 540 r and omly selected patients with physician diagnosed asthma 150 ( 28 % ; 95%CI 19 - 37 % ) did not have asthma when objective ly studied . 71 % of these misdiagnosed patients were on some asthma medications . Incorporating the incremental cost of secondary -screening for the diagnosis of asthma , we found that the average cost savings per 100 individuals screened was $ 35,141 ( 95%CI $ 4,588-$69,278 ) . Conclusion Cost savings primarily result ed from lifetime costs of medication use averted in those who had been misdiagnosed The clinical and physiological effects of a medically supervised , indoor physical training programme were investigated in 36 asthmatic subjects aged 16 - 40 years . After clinical evaluation , lung function assessment , and progressive incremental exercise testing subjects were r and omly allocated to control and training groups . The measurements were repeated after a six week run in period and after a further three months in which those in the training group underwent an indoor training programme . The measurements made at three months were compared with those at the end of the run in period . There was no significant change in anthropometric characteristics , blood lipid profiles , or the provocative concentration of histamine causing a 20 % fall in FEV1 ( histamine PC20 ) in the group who underwent training . After training there were significant increases in mean maximal oxygen uptake ( ml kg-1 min-1 ) from 23 ( 5 ) to 28 ( 6 ) , oxygen pulse ( ml/beat ) from 8.8 ( 2.3 ) to 10.8 ( 2.4 ) , and anaerobic threshold ( 1/min ) from 1.11 ( 0.27 ) to 1.38 ( 0.33 ) . These changes were significantly greater in the group undergoing training than in the control group . There was also a significant fall in breathlessness scores ( Borg ratings ) , blood lactate , carbon dioxide output , and minute ventilation during submaximal exercise in the training group , with no change in the control group . The subject 's motivation , the initial level of fitness , and the symptom score at the time of training were the most important factors influencing improvements in cardiorespiratory fitness . Thus submaximal physical exercise of controlled intensity , sustained for three months , produced significant improvements in fitness and cardiorespiratory performance that should be advantageous to the exercising asthmatic patient . The availability of medical supervision throughout the exercise programme appears to have contributed to the successful outcome Global asthma control levels are suboptimal . The influence of regular exercise on asthma control is unclear . We assessed the effects of a 12-week supervised exercise intervention followed by 12 weeks of self-administered exercise on adults with partially controlled asthma ( n = 21 ) and matched controls ( n = 15 ) . Assessment s were conducted at baseline and week 12 for both the exercise and control group , and again at week 24 for the exercise group . There was a significant treatment effect on asthma control in the exercise group , as measured by the Asthma Control Question naire ( ACQ ) , from baseline to week 12 , compared with the control group . A clinical ly significant improvement ( 0.5 increase in ACQ score ) was observed for asthma quality of life and ACQ in the exercise group from baseline to week 12 . There was a significant improvement in aerobic fitness from baseline to week 24 in the exercise group . In conclusion , a 12-week supervised exercise intervention led to improvements in asthma control and quality of life in partially controlled asthmatics motivated to exercise . These improvements were maintained , while aerobic fitness and perceived asthma control significantly improved over an additional 12 weeks of self-administered exercise . These findings indicate that a structured exercise intervention can improve asthma control BACKGROUND Aerobic training has a number of well known beneficial effects in both normal and asthmatic children . However , the impact of training on the clinical management of the underlying bronchial asthma remains controversial , particularly in the most severe patients . METHODS Clinical evaluation , spirometric tests , symptom limited maximum exercise testing , and exercise challenge tests were performed in a group of children with stable moderate to severe asthma . Forty two patients ( 24 boys ) aged 8–16 were evaluated twice : before and after supervised aerobic training ( group 1 , n = 26 ) and two months apart ( untrained group 2 , n = 16 ) . RESULTS Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 ( p<0.05 ) but medication and clinical scores and the occurrence of exercise induced bronchospasm ( EIB ) did not differ between the two groups . Aerobic improvement with training ( maximal oxygen uptake and /or anaerobic threshold increment > 10 % and 100 ml ) was inversely related to the baseline level of fitness and was independent of disease severity . Although the clinical score and the occurrence of EIB did not change after training , aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids ( p<0.05 ) . CONCLUSIONS Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids , independent of the severity of the disease Background There is a substantial body of evidence on the efficacy of yoga in the management of  bronchial asthma .  Many studies have reported , as the effects of yoga on bronchial asthma , significant improvements in pulmonary functions , quality of life and reduction in airway hyper-reactivity , frequency of attacks and medication use . In addition , a few studies have attempted to underst and the effects of yoga on exercise-induced bronchoconstriction ( EIB ) or exercise tolerance capacity . However , none of these studies has investigated any immunological mechanisms by which yoga improves these variables in bronchial asthma . Methods The present r and omized controlled trial ( RCT ) was conducted on 57 adult subjects with mild or moderate bronchial asthma who were allocated r and omly to either the yoga ( intervention ) group ( n = 29 ) or the wait-listed control group ( n = 28 ) . The control group received only conventional care and the yoga group received an intervention based on yoga , in addition to the conventional care . The intervention consisted of 2-wk supervised training in lifestyle modification and stress management based on yoga followed by closely monitored continuation of the practice s at home for 6-wk . The outcome measures were assessed in both the groups at 0 wk ( baseline ) , 2 , 4 and 8 wk by using Generalized Linear Model ( GLM ) repeated measures followed by post-hoc analysis . Results In the yoga group , there was a steady and progressive improvement in pulmonary function , the change being statistically significant in case of the first second of forced expiratory volume ( FEV1 ) at 8 wk , and peak expiratory flow rate ( PEFR ) at 2 , 4 and 8 wk as compared to the corresponding baseline values . There was a significant reduction in EIB in the yoga group . However , there was no corresponding reduction in the urinary prostagl and in D2 metabolite ( 11β prostagl and in F2α ) levels in response to the exercise challenge . There was also no significant change in serum eosinophilic cationic protein levels during the 8-wk study period in either group . There was a significant improvement in Asthma Quality of Life ( AQOL ) scores in both groups over the 8-wk study period . But the improvement was achieved earlier and was more complete in the yoga group . The number-needed-to-treat worked out to be 1.82 for the total AQOL score . An improvement in total AQOL score was greater than the minimal important difference and the same outcome was achieved for the sub-domains of the AQOL . The frequency of rescue medication use showed a significant decrease over the study period in both the groups . However , the decrease was achieved relatively earlier and was more marked in the yoga group than in the control group . Conclusion The present RCT has demonstrated that adding the mind-body approach of yoga to the predominantly physical approach of conventional care results in measurable improvement in subjective as well as objective outcomes in bronchial asthma . The trial supports the efficacy of yoga in the management of bronchial asthma . However , the preliminary efforts made towards working out the mechanism of action of the intervention have not thrown much light on how yoga works in bronchial asthma . Trial registration Current Controlled Trials IS RCT The effects of a 3-month physical training programme on airway inflammation and clinical outcomes were studied in school-aged children with asthma . Subjects with persistent allergic asthma ( aged 12.7±3.4 yrs ; n = 34 ) were r and omly allocated into training and control groups . Exercise consisted of twice-weekly 50-min sessions for 12 weeks . Inflammation was assessed by levels of exhaled nitric oxide , blood eosinophils , eosinophil cationic protein , C-reactive protein , and total and mite-specific immunoglobulin (Ig)E. Lung volumes and bronchial responsiveness to methacholine were determined . The Paediatric Asthma Quality of Life Question naire and Paediatric Asthma Caregiver 's Quality of Life Question naire were used to evaluate activity restrictions , symptoms and emotional stress . The efficacy of the training was assessed by accelerometry . Following the programme , the exercise group spent twice as much time as the controls undertaking moderate-to-vigorous activities . No differences in changes were seen between groups for asthma outcomes . However , total IgE decreased more in the exercise group , as did mite-specific IgE. Training did not increase inflammation in children with persistent asthma , and may have decreased both total and allergen-specific immunoglobulin E levels . It is concluded that there is no reason to discourage asthmatic children with controlled disease to exercise OBJECTIVE The objectives of our study were to compare patient characteristics and severity of disease in obese and normal-weight-confirmed people with asthma and to explore reasons for misdiagnosis of asthma , including potential interactions with obesity . METHODS We r and omly selected patients with physician-diagnosed asthma from eight Canadian cities . Asthma diagnosis was confirmed via a sequential lung function testing algorithm . Logistic analysis was conducted to compare obese and normal-weight-confirmed people with asthma and to assess characteristics associated with misdiagnosis of asthma . Interaction with obesity was investigated . RESULTS Complete assessment s were obtained on 496 subjects who reported physician-diagnosed asthma ( 242 obese and 254 normal-weight subjects ) ; 346 had asthma confirmed with sequential lung testing , and in 150 subjects a diagnosis of asthma was ruled out . Obese subjects with asthma were significantly more likely to be men , have a history of hypertension and gastroesophageal reflux disease , and have a lower FEV(1 ) compared with normal-weight subjects with asthma . Older subjects , men , and subjects with higher FEV(1 ) were more likely to have received misdiagnoses of asthma . Obesity was not an independent predictor of misdiagnosis , however there was an interaction between obesity and urgent visits for respiratory symptoms . The odds ratio for receiving a misdiagnosis of asthma for obese individuals as compared with normal-weight individuals was 4.08 ( 95 % CI , 1.23 - 13.5 ) for those with urgent visits in the past 12 months . CONCLUSIONS Obese people with asthma have lower lung function and more comorbidities compared with normal-weight people with asthma . Obese individuals who make urgent visits for respiratory symptoms are more likely to receive a misdiagnosis of asthma BACKGROUND In 2010 , the Canadian Thoracic Society ( CTS ) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older , and adults , including an up date d Asthma Management Continuum . The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline up date process , focusing , in this first iteration , on topics of controversy and ⁄or gaps in the previous guidelines . METHODS Four clinical questions were identified as a focus for the up date d guideline : the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy ; the initiation of adjunct therapy to inhaled corticosteroids ( ICS ) for uncontrolled asthma ; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever , and as a reliever and a controller ; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan . The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics . In addition , literature search es were performed to identify relevant systematic review s and r and omized controlled trials . The panel formally assessed and grade d the evidence , and made 34 recommendations . RESULTS The up date d guideline recommendations outline a role for inclusion of assessment of sputum eosinophils , in addition to st and ard measures of asthma control , to guide adjustment of controller therapy in adults with moderate to severe asthma . Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations . New recommendations for the adjustment of controller medication within written action plans are provided . Finally , priority areas for future research were identified . CONCLUSIONS The present clinical practice guideline is the first up date of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee 's new guideline development process . Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide up date s reflecting new evidence Twenty-six adults ( 23 to 58 years ) with mild to moderate asthma underwent a 10-week supervised rehabilitation program , with emphasis on physical training . In the first 2 weeks , they exercised daily in an indoor swimming pool ( 33 degrees C ) and received education about asthma , medication , and principles of physical training . In the following 8 weeks , they exercised in the pool twice a week . Every training session lasted 45 min . The training sessions were made as suitable as possible for the individual subjects , in order to minimize " drop outs " from the program . The aim of the study was to evaluate the efficacy of the rehabilitation program and to determine if inactive asthmatic adults can exercise at high intensity . The rehabilitation program was preceded by a 6-min submaximal cycle ergometry test , a 12-min walking test , spirometry , and a methacholine provocation test . The subjects also responded to a five-item question naire related to anxiety about exercise , breathlessness , and asthma symptoms using a visual analogue scale . All subjects were able to perform physical training at a very high intensity , to 80 to 90 % of their predicted maximal heart rate . No asthmatic attacks occurred in connection with the training sessions . Twenty-two of the 26 subjects completed the rehabilitation program , felt confident with physical training , and planned to continue regular physical training after the 10-week program . Improvements in cardiovascular conditioning , measured as a decreased heart rate at the same load on the cycle ergometer ( average of 12 beats/min ) , and as a longer distance at the 12-min walking test ( average of 111 m ) , were observed during the program . FEV1 increased significantly from 2.2 to 2.5 L. Forced expiratory flow at 25 % of vital capacity also increased slightly but significantly . Methacholine provocation dose causing a fall in FEV1 by 20 % was unchanged . Seventeen subjects had a peak expiratory flow reduction of more than 15 % after the preprogram ergometry test and were classified as having exercise-induced asthma ( EIA ) . Only three of these subjects had EIA after 10 weeks . The asthmatic subjects were less afraid of experiencing breathlessness during exercise and less anxious about exercising at a high intensity after 10 weeks ( p < 0.05 ) . The asthma symptoms abated significantly during the rehabilitation program and the subjects needed less acute asthma care after the rehabilitation program . The results indicate that asthmatic persons benefit from a rehabilitation period , including physical training . Rehabilitation programs are therefore of value as a supplement to conventional pharmacologic treatment of asthma . This rehabilitation program can be adapted for use in clinical practice PURPOSE Aerobic training has been shown to be effective in improving cardiopulmonary fitness in asthmatic children . However , the actual impact of physical training on clinical indicators of disease control remains controversial . METHODS Thirty-eight children with moderate to severe persistent asthma were r and omly assigned to control ( N=17 ) and training ( N=21 ) groups . Spirometry , exercise challenge , and maximum incremental cardiopulmonary exercise tests were performed 16 wk apart . Daily doses of inhaled steroids and Pediatric Asthma Quality of Life Question naire ( PAQLQ ) scores were also recorded . RESULTS Physical training was associated with significant improvements in physiological variables at peak and submaximal exercise ( P<0.05 ) ; in contrast , no significant changes were found in controls . Severity of exercise-induced bronchoconstriction ( EIB ) and postexercise breathlessness were significantly lessened in trained patients ; improvement in fitness and EIB , however , were not linearly related ( P>0.05 ) . In addition , PAQLQ scores improved only in trained children ( P<0.01 ) . Daily doses of inhaled steroids were reduced in trained patients ( 52 % ) , but they remained unchanged or increased in controls ( 70.6 % ) ( P=0.07 ) . CONCLUSION Supervised exercise training might be associated with beneficial effects on disease control and quality of life in asthmatic children . These data suggest an adjunct role of physical conditioning on clinical management of patients with more advanced disease BACKGROUND Mild eosinophilic airway inflammation and bronchial hyperresponsiveness-ie , mild asthma-have been shown to affect a high proportion of endurance athletes . The persistence of airway inflammation , bronchial hyperresponsiveness , and asthma in this population is not known , however , inasmuch as follow-up studies of athletes ' asthma have not been performed . OBJECTIVE The purpose of this study was to investigate effect of finishing high-level sports on airway inflammation , bronchial hyperresponsiveness , and asthma . METHODS Forty-two elite competitive swimmers , most of them from the Finnish national team ( 37/42 ; 88 % ) , were followed for 5 years in a prospect i ve manner . All of the swimmers completed question naires and underwent resting spirometry , histamine challenge testing , and skin prick tests at baseline and at follow-up . Twenty-nine swimmers ( 69 % ) also gave induced sputum sample s on both occasions . Sixteen ( 38 % ) of the swimmers had continued their competitive careers during follow-up ( active swimmers ) , but 26 ( 62 % ) had stopped competing more than 3 months before the follow-up examination ( past swimmers ) . RESULTS Bronchial responsiveness was increased in 7 ( 44 % ) of the 16 active swimmers at baseline and in 8 ( 50 % ) of the 16 active swimmers at follow-up ; it was increased in 8 ( 31 % ) of the 26 past swimmers at baseline and in 3 ( 12 % ) of the 26 past swimmers at follow-up ( McNemar test , P = .025 ) . The difference in the change in bronchial hyperresponsiveness between the study groups was significant ( likelihood ratio test , P = .023 ) . Current asthma ( defined as bronchial hyperresponsiveness and exercise-induced bronchial symptoms monthly ) was observed in 5 ( 31 % ) of the active swimmers at baseline and in 7 ( 44 % ) of the active swimmers at follow-up ; of the past swimmers , it occurred in 6 ( 23 % ) at baseline and in 1 ( 4 % ) at follow-up ( McNemar test , P = .025 ) . The difference in the change in current asthma between the study groups was significant ( likelihood ratio test , P = .0040 ) . The sputum differential cell counts of eosinophils and lymphocytes increased significantly during the follow-up period in the active swimmers ( Wilcoxon signed rank sum test ; P = .033 and P = .0029 , respectively ) ; in the past swimmers , the sputum differential cell counts of eosinophils tended to decrease during the follow-up period ( P = .17 ) , whereas the differential cell counts of lymphocytes did not change significantly . The changes in the sputum differential cell counts of eosinophils between the study groups differed significantly ( Mann-Whitney U test , P = .019 ) . CONCLUSION In swimmers who had stopped high-level training , bronchial hyperresponsiveness and asthma attenuated or even disappeared . Mild eosinophilic airway inflammation was aggravated among highly trained swimmers who remained active during the 5-year follow-up . Our results suggest that athletes ' asthma is partly reversible and that it may develop during and subside after an active sports career Background Pathophysiology of  corticosteroid (CS)‐resistant asthma remains incompletely understood We estimated the association between bronchial responsiveness and hours of exercise per week in children with and without asthma . A r and om sample of school children ( n = 2188 ) , 6 - 16 years old , was enrolled in a cross-sectional study of asthma in Oslo using the ISAAC question naire . Lung function and bronchial responsiveness ( BR ) using methacholine was measured in a r and om sample of 80 children with asthma , wheeze and no asthma/no wheeze . The relation between hours of exercise per week and BR [ log ( DRS ) ] was estimated by linear regression . Sex and age were included as covariates . Hours of exercise were categorized in : none , 30 min , 1 h , 2 - 3 h , 4 - 6 h and 7 h or more . The mean values of log ( DRS ) were different in the low and high exercise groups for children with asthma ( P = 0.02 ) , whereas there was no effect of exercise on BR for children without asthma . BR increased with decreasing hours of exercise per week in children with asthma . The bronchial responsiveness decreased with 0.11 ( 95 % CI -0.20 , -0.01 ) pr unit in scale . This pattern was not present in children without asthma . The results suggest that there is a relation between  hours of exercise per week and bronchial responsiveness in children with asthma Background : It is unclear whether asthma is overdiagnosed in developed countries , particularly among obese individuals , who may be more likely than nonobese people to experience dyspnea . Methods : We conducted a longitudinal study involving nonobese ( body mass index 20–25 ) and obese ( body mass index ≥ 30 ) individuals with asthma that had been diagnosed by a physician . Participants were recruited from 8 Canadian cities by means of r and om-digit dialing . A diagnosis of current asthma was excluded in those who did not have evidence of acute worsening of asthma symptoms , reversible airflow obstruction or bronchial hyperresponsiveness , despite being weaned off asthma medications . We stopped asthma medications in those in whom a diagnosis of asthma was excluded and assessed their clinical outcomes over 6 months . Results : Of 540 individuals with physician-diagnosed asthma who participated in the study , 496 ( 242 obese and 254 nonobese ) could be conclusively assessed for a diagnosis of asthma . Asthma was ultimately excluded in 31.8 % ( 95 % confidence interval [ CI ] 26.3%–37.9 % ) in the obese group and in 28.7 % ( 95 % CI 23.5%–34.6 % ) in the nonobese group . Overdiagnosis of asthma was no more likely to occur among obese individuals than among nonobese individuals ( p = 0.46 ) . Of those in whom asthma was excluded , 65.5 % did not need to take asthma medication or seek health care services because of asthma symptoms during a 6-month follow-up period . Interpretation : About one-third of obese and nonobese individuals with physician-diagnosed asthma did not have asthma when objective ly assessed . This finding suggests that , in developed countries such as Canada , asthma is overdiagnosed To study the respiratory and physical health of young men , 224 asthmatic and 668 non-asthmatic military conscripts were recruited from the intake groups of July 2004 and January 2005 in Kajaani , Finl and . Factors affecting respiratory health were elicited by a question naire at the beginning of the service , and results of high sensitive C-reactive protein ( hsCRP ) determination , peak expiratory flow ( PEF ) , and 12-minute running test were collected at the beginning and the end of the service . Respiratory infections were diagnosed by a study physician . Upon entering military service , asthmatics had frequent exercise- and cold-related asthma symptoms ( 69.6 % and 76.3 % ) , and 48 % of them had no medication for asthma . At the beginning , 25.8 % of asthmatics and 19.1 % of non-asthmatics had a poor result of less than 2,200 m ( p = 0.05 ) in the 12-minute running test , and after 180 to 362 days of service , the corresponding percentages were 11.7 % and 9.7 % ( p = 0.434 ) . The levels of hsCRP , a marker of low- grade systemic inflammation , decreased significantly among both asthmatics , 1.5 ( p = 0.001 ) , and non-asthmatics , 1.6 mg/L ( p < 0.001 ) . Asthmatic men had 0.2 and non-asthmatics 0.1 respiratory infections per month ( p < 0.001 ) . In summary , asthmatic conscripts can enhance their physical fitness by training similarly to non-asthmatic ones . Their levels of hsCRP also decrease BACKGROUND The association of obesity with asthma outcomes is not well understood . OBJECTIVE The objective of this study was to examine the association of obesity , as represented by a body mass index ( BMI ) of greater than 30 kg/m(2 ) , with quality -of-life scores , asthma control problems , and asthma-related hospitalizations . METHODS The study followed a cross-sectional design . Question naires were completed at home by a r and om sample of 1113 members of a large integrated health care organization who were 35 years of age or older with health care use suggestive of active asthma . Outcomes included the mini-Asthma Quality of Life Question naire , the Asthma Therapy Assessment Question naire , and self-reported asthma-related hospitalization . Several other factors known to influence asthma outcomes also were collected : demographics , smoking status , oral corticosteroid use in the past month , evidence of gastroesophageal reflux disease , and inhaled corticosteroid use in the past month . Multiple logistic regression models were used to measure the association of BMI status with outcomes . RESULTS Even after adjusting for demographics , smoking status , oral corticosteroid use , evidence of gastroesophageal reflux disease , and inhaled corticosteroid use , obese adults were more likely than those with normal BMI s ( < 25 kg/m(2 ) ) to report poor asthma-specific quality of life ( odds ratio [ OR ] , 2.8 ; 95 % CI , 1.6 - 4.9 ) , poor asthma control ( OR , 2.7 ; 95 % CI , 1.7 - 4.3 ) , and a history of asthma-related hospitalizations ( OR , 4.6 ; 95 % CI , 1.4 - 14.4 ) . CONCLUSIONS Our findings suggest that obesity is associated with worse asthma outcomes , especially an increased risk of asthma-related hospitalizations PURPOSE there is evidence suggesting that physical activity has anti-inflammatory effects in many chronic diseases ; however , the role of exercise in airway inflammation in asthma is poorly understood . We aim ed to evaluate the effects of an aerobic training program on eosinophil inflammation ( primary aim ) and nitric oxide ( secondary aim ) in patients with moderate or severe persistent asthma . METHODS sixty-eight patients r and omly assigned to either  control  ( CG ) or aerobic training ( TG ) groups were studied during the period between medical consultations . Patients in the CG ( educational program + breathing exercises ; N = 34 ) and TG ( educational program + breathing exercises + aerobic training ; N = 34 ) were examined twice a week during a 3-month period . Before and after the intervention , patients underwent induced sputum , fractional exhaled nitric oxide ( FeNO ) , pulmonary function , and cardiopulmonary exercise testing . Asthma symptom-free days were quantified monthly , and asthma exacerbation was monitored during 3 months of intervention . RESULTS at 3 months , decreases in the total and eosinophil cell counts in induced sputum ( P = 0.004 ) and in the levels of FeNO ( P = 0.009 ) were observed after intervention only in the TG . The number of asthma symptom-free days and VO(2max ) also significantly improved ( P < 0.001 ) , and lower asthma exacerbation occurred in the TG ( P < 0.01 ) . In addition , the TG presented a strong positive relationship between baseline FeNO and eosinophil counts as well as their improvement after training ( r = 0.77 and r = 0.9 , respectively ) . CONCLUSIONS aerobic training reduces sputum eosinophil and FeNO in patients with moderate or severe asthma , and these benefits were more significant in subjects with higher levels of inflammation . These results suggest that aerobic training might be useful as an adjuvant therapy in asthmatic patients under optimized medical treatment For decades , exercise has been considered a cornerstone of diabetes management , along with diet and medication . However , high- quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years . The present document summarizes the most clinical ly relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these . Our recently published technical review on physical activity/exercise and type 2 diabetes ( 1 ) includes greater detail on individual studies , on prevention of diabetes , and on the physiology of exercise . The present statement focuses on type 2 diabetes . Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement . The levels of evidence used are defined by the ADA in ref . 2 . Two r and omized trials each found that lifestyle interventions including ∼150 min/week of physical activity and  diet-induced weight loss of 5–7 % reduced the risk of progression from impaired glucose tolerance ( IGT ) to type 2 diabetes by 58 % ( 3,4 ) . A cluster-r and omized trial found that diet alone , exercise alone , and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes ( 5 ) . Therefore , there is firm and consistent evidence that programs of increased physical activity  and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT . Boule et al. ( 6 ) undertook a systematic review and meta- analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c ( A1C ) and body mass in people with type 2 diabetes . Postintervention A1C was significantly lower in exercise than control groups ( 7.65 vs. 8.31 % , weighted mean difference −0.66 % ; P < 0.001 ) . In contrast , postintervention body weight did not differ between the exercise and control groups . Meta-regression confirmed that the beneficial effect of exercise on A1C BACKGROUND A study was undertaken to determine whether swimming training improved aerobic capacity , exercise induced bronchoconstriction ( EIB ) , and bronchial responsiveness to inhaled histamine in children with asthma . METHODS Eight children with mild or moderate asthma participated in swimming training every day for six weeks . The intensity of training was individually determined and set at 125 % of the child ’s lactate threshold ( LT ) , measured using a swimming ergometer .  Another group of eight asthmatic children served as control subjects .  Aerobic capacity and the degree of EIB were assessed by both cycle ergometer and swimming ergometer before and after swimming training . RESULTS The mean ( SD ) aerobic capacity at LT increased by 0.26 ( 0.11 ) kp after training when assessed with the swimming ergometer and by 10.6 ( 4.5 ) W when assessed with the cycle ergometer , and these changes were significantly different from the control group . The mean ( SD ) maximum % fall in forced expiratory volume in one second ( FEV1 ) to an exercise challenge ( cycle ergometer ) set at 175 % of LT decreased from 38.7 (15.4)% before training to 17.9 (17.6)% after training , but with no significant difference from the control group . There was , however , no difference in histamine responsiveness when compared before and after the training period . CONCLUSION A six week swimming training programme has a beneficial effect on aerobic capacity but not on histamine responsiveness in children with asthma The purpose of this study was to determine whether inactive asthmatic patients could perform high-intensity physical training equally well on l and as in water , and to compare the effects of these training forms . Thirty-two adults with asthma , r and omized into two groups , underwent a 10-week supervised rehabilitation program with emphasis on physical training . All patients , irrespective of training form , were able to exercise to maximal intensity ( 80 - 90 % of estimated maximal heart rate ) . No asthmatic attacks occurred in connection with the training sessions . Respiratory variables remained almost unchanged in both groups . The asthma symptoms declined during the rehabilitation period , and the subjects needed less acute asthma care after the rehabilitation . The cardiovascular condition improved significantly and similarly in the two groups . Ten patients , 5 in each group , had exercise-induced asthma  at the start of the rehabilitation . Only 3 patients , 2 from the water group and 1 from the l and group , had exercise-induced asthma after 10 weeks . We conclude that indoor training , either on l and or in water , is beneficial . The effects of these two training forms are almost equivalent Context Pulmonary rehabilitation programs improve outcomes , but access to outpatient , hospital-based programs is very limited . Contribution In a 10-center , r and omized , noninferiority trial in Canada , investigators r and omly assigned 252 patients to home-based or outpatient , hospital-based exercise training for 8 weeks . At 1 year , the 2 interventions had reduced dyspnea by the same amount , as measured on the dyspnea subscale of the Chronic Respiratory Question naire . The difference between the programs in dyspnea at 1 year was statistically very unlikely to be clinical ly important . Caution The study was unblinded , and its primary outcome was self-reported . Implication Home-based pulmonary rehabilitation is a reasonable alternative to hospital-based programs . The Editors Chronic obstructive pulmonary disease ( COPD ) is a major cause of morbidity and mortality throughout the world . It is currently the fourth leading cause of death , and prevalence is expected to increase ( 1 ) . By focusing on the multiple needs of patients with COPD , pulmonary rehabilitation offers the best chance to address the disability associated with this chronic , progressive disease . This therapeutic approach typically combines exercise training and patient education to achieve the goals of alleviating dyspnea , improving health status , and reducing health care utilization . Despite documented efficacy in a meta- analysis of r and omized trials ( 2 ) and strong recommendations to use it routinely for COPD care ( 3 ) , pulmonary rehabilitation is largely underutilized ( 4 ) . For instance , in 2005 , only an estimated 1 % to 2 % of the Canadian COPD population had access to pulmonary rehabilitation (4)a statistic similar to that reported from other countries ( 5 , 6 ) . We need strategies to increase access to pulmonary rehabilitation . Outpatient , hospital-based programs ( 2 ) are the st and ard against which to compare new forms of pulmonary rehabilitation . The major shortcoming of outpatient , hospital-based pulmonary rehabilitation is limited availability . Self-monitored , home-based rehabilitation is an alternative to outpatient rehabilitation ( 7 , 8) , but only a few small trials have compared it with outpatient , hospital-based rehabilitation ( 9 , 10 ) . We hypothesized that self-monitored , home-based rehabilitation  would be as effective as outpatient , hospital-based rehabilitation for improving dyspnea at 1 year . Our secondary objectives were to compare the effects of home-based rehabilitation on health status and exercise tolerance and to evaluate its safety . Methods Design This study was a parallel-group , r and omized , noninferiority , multicenter clinical trial . Eight university-based centers and 2 community-based centers participated . All but 2 centers had experience in providing pulmonary rehabilitation . All patients first participated in a 4-week , st and ardized , comprehensive , self-management education program delivered by a trained health professional acting as a case manager in collaboration with the treating physician . Then , we r and omly assigned participants either to self-monitored , home-based exercise training or to outpatient , hospital-based exercise training for 8 weeks . After the 12-week intervention , we encouraged patients in both groups to continue exercising at home , and we followed them for 40 weeks to complete the 1-year study . We provided an identical educational intervention to both study groups so that we could compare home-based and outpatient exercise-training interventions . During the maintenance phase ( 3 to 12 months ) , contacts with study personnel were limited to telephone interviews to reinforce the importance of exercise and to ask about adverse events . We assessed patients at baseline ( before the educational program ) , immediately after the exercise program , and at 1 year . Each institutional research ethics board approved the study , and each patient provided informed consent . Patient Selection We recruited patients from the pulmonary clinics of the participating centers . Patients were eligible for participation if they had stable COPD , that is , no change in medication and symptoms ( dyspnea , volume , or color of sputum ) for at least 4 weeks before the study ; were 40 years or older ; were current or former smokers of at least 10 pack-years ( 20 cigarettes per pack ) ; had an FEV1 less than 70 % of the predicted value and FEV1FVC ratio less than 0.70 ; and had a Medical Research Council dyspnea score of at least 2 ( 11 ) . No participants had previously been involved in pulmonary rehabilitation or had lived in a long-term care facility . Everyone understood , read , and wrote French or English . Exclusion criteria included a previous diagnosis of asthma , congestive left heart failure as the primary disease , a terminal disease , dementia , or an uncontrolled psychiatric illness . We sought to study a broad COPD population and did not exclude patients with oxygen dependence or other comorbid conditions . Interventions Educational Program Both study groups received the same educational intervention . The self-management educational program Living Well with COPD consisted of an educational flipchart and 6 skill-oriented , self-help , patient workbook modules . The program was provided in the hospital on an outpatient basis . A health professional gave 8 lectures to small groups of 4 to 8 study participants at a rate of 2 sessions per week for 4 weeks . A qualified exercise trainer presented the exercise module . Another study gives a detailed description of the program and confirms its efficacy ( 12 ) . The program is available at www.livingwellwith copd .com ( password : copd ) .  Outpatient Hospital-Based Exercise Program Exercise training began after the educational program ended . The training program combined aerobic and strength exercises ( 3 ) at a rate of 3 sessions per week for 8 weeks . Briefly , the aerobic training consisted of stationary leg cycling for 25 to 30 minutes in each session . The target training intensity was 80 % of peak work capacity during incremental exercise . Patients used supplemental oxygen  if they had exercise-induced oxygen desaturation during the initial exercise session ( SpO2 < 88 % ) or if they were already receiving home oxygen . The study protocol permitted therapists to adjust the training intensity according to the level of dyspnea and heart rate and in cases of severe dyspnea ( Borg scale score 7 ) , dizziness , or unusually severe chest or leg discomfort . The strength-training exercises lasted 30 minutes , starting with 1 set of 10 repetitions per exercise for a maximum of 3 sets . When the patient reached this goal , we increased resistance through use of elastic b and s , s and bags , and weight against gravity . During training , a qualified exercise specialist closely supervised patients in a ratio of 4 to 5 participants for 1 trainer ( 13 ) . The exercise specialists recorded attendance at the exercise sessions . Home-Based Exercise Program The home program was self-monitored and included aerobic and strength exercises 3 times a week for 8 weeks ( 14 ) . A qualified exercise specialist initiated the program in the patient 's home to ensure full underst and ing . During the 8 weeks , the exercise trainer made weekly telephone calls to reinforce the importance of the exercises and to detect problems . The patients did aerobic training with portable ergocycles with manually adjustable resistance , which we loaned to participants for the 8-week exercise program . The target intensity was 60 % of the maximum work rate achieved during a test of peak exercise capacity for 40 minutes per day , 3 times a week . We instructed patients to reduce intensity in case of severe dyspnea . We recommended a lower training intensity at home than in the outpatient , hospital-based program to ensure participants ' safety , but the sessions were 40 minutes , as opposed to 30 minutes in the outpatient , hospital-based program , to obtain a similar amount of training . The strengthening exercises and use of supplemental oxygen were the same as in the outpatient program . We asked patients to keep a diary of each completed training session . Exercise Maintenance Strategy The maintenance program was identical in both interventions it did not include supervised training sessions . We encouraged patients to buy their own exercise equipment and gave personalized exercise-training recommendations . The case manager contacted patients of both groups every 2 months to reinforce mastery of the intended behavior ( home exercises 3 times per week ) . The case manager was also available to take calls for advice during business hours through a pager or dedicated telephone line . R and omization We r and omly assigned patients to an intervention after they completed the 4-week educational program . Neither research staff nor patients were aware of treatment assignments before patients received them . We used a central ly administered , computer-generated permuted block r and omization scheme using blocks of 2 , stratified according to sex and participating site . We communicated assignments by e-mail to research staff who were not otherwise involved in the trial . The case manager subsequently informed patients of their group allocation . Study personnel were unaware of the permuted block size . Measurements and Outcomes We scheduled evaluation visits at the study center at enrollment ( initial visit ) , 3 months ( immediately after completion of the exercise-training program ) , and 12 months ( end of study ) . Patients in both groups kept a diary to help collect information on medical events . An independent research assistant , unaware of the patient 's group assignment , conducted a st and ardized telephone interview every 4 weeks to identify adverse events . To minimize bias , we asked patients not to discuss their group assignment with the research assistant . Research assistants had no contact with participants other than during the evaluations . Primary Outcome Variable The prespecified primary outcome was the change in the dyspnea domain of the Chronic PURPOSE Data from the general population suggest that habitual exercise decreases bronchial responsiveness , but the possible role of exercise in asthmatics is undefined . The leukotriene receptor antagonist montelukast decreases bronchial responsiveness and exercise-induced symptoms in asthmatic children . This r and omized study in children with mild asthma evaluated the combined effects of aerobic training for 12 wk and montelukast or placebo on bronchial responsiveness ( BHR ) to methacholine , exercise-induced bronchoconstriction ( EIB ) , inflammatory markers in exhaled breath condensate ( EBC ) , and asthma exacerbations . METHODS Fifty children ( mean age + /- SD : 10.2 + /- 2.4 yr ) with mild stable asthma were r and omly assigned to placebo ( N = 25 ) or montelukast ( N = 25 ) . Before and after training , we assessed BHR and EIB and markers of airway inflammation-that is , exhaled nitric oxide ( eNO ) , pH , and cysteinyl-leukotriene concentration-in EBC . RESULTS Training increased maximal workload and peak minute ventilation . After training , the methacholine dose causing a 20 % fall in FEV1 ( PD20 ) increased in both groups . A decreased slope of FEV1 decline at increasing methacholine dose was found only in montelukast-treated children . EIB prevalence halved after training in both groups ( EIB + children , placebo group : 10 pretraining , 4 posttraining ; EIB + children , montelukast group : 8 pretraining , 5 posttraining ; P < 0.05 by chi on all children ) . Resting eNO was unaffected , whereas the pH of EBC decreased after training in both groups . Cysteinyl-leukotriene concentrations were low in most children at both times . During training , montelukast-treated children showed fewer asthma exacerbations compared with the same period of the previous year . CONCLUSIONS In children with mild stable asthma , exercise training decreased bronchial responsiveness to methacholine . Montelukast also decreased bronchial reactivity ( FEV1 slope ) and protected against exacerbations , suggesting a beneficial synergistic action of these two interventions in mild asthma PURPOSE Radiotherapy for prostate cancer ( PCa ) may cause unfavorable changes in fatigue , quality of life ( QOL ) , and physical fitness . We report results from the Prostate Cancer Radiotherapy and Exercise Versus Normal Treatment study examining the effects of 24 weeks of resistance or aerobic training versus usual care on fatigue , QOL , physical fitness , body composition , prostate-specific antigen , testosterone , hemoglobin , and lipid levels in men with PCa receiving radiotherapy . PATIENTS AND METHODS Between 2003 and 2006 , we conducted a r and omized controlled trial in Ottawa , Canada , where 121 PCa patients initiating radiotherapy with or without and rogen deprivation therapy  were r and omly assigned to usual care ( n = 41 ) , resistance ( n = 40 ) , or aerobic exercise ( n = 40 ) for 24 weeks . Our primary end point was fatigue assessed by the Functional Assessment of Cancer Therapy-Fatigue scale . RESULTS The follow-up assessment rate for our primary end point of fatigue was 92.6 % . Median adherence to prescribed exercise was 85.5 % . Mixed-model repeated measures analyses indicated both resistance ( P = .010 ) and aerobic exercise ( P = .004 ) mitigated fatigue over the short term . Resistance exercise also produced longer-term improvements ( P = .002 ) . Compared with usual care , resistance training improved QOL ( P = .015 ) , aerobic fitness ( P = .041 ) , upper- ( P < .001 ) and lower-body ( P < .001 ) strength , and triglycerides ( P = .036 ) , while preventing an increase in body fat ( P = .049 ) . Aerobic training also improved fitness ( P = .052 ) . One serious adverse event occurred in the group that performed aerobic exercise . CONCLUSION In the short term , both resistance and aerobic exercise mitigated  fatigue in men with PCa receiving radiotherapy  . Resistance exercise generated longer-term improvements and additional benefits for QOL , strength , triglycerides , and body fat
Background The majority of the global population can not afford existing asthma pharmacotherapy .
Physical training as an airway anti-inflammatory therapy for asthma could potentially be a non-invasive , easily available , affordable , and healthy treatment modality .
However , effects of physical training on airway inflammation in asthma are currently inconclusive .
The main objective of this review is to summarize the effects of physical training on airway inflammation in asthmatics .