A randomised 6-month study compared two maintenance doses of budesonide/formoterol (Symbicort(®) Turbuhaler(®))(1) maintenance and reliever therapy (Symbicort SMART(®)), 160/4.5 μg 1 × 2 and 2 × 2, in 8053 asthmatics with symptoms despite treatment with inhaled corticosteroids ± inhaled long-acting β(2)-agonists.

This analysis compared response to the two treatments in elderly patients, ≥65 years, with that in younger patients. Elderly patients with early- or late-onset asthma were also compared. Elderly patients had lower post-bronchodilator FEV(1) percentage predicted normal at baseline than younger patients (85.6% vs. 91.0%, respectively). The elderly had more exacerbations and risk of first severe exacerbation was increased by 55.3% (hazard ratio 1.553; 95% confidence interval: 1.249-1.931, p < 0.0001). However, no differences in exacerbations were seen between 1 × 2 or 2 × 2 budesonide/formoterol maintenance and reliever therapy treatment in the elderly. Five-item Asthma Control Questionnaire (ACQ-5) scores improved equally in the two age groups. Changes in mean ACQ-5 scores between 1 × 2 and 2 × 2 were significant in both age groups but not clinically relevant (≥65 years, 0.12; p = 0.018; <65 years, 0.09; p < 0.0001).

Elderly patients with early- and late-onset asthma responded equally well to treatment. Budesonide/formoterol maintenance and reliever therapy (1 × 2 or 2 × 2) is an effective, well-tolerated and practical treatment concept in elderly and younger asthmatic patients.

Asthma is the most common chronic medical condition that school-teachers are likely to encounter among their pupils. This study aimed to identify the needs of physical education teachers in dealing with adolescents with exercise-induced asthma, study their self-reported knowledge of asthma and identify future topics for education about exercise-induced asthma.

A questionnaire was drawn up on the basis of the requirements that had emerged in the course of interviews with 18 physical education teachers. One hundred and six physical education teachers at secondary schools in the city of Trondheim and colleges in Sør-Trøndelag County in Norway answered the questionnaire (65% response rate). Eighty-two physical education teachers (78.1%) had pupils with asthma in their sports classes, and 89.4% answered positively regarding their need for advice on teaching pupils with asthma. Twenty-seven (25.9%) reported that they had sufficient knowledge to teach adolescents with asthma.

Topics about asthma, its management and activities suitable for asthmatics were given high priority by the teachers.

The measurement of hydrogen peroxide (H(2)O(2)) in exhaled breath condensate (EBC) has been proposed as a noninvasive way of monitoring airway inflammation. However, results from individual studies on EBC H(2)O(2) evaluation of asthma are conflicting. The purpose of this study was to explore whether EBC H(2)O(2) is elevated in asthmatics, and whether it reflects disease severity, control or responds to corticosteroid treatment.

METHODS: Studies were identified by searching PubMed, Embase, Cochrane Database, CINAHL andwww.controlled-trials.com for relevant reports published before September 2010. Observational studies comparing levels of EBC H(2)O(2) between non-smoking asthmatics and healthy subjects were included. Data were independently extracted by two investigators and analyzed using STATA 10.0 software.

RESULTS: Eight studies (involving 728 participants) were included. EBC H(2)O(2) concentrations were significantly higher in non-smoking asthmatic patients compared to healthy subjects and higher values of EBC H(2)O(2) were observed at each level of asthma classified either by severity or control level and the values were negatively correlated with FEV(1). In addition, EBC H(2)O(2) concentrations were lower in corticosteroid-treated asthmatics than in patients not treated with corticosteroids.

CONCLUSIONS: H(2)O(2) might be a promising biomarker for guiding asthma management; however, further investigation is needed to establish its role.

The present review article concerns physical activity and sports in asthmatic adolescents. Exercise induced asthma (EIA) is found in 8-10% of a normal child population and in approximately 35% of children with current asthma as reported from a population based birth cohort study. The mechanisms of EIA are related to markedly increased ventilation during exercise, causing increased heat and water loss through respiration, leading to bronchial constriction.

In athletes and especially in endurance athletes, the repeated daily physical activity during training will over time cause epithelial damage and increase inflammation in the respiratory mucosa. With increased exposure to environmental agents as cold air in skiers and chlorine compunds in swimmers, the athlete may contract symptoms and signs of asthma and bronchial hyperresponsiveness, either worsening an existing asthma or causing symptoms in a previous healthy adolescent athlete. There are several causes of breathlessness in adolescents including EIA, vocal cord dysfunction, poor physical fitness and others, important to consider in the diagnostic procedure.

The asthmatic athlete should follow the same guidelines for treating his/her asthma as the ordinary asthmatic patient with concern made to the special diagnostic rules given for the use of asthma drugs in sports, especially for inhaled β2-agonists.