The adequate control of asthma includes the absence of nocturnal symptoms, minimal use of medication, normal or nearly normal lung function and no limitations to physical activity. The choice of a more sedentary lifestyle can lead to physical de-conditioning, thereby aggravating asthma symptoms and increasing the risk of obesity.

Background. Children with asthma experience changes in functional capacity and autonomic control. The literature suggests that this imbalance is responsible for bronchial hyperresponsiveness, primarily during physical effort. Objective. The aim of the present study was to evaluate variables of autonomic modulation and functional capacity in asthmatic children after maximum and submaximum work rate. Methods. A cross-sectional study was carried out with 24 children [18 in the asthma group (AG) and 6 in the control group (CG)]. Evaluations involved heart rate variability (HRV) and functional capacity [shuttle walk test (SWT) and three-minute step test]. Pulmonary function was also evaluated through spirometry and the fractional concentration of expired nitric oxide (FeNO). Results. The asthma diagnostic variables FEV1 and FeNO differed significantly between groups (p = .01). Distance traveled on the SWT was lower in the AG (333.13 ± 97.25 m vs. 442.66 ± 127.21 m; p = .04). Perceived exertion was greater in the AG. The HRV variables rMSSD and HF did not decrease significantly during the SWT (maximum work rate) in the AG (p = .01 and .04). FeNO was negatively correlated with FEV₁/FVC (r = −0.70; p = .004) and positively correlated with pNN50 (r = 0.50; p = .03) in the AG. Conclusion. From the autonomic standpoint, asthmatic and non-asthmatic children respond differently to stress. No withdrawal of parasympathetic cardiac modulation occurs in asthmatic children after maximum work rate. Children with asthma experience changes in functional capacity and lung function may vary depending on the degree of inflammation of the airways.

Asthma is the most common inflammatory disease affecting the lungs, which can be caused by intrauterine or postnatal insults depending on the exposure to environmental factors. During early life, the exposure to different risk factors can influence the microbiome leading to undesired changes to the immune system. The modulations of the immunity, caused by dysbiosis during development, can increase the susceptibility to allergic diseases. On the other hand, immune training approaches during pregnancy can prevent allergic inflammatory diseases of the airways. In this review, we focus on evidence of risk factors in early life that can alter the development of lung immunity associated with dysbiosis, that leads to asthma and affect childhood and adult life. Furthermore, we discuss new ideas for potential prevention strategies that can be applied during pregnancy and postnatal period.

Asthma is a widespread disease characterized by chronic airway inflammation. It causes substantial disability, impaired quality of life, and avoidable deaths around the world. The main treatment for asthmatic patients is the administration of corticosteroids, which improves the quality of life; however, prolonged use of corticosteroids interferes with extracellular matrix elements. Therefore, cell-based therapies are emerging as a novel therapeutic contribution to tissue regeneration for lung diseases. This study aimed to summarize the advancements in cell therapy involving mesenchymal stromal cells, extracellular vesicles, and immune cells such as T-cells in asthma. Our findings provide evidence that the use of mesenchymal stem cells, their derivatives, and immune cells such as T-cells are an initial milestone to understand how emergent cell-based therapies are effective to face the challenges in the development, progression, and management of asthma, thus improving the quality of life.

Purpose: Asthma is a chronic inflammatory condition characterized by bronchial hypersensitivity to endogenous or exogenous agents and variable airflow limitation, which is reversible either spontaneously or with the use of medication. The evaluation of functional capacity in these patients is commonly performed using field tests to gauge activity of daily living. However, the reliability of the symptom-controlled shuttle walk test has not yet been determined for individuals with difficult-to-control asthma. The aim of the present study was to determine the reliability of the shuttle walk test in patients with severe, difficult-to-control asthma. Methods: Forty-five patients were evaluated including lung function tests, the International Physical Activity Questionnaire (IPAQ), and the Asthma Control Questionnaire. The participants performed a shuttle walk test twice, with a 20-min rest period between tests. Results: The mean distance walked for this cohort was 330.5 m (range, 50-570 m) on the first walk test and 336.3 m (range, 60-571 m) on the second test. There was no statistical difference between the mean distances walked. The Bland-Altman plots of the 2 tests revealed a mean difference of -12.7 m, with a 95% CI of 37.9 to -63.2 m. Significant correlations were found between the distance walked in meters and the IPAQ (r = 0.36, P < .01) and distance in meters and muscle mass (r = 0.39, P < .009). Conclusion: The shuttle walk test is reliable for individuals with difficult-to-control asthma and can be used in the evaluation of functional capacity.

[Purpose] This study evaluated the effect of Bilevel Positive Airway (BiPAP) on the autonomic control of heart rate, assessed by heart rate variability (HRV), in patients hospitalized with decompensated heart failure. [Subjects and Methods] This prospective cross-sectional study included 20 subjects (age: 69±8 years, 12 male, left ventricular ejection fraction: 36 ±8%) diagnosed with heart failure who were admitted to a semi-intensive care unit with acute decompensation. Date was collected for HRV analysis during: 10 minutes spontaneous breathing in the resting supine position; 30 minutes breathing with BiPAP application (inspiratory pressure = 20 cmH2O and expiratory pressure = 10 cmH2O); and 10 minutes immediately after removal of BiPAP, during the return to spontaneous breathing. [Results] Significantly higher values for indices representative of increased parasympathetic activity were found in the time and frequency domains as well as in nonlinear Poincaré analysis during and after BiPAP in comparison to baseline. Linear HRV analysis: standard deviation of the average of all R-R intervals in milliseconds = 30.99±4.4 pre, 40.3±6.2 during, and 53.3±12.5 post BiPAP. Non-linear HRV analysis: standard deviations parallel in milliseconds = 8.31±4.3 pre, 12.9±5.8 during, and 22.8 ±6.3 post BiPAP. [Conclusion] The present findings demonstrate that BiPAP enhances vagal tone in patients with heart failure, which is beneficial for patients suffering from acute decompensation.