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Background and Purpose: Asthma is the most common chronic disease in children. The aim of this study was to investigate the relationship between pre-term delivery and breastfeeding with asthma.
Materials and Methods: We studied 228 asthmatic patients who were referred to the Allergy Department in Children’s Medical Center (Tehran). Asthma was diagnosed based on the history, physical exam and dspirometery (if possible) by an allergist. Pre-term and method of delivery was on delivery card and breastfeeding duration (divided 6 months or more), was based on Mothers statement to gain data and was analyzed by T-test.
Results: 228 asthmatic patients (aged 5-17 years) of whom were 132 Males and 96 Females. 216 cases were term and 12 cases pre-term. Exclusive breastfeeding duration for at least 6 months was reported in 183 cases. Cesarean section was in 78 cases (34.22%), while normal delivery was observed in 150cases (65.78%).
Conclusion: In this study, breastfeeding (at least 6 months) and normal delivery can be decreased by asthma however, pre-term delivery was not affected by the asthma prevalence.

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Background and purpose: The goal of asthma therapy is to achieve clinical control and near normal lung functions. Many patients with moderate persistent asthma fail to achieve this goal with a low dose of inhaled corticosteroid (ÏÇS) plus long-acting β2 agonist (LÂBÂ). Ïn the present study, we have checked whether another controller medication (in the form of ginger capsule) add on to ÏÇSlow dose + LÂBÂ helps in achieving the asthma goal or not.
Materials and methods: Thirty two adult asthmatics (17 male and 15 female) completed a 10 week trial consisting of a 1 week single blind run in period, during which placebo (250 mg capsule of lactose 3 times a day) was added to usual treatment (inhaled beclomethasone diproprionate 200 µg/twice daily plus salmeterol 50 µg/twice daily), a 4 week double blind active treatment period in which subjects received ginger (250 mg capsule of powdered ginger 3 times a day) or placebo capsule, a single blind 1 week washout period receiving placebo and a final 4 week double blind cross-over active treatment period. The primary efficacy variable was the forced expiratory volume at 1 second (FËV1) secondary efficacy variables were the peak expiratory flow (PËF) and the asthma control test (ÂÇT) scores. These variables were measured at the completion of each phase, i.e. the end of weeks 1, 5, 6 and 10. Statistical comparisons of all variables were made by two-way analysis of variance (ÂNÔVÂ) with patient, period, and treatment as fixed factors. P< 0.05 was considered statistically significant.
Results: Âll the patients of the ginger group had significant improvement in FËV1 , PËF and ÂÇT scores (P<0.001) at the end of 10 weeks. Mean (95% ÇÏ) measurements for ginger vs placebo treatment periods were 1.99 vs 1.49 (0.32 to 0.68) L for FËV1, 255.8 vs 205.4 (27.1 to 73.8) L min-1 for PËF and 20.6 vs 17.3 (2.77 to 3.73) for ÂÇT scores. There was a similar frequency of minor adverse effects reported during placebo (13%) and ginger (16%) treatments (P>0.05).
Çonclusion: Powdered ginger rhizome capsule as an add on to inhaled corticosteroid and long-acting β2 agonist is effective in the improvement of FËV1, PËF, and ÂÇT scores of the patients of a moderate type of persistent asthma uncontrolled on standard treatment.

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Background and purpose: Recent studies show that bronchial hyper-responsiveness occurs in a high proportion of inflammatory bowel disease. Âirway inflammation is a common pattern of respiratory involvement in ÏBD patients and is a major finding in bronchial asthma. This study was designed to evaluate the prevalence of asthma and air way hyper-responsiveness among ulcerative colitis patients.
Materials and methods: Through a case-control study, spirometry was performed for 40 ulcerative colitis patients and 40 normal controls who were admitted to the Ïmam Khomeini hospital in Sari. The methacholine challenge test was performed in all cases with normal spirometry results. Then the data were analyzed using SPSS version 17.
Results: The results of the present study showed abnormal spirometry results for 55 % of ulcerative colitis patients compared to 22.5% of normal healthy controls (P<0.05). Ït has been found that air way hyper responsiveness occurred in 37.5% and 17.5% (P<0.05), asthma occured in 2.5% and 0% (P>0.05) and small airway disease occured in 15% and 5% (P>0.05) of cases and controls respectively. We observed that restrictive lung disease occured in 10% of both groups (P>0.05). There was also inverse correlation between duration of ÏBD and FËV1 (R=0.395, P=0.012) as well as FVÇ (R=0.367, P=0.02).
Çonclusion: Ôur results show that air way hyper-responsiveness is one of most common respiratory manifestations of ulcerative colitis patients with no symptom of airway involvement.

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The best example of irritant induced occupational asthma is reactive airways dysfunction syndrome (RADS) which is usually unregarded. We present a 29-year-old security guard from an Iranian car manufacturing company who was exposed to heavy smoke during a fire in work place in five years ago. He was referred because of his persistent asthma like symptoms after that accident to determin the accosiation between profession and the symptoms. He fulfilled criteria for RADS according to Brook’s criteria, therefore his asthma was reported as work related.

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Çhurg-Strauss is a disease with a prevalence of one to three cases per 100 thousand people. This disease is usually observed in the patients with a history of asthma being treated with steroids whose steroid therapy has been discontinued in the process. This patient was a 62-year-old woman with asthma who was treated for 6 months. Five days before she referred to the hospital, she developed skin involvement in her body. Drooping in the left wrist and her two ankles was evident. Ëosinophilitic vasculitis and degenerative changes along the nerve pathway were reported in the nerve biopsy. Methylprednisolone pulse therapy 1 g daily for three days followed by Ânoksan (150 mg daily) and Prednisolone (60 mg daily) tablets were administered. Lesions began to recover on the fifth day of hospitalization and after a week they completely disappeared. Ït can be concluded that in asthmatic patients who suffer from the change in clinical conditions, especially skin lesions, the Çhurg-Strauss disease should be considered as one of the differential diagnosis.

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Asthma is a common chronic inflammatory of airways especially in childhood. Clinical manifestations include coughing, wheezing and sometimes dyspnea. Allergic rhinitis (AR) is a common nasal inflammatory disease in the world. Prevalence of AR is 10-40% in different regions of the world. Clinical manifestations of allergic rhinitis are sneezing, pruritus, congestion and rhino rhea. Etiologies of allergic disorders are multifactorial. Many patients with chronic urticaria are concerned about different allergens such as aeroallergens or food allergens that could induce or exacerbate their disease. Aeroallergens have an important role in exacerbation of allergic disorders especially asthma and allergic rhinitis, however, their role is less important in eczema and chronic urticaria. Several studies carried out in Iran using Skin Prick Test (a standard test for diagnosis of aeroallergens) showed involvement of pollens from grasses, weeds and trees in dry and warm climates but mites are more common in humid and warm climates such as north of Iran.

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Background and purpose: Asthma is the most common chronic disease of childhood and adolescence resulting in variable restrictions in most aspects of patients’ life and decreases their quality of life (QOL). Control of the triggers could be of great benefit in the management of asthma. This study was conducted to assess the effect of education on asthma triggers and controlling them on QOL among adolescents suffering from asthma. Materials and methods: This randomized clinical trial was performed in 60 adolescents aged between 12-18 years. They were randomly assigned into intervention and control groups. Mini Pediatric Asthma Quality of Life Questionnaire (Juniper 1997) was used prior to intervention and five weeks post-intervention in both groups. The intervention group was educated regarding asthma triggers, then they were followed up through telephone calls. The data was analyzed using SPSS V.13, Chi square and t-tests. Results: Significant differences were found in the scores of QOL among both groups. Therefore, education on triggers of asthma and controlling them was effective in enhancing QOL (P≤0.001). Conclusion: This intervention was found potent in improving the QOL of adolescents with asthma. Hence, educational programs should be carried out in outpatient clinics on triggers of asthma with the participation of adolescents instead of their parents. (Clinical Trial Registry Number: IRCT201112078315N1)

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Background and purpose: Asthma is a chronic inflammatory disorder of the airway associated with airway hyper responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. Low dietary magnesium (Mg) could influence the occurrence and management of asthma. Mg is an essential element of human body, but its benefit for pulmonary function is not completely known. Material and Methods: This randomized, double-blind, placebo controlled, clinical trial was performed on 112 patients with mild and moderate persistent asthma. The diagnosis was based on clinical history and spirometric pulmonary testing. Blood samples were taken and level magnesium was measured. Participants were randomly assigned to consume either 340 mg of Mg as Mg citrate per day or placebo for two months. Each outcome was compared within treatment groups by paired t test for parametric data and the Wilcoxon signed rank test for non-parametric data. The significance level was considered as P<0.05. Results: After two months administration of oral Mg supplementation, significant changes were observed in FVC (P=0.002), FEV1 (P=0.000), FEV1/FVC ratio (P=0.000). The FVC, FEV1 have increased and the FEV1/FVC ratio value has decreased significantly. Conclusions: This study provides evidence that oral magnesium supplementation can improve lung function in patients with mild and moderate asthma

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Background and purpose: Allergic asthma is a chronic inflammatory disease identified by high response to allergens and excessive air ways edema. T-bet and GATA-3 are two transcriptional factors that differentiate Th1 and Th2 from Tnaive. In this study, we examined the expression levels of these two factors in patients with allergic asthma incomparison with healthy controls. Material and methods: In a case- control study, 26 patients with allergic asthma and 26 healthy subjects were studied who were matched for age and sex. Sampling was done and peripheral blood mononuclear cells were isolated and cDNA was synthesized after RNA extraction. Gene’s expressions were evaluated by Real-time Polymerase chain reaction. Results: The results showed that T-bet and GATA-3 expression levels significantly increased in patients in comparison with control group. In addition, GATA-3/T-bet ratio showed a significant increase in case group (P=0.005). Conclusion: This study showed that the genes expression of T-bet and GATA-3 regulate the balance ofTh1/Th2. Therefore, evaluation of T-bet and GATA-3 is believed to have an important role in treatment and clinical condition of asthma patients.

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Background and purpose: Asthma is a widespread chronic inflammatory disease of the airways that may become uncontrollable in severe subtypes, even with radical treatments. The present study attempts to determine the risk factors of the irreversible airway obstruction in severe asthma patients. Materials and methods: The study population were 72 patients with severe asthma, aged 16- 75 year old. Spirometry was performed and after receiving Salbutamol the subjects were divided into two groups (n= 36 per group). Group I included patients with severe reversible asthma and group II had severe irreversible asthma. Clinical risk factors were considered including age of the first onset of asthma, smoking, BMI, aspirin allergy, taking corticosteroids, and history of animals contact. Moreover, the level of total serum IgE, and the percentage of eosinophils in peripheral blood smear and sputum were investigated. Afterwards, a comparison was made between the two groups. Results: Adult-onset rate was significantly higher in patients with irreversible asthma (P=0.34). Smoking rate (P= 0.003), serum IgE levels (P =0.003), percentage of sputum eosinophil (P =0.003) were significantly higher among patients with irreversible asthma. There was no significant difference between the two groups in the use of corticosteroids, BMI, aspirin sensitivity, history of contacts with animals, and peripheral blood eosinophil levels. Conclusion: Smoking is a great risk factor and its quitting is of great benefit for patients with asthma. Serum IgE and sputum eosinophil levels may be considered as co-factors in patients with irreversible asthma.

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Abstract Background and purpose: Asthma is one of the most common chronic diseases worldwide and its prevalence has increased over the past decades in industrialized and developing countries. Cox proportional hazards model is one of the main models used in the analysis of survival data. This study was performed to evaluate the Stratified cox model in identifying the factors influencing readmission of asthma patients in Sanandaj Besat Hospital. Materials and methods: In a retrospective study, 301 records of asthma patients hospitalized during 2005 -2012 in Sanandaj’s Besat Hospital were reviewed, and information was extracted in a check list. Data was then fitted to R 2.14.0 stratified Cox model. Results: By using Goodness-of-fit test (GOF) Proportional Hazard (PH) assumption was tested. PH assumption was true for all variables, except for dust and marital status. Fitted stratified Cox model showed occupational exposure, viral infections, and PM10 with significant effect on the time of readmission (P <0.05). Conclusion: In this study occupational exposure (such as farms and contact with chemical materials), viral infections, and PM10 were significant factors associated with readmission of asthma patients. Therefore, it is recommended to focus more on principles of occupational health, practicing personal hygiene in exposure to viral infections and caring for people with asthma on polluted days.

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Allergic Bronchopulmonary Aspergillosis (ABPA) is a hypersensitivity response to Aspergillus antigens in patients with asthma or cystic fibrosis (CF). The inhalation of spores from the environment is followed by growth of hyphae in the mucus of the bronchial tree and stimulates an immune response involving Th2 CD4+ T cells and IgE and IgG antibodies. Although diagnostic procedure for ABPA is a big challenge, serological marker (measurement of IgE antibody) for the diagnosis of ABPA is chosen in clinical. However, cross-reactivity may also occur between crude fungal extracts. Therefore, combination of clinical, biological and radiological criteria with molecular-based allergy can solve this problem. Although, the mainstay of treatment for ABPA is corticosteroids followed by antifungal regimes, but treatment is dependent on the ABPA stage with asthma control, prevention and treatment of acute disease, and preventing the progression of bronchiectasis. The current review paper presents a comprehensive overview of the allergic bronchopulmonary aspergillosis based on diagnostic and therapeutic aspects.

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Background and purpose: Allergic asthma is a chronic inflammatory disorder with increased inflammation and bronchial over react to stimulants. Th1 and Th2 cells are the main cells involved in the pathophysiology of asthma. The function of these cells is under the influence of T-bet and GATA3 transcription factors. This study aimed to investigate the impairment of immune responses in patients with allergic asthma compared with controls.

Materials and methods: In a case-control study, 24 patients with allergic asthma and 10 healthy individuals were recruited. The Mononuclear cells (PBMCs) were isolated and cDNA was synthesized after RNA extraction. Gene’s expressions of T-bet and GATA3 were evaluated by Real-time Polymerase chain reaction and their relationships with risk factors for asthma were analyzed using statistical tests.

Results: In our study, the GATA3 gene expression in patients increased 29 times more than that in controls (P= 0.002) but the expression of T-bet declined (0.43, P =0.32). Evaluation of T-bet / GATA3 showed that this ratio was significantly lower in patients compared with that in the controls (P<0.0001).

Conclusion: Increased expression of GATA3 and significant reduction of T-bet / GATA3 ratio in patients showed disturbed immune responses in asthma. So, any remedial or control actions should focus on improving the unbalanced situation.

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Background and purpose: Asthma is a chronic inflammatory disease of the airways that is caused by hypersensitivity to environmental allergens. Symptoms of asthma include shortness of breath, airway hyper-responsiveness, wheezing, and cough. The disease might vary from a mild to severe and intermittent to chronic disease. Asthma is known as a multifactorial disease due to the interaction of genetic and environmental factors in its development. Identifying the environmental and genetic factors are of great benefit for prevention, diagnosis and treatment of allergic asthma. The aim of this review was to investigate the factors that increase the risk of asthma.
Materials and methods: Electronic databases including Scopus, PubMed, Google Scholar, Scientific Information Database (SID), Magiran, and Irandoc were searched for relevant articles published between 1990 and 2016. The search keywords were asthma, atopy, genetic factors, polymorphisms, environmental factors, and gene-environment interaction.
Results: This review showed that asthma is a complex and multifactorial disease and the combination and interaction of environmental and genetic factors have a role in its development and progression. Therefore, each of these factors cannot be considered as an absolute cause of asthma, but a set of factors such as genes influencing inflammatory pathways, airway rebuilding, and environmental factors should be considered as risk factors.
Conclusion: Asthma is a complex and multifactorial disease and interaction of several genetic and environmental factors are involved in its clinical presentation. A major step in determining the genetic causes of asthma is identifying chromosomal regions and candidate genes associated with asthma.

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Background and purpose: Asthma is a chronic inflammatory disease of the airways that is associated with excessive irritation and airway obstruction. The aim of the present study was to investigate the immunomodulatory effects of betaine on experimental model of asthma in Balb/c mice.
Materials and methods: The statistical population consisted of 32 Balb/c mice that were randomly divided into four groups (n=8 per group). One group (control) was not sensitized with ovalbumin to induce experimental asthma. Experimental asthma was induced in other three groups by injecting ovalbumin. These groups were treated with saline phosphate buffer, betaine (1% w/w), and prednisolone (3 mg/kg) in drinking water, for 81 days after induction of the disease, respectively. Then, blood and spleen samples were collected for biochemical studies.
Results: Betaine treatment of ovalbumin-sensitized mice significantly reduced IgE antibody production, spleen cell proliferation, IL-5 and IL-17 levels, and significantly increased TGF-β and INF-γ levels (P<0.05).
Conclusion: Betaine as a naturally occurring chemical in the body has significant effects on IgE production and levels of some key cytokines of asthma. So, this substance could be considered as as a possible candidate for modulating immune responses in asthma.

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 Background and purpose: Fatigue and dyspnea are common asthma symptoms and using non-phamacological methods are preferred to reduce the symptoms in elderly. Guided imagery is a mind-body intervention and is effective in reducing physiological problems. The present study was conducted to determine the effect of guided imagery on fatigue and asthma control in older adults.
Materials and methods: In a randomized clinical trial, 90 elderly with asthma attending Sari Imam Khomini Hospital and Qaemshahr Razi Hospital (2020) were allocated into either an intervention group or a control group (n= 45 per group) using randomized blocking. Patients in intervention group listened to a 12-minute audio file of guided imagery for six weeks, twice a day (except weekends). Data were collected using demographic questionnaire, asthma control questionnaire, and fatigue severity scale and then analyzed in SPSS V22 applying Mann-Whitney U test, Wilcoxon test, and Chi-square test.
Results: A total of 80 elderly were analyzed. After six months, the score for fatigue in intervention group reduced to 33.10±6.74 from 38.11±6.65 before the study (P<0.001), but no significant difference was seen in control group before and after the study (37.96±6.60 and 38.17±6.42, respectively, P=0.059). After six months, asthma control score in intervention group increased to 17.90±4.78 from 14.22±3.40 before the intervention (P<0.001). But the score change in control group was not found to be significant (17.77±4.66 before the study and 17.83±4.50 after the study, P=0.226).
Conclusion: Guided imagery as a non-pharmacological method seems to improve asthma control and decreases fatigue in elderly with asthma. Implementing such measures is recommended to health providers.
 
(Clinical Trials Registry Number: IRCT20160527028101N5)

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 Background and purpose: Asthma is a chronic inflammatory disorder of the airways caused by a combination of complex environmental and genetic interactions. There is an incomplete understanding of this mechanism which affect both severity of the disease and how it responds to treatment. Different gene expressions are reported in patients with asthma and healthy controls.
Materials and methods: In this study, a common list of different genes expressed (DEG) was identified using bioinformatics methods. Three studies from microarray data that met the study’s inclusion criteria were selected. These studies included 268 samples, consisting of 167 patients and 101 healthy people. These studies were analyzed, and then a meta-analysis was performed.
Results: Common genes that led to significant decrease or increase in gene expressions were identified and their biological, molecular, and cellular pathways were examined. In general, it was found that this set of genes can be involved in asthma and some pathways affecting the function of disease.
Conclusion: According to current findings, examining the objectives of efficacy and functional analysis of new genes effective in asthma and their protein products, and also investigating the role of interactions in asthma could help in taking appropriate treatment strategies to control asthma complications and injuries.
 

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Background and purpose: Serum procalcitonin (PCT) indicates a bacterial infection that can reduce the administration of antibiotics. The aim of this study was to compare serum procalcitonin levels in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) and asthma and its relationship with lung function and inflammatory factors.
Materials and methods: In this cross-sectional study, patients with acute exacerbation of asthma (n= 46) and COPD (n= 23) attending Shahrekord Kashani Hospital were included. After obtaining clinical and demographic information, the participants underwent spirometry and the levels of procalcitonin, ESR, white blood cell and PMN counts were determined. Data were analyzed in SPSS V19.
Results: There were significant differences between patients with exacerbation of COPD and asthma in age, sex, ICU hospitalization, and FEV1 percentage (P <0.05) but no significant differences were seen in mean ESR, WBC and PMN (P> 0.05). PCT results in asthma and COPD patients were 8.7% and 56.5%, respectively (P<0.05). Logistic regression analysis showed that gender and FEV1 had significant effects on PCT level (odds ratio 0.192 and 0.958, respectively (P<0.05).
Conclusion: Procalcitonin in patients with exacerbation of COPD was significantly higher than that in patients with exacerbation of asthma, which indicates the role of exacerbation of bacteria in COPD.

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Background and purpose: Asthma is one of the most prevalent chronic respiratory diseases which has become more prevalent over the past three decades. Seroflo and Seretide are inhalers that contain fluticasone (an anti-inflammatory corticosteroid) and salmeterol (a long-acting bronchodilator). This study aimed to compare the effects of Seroflo and Seretide nasal sprays on spirometry criteria and clinical symptoms in pediatric patients with moderate to severe asthma.
Materials and methods: A retrospective study was performed using the medical records of 42 patients aged 6-15 years with a history of moderate-to-severe persistent asthma who were treated with Seroflo (group A)and Seretide (group B) inhalers in Shahid Motahari Hospital (affiliated with Urmia University of Medical Sciences). Data, including age, gender, clinical symptoms (coughs and shortness of breath), and spirometry variables were documented in pre-made checklists. Data analysis was carried out in SPSS V22.
Results: Changes in PEF and FEV1 (parameters of treatment responses) were statistically significant in both groups (P<0.05), but no significant differences were observed in these parameters between the two groups (P>0.05). In this study, treatment with Seroflo caused more significant relief in clinical symptoms, including coughs, intermittent shortness of breath, daily attacks, and wheezing compared to Seretide after one and three months of treatment (P<0.05).
Conclusion: This study suggested that Seroflo and Seretide inhalers improved the spirometry indices to a similar degree, but treatment with Seroflo relieved the patients’ clinical symptoms more than Seretide.

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 Background and purpose: Asthma is a prevalent disease that affects oral health-related quality of life (OHQoL). There is no study on this issue in Iran, so this study investigated the OHQoL in asthmatic patients.
Materials and methods: In this descriptive analytical study, 54 asthmatic patients in Sari Tuba Medical Center were examined. They were selected by convenience sampling. The Oral Health Impact Profile-14 (OHIP-14) was administered and Ramfjord teeth were selected to examine the OHI-S index. Data analysis was done applying descriptive statistics and Kolmogorov Smirnov test in SPSS V25.
Results: The mean age of patients was 38.05±12.57 and 75.9% were women. The mean scores for OHIP-14 and OHI-S were 2.40±1.14. The highest score in the quality of life questionnaire was related to physical discomfort (1.17±0.96). There were no significant differences between gender, DI, and CI in OHQoL (P=0.893), and OHI-S and OHQoL (P=0.690).
Conclusion: In current study, no relationship was found between oral health of asthma patients and the OHQoL, but dentists are recommended to consider the impact of oral problems on patients' quality of life in addition to professional measures.