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Theme Issue:
Challenges and Opportunities in Asthma
Asthma remains a complex and heterogeneous condition, influenced by genetic, environmental, and lifestyle factors. Despite advances in treatment, variability in disease presentation, disparities in access to care, and adherence to long-term therapy continue to pose significant challenges.
This theme issue presents opportunities to transform asthma management through innovation and collaboration. Precision medicine and biologic therapies are redefining treatment pathways, while digital health tools and real-time monitoring are improving patient engagement and outcomes.
Beyond clinical advances, practical barriers such as cost, healthcare inequalities, and the need for patient education highlight the importance of patient-centered strategies and supportive health policies.
Together, these contributions underscore the evolving landscape of asthma care, where scientific progress and real-world implementation converge to improve outcomes for patients worldwide.
This theme issue was organized in collaboration with the Respiratory Health Committee.
Contents
Review Article
Occupational Asthma and Challenges in Classifying Chemical Respiratory Allergens
Respiratory Sensitisation is a serious health condition that can have life-threatening consequences and that is regulated under GHS and CLP. Classification relies on clinical evidence of causation of substance-specific respiratory hypersensitivity, typically seen as occupational asthma. Significant advances have been made in recent years in the phenotyping of both asthma and occupational asthma since the introduction of criteria and guidance for classification. Typically generated clinical data, including specific inhalation challenge tests, while sufficient for diagnosis and health management is often deficient for regulatory classification purposes as it fails to reliably distinguish between occupational asthma and non-specific irritant exacerbation of pre-existing asthma that is regulated under another classification endpoint.
By Mark A Pembertona
Case Report
A twelve-year-old boy with Overlapping Features of Asthma and Protracted Bacterial Bronchitis
A twelve-year-old boy presented with repeated attacks, almost every month, of dry cough, shortness of breath, and wheezing for over 18 months, which responded to bronchodilators and relapsed despite anti-inflammatory prophylaxis. The child had persistent leucocytosis and neutrophilia, not responding to short courses of oral antibiotics given during the relapses. A severe attack necessitated admission to a tertiary care hospital, where he was treated with IV antibiotics for a longer duration. Thereafter, there has been no relapse for the last six months, and the blood counts returned to normal. Thus, this patient’s clinical presentation combines bronchial asthma and protracted bacterial bronchitis features.
By Subhashchandra Daga - The Primary Health Centre, Kamshet, 410405 (India)
Review Article
Oral theophylline as a preventer and oral salbutamol as a reliever in childhood asthma: An option when resources are scarce
Asthma treatment remains challenging, especially in low-resource settings, as it revolves around inhaler devices. The inhalers are too expensive to buy from a pharmacy and not available from a public health facility. Besides, one-to-one training is required for the correct use of inhalers. Therefore, this therapy is associated with low adherence. Improper training leads to faulty use, inadequate treatment, and drug wastage. Asthma is an inflammatory condition that requires a bronchodilator for relief during acute exacerbation and an anti-inflammatory agent for prevention. The use of oral salbutamol, in place of inhaled beta-agonists, and oral slow-release theophylline in place of inhaled corticosteroids offers a feasible option. This may make the treatment easier to deliver and more affordable in low-resource settings.
By Subhashchandra Daga - The Primary Health Centre, Kamshet, 410405 (India)
Research Article
Alternative Ways to Improve Asthma Control in Obese Patients
Diseases of the respiratory tract occupy one of the leading places among pathologies in people of working age in the world. According to the data of world studies, it can be considered that these two comorbidities are mutually aggravating, but scientists do not have a unanimous opinion about whether this is a simple coincidence or whether these pathologies are pathogenetically related. There is considerable evidence that asthma patients do not achieve adequate asthma control worldwide. Yes, according to Maria Sandra Magnoni et al. 77.8% of patients with asthma have an uncontrolled course of asthma, although 68.4% of them believe that they have sufficient asthma control, and their treatment does not require correction.
By Daria Lahoda - Doctor of Philosophy in Medicine (PhD), Assistant Professor of the Department of Family Medicine and Polyclinic Therapy, Odesa National Medical University, ave. 2 Valikhovskyi St., Odesa, Ukraine 65000, 0966419743
Research Article
Exposure to Antibodies Anti-Chlamydophila Pneumoniae Associated to Respiratory Symptoms of Asthma among Adolescents.
Previous report shows relationship between C. pneumonie and Asthma. In this study, we assessed the association between exposure to C. pneumoniae infection and the risk of bronchial asthma in adolescents in the State of Morelos, Mexico. An analysis was performed on a population-based cohort study of 80 adolescents with respiratory symptoms of asthma defined by ISAAC and 202 healthy adolescents between 12 and 17 years old. The information was collected twice from questionnaires, anthropometry, and sampling.
By Guadalupe García Elorriaga, Maximino Miranda-García, Guillermo Del Rey-Pineda, Luisa María Sánchez-Zamorano, Eduardo César Lazcano-Ponce, and Eduardo Salazar-Martínez Medical Research Unit in Immunology and Infectology. Hospital of Infectology.NationalMedical Center “La Raza”. Mexican Institute of Social Security, Mexico City, Mexico. Head of the Information Quality Area. Mexican Institute of Social Security. State of Mexico Delegation, Mexico. Blood Central Bank, Medical Center “La Raza”, Mexican Institute of Social Security, Mexico City, Mexico Infectology Department. Children Hospital of Mexico “Federico Gómez”. Minister of Health, Mexico City, Mexico Center of Research in Population Health, National Institute of Public Health, Cuernavaca, Morelos, Mexico. Academic Secretariat, School of Public Health of Mexico, Cuernavaca, Morelos, Mexico. Chronical Diseases Division, Center of Research in Population Health, National Institute of Public Health.. Cuernavaca, Morelos, Mexico.
Editorial
Asthma in Disaster Zones
The Global Asthma Network (GAN) report issued in 2022 and the Global Initiative for Asthma (GINA) report of 2023 emphasize challenges and difficulties faced by health workers in managing asthma in Low- and Middle-income countries (LMICs). Among the many reasons for these difficulties are insufficient knowledge of health workers of management guidelines, and lack of medical resources especially inhaler medications1,2,3. When available in limited amounts, these resources are prohibitively expensive4,5,6. These reports did not address the impact of disaster on asthma care. In this article, we aim to highlight this issue, hoping that future international asthma reports will take this aspect into consideration.
By Yousser Mohammad, MD, PhD and Basim Dubaybo - Al-Sham Private University, Faculty of Medicine and Pharmacy, Damascus and Latakia, Syria; Centre for Research on Chronic Respiratory Diseases (Director of the Center), Tishreen University, Lattakia, Syria. Faculty Affairs and Professional Development, Wayne State University School of Medicine, Detroit, MI, USA
Review Article
Factors Influencing the Asthma Control among Children
Bronchial sensitive individuals are prone to develop many health issues from airborne allergens, and viral and bacterial respiratory infections. Studies have shown that airborne allergen causes allergies and asthma in the susceptible population. Some other environmental factors such as tobacco smoke, air pollution and diet have also been linked to an increased risk for the onset of asthma. The burden of asthma is increasing day by day but the exact etiology of asthma is yet unknown. Some genetic predisposition and environmental factors are thought to play a role in causation of disease, yet how they interact to cause asthma it is still being investigated.
By Razia Sultana Mansoor Ghani, Ann Smith, Shazia Ashraf, and Shakeela Bashir; University of Health Sciences Lahore, Pakistan University of South Florida, College of Nursing, Tampa, Florida, USA Aman Medical Institute, Islamabad, Pakistan Pakistan Institute of Fashion and Design, Lahore, Pakistan
RESEARCH ARTICLE
Assessment of asthma control in adult patients by Fractional Exhaled Nitric oxide and Asthma Control Test
Research revealed a highly significant link between the level of FeNO at diagnosis and the biggest variations in FeNO readings after diagnosis. Using FeNO as a supplementary non-invasive method for assessing asthma control may be effective in both steroid-naive asthmatics and those who are being treated with steroids.
By MUHAMMED ANAS AYOOB, Soumya Mol Mohammed Ismail, and Dr. Prasad - NMC Healthcare; Pulmonologist, NMC Specialty Hospital
RESEARCH ARTICLE
Impulse Oscillometry Parameters in Childhood Asthma, Childhood Obesity and Childhood Obesity with Asthma
Monitoring of lung function is necessary to detect irreversible airway obstruction in both asthma and obesity. Impulse oscillometry (IOS), a novo non-invasive equipment, is increasing popularity to measure airway resistance in young children worldwide.
By Tassalapa Daengsuwan, MD, and Thitaya Sangsawang, MD - Division of Allergy and Immunology, Department of Pediatrics Queen Sirikit National Institute of Child Health, Bangkok, Thailand; College of Medicine, Rangsit University, Bangkok, Thailand Division of Allergy and Immunology, Department of Pediatrics Queen Sirikit National Institute of Child Health, Bangkok, Thailand
REVIEW ARTICLE
Asthma and Lung Function in Adulthood After Early-Childhood Wheezing
The risk of asthma and lung function reduction is increased in children who have presented with wheezing associated with respiratory tract infection in early childhood. Three prospective cohort studies consisting of patients hospitalized for infection-associated wheezing at <24 months of age, which started in Finland and Sweden in the 1980`s and 1990`s, have reported outcomes at >25 years of age. These three cohorts are even globally the only cohorts consisting of early-childhood wheezers followed prospectively until adulthood. Initially, the studies were not controlled, and the risk of asthma and reduced lung function and the risk factors in question were assessed by analyses within the cohorts.
By Matti Korppi - Tampere University
RESEARCH ARTICLE
Asthma in Children with Sickle Cell Disease
Sickle Cell Disease is a life-threatening hereditary blood disorder which affects millions of people worldwide. Pulmonary complications are important causes of morbidity and mortality in patients with sickle cell disease. Asthma is a recognised comorbidity of sickle cell disease and may occur in between 15 and 28% of children with sickle cell disease. It has been associated with increased episodes of acute chest syndrome and all cause mortality.
By Oishi Sikdar and Anne Greenough - Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London Neonatal Intensive Care Centre, King’s College Hospital NHS Foundation Trust, 4th Floor Golden Jubilee Wing, Denmark Hill, London, SE5 9RS
RESEARCH ARTICLE
Comparison of Spirometry and Impulse Oscillometry in Thai Childhood Asthma
Impulse oscillometry (IOS), a new respiratory impedance measurement, is increasing in its popularity as a means to assess airway resistance in young children. Its great advantage lies in its effortless and fast performance, making the airway obstruction measurement easier for patients who are not able to perform spirometry tests. However, studies comparing spirometry with IOS in Thai children are rare.
By Tassalapa Daengsuwan and On-anong Nilwalaikul -Division of Allergy and Immunology, Department of Pediatrics Queen Sirikit National Institute of Child Health, Bangkok, Thailand; College of Medicine, Rangsit University, Bangkok, Thailand Division of Allergy and Immunology, Department of Pediatrics Queen Sirikit National Institute of Child Health, Bangkok, Thailand
RESEARCH ARTICLE
Frequency of ADIPOQ 276 and ADIPOQ 45 Polymorphisms in Obese and Eutrophic Adolescents with and without Asthma and their Relationship with Serum Adiponectin Levels
Asthma is a chronic allergic disease characterized by variable airflow limitation; Obesity is a chronic disease that has reached epidemic proportions globally. Both are diseases with a significant inflammatory component, and their relationship suggests being weight dependent. Adiponectin (ADIPOQ) is the main adipokine secreted by white adipose tissue, it is an insulin synthesizer and regulator of energy homeostasis, and its plasma levels are inversely correlated with obesity and asthma. The effect of genetic factors in both diseases has been investigated, and haplotypes of the ADIPOQ 45 T/G (rs2241766) and ADIPOQ 276 G/T (rs1501299) polymorphisms have been related.
González-Uribe, V., Martínez-Tenopala, R., Baro-Alvarez, P., & Mojica-Gonzalez, Z. S. (2022).
REVIEW ARTICLE
Citizens’ Image of Asthma and Their Actions During and After the Yokkaichi Lawsuit
Yokkaichi asthma is one of Japan’s four “big pollution diseases.” It occurred in the early 1960s and was caused by emissions from the petrochemical industry. The disease led to the first litigation concerning air pollution in Japan. From 1967 to 1972, citizens fought against corporations as part of the Yokkaichi lawsuit. This article explores how Yokkaichi asthma occurred, how citizens saw the disease before and during the lawsuit, and what actions they took to react to the problem. By appealing, studying, recording, and measuring, citizens in Yokkaichi made their voices heard and helped scientists testify during the legal proceedings, ultimately promoting Japan’s environmental legislation.
Danyang Feng - Chinese Research Academy of Environmental Sciences, Beijing 100012, China
RESEARCH ARTICLE
Salbutamol and exercise-induced inspiratory flow limitation in asthmatic children
We observed a significant but inconsistent, individually variable protection of salbutamol against exercise induced inspiratory flow limitation in contrast to the consistent protective effect of salbutamol against EIB. We confirmed that a substantial number of the children with exercise induced flow limitation have an inspiratory flow limitation. Asthmatic children who experience persistent exercise induced asthmatic symptoms despite the use of (prophylactic) salbutamol, may suffer from an inspiratory flow limitation as a component of their asthma.
Reina Visser - Medisch Spectrum Twente, Enschede, The Netherlands tel 0031534872000
RESEARCH ARTICLE
Lung sounds in bronchial asthma
Since the historical article by Forgacs in 1978, many studies have clarified the changes of lung sounds due to airway narrowing as well as the mechanism of genesis of these sounds. Studies using bronchoprovocation have shown that an increase of the frequency and/or intensity of lung sounds was a common finding of airway narrowing and correlated well with lung function in bronchial asthma. Bronchoprovocation studies also showed that wheezing may not be as sensitive as changes in basic lung sounds in acute airway narrowing in adult asthmatics.
Yukio Nagasaka and Michiko Tsuchiya - Rakuwakai Kyoto Pulmonary Center, Rakuwakai Otowa Hospital, Otowachinji-cho 2, Yamashina-ku, Kyoto 607-8062, Japan
RESEARCH ARTICLE
Evaluation of the safety of dose escalation period of subcutaneous specific allergic immunotherapy in patients with rhino-conjunctivitis or allergic asthma previously vaccinated against SARS-CoV-2
The well-known safety profile of the subcutaneous allergen immunotherapy using pollen or house dust mite allergoids has not been changed after the SARS-CoV-2 vaccine administration. No relevant differences in the incidence of local or systemic allergic reactions during the dose escalation phase were identified, so it is considered that the patient’s safety has not been compromised to initiate this treatment after the SARS-CoV-2 vaccine administration.