OBJECTIVETo get a comprehensive understanding about the relationship between obstructive sleep apnea (OSA) and asthma by reviewing the epidemiology, pathophysiology, and clinical manifestation and then summarizing the latest progress on diagnosis and treatment.

DATA SOURCESArticles referred in this review were mainly collected from a comprehensive search of the PubMed published in English from 1990 to 2015 with the terms "OSA" and "asthma" as the main keywords. Highly regarded older publications were also included.

STUDY SELECTIONInformation about the features of the two diseases in common, the pathophysiologic association between them and their current treatments from the literature search were identified, retrieved, and summarized.

RESULTSBoth OSA and asthma are very prevalent conditions. The incidences of them have kept on rising in recent years. Asthma is often accompanied by snoring and apnea, and OSA often combines with asthma, as well. They have many predisposing and aggravating factors in common. Possible shared direct mechanistic links between them include mechanical effects, intermittent hypoxia, nerve reflex, inflammation, leptin, etc. Indirect mechanistic links include medication, nose diseases, smoking, obesity, and gastroesophageal reflux disease. Since OSA presents many similar features with nocturnal asthma, some scholars termed them as a sole syndrome - "alternative overlap syndrome," and proved that asthma symptoms in those patients could be improved through the treatment of continuous positive airway pressure.

CONCLUSIONSOSA and asthma are closely associated in pathogenesis, symptoms, and therapies. With the growing awareness of the relationship between them, we should raise our vigilance on the coexistence of OSA in those difficult-to-control asthmatic patients. Further studies are still needed to guide the clinical works.

Asthma ; diagnosis ; physiopathology ; Humans ; Risk Factors ; Sleep Apnea, Obstructive ; diagnosis ; physiopathology

OBJECTIVETo study the clinical significance of tidal breathing lung function test in 1-4 years old children with wheezing diseases.

METHODSA total of 141 1-4 years old children with wheezing diseases were enrolled as the observed groups (41 cases of asthma, 54 cases of asthmatic bronchitis, and 46 cases of bronchopneumonia). Thirty children without respiratory diseases were enrolled as the control group. All the recruits underwent tidal breathing lung function test. The observed groups underwent bronchial dilation test, and tidal breathing flow volume (TBFV) parameters were evaluated before and after bronchial dilation test.

RESULTSThe observed groups showed obstructive ventilatory disorder (65%) according to the TBFV loop, and their ratio of time to peak tidal expiratory flow (TPTEF) to total expiratory time (TE) and ratio of volume to peak expiratory flow (VPEF) to total expiratory volume (VE) were significantly lower than in the control group (P<0.05). The asthma subgroup had significantly improved TPTEF/TE and VPEF/VE after bronchial dilation test (P<0.05). Taking an improvement rate of ≥ 15% either for TPTEF/TE or for VPEF/VE as an indicator of positive bronchial dilation test, the bronchial dilation test had a sensitivity of 47% and a specificity of 84% in diagnosing asthma in 1-4 years old children. The positive rate was 28% among the children in the asthma subgroup with an TPTEF/TE ratio of ≥ 23% before bronchial dilation test, versus 65% in those with an TPTEF/TE ratio of <23%.

CONCLUSIONSObstructive ventilatory disorder is the main impairment of tidal breathing lung function in 1-4 years old children with wheezing diseases. Tidal breathing bronchial dilation test can reflect a reversal of airway obstruction to a certain extent. The sensitivity of bronchial dilation test for the diagnosis of asthma is not satisfactory in 1-4 years old children with wheezing diseases, but this test has a relatively high diagnostic value in children with severe airway obstruction.

Asthma ; diagnosis ; physiopathology ; Bronchitis ; diagnosis ; physiopathology ; Bronchopneumonia ; diagnosis ; physiopathology ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Respiration ; Respiratory Function Tests ; methods ; Respiratory Sounds ; diagnosis ; drug effects ; physiopathology

Children allergic rhinitis, referred to as children allergic rhinitis (AR), is a kind of non-infectious inflammation of the nasal mucosa mediated by IgE with the main symtoms of paroxysmal sneezing, rhinorrhoea, nasal itching and nasal obstruction when the susceptible individuals contact the allergen. It is a high reaction disease of the respiratory mucosa common with childhood, which has serious implications to the Children's quality of life, study, rest and growth. The global sampling survey reveals that the morbidity is about 14%, of which 10% in our country and there is an upward trend year by year. At present, drug therapy is still one of the most important methods for children AR. Definite diagnosis, standardized drug therapy and the development of new specific immune therapy make children AR in a good control . This review updates the diagnosis and treatment for children AR, referring to the newest guide by WHO about allergic rhinitis and its impact on asthma (ARIA).
Asthma ; Child ; Humans ; Nasal Mucosa ; physiopathology ; Quality of Life ; Rhinitis, Allergic ; diagnosis ; therapy

OBJECTIVETo study the diagnostic values of fractional exhaled nitric oxide (FeNO) for typical bronchial asthma and cough variant asthma in children, and to explore whether FeNO can be applied to differentiate typical bronchial asthma from cough variant asthma in children.

METHODSA total of 150 children who were newly diagnosed with typical bronchial asthma between June 2012 and June 2014, as well as 120 children who were newly diagnosed with cough variant asthma during the same period, were selected as subjects. FeNO measurement, spirometry, and methacholine provocation test were performed for both groups. Meanwhile, 150 healthy children were selected as the control group, and their FeNO was measured. The diagnostic values of FeNO for typical bronchial asthma and cough variant asthma were analyzed using the receiver operating characteristic curve.

RESULTSThe FeNO values in the typical bronchial asthma and cough variant asthma groups were significantly higher than in the control group (P<0.01), and the FeNO value in the typical bronchial asthma group was significantly higher than in the cough variant asthma group (P<0.01). FEV1/FVC%, FEV1%pred, and PD20 were significantly lower in the typical bronchial asthma group than in the cough variant asthma group (P<0.01). The optimal cut-off value of FeNO was 19.5 ppb for the diagnosis of typical bronchial asthma, with a sensitivity of 83.3% and a specificity of 86.7%; the optimal cut-off value of FeNO was 15.5 ppb for the diagnosis of cough variant asthma, with a sensitivity of 67.5% and a specificity of 78.0%; the optimal cut-off value of FeNO was 28.5 ppb for the differentiation between typical bronchial asthma and cough variant asthma, with a sensitivity of 60.7% and a specificity of 82.5%.

CONCLUSIONSMeasurenment of FeNO may be useful in the diagnosis and differential diagnosis of typical bronchial asthma and cough variant asthma.

Asthma ; diagnosis ; physiopathology ; Breath Tests ; Child ; Cough ; diagnosis ; physiopathology ; Female ; Forced Expiratory Volume ; Humans ; Male ; Nitric Oxide ; analysis ; ROC Curve ; Vital Capacity

OBJECTIVETo investigate the value of fractional nitric oxide concentration in exhaled breath (FeNO) in assessing the level of asthma control in children.

METHODSA total of 226 asthmatic children were divided into controlled asthma (n= 86), partially controlled asthma (n=63), and uncontrolled asthma groups (n=77). Ninety healthy children were enrolled as controls. FeNO was measured for both asthmatic and healthy children using the Swedish-designed NIOX system.

RESULTSThe control group had an FeNO of 14±6 ppb, the controlled asthma group had an FeNO of 29±26 ppb, the partially controlled asthma group had an FeNO of 32±30 ppb, and the uncontrolled asthma group had an FeNO of 40±32 ppb. The three asthma groups showed significantly higher FeNO than the control group (P<0.05). The uncontrolled asthma group showed significantly higher FeNO than the controlled asthma group (P<0.05), but there were no significant differences in FeNO between the partially controlled and uncontrolled asthma groups and between the partially controlled and controlled asthma groups (P>0.05).

CONCLUSIONSAsthmatic children have significantly higher FeNO than healthy children, and FeNO is correlated with the level of asthma control.

Adolescent ; Asthma ; diagnosis ; physiopathology ; therapy ; Breath Tests ; Child ; Female ; Forced Expiratory Volume ; Humans ; Male ; Nitric Oxide ; analysis

OBJECTIVECysteinyl leukotriene (CysLTs) plays an important role in airway inflammation and remodeling in asthma. Measurement of urinary leukotriene E(4) (LTE(4)) is a sensitive and noninvasive method of assaying total body CysLTs level. This study aimed to evaluate the clinical significance of urinary leukotriene E(4) (LTE(4)) in childhood asthma.

METHODSSixty children with acute asthma were randomly divided into montelukast (leukotriene receptor antagonist) treatment and conventional treatment groups (n = 30 each). Urinary LTE(4) levels were measured using ELISA and the airway resistance Rint was assessed by the lung function instrument at the acute and the convalescence phases. Twenty healthy children were used as the control group.

RESULTSUrinary LTE(4) levels in asthmatic children at the acute and the convalescence phases were significantly higher than those in the control group (p<0.01). The urinary LTE(4) levels at the convalescence phase were significantly reduced compared with those at the acute phase in asthmatic children (p<0.01). More significantly decreased urinary LTE(4) levels were noted in the montelukast treatment group than the conventional treatment group at the convalescence phase (p<0.01). In the acute phase, there was no correlation between urinary LTE4 level and Rint in asthmatic children.

CONCLUSIONSUrinary LTE(4) level is significantly increased in children with acute asthma. Urinary LTE(4) is a useful marker for the diagnosis of asthma and can be as a predictor of asthma control and marker of susceptibility to treatment with leukotriene receptor antagonists.

Airway Resistance ; Asthma ; diagnosis ; physiopathology ; urine ; Child, Preschool ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Infant ; Leukotriene E4 ; urine ; Male

OBJECTIVETo investigate the association of forced expiratory volume in 1 second (FEV1) and the maximum peak expiratory flow (PEF) with small airway function in asthmatic children of different ages and genders.

METHODSThis cross-sectional study was conducted among 619 asthmatic children with disease remission aged 3 to 13 years. The children were divided into 3 age groups, namely 3 to 5 years group (314 cases), 6 to 9 years group (207 cases) and 10 to 13 years group (98 cases), and their respiratory physiological parameters such as FEV1 and PEF were measured.

RESULTSOf the airway function parameters, PEF showed the highest abnormality rate (>85%) in these asthmatic children. In male and female asthmatic children aged 6 to 9 years, abnormalities in forced expiratory flow rate 25% (MEF25) showed the highest frequency (56% and 63%, respectively). In 3-5 years and 10-13 years groups, MEF25 abnormalities were the most frequent in male children (43% and 71%, respectively), whereas abnormalities in MEF50 were the most common in female children (33% and 69%, respectively). FEV1 and PEF were positively correlated to all the parameters of small airway functions in these asthmatic children (r>0.5, P<0.01) except for MEF25 in female asthmatic children aged 3 to 5 years (r=0.19, P=0.168; r=0.086, P=0.535).

CONCLUSIONIn asthmatic children, FEV1 and PEF are positively correlated to the parameters of small airway function with only the exception of MEF25 in female children aged 3 to 5 years, suggesting the value of FEV1 in the diagnosis of asthma in children.

Adolescent ; Asthma ; diagnosis ; physiopathology ; Bronchi ; physiopathology ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Forced Expiratory Volume ; physiology ; Humans ; Male ; Maximal Expiratory Flow Rate ; physiology ; Respiratory Function Tests

Asthma ; diagnosis ; drug therapy ; physiopathology ; Child, Preschool ; Diagnosis, Differential ; Glucocorticoids ; therapeutic use ; Humans ; Infant ; Recurrence ; Respiratory Sounds ; diagnosis ; drug effects ; etiology ; Treatment Outcome

BACKGROUNDThe current theory of dyspnea perception presumes a multidimensional conception of dyspnea. However, its validity in patients with cardiopulmonary dyspnea has not been investigated.

METHODSA respiratory symptom checklist incorporating spontaneously reported descriptors of sensory experiences of breathing discomfort, affective aspects, and behavioral items was administered to 396 patients with asthma, chronic obstructive pulmonary disease (COPD), diffuse parenchymal lung disease, pulmonary vascular disease, chronic heart failure, and medically unexplained dyspnea. Symptom factors measuring different qualitative components of dyspnea were derived by a principal component analysis. The separation of patient groups was achieved by a variance analysis on symptom factors.

RESULTSSeven factors appeared to measure three dimensions of dyspnea: sensory (difficulty breathing and phase of respiration, depth and frequency of breathing, urge to breathe, wheeze), affective (chest tightness, anxiety), and behavioral (refraining from physical activity) dimensions. Difficulty breathing and phase of respiration occurred more often in COPD, followed by asthma (R(2) = 0.12). Urge to breathe was unique for patients with medically unexplained dyspnea (R(2) = 0.12). Wheeze occurred most frequently in asthma, followed by COPD and heart failure (R(2) = 0.17). Chest tightness was specifically linked to medically unexplained dyspnea and asthma (R(2) = 0.04). Anxiety characterized medically unexplained dyspnea (R(2) = 0.08). Refraining from physical activity appeared more often in heart failure, pulmonary vascular disease, and COPD (R(2) = 0.15).

CONCLUSIONSThree dimensions with seven qualitative components of dyspnea appeared in cardiopulmonary disease and the components under each dimension allowed separation of different patient groups. These findings may serve as a validation on the multiple dimensions of cardiopulmonary dyspnea.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Asthma ; physiopathology ; Dyspnea ; classification ; diagnosis ; etiology ; Female ; Heart Failure ; physiopathology ; Humans ; Lung Diseases ; physiopathology ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; physiopathology ; Young Adult

Allergic rhinitis (AR) clinically expressed by sneezing, rhinorrhea, nasal itching and congestion is an allergen-driven mucosal inflammatory disease which is modulated by immunoglobulin E. Epidemiological studies have indicated that prevalence of AR continues to increase, and it has been a worldwide health problem that places a significant healthcare burden on individuals and society. Given the evolving understanding of the process by which an allergen is recognized and the roles of mediators which account for AR progress, the pathogenesis of AR has become clearer. Current studies have demonstrated local allergic rhinitis (LAR) that patients with both sug- gestive symptoms of AR and a negative diagnostic test for atopy may have local allergic inflammation is a prevalent entity in patients evaluated with rhinitis, but further research remains needed. Management of AR includes aller- gen avoidance, pharmacological treatment and allergen-specific immunotherapy. Recently montelukast has exhibited previously undocumented anti-inflammatory properties, leukotriene receptor antagonists therefore may serve a more important role in the treatment of AR. Not only has immunotherapy proved its efficacy, but also been able to alter disease course and thereby mitigate progression to asthma. Thus immunotherapy can be initiated while receiving pharmacotherapy, especially in children with AR. As clinical guidelines, the ARIA (Allergic Rhinitis and its Impact on Asthma) provides basic principles of effective treatment of AR. Besides, choosing an appropriate treatment strategy should be based on the severity and chronicity of patient's symptom. The aim of this review was to provide an update mainly on the pathophysiology, epidemiology, and management of AR.
Acetates ; therapeutic use ; Allergens ; Anti-Inflammatory Agents ; therapeutic use ; Asthma ; prevention & control ; Child ; Humans ; Hypersensitivity, Immediate ; diagnosis ; physiopathology ; Immunoglobulin E ; immunology ; Immunotherapy ; Inflammation ; physiopathology ; Leukotriene Antagonists ; therapeutic use ; Prevalence ; Quinolines ; therapeutic use ; Rhinitis, Allergic ; diagnosis ; immunology ; physiopathology