Recently, a few studies have linked soft drink consumption to increased asthma risk, but the contribution of different types of soft drinks is unknown. We investigated cross-sectional associations between six different types of soft drinks and asthma in 11-year-old children.

We analyzed data of 2406 children participating in the Dutch Prevention and Incidence of Asthma and Mite Allergy birth cohort. At age 11, children self-reported consumption of sugar-added drinks, diet drinks, sweetened milk drinks, 100% fruit juice, energy drinks and sport drinks. The definition of asthma was based on parental reports of wheezing, prescription of inhaled corticosteroids and doctor's diagnosis of asthma.

Results:The prevalence of asthma in this study was 5.8%. In adjusted logistic regression analyses, asthma risk was increased for high (⩾10 glasses/week (gl/wk) versus low (<4 gl/wk) consumption of 100% fruit juice (odds ratio (OR): 2.09, 95% confidence interval (CI): 1.21-3.60), sugar-added drinks (OR: 1.56, 95%CI: 0.95-2.56) and for very high (>21.5 gl/wk) versus low (<12.5 gl/wk) total sugar-containing beverage (SCB) consumption (OR: 1.91, 95%CI: 1.04-3.48). Consumption of other beverages and consumption of fruit were not associated with increased asthma risk. No evidence for mediation of the observed associations by body mass index was found.

Conclusions:This study indicates that high consumption of 100% fruit juice and total SCBs is associated with increased asthma risk in children. The positive association between consumption of 100% fruit juice and asthma is an unexpected finding that needs confirmation in future studies.European Journal of Clinical Nutrition advance online publication, 13 August 2014; doi:10.1038/ejcn.2014.153.

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Inhaled corticosteroids (ICS) are the cornerstone of maintenance asthma therapy. However, in spite of this, adherence to ICS remains low. The aim of this systematic literature review was to provide an overview of the current knowledge of adherence to ICS, effects of poor adherence, and means to improve adherence.

A total of 19 studies met the inclusion criteria: 9 focusing on the level of adherence, 6 focusing on effects of poor adherence, and 7 focusing on interventions to improve adherence. Three of the studies focused on more than one of these end points. The mean level of adherence to ICS was found to be between 22 and 63%, with improvement up to and after an exacerbation. Poor adherence was associated with youth, being African-American, having mild asthma, < 12 y of formal education, and poor communication with the health-care provider, whereas improved adherence was associated with being prescribed fixed-combination therapy (ICS and long-acting β2 agonists). Good adherence was associated with higher FEV1, a lower percentage of eosinophils in sputum, reduction in hospitalizations, less use of oral corticosteroids, and lower mortality rate. Overall, 24% of exacerbations and 60% of asthma-related hospitalizations could be attributed to poor adherence.

Most studies have reported an increase in adherence following focused interventions, followed by an improvement in quality of life, symptoms, FEV1, and oral corticosteroid use. However, 2 studies found no difference in health-care utilization, one observed no effect on symptoms, and one observed more symptoms in subjects in the intervention group compared with the control group. Good adherence to ICS in asthma improves outcome but remains low.

Interventions to improve adherence show varying results, with most studies reporting an increase in adherence but unfortunately not necessarily an improvement in outcome. Even following successful interventions, adherence remains low. Further research is needed to explore barriers to adherence and interventions for improvement.

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The hypothesis that GER can trigger or exacerbate asthma is supported by several clinical trials that have shown amelioration in asthma symptoms and/or an improvement in pulmonary function after antireflux therapy.

Aims: To investigate the prevalence of GER in patients with difficult to control asthma and to determine the effect of omeprazole on asthma symptoms, reflux symptoms, pulmonary function and on the requirement of asthma medications.

Materials and Methods: Patients with difficult to control asthma were recruited into the study. All patients underwent esophageal manometry and 24 hour esophageal pH monitoring. Pulmonary function tests were done before and after treatment. The severity of asthma and reflux was assessed by a 1 week pulmonary symptom score(PSS) and reflux symptom score(RSS) respectively before and after treatment. Those who had an abnormal pH study (pH <4 in the distal esophagus for >5% of the time) underwent anti-GER treatment with lifestyle changes, and a proton pump inhibitor (omeprazole 40 mg, bid) for 3 months. Asthma medications were added or deleted based on severity of asthma.

Results: Out of 250 asthmatic patients screened, forty patients fulfilled the inclusion criteria. Twenty eight of 40 patients(70%) were diagnosed to have GERD. Of the patients 28 with GER, 8 patients(28.5%) had no reflux symptoms. On 24 hr pH metry, the percentage time pH <4.0 was 10.81 ± 4.72 and 1.11 ± 1.21; Deemester score was 37.65 ± 14.54 and 4.89 ± 6.39 (p-value is 0.0001) in GERD and non-GERD patients respectively.In GERD group, post treatment reflux symptom score(RSS) improved from 22.39 ± 14.99 to 1.04 ± 1.07, pulmonary symptom score(PSS) improved from27.14 ± 7.49 to 13.82 ± 4.21and night time asthma symptom score(NASS) improved from 6.71 ± 1.80 to 3.04 ± 1.23 (p-value <0.0001). After treatment, FEV1 and PEFR increased from 1.38 ± 0.57 and 4.14 ± 1.97 to 1.47 ± 0.54 and 5.56 ± 1.72, respectively (p-value 0.00114).

Conclusions: PPI therapy improves nocturnal asthma symptoms, daytime asthma symptoms, pulmonary function and decreases requirement of asthma medications in these patients.

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Hyperventilation has been associated with adverse effects on lung function, symptoms, and well-being in asthma. We examined whether raising end-tidal carbon-dioxide levels (PCO2), compared to slow breathing, was associated with improvements in asthma control, including peak-flow variability.

Method:120 asthma patients were randomly assigned to capnometry-assisted respiratory training (CART) for raising PCO2 or slowing respiratory rate (SLOW). Patients received five weekly sessions and completed twice-daily homework exercises over 4 weeks. Blinded assessments at baseline, posttreatment, 1-month and 6-months follow-up of asthma control, PCO2, and diurnal peak-flow variability were primary outcome measures. Additionally, we measured pulmonary function (spirometry, forced oscillation, exhaled nitric oxide, methacholine challenge), symptoms, quality of life, and bronchodilator use. Because the control group received an active treatment, we expected improvements in asthma control in both groups, but more pronounced benefits from CART.

Results:Improvements were seen in 17 of 21 clinical indices (81.0%) in both interventions, including the primary outcome variables asthma control (d=.81), peak-flow variability (d=.54), quality of life, bronchodilator use, lung function, and airway hyperreactivity. Most improvements were sustained across 6-month follow-up. Compared with slow breathing, CART showed greater increases in PCO2 (CART: d=1.45 vs. SLOW: d=.64) and greater reductions in respiratory impedance during treatment, less distress during methacholine challenge, and greater reduction in asthma symptoms at follow-up (Ps<.05).

Conclusions:Brief interventions aimed at raising PCO2 or slowing respiratory rate provide significant, sustained, and clinically meaningful improvements in asthma control. Raising PCO2 was associated with greater benefits in aspects of lung function and long-term symptoms. Trial Registration:clinicaltrials.gov Identifier: NCT00975273.

Background: Hyperventilation has been associated with adverse effects on lung function, symptoms, and well-being in asthma. We examined whether raising end-tidal carbon-dioxide levels (PCO2), compared to slow breathing, was associated with improvements in asthma control, including peak-flow variability.
Method: 120 asthma patients were randomly assigned to capnometry-assisted respiratory training (CART) for raising PCO2 or slowing respiratory rate (SLOW). Patients received five weekly sessions and completed twice-daily homework exercises over 4 weeks. Blinded assessments at baseline, posttreatment, 1-month and 6-months follow-up of asthma control, PCO2, and diurnal peak-flow variability were primary outcome measures. Additionally, we measured pulmonary function (spirometry, forced oscillation, exhaled nitric oxide, methacholine challenge), symptoms, quality of life, and bronchodilator use. Because the control group received an active treatment, we expected improvements in asthma control in both groups, but more pronounced benefits from CART.
Results: Improvements were seen in 17 of 21 clinical indices (81.0%) in both interventions, including the primary outcome variables asthma control (d=.81), peak-flow variability (d=.54), quality of life, bronchodilator use, lung function, and airway hyperreactivity. Most improvements were sustained across 6-month follow-up. Compared with slow breathing, CART showed greater increases in PCO2 (CART: d=1.45 vs. SLOW: d=.64) and greater reductions in respiratory impedance during treatment, less distress during methacholine challenge, and greater reduction in asthma symptoms at follow-up (Ps<.05).
Conclusions: Brief interventions aimed at raising PCO2 or slowing respiratory rate provide significant, sustained, and clinically meaningful improvements in asthma control. Raising PCO2 was associated with greater benefits in aspects of lung function and long-term symptoms.
Trial Registration: clinicaltrials.gov Identifier: NCT00975273.

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