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Introduction: We test the effects of positive affect and its arousal subscale components of calm, wellbeing, and vigor on asthma control and symptom severity in adolescents with moderate to severe asthma. Additionally, we test whether positive affect (and its arousal components) moderate how stress impacts asthma control and symptom severity. Methods: Adolescents with asthma (N = 66, ages 12–17) completed brief surveys 4 times a day for 7 days reporting on their positive affect, stress, and asthma symptom severity and conducted a morning peak expiratory flow assessment each day. Asthma control and psychological asthma triggers were assessed at the end of the 7 days. Results: Positive affect moderated the association between stress and asthma control (b = −0.33, p = 0.009) as well as the association between psychological triggers and asthma control (b = −0.74, p = 0.007). When assessing the positive affect arousal components, calm and wellbeing seemed to be driving these effects. Additionally, calm moderated the association between stress and asthma symptom severity (b = −0.33, p = 0.036) as well as the association between psychological triggers and asthma symptom severity (b = −0.75, p = 0.021). Conclusions: When considering patient stress (e.g., general stress, psychological asthma triggers), positive affect and its arousal components of calm and wellbeing may be helpful for patients with higher levels of stress and/or for patients experiencing greater numbers of psychological triggers. [ABSTRACT FROM AUTHOR]

Background: Mast cells (MCs) develop from a rare population of peripheral blood circulating MC progenitors (MCps). Here, we investigated whether the frequency of circulating MCps is altered in asthma patients sensitized to birch pollen during pollen season, compared to out of season. Methods: Asthma patients were examined during birch pollen season in late April to early June (May), and out of season in November–January. Spirometry measurements, asthma and allergy‐related symptoms, asthma control questionnaire (ACQ), and asthma control test (ACT) scores were assessed at both time points. The MCp frequency was determined by flow cytometry in ficoll‐separated blood samples from patients with positive birch pollen‐specific IgE, and analyzed in relation to basic and disease parameters. Results: The frequency of MCps per liter of blood was higher in May than in November (p =.004), particularly in women (p =.009). Patients that reported moderate to severe asthma symptoms (<.0001), nose or eye symptoms (p =.02; p =.01), or reduced asthma control (higher ACQ, p =.01) had higher MCp frequency in May than those that did not report this. These associations remained significant after adjusting for sex and BMI. The change in asthma control to a lower ACT score in May correlated with an increase in MCp frequency in May (p =.006, rho = 0.46). Conclusions: The data suggest that the frequency of MCps increases in symptomatic patients with allergic asthma. Our results unravel a link between asthma symptoms and circulating MCps, and bring new insight into the impact of natural allergen exposure on the expansion of MCs. [ABSTRACT FROM AUTHOR]

Asthma medication adherence is of crucial importance for successful disease management. The aim of this study was to identify and rank factors associated with medication adherence among adults with asthma in the general population. We used data on physician-diagnosed asthma, medication adherence, and factors associated with asthma medication adherence from the Danish General Suburban Population Study using a cross-sectional study design. We ranked factors associated with asthma medication adherence based on the magnitude of odds ratios, and the population attributable fractions. Among 20,032 individuals from the general population, 1,128 (6%) suffered from asthma and 822 (73%) of these were adherent to asthma medications. Based on odds ratios, the three top-ranked factors associated with asthma medication adherence were asthma attacks within the past year (4.0; 95% CI: 2.9–5.5), allergy medication use (3.8; 2.6–5.6), and age above median (3.4; 2.4–4.7), followed by asthma severity markers like airway obstruction, and coughing with mucus. Based on population attributable fractions, the three top-ranked factors associated with adherence to asthma medications were asthma attacks within the past year (70%), age above median (57%), and use of allergy medication (49%). The study showed that in the general population recent asthma attacks, higher age, and taking allergy medication were the three most important factors associated with asthma medication adherence. The importance of maintaining adherence to asthma medications even in the absence of severe disease or expressed asthma symptoms should be better communicated to the general population. [ABSTRACT FROM AUTHOR]

Background: Asthma is associated not only with lower health-related quality of life (HRQL) but also with psychological health and insomnia. The aim of this study was to investigate associations between HRQL, asthma symptoms, psychological status and insomnia in adults from three Nordic countries. Methods: This study comprised 2,270 subjects aged 29–55 from Sweden, Iceland and Norway. HRQL was measured with the 36-Item Short Form Health Survey (SF-36). The physical (PCS) and mental health (MCS) component scores were calculated with higher values, indicating better health status. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Insomnia was assessed with the Basic Nordic Sleep Questionnaire. An asthma score consisting of a sum of the positive answers to five respiratory symptoms was used in the analysis. Spirometry and allergy tests were also performed. Results: High HADS and sleep disturbance scores were both related to a low PCS and MCS, respectively, after adjusting for confounders. High age and high body mass index (BMI) were associated with low scores on the PCS, whilst the opposite was found for the MCS. A higher asthma score was related to a low PCS. An interaction between the HADS and the asthma symptom score was observed for the PCS (P = 0.0002), where associations between psychological status and the PCS were more pronounced for individuals with more symptoms than for individuals without symptoms. Conclusions: In this study, we found that HRQL of life was independently related to the HADS, insomnia and asthma symptoms. Further prospective studies to identify the most efficient target for intervention in order to improve asthma control are needed.

Triple-crossover randomized controlled intervention trial to test whether reduced exposure to household NO2 or fine particles results in reduced symptoms among children with persistent asthma. Children (n = 126) aged 5–11 years with persistent asthma living in homes with gas stoves and levels of NO2 15 ppb or greater recruited in Connecticut and Massachusetts (2015–2019) participated in an intervention involving three air cleaners configured for: (1) NO2 reduction: sham particle filtration and real NO2 scrubbing; (2) particle filtration: HEPA filter and sham NO2 scrubbing; (3) control: sham particle filtration and sham NO2 scrubbing. Air cleaners were randomly assigned for 5-week treatment periods using a three-arm crossover design. Outcome was number of asthma symptom-days during final 14 days of treatment. Treatment effects were assessed using repeated measures, linear mixed models. Measured NO2 was lower (by 4 ppb, p <.0001) for NO2-reducing compared to control or particle-reducing treatments. NO2-reducing treatment did not reduce asthma morbidity compared to control. In analysis controlling for measured NO2, there were 1.8 (95% CI −0.3 to 3.9, p =.10) fewer symptom days out of 14 in the particle-reducing treatment compared to control. It remains unknown if using an air cleaner alone can achieve levels of NO2 reduction large enough to observe reductions in asthma symptoms. We observed that in small, urban homes with gas stoves, modest reductions in asthma symptoms occurred using air cleaners that remove fine particles. An intervention targeting exposures to both NO2 and fine particles is complicated and further research is warranted. NCT02258893. [ABSTRACT FROM AUTHOR]

Asthma has a high prevalence in Indonesia. Good self-management is necessary for therapy and greatly affects the level of asthma control symptoms. The patient's perception plays an important role in the success of asthma therapy, especially among students, because education affects a person's mindset and perception of disease conditions. The purpose was to determine the relationship between illness perception and control of asthma symptoms in adolescents. The method was cross-sectional and was conducted from November 2019 to January 2020. The variables were asthma control and illness perception. This research was conducted on a campus in Surabaya city. Respondents were asked to fill out the Illness Perception Questionnaire (IPQ) and asthma control test (ACT) questionnaire and analyze by calculating each answer point. This study used a chi-square test to analyze the relationship between ACT and Illness perception. This study involved 75 respondents. Of most of the respondents, 58 people have their asthma partially controlled. Most respondents experienced shortness of breath and wheezing symptoms, and most understood that they were related to their asthma. There was a relationship between asthma control scores and illness perception (p>0.05) on the timeline (p=0.03), personal control (p=0.03), and causal representation (p=0.01). Illness perception can affect asthma symptoms. Asthma will be experienced for a long time, and respondents will better adjust their lifestyle and have confidence that it was controlled. Material factors were also considered. If their asthma was controlled, it was hoped not to affect their finances.

Background and objective: Individuals with asthma are more likely to develop sleep‐disordered breathing. Exercise training improves sleep; however, the effect of physical activity (PA) on improving sleep quality remains unknown. This study had two objectives: (i) to evaluate the effect of a behavioural intervention to increase physical activity in daily living (PADL) on sleep quality in adults with asthma; (ii) to verify the association between a change in sleep quality, quality of life, anxiety, depression and asthma symptoms. Methods: This randomized controlled clinical trial included adults physically inactive with asthma. Participants were randomized into the control (CG; n = 25) and intervention groups (IG; n = 24). IG was submitted to a behavioural intervention to increase PADL, and CG received the usual care. Pre‐ and post‐intervention assessments of sleep quality (by actigraphy and questionnaire), PADL level (by accelerometry), asthma control, health‐related quality of life and anxiety and depression levels were conducted. Results: Both groups were similar at baseline. After the intervention, IG increased daily steps and moderate to vigorous PA levels. IG also improved sleep efficiency and latency as well as increased asthma‐symptom‐free days compared to CG. In addition, a greater proportion of participants in the IG had improved sleep quality after the intervention. Lastly, IG presented clinical improvement in the asthma‐related quality of life questionnaire and a reduction in anxiety symptoms. Conclusion: Our results demonstrate that a behavioural intervention can increase PA, enhance behavioural sleep quality, efficiency and quality of life and reduce asthma and anxiety symptoms. [ABSTRACT FROM AUTHOR]

Marta A Kisiel,1,&ast; Martin Jacobsson,2,&ast; Susann Järhult,3 Linda Ekerljung,4 Kjell Alving,5 Roelinde Middelveld,6 Karl Franklin,7 Christer Janson2 1Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; 2Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; 3Department of Medical Sciences, Emergency Department, Uppsala University, Uppsala, Sweden; 4Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, University of Gothenburg, Gothenburg, Sweden; 5Department of Women’s and Children’s Health, Paediatric Research, Uppsala University, Uppsala, Sweden; 6Centre for Allergy Research and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 7Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden&ast;These authors contributed equally to this workCorrespondence: Marta A Kisiel, Dag Hammarskjölds väg 60, Uppsala, 751 85, Sweden, Tel +46704145919, Email marta.kisiel@medsci.uu.seBackground: Asthma is a common chronic disease presenting with airway symptoms such as wheezing, chest tightness and attacks of breathlessness. Underdiagnosis of asthma is common and correlates to negative outcomes such as a lower quality of life and reduced work capacity.Purpose: This study aims to identify factors for not being diagnosed with asthma if presenting with asthma symptoms.Patients and Methods: A questionnaire was sent to 45,000 subjects (age 16– 74 years) in Sweden. Subjects who reported both wheeze and breathlessness and wheeze when not having a cold were defined as having asthma-related symptoms. Data on demographics, educational level, smoking, physical activity, comorbidities, symptoms and asthma were collected. Logistic regression was used to identify risk factors for not being diagnosed with asthma.Results: Of the 25,391 who responded to the survey, 6.2% reported asthma-related symptoms. Of these, 946 had been diagnosed with asthma previously, while 632 had not. Independent risk factors for not being diagnosed with asthma were higher age (OR (95% CI) (2.17 (1.39– 3.40))), male sex (1.46 (1.17– 1.81)), current smoking (2.92 (2.22– 3.84)), low level of education (1.43 (1.01– 2.01)), low physical activity (1.36 (1.06– 1.74)), and hypertension (1.50 (1.06– 2.12)).Conclusion: Men, smokers, older subjects, and those with low educational level or low physical activity are less likely to be diagnosed with asthma despite presenting asthma-related symptoms.Keywords: asthma symptoms, no diagnosis despite symptoms of asthma

Background: Accurate assessment of asthma symptoms is central to appropriate treatment and management; however effective communication about symptoms−how it is perceived and reported−remain challenging in pediatric clinical and research settings. Objective: To synthesize the existing pediatric literature on children's and adolescents’ word descriptors of asthma symptoms. Methods: In this integrative review, we systematically searched Cumulative Index of Nursing and Allied Health Literature and PubMed databases to identify original research studies from 1980 to 2021 on children and adolescents’ word descriptors of asthma symptoms. Results: The search yielded 2,232 articles, of which 21 studies met the eligibility criteria. Scientific literature focused on children and adolescents’ descriptions of asthma symptoms are limited. In addition to standard asthma symptom terminology (e.g. cough, wheeze, chest tightness, shortness of breath), pediatric populations used nonstandard word choices to describe the asthma symptom experience. Children and adolescents used a variety of affective (e.g. ‘helpless’, ‘afraid of dying’) and sensory words (e.g. ‘pressure in chest’, ‘tightness, lungs feel shut’) to describe the phenomena. Literature examining race differences in word descriptors in pediatrics is limited; thus it is unclear if word descriptors vary by race or ethnicity. Evidence of relationships between descriptors and gender and age are also lacking. Conclusions: Our review elucidates gaps in the literature regarding the full extent of the language common to racially and ethnically diverse samples of children and adolescents. Further research is warranted to help clinicians and researchers query children and adolescents’ experience of asthma symptoms.

Background: Asthma affects millions of people globally, and high levels of air pollution aggravate asthma occurrence. This study aimed to determine the association between short-term lagged PM 2.5 exposure and airway inflammation, lung function, and asthma symptom scores among schoolchildren in communities in the Highveld high-pollution region in South Africa., Methods: A cross-sectional study was conducted among schoolchildren aged 9-14 years in six communities in the Highveld region in South Africa, between October 2018 and February 2019. A NIOX 200 instrument was used to measure fractional exhaled nitric oxide (FeNO). Lung function indices (forced expiratory volume in one second [FEV 1 ]; forced vital capacity [FVC] and FEV 1 /FVC) were collected using spirometry and the percent of predicted of these was based on the reference equations from the Global Lung Initiative, without ethnic correction. These values were further analyzed as binary outcomes following relevant thresholds (lower limits of normal for lung function and a cutoff of 35 ppb for FeNO). Asthma symptoms were used to create the asthma symptom score. Daily averages of PM 2.5 data for the nearest monitoring station located in each community, were collected from the South African Air Quality Information System and created short-term 5-day lag PM 2.5 concentrations. Additional reported environmental exposures were collected using standardized instruments., Results: Of the 706 participating schoolchildren, only 1.13% of the participants had doctor-diagnosed asthma, compared to a prevalence of 6.94% with an asthma symptom score suggestive of asthma. Lag 1 (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00, 1.02, P = 0.039) and 5-day average lagged PM 2.5 (OR: 1.02; 95% CI: 0.99, 1.04, P = 0.050) showed increased odds of the FeNO > 35 ppb. Lung function parameters (FEV 1 < lower limit of normal [LLN] [OR: 1.02, 95% CI: 1.00, 1.03, P = 0.018], and FEV 1 /FVC < LLN [OR: 1.01; 95% CI: 1.00, 1.02, P < 0.001]) and asthma symptom score ≥ 2 (OR: 1.02; 95% CI: 1.00, 1.04, P = 0.039) also showed significant associations with lag 2, lag 4 and lag 1 of PM 2.5 , respectively., Conclusion: Lagged PM 2.5 exposure was associated with an increased odds of airway inflammation and an increased odds of lung function parameters below the LLN particularly for the later lags, but a significant dose-response relationship across the entire sample was not consistent., Competing Interests: The authors declare that they have no conflicts of interest with regard to the content of this report., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Environmental Epidemiology. All rights reserved.)

Objective - The aim of study was to evaluate the effects of parental smoking and tobacco smoke exposure (TSE) on asthma symptoms in children, and to raise awareness of the detrimental effects of TSE for asthmatic children. Methods - A modified and validated questionnaire on TSE was completed by 76 parents and their children who were being treated at Srebrnjak Children's Hospital for asthma. Patients filled in a standardized ACT questionnaire about their asthma symptoms, whereas parental smoking data were derived from a questionnaire filled in by the parents. The answers were structured as ordinal and categorical variables. The non-parametric Mann-Whitney U test and Kruskal-Wallis test were performed. Results -There are statistically significant differences in the frequency of asthma symptoms in children depending on whether household members smoked cigarettes, with statistically significant differences in the frequency of asthma symptoms in children depending on whether their parents smoked cigarettes outside the house, only in one/certain room or everywhere in the house. 34.1% of smoking parents vs 9.4% of nonsmoking parents allow smoking in a car while the child is riding in it. 40.9% of parents who smoke vs 21.9% of non-smoking parents believe that their child is exposed to tobacco smoke somewhere other than in their household or car. Conclusion - TSE is associated with more symptoms and worse asthma control in asthmatic children. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies have indicated that anti-Ascaris IgE enhances asthma and allergies under specific conditions although the association between them is still controversial. The association of anti-Ascaris IgE with increased asthma symptoms among children from a general population with a mild to moderate Ascaris infection prevalence was investigated. Methods: A total of 126 children aged 5 years with wheezing during the previous year and 110 children who did not have wheezing were selected randomly from the rural service area of the International Centre for Diarrhoeal Disease Research, Bangladesh. Serum levels of total, anti-Ascaris, anti-Dermatophagoides pteronyssinus, and anti-cockroach IgEs were tested, and their risks for wheezing were analyzed. The wheezing children were then classified by hierarchical cluster analysis to investigate the contribution of anti-Ascaris IgE to wheezing. Results: The anti-Ascaris IgE levels in wheezing and never-wheezing children were 1.07 and 0.65 UA/mL, and it contributed to 11% of wheezing in children. Anti-Ascaris IgE was significantly associated with wheezing (odds ratio [OR] per loge increment: 1.37 [95% CI: 1.01–1.87], p = 0.046). The ORs, which were adjusted for sex, parental asthma, pneumonia history, helminth infections, Haemophilus influenzae type B combination vaccination, antibiotic use during infancy, and total and specific IgE levels, increased even when only children with more specific symptoms of asthma were included in the analysis. Namely, the ORs for wheezing with sleep disturbance, four or more attacks, and wheezing with speech difficulties during the previous 1 year were OR = 1.44/loge increment [95% CI: 1.01–2.07], OR = 1.90/loge increment [95% CI: 1.11–3.25], and OR = 1.78/loge increment [95% CI: 1.01–3.14], respectively. Conclusions: The anti-Ascaris IgE levels in wheezing and never-wheezing children in the current study significantly decreased concurrently with Ascaris infection prevalence compared with their corresponding values in 2001. The contribution of anti-Ascaris IgE to wheezing also dropped from 26% in 2001 to 11% in the current study. Despite significant decreases in the levels and the seroprevalence and its contribution to wheezing, anti-Ascaris IgE remained significantly associated with increased risk of wheezing. Anti-Ascaris IgE significantly increased the risk of wheezing in a general population with a mild to moderate Ascaris infection prevalence, suggesting robustness as a risk factor and a possible dose-response relationship. [ABSTRACT FROM AUTHOR]

Indoor microbiome exposure is important for asthma development, but current studies characterize the microbiome at the genus or above levels due to technical limitations. We aim to profile bacterial and fungal composition and concentration at the species level and assess its potential health effects. Four hundred sixty-three students from 8 junior high schools in Terengganu, Malaysia, were surveyed for asthma symptoms. Full-length PacBio amplicon sequencing and qPCR were conducted to quantify the absolute microbial concentration in the vacuum dust of the selected classroom. In total, 1358 bacterial and 358 fungal species were characterized, and drastic compositional variation was observed among classrooms. Three-level linear regression analyses revealed that taxa richness in Cyanobacteria were negatively associated with asthma (FDR < 0.001). The absolute concentration of Nocardioides exalbidus was protectively associated with asthma, and four bacteria species were positively associated with asthma (FDR < 0.1). Interestingly, all five species were recently isolated and characterized in Asian countries and never reported to associate with asthma. Indoor NO2 and formaldehyde concentration were associated with the overall bacterial community variation and fungal richness, respectively (p < 0.05). No environmental characteristics were directly associated with asthma, but indoor relative humidity, CO2 concentration, and weight of vacuum dust were associated with the asthma-related species (p < 0.05), suggesting a potential indirect health effect on students. This is the first study to characterize indoor microbiome and asthma-associated microorganisms at the species level, representing a region-specific microbiome exposure pattern in a tropical Asian country. [ABSTRACT FROM AUTHOR]

Background: Chronic respiratory diseases such as asthma are often caused by a variety of variables, and there is growing interest in the role of hormones, especially those related to the female menstrual cycle. Objective: The purpose of the study was to elucidate the relationship between the menstrual cycle and the symptoms of asthma in female patients. Methodology: The purpose of the cross-sectional research, which was carried out at Liaquat Memorial Hospital Kohat, Women and Children hospital Abbottabad, Khyber Teaching Hospital Peshawar and Poonch Medical College/ CMH Rawalakot AJK from January 2020 to March 2021, was to explore the impact of menstruation on asthma symptoms in female patients. According to the authorized research design, female patients who visited emergency department, gynae opd, were given a thorough health questionnaire to complete in order to prospectively gather data. Menstrual-Related Asthma (MLA) was self-identified by the subjects, who ranged in age from 14 to 45. Spirometric readings were taken after the questionnaire. Several health-related characteristics were taken into consideration while comparing participants with and without MLA using statistical analysis, which included chisquare tests and logistic regression. Results: In our study involving 240 female participants (76.19% response rate), 13.33% reported MLA. Pregnant women with MLA had substantially greater rates of asthma exacerbations (52.38% vs. 29.18%, p=0.032) and higher incidence of allergies (p<0.001). Although the frequencies of symptoms were similar in both groups, women with MLA reported greater doses of rescue medicine (53.33% vs. 37.29%, p=0.010) and more chest tightness (38.09% vs. 27.56%, p=0.101). MLA was linked to more urgent/emergent medical visits, especially to the emergency department (p=0.034), and asthma-related absenteeism (54.76% vs. 36.75%, p=0.003). In comparison to women without MLA, those with MLA also had greater rates of eczema (n=13; 30.95%), heart disease (n=5; 11.90%), and rheumatoid arthritis (n=5; 11.90%). Conclusion: The results of this thorough study highlight the need for customized interventions to meet the particular healthcare needs of women with MLA. They also show a significant correlation between MLA in female patients and distinct exacerbations, increased reliance on rescue medication, elevated asthma-related absenteeism, and a higher prevalence of comorbid health conditions. [ABSTRACT FROM AUTHOR]

Background: Asthma is associated not only with lower health-related quality of life (HRQL) but also with psychological health and insomnia. The aim of this study was to investigate associations between HRQL, asthma symptoms, psychological status and insomnia in adults from three Nordic countries. Methods: This study comprised 2,270 subjects aged 29-55 from Sweden, Iceland and Norway. HRQL was measured with the 36-Item Short Form Health Survey (SF-36). The physical (PCS) and mental health (MCS) component scores were calculated with higher values, indicating better health status. Symptoms of depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Insomnia was assessed with the Basic Nordic Sleep Questionnaire. An asthma score consisting of a sum of the positive answers to five respiratory symptoms was used in the analysis. Spirometry and allergy tests were also performed. Results: High HADS and sleep disturbance scores were both related to a low PCS and MCS, respectively, after adjusting for confounders. High age and high body mass index (BMI) were associated with low scores on the PCS, whilst the opposite was found for the MCS. A higher asthma score was related to a low PCS. An interaction between the HADS and the asthma symptom score was observed for the PCS (P = 0.0002), where associations between psychological status and the PCS were more pronounced for individuals with more symptoms than for individuals without symptoms. Conclusions: In this study, we found that HRQL of life was independently related to the HADS, insomnia and asthma symptoms. Further prospective studies to identify the most efficient target for intervention in order to improve asthma control are needed. [ABSTRACT FROM AUTHOR]

Background: Accurate symptom monitoring is vital when managing pediatric asthma, providing an opportunity to improve control and relieve associated burden. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) has been validated for asthma control assessment in children; however, there are concerns that response option images used in the C-ACT are not culturally universal and could be misinterpreted. This cross-sectional, qualitative study developed and evaluated alternative response option images using interviews with children with asthma aged 4–11 years (and their parents/caregivers) in the United States, Spain, Poland, and Argentina. Interviews were conducted in two stages (with expert input) to evaluate the appropriateness, understanding and qualitative equivalence of the alternative images (both on paper and electronically). This included comparing the new images with the original C-ACT response scale, to provide context for equivalence results. Results: Alternative response option images included scale A (simple faces), scale B (circles of decreasing size), and scale C (squares of decreasing quantity). In Stage 1, most children logically ranked images using scales A, B and C (66.7%, 79.0% and 70.6%, respectively). However, some children ranked the images in scales B (26.7%) and C (58.3%) in reverse order. Slightly more children could interpret the images within the context of their asthma in scale B (68.4%) than A (55.6%) and C (47.5%). Based on Stage 1 results, experts recommended scales A (with slight modifications) and B be investigated further. In Stage 2, similar proportions of children logically ranked the images used in modified scales A (69.7%) and B (75.7%). However, a majority of children ranked the images in scale B in the reverse order (60.0%). Slightly more children were able to interpret the images in the context of their asthma using scale B (57.6%) than modified scale A (48.5%). Children and parents/caregivers preferred modified scale A over scale B (78.8% and 90.9%, respectively). Compared with the original C-ACT, most children selected the same response option on items using both scales, supporting equivalency. Following review of Stage 2 results, all five experts agreed modified scale A was the optimal response scale. Conclusions: This study developed alternative response option images for use in the C-ACT and provides qualitative evidence of the equivalency of these response options to the originals. Plain English summary: Accurate monitoring of the symptoms associated with pediatric asthma is important when managing the condition. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) is a questionnaire widely used to measure asthma severity in young children (aged 4–11 years). Each question answered by the child in the C-ACT has four possible answer choices. To help children answer, each choice is presented alongside an image of a male child's face ranging from sad to happy. However, there are concerns that the images used are not culturally universal and could be misinterpreted—due to difficulties translating to electronic formats and a lack of differentiation between the images used. Through interviewing children with asthma, we aimed to address these concerns by developing and testing new images. Alternative image options developed included simpler faces, circles of decreasing size and squares of decreasing quantity. Children aged 4–11 years old were interviewed to test whether they understood the response scale using the new images and if they answered in the same way as with the original images. Interviews were conducted in two stages, with expert guidance at key stages. Results showed that children can interpret and understand the newly developed images and that they answer the questions the same as they would using the original images. These new images have the advantages of being culturally neutral and easier to implement on an electronic device. [ABSTRACT FROM AUTHOR]

Electronic cigarettes use is increasing in the United States. One motive for e-cigarette's popularity is that they wean from combustible cigarettes. Smokers perceive electronic cigarette products as healthier than cigarette smoking and as a useful tool for smoking cessation. However, research has indicated the use of electronic cigarettes may have harmful effects on respiratory function even with short-term use. Respiratory effects of e-cigarette use among asthmatics are little understood. The aim of this study was to determine the association between e-cigarette use and frequency of asthma symptoms among adult asthmatics in California from 2015–2016. This cross-sectional study included a total of 1277 adult asthmatics. The presence of asthma was based on an adult's self-reported doctor diagnosis. The analysis was controlled for age, education, sex, race, body mass index, and smoking status. E-cigarette use was associated with increased odds of having more frequent asthma symptoms (OR = 1.69, CI: 1.20–2.39, p = 0.002; ORadj = 1.65, CI: 1.09–2.49, p = 0.016). Male e-cigarette users were more likely to have more frequent asthma symptoms compared to male nonusers (OR = 1.90, CI: 1.13–3.19, p = 0.015; ORadj = 2.42, CI: 1.28–4.55, p = 0.006). No differences were found between female e-cigarette users and nonusers (OR = 1.43, CI: 0.86–2.37, p = 0.162; ORadj = 1.26, CI: 0.72–2.18, p = 0.162). Our findings suggest that e-cigarette use is associated with more frequent asthma symptoms and disproportionally affects male asthmatics. [ABSTRACT FROM AUTHOR]

ObjectiveThe purpose of this study was to examine the incidence, characteristics of asthma morbidity and care, and ethnic differences that exist in older adults with asthma in California.MethodsData were from the 2009 California Health Interview Survey (CHIS). Characteristics of older adults (≥65 years) with and without asthma were compared using population-weighted estimates. Asthma-specific variables were compared among different ethnic groups. Multivariate analyses were preformed to determine factors associated with asthma status, asthma episodes/attacks, asthma symptom frequency and emergency department (ED) visits due to asthma.ResultsAsthma was present in 8.1% of older adults, among which, 67.3% reported taking medication daily for asthma. Asthma symptoms were experienced every day by almost 20%, with over 34% of seniors with asthma having symptoms at least once per week. Despite having a lower frequency of asthma symptoms, Hispanics were 5.31 times more likely to visit the ED due to asthma than were Caucasians.ConclusionsThe findings from the study showed that older adults with asthma had difficulty with asthma control. We recommend a focus on asthma education so that when symptoms do occur, options are available to avoid costly ED visits. Further research should focus on specific asthma management skills and adherence to asthma treatment regimen among ethnic groups.

Objectives: To evaluate the effects of a one-time, apartment-level Integrated Pest Management (IPM) intervention on healthcare utilization and asthma symptoms among children with persistent asthma living in households with a pest infestation. Study design: In a randomized controlled trial of 384 children aged 5–12 years with persistent asthma, we assigned 183 to receive IPM and 197 to usual care (UC). The primary outcome was healthcare utilization from hospital and Medicaid claims records. Secondary outcomes included caregiver-reported asthma symptoms, pest infestation levels, missed days of school due to asthma, and rescue medication use. Results: The entire cohort improved over the study period, with significant but equivalent declines in mean healthcare utilization in both groups. IPM group had fewer days with reduced activity due to asthma (p = 0.04) and larger declines that fell short of statistical significance in asthma symptom days (p = 0.22), severe symptoms (p = 0.16), missed school (p = 0.27) and rescue medication use (p = 0.27). Both roach (p = 0.001) and mice (p = 0.11) infestations decreased much more in the IPM group than the UC group. Conclusions: After a one-time, apartment-level IPM intervention, we found no difference in health care utilization, but fewer days of reduced activity and consistent suggestive evidence of clinically meaningful improvements relative to usual care across other secondary outcomes. Coupled with the established effectiveness of IPM in reducing allergens and scientific consensus on pest-related allergens as asthma triggers, these findings support adding home pest control to traditional medical management of children with severe asthma. [ABSTRACT FROM AUTHOR]

Abstract The genetic architecture of asthma was relatively well explored. However, some work remains in the field to improve our understanding on asthma genetics, especially in non-Caucasian populations and with regards to commonly neglected genetic variants, such as Copy Number Variations (CNVs). In the present study, we investigated the contribution of CNVs on asthma risk among Latin Americans. CNVs were inferred from SNP genotyping data. Genome wide burden and association analyses were conducted to evaluate the impact of CNVs on asthma outcome. We found no significant difference in the numbers of CNVs between asthmatics and non-asthmatics. Nevertheless, we found that CNVs are larger in patients then in healthy controls and that CNVs from cases intersect significantly more genes and regulatory elements. We also found that a deletion at 6p22.1 is associated with asthma symptoms in children from Salvador (Brazil) and in young adults from Pelotas (Brazil). To support our results, we conducted an in silico functional analysis and found that this deletion spans several regulatory elements, including two promoter elements active in lung cells. In conclusion, we found robust evidence that CNVs could contribute for asthma susceptibility. These results uncover a new perspective on the influence of genetic factors modulating asthma risk.

Ting Ting Ma,1–3 Yan Zhuang,1 Hai Ying Gong,4 Anthony Chauang Yii,5 Xue Yan Wang,1 Huan Zhong Shi2,3 1Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, 2Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Capital Medical University, 3Center of Medical Research, Beijing Institute of Respiratory Diseases, 4Fangshan District Center for Disease Control and Prevention, Beijing, People’s Republic of China; 5Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore Background: The diagnosis of asthma is made on the basis of variable respiratory symptoms and supported by objective evidence of variable airflow limitation. However, spirometry and bronchoprovocation tests may not be routinely available in resource-scarce settings or in the context of large-scale epidemiological studies. There is a gap in knowledge about the predictive value of respiratory symptoms for the diagnosis of pollen-induced asthma.Objective: The aim of this study was to investigate the predictive value of self-reported respiratory symptoms for diagnosing pollen-induced asthma.Patients and methods: We recruited 1,161 patients with respiratory symptoms who presented to the respiratory medicine outpatient clinic of two central hospitals in Inner Mongolia during the pollen season of July–September 2015. All patients were interviewed by a respiratory physician and completed a questionnaire survey, lung function tests and skin prick tests for common inhaled allergens.Results: A total of 392 patients (33.8%) were diagnosed with asthma and 292 (25.2%, 160 adults, 132 children) with pollen-induced asthma. Respiratory symptoms of cough, wheezing, dyspnea, chest pain and nocturnal awakenings due to breathlessness were all associated with increased odds of being diagnosed with pollen-induced asthma, with cough being the most common symptom in both adults and children, giving a sensitivity of 90.6% in adults and 88.6% in children. Wheezing was the most specific symptom (78% and 89.5% in adults and children, respectively) compared to other symptoms. Overall, the positive predictive value of respiratory symptoms was poor for diagnosing pollen-induced asthma, with the exception of wheezing in children which had a high positive predictive value of 72.7%.Conclusion: Cough was the predominant symptom in adults and children with pollen-induced asthma. Wheezing was a reliable predictor of pollen-induced asthma in children. In adults, respiratory symptoms were not sufficiently reliable for diagnosing pollen-induced asthma. Keywords: pollen-induced asthma, asthma symptoms, wheezing, cough, shortness of breath

Abstract Background This study aims to elucidate factors that among adults with asthma are associated with working full-time. Methods This cross-sectional survey of 2613 working-age adults with asthma included questions on asthma history, symptoms and use of asthma medication, socioeconomic factors and health behavior. Full-time workers were compared to groups according to employment status: unemployed, work disability and retired due to age. Results Adults with asthma working full time were younger and more often nonmanual workers, experienced less asthma symptoms, used less asthma medication and smoked less than subjects with work disability. After adjusting for age, gender, smoking and professional status, having frequent symptoms of asthma during last month was associated with an increase in the risk of unemployment (OR 2.3, 95% CI 1.3–4.2) and with an increase in the risk of work disability (OR 4.4, 95% CI 2.3–8.2). Conclusions Among adults with asthma, full-time work was associated with younger age, less symptomatic asthma despite of less medication, nonmanual work and less smoking. Having more severe symptoms of asthma was associated with undesirable employment status such as unemployment or work disability. Possibilities to change from manual to nonmanual work may be important in preventing work disability and early exit from work.

Asthma is a heterogeneous disease with varying severity and subtypes. Recent reviews of epidemiologic studies have identified cleaning and disinfecting activities (CDAs) as important risk factors for asthma-related outcomes among healthcare workers. However, the complexity of CDAs in healthcare settings has rarely been examined. This study utilized a complex survey dataset and data reduction approaches to identify and group healthcare workers with similar patterns of asthma symptoms, and then explored their associations with groups of participants with similar patterns of CDAs. Self-reported information on asthma symptoms/care, CDAs, demographics, smoking status, allergic status, and other characteristics were collected from 2030 healthcare workers within nine selected occupations in New York City. Hierarchical clustering was conducted to systematically group participants based on similarity of patterns of the 27 asthma symptom/care variables, and 14 product applications during CDAs, separately. Word clouds were used to visualize the complex information on the resulting clusters. The associations of asthma health clusters (HCs) with exposure clusters (ECs) were evaluated using multinomial logistic regression. Five HCs were identified (HC-1 to HC-5), labelled based on predominant features as: "no symptoms", "winter cough/phlegm", "mild asthma symptoms", "undiagnosed/untreated asthma", and "asthma attacks/exacerbations". For CDAs, five ECs were identified (EC-1 to EC-5), labelled as: "no products", "housekeeping/chlorine", "patient care", "general cleaning/laboratory", and "disinfection products". Using HC-1 and EC-1 as the reference groups, EC-2 was associated with HC-4 (odds ratio (OR) = 3.11, 95% confidence interval (95% CI) = 1.46-6.63) and HC-5 (OR = 2.71, 95% CI = 1.25-5.86). EC-3 was associated with HC-5 (OR = 2.34, 95% CI = 1.16-4.72). EC-4 was associated with HC-5 (OR = 2.35, 95% CI = 1.07-5.13). EC-5 was associated with HC-3 (OR = 1.81, 95% CI = 1.09-2.99) and HC-4 (OR = 3.42, 95% CI = 1.24-9.39). Various combinations of product applications like using alcohols, bleach, high-level disinfectants, and enzymes to disinfect instruments and clean surfaces captured by the ECs were identified as risk factors for the different asthma symptoms clusters, indicating that prevention efforts may require targeting multiple products. The associations of HCs with EC can be used to better inform prevention strategies and treatment options to avoid disease progression. This study demonstrated hierarchical clustering and word clouds were useful techniques for analyzing and visualizing a complex dataset with a large number of potentially correlated variables to generate practical information that can inform prevention activities. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between secondhand smoke exposure (SHSe) and asthma symptoms, medication use, and emergency department (ED)/urgent care (UC) utilization among adolescents. Methods: We performed a secondary cross-sectional analysis of Population Assessment of Tobacco and Health Study Wave 2 (2014–2015) including asthmatic adolescents (N = 2198). Logistic regression models and Poisson regression models were built. Results: Participants with SHSe ≥1 hour in the past 7 days were at increased risk of reporting shortness of breath and harder to exercise aOR, 1.22; 95% CI, 1.04–1.43), wheezing (aOR, 1.26; 95% CI, 1.01–1.56), wheezing disturbing sleep (aOR, 1.88; 95% CI, 1.35–2.63), wheezing during/after exercise (aOR, 1.41; 95% CI, 1.19–1.66), wheezing limiting speech (aOR, 2.11; 95% CI, 1.55–2.86), dry cough at night (aOR, 1.86; 95% CI, 1.54–2.24), and asthma symptoms disturbing sleep (aOR, 2.25; 95% CI, 1.81–2.79). Participants with SHSe ≥1 hour were more likely to take asthma medications (aOR, 1.25; 95% CI, 1.03–1.52), including steroids (aOR, 1.86; 95% CI, 1.19–2.91), oxygen therapy (aOR, 2.88; 95% CI, 1.82–4.54), and controlling medications (aOR, 1.50; 95% CI, 1.24–1.82). Symptoms and medications varied by living with a smoker and home SHSe. Participants with SHSe were at increased risk of having a higher number of asthma attacks that required steroid use. Participants who lived with a smoker and had home SHSe were at increased risk of having higher ED/UC visits for asthma. Conclusions: SHSe reduction efforts are needed for asthmatic adolescents, and EDs/UCs are promising venues. [ABSTRACT FROM AUTHOR]

Background: If asthmatic children cannot obtain sufficient control of their disease, not only do they suffer from asthma symptoms, but the daily life activities of their caregivers are also disrupted. We investigated the effectiveness of an inhaled corticosteroid (ICS) for symptom control in previously ICS-untreated school-aged asthmatic children as well as caregiver treatment satisfaction (CTS). Methods: A multicenter, open-label, single-arm study on 12-week ICS (budesonide Turbuhaler®) monotherapy was undertaken in subjects aged 5–15 years with bronchial asthma not treated with ICS during the previous 3 months. At 0, 4, 8, and 12 weeks after start of ICS administration, Japanese Pediatric Asthma Control Program (JPAC) scores, and CTS scores were summated and lung function measured. At weeks 0 and 12, questionnaires on caregiver anxiety were also assessed. Results: Seventy-five patients were enrolled, and 69 assessed. Ninety percent of subjects had been treated with asthma controller medication except ICS before study enrollment. JPAC score and CTS score were improved significantly at weeks 4, 8, and 12 (p

Purpose: The purpose of this study was to determine how four different definitions of bronchodilator response (BDR) relate to asthma control and asthma symptom burden in a large population of participants with poorly controlled asthma., Procedures: We examined the baseline change in FEV1 and FVC in response to albuterol among 931 participants with poorly controlled asthma pooled from three clinical trials conducted by the American Lung Association - Airways Clinical Research Centers. We defined BDR based on four definitions and analyzed the association of each with asthma control as measured by the Asthma Control Test or Asthma Control Questionnaire, and asthma symptom burden as measured by the Asthma Symptom Utility Index., Main Findings: A BDR was seen in 31-42% of all participants, depending on the definition used. There was good agreement among responses (kappa coefficient 0.73 to 0.87), but only 56% of participants met all four definitions for BDR. A BDR was more common in men than women, in Blacks compared to Whites, in non-smokers compared to smokers, and in non-obese compared to obese participants. Among those with poorly controlled asthma, 35% had a BDR compared to 25% of those with well controlled asthma, and among those with a high symptom burden, 34% had a BDR compared to 28% of those with a low symptom burden. After adjusting for age, sex, height, race, obesity and baseline lung function, none of the four definitions was associated with asthma control or symptom burden., Conclusion: A BDR is not associated with asthma control or symptoms in people with poorly controlled asthma, regardless of the definition of BDR used. These findings question the clinical utility of a BDR in assessing asthma control and symptoms., Competing Interests: Declaration of competing interest DAK – David A. Kaminsky reports article publishing charges and statistical analysis were provided by American Lung Association. David A. Kaminsky reports a relationship with MGC Diagnostics Corporation that includes: speaking and lecture fees. David A. Kaminsky reports a relationship with UptoDate Inc that includes: consulting or advisory. Editor, Netter Respiratory Disease, Elsevier, Inc. - DAK CGI – Charles G Irvin reports a relationship with Medical Graphics Corp that includes: board membership and travel reimbursement. AED – Anne Dixon reports a relationship with American Lung Association that includes: board membership. Anne Dixon reports a relationship with American Board of Internal Medicine that includes: consulting or advisory. Anne Dixon reports a relationship with UptoDate Inc that includes: consulting or advisory. LJS- Lewis Smith reports financial support was provided by American Lung Association. RAW – Consultant: Astra-Zeneca, Boehringer Ingelheim, GlaxoSmithKline, Glenmark Pharmaceuticals, Verona. JH, RH, JM, EAS, JTH – no declarations., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The diagnosis of asthma is made on the basis of variable respiratory symptoms and supported by objective evidence of variable airflow limitation. However, spirometry and bronchoprovocation tests may not be routinely available in resource-scarce settings or in the context of large-scale epidemiological studies. There is a gap in knowledge about the predictive value of respiratory symptoms for the diagnosis of pollen-induced asthma.Objective: The aim of this study was to investigate the predictive value of self-reported respiratory symptoms for diagnosing pollen-induced asthma.Patients and Methods: We recruited 1,161 patients with respiratory symptoms who presented to the respiratory medicine outpatient clinic of two central hospitals in Inner Mongolia during the pollen season of July-September 2015. All patients were interviewed by a respiratory physician and completed a questionnaire survey, lung function tests and skin prick tests for common inhaled allergens.Results: A total of 392 patients (33.8%) were diagnosed with asthma and 292 (25.2%, 160 adults, 132 children) with pollen-induced asthma. Respiratory symptoms of cough, wheezing, dyspnea, chest pain and nocturnal awakenings due to breathlessness were all associated with increased odds of being diagnosed with pollen-induced asthma, with cough being the most common symptom in both adults and children, giving a sensitivity of 90.6% in adults and 88.6% in children. Wheezing was the most specific symptom (78% and 89.5% in adults and children, respectively) compared to other symptoms. Overall, the positive predictive value of respiratory symptoms was poor for diagnosing pollen-induced asthma, with the exception of wheezing in children which had a high positive predictive value of 72.7%.Conclusion: Cough was the predominant symptom in adults and children with pollen-induced asthma. Wheezing was a reliable predictor of pollen-induced asthma in children. In adults, respiratory symptoms were not sufficiently reliable for diagnosing pollen-induced asthma. [ABSTRACT FROM AUTHOR]

Background: This study aims to elucidate factors that among adults with asthma are associated with working full-time. Methods: This cross-sectional survey of 2613 working-age adults with asthma included questions on asthma history, symptoms and use of asthma medication, socioeconomic factors and health behavior. Full-time workers were compared to groups according to employment status: unemployed, work disability and retired due to age. Results: Adults with asthma working full time were younger and more often nonmanual workers, experienced less asthma symptoms, used less asthma medication and smoked less than subjects with work disability. After adjusting for age, gender, smoking and professional status, having frequent symptoms of asthma during last month was associated with an increase in the risk of unemployment (OR 2.3, 95% CI 1.3-4.2) and with an increase in the risk of work disability (OR 4.4, 95% CI 2.3-8.2). Conclusions: Among adults with asthma, full-time work was associated with younger age, less symptomatic asthma despite of less medication, nonmanual work and less smoking. Having more severe symptoms of asthma was associated with undesirable employment status such as unemployment or work disability. Possibilities to change from manual to nonmanual work may be important in preventing work disability and early exit from work. [ABSTRACT FROM AUTHOR]

Background: Approximately 70% of rural Nigerian households rely on biomass fuels for cooking. The International Study of Asthma and Allergies in Childhood (ISAAC) estimates the prevalence of current wheeze among children in Nigeria to have risen from 10.7% in 1999 to approximately 20% in 2014.Objective: To examine the effects of biomass smoke exposure on asthma symptom prevalence in rural children in Nigeria.Methods: We conducted a cross-sectional survey in rural communities in Nigeria. Asthma symptoms were defined according to ISAAC definitions. Biomass smoke exposure was determined by the types of fuel used for cooking. Logistic regression was used to explore associations between biomass smoke and asthma symptoms.Results: The study population comprised 1,690 school children, of which 865 lived in households cooking with biomass and 825 lived in households not using biomass. Asthma symptoms were reported in 481 (28.5%) children. Biomass fuel was associated with increased odds of asthma symptoms. Adjusted odds ratios (aORs) were 1.38 (95% CI: 1.05–1.80) for nocturnal cough, 1.26 (95% CI: 1.00–1.61) for current wheeze, and 1.33 (95% CI: 1.05–1.69) for report of any asthma-related symptoms. Sex modified the associations between asthma symptoms with biomass fuel: aORs were stronger and significant for males (nocturnal cough = 1.85, 95% CI: 1.24–2.76; current wheeze = 1.48, 95% CI: 1.03–2.13; report of any asthma-related symptoms = 1.60, 95% CI: 1.12–2.28), but weaker and non-significant for females.Conclusion: The risk of asthma symptoms related to biomass smoke exposure appears to differ by sex. [ABSTRACT FROM AUTHOR]

Within cross-sectional studies like the U.S. National Health and Nutritional Examination Survey (NHANES), researchers have observed positive associations between polycyclic aromatic hydrocarbon (PAH) exposure and asthma diagnosis. It is unclear whether similar relationships exist for measures of acute asthma outcomes, including short-term asthma medication use to alleviate symptoms. We examined the relationship between markers of recent PAH exposure and 30-day short-acting beta agonist (SABA) or systemic corticosteroid use, an indicator for recent asthma symptoms. For 16,550 children and adults across multiple waves of NHANES (2005–2016), we fit quasi-Poisson multivariable regression models to describe the association between urinary 1-hydroxypyrene (a metabolite of PAH) and SABA or systemic corticosteroid use. We assessed for effect modification by age group and asthma controller medication use. All models were adjusted for urinary creatinine, age, female/male designation, race/ethnicity, poverty, insurance coverage, and serum cotinine. After controlling for confounding, an increase of one standard deviation of 1-hydroxypyrene was associated with greater prevalence of recent SABA or systemic corticosteroid use (PR: 1.06, 95% CI: 1.03–1.10). The results were similar among those with ever asthma diagnosis and across urine creatinine dilution methods. We did not observe effect modification by age group (p-interaction = 0.22) or asthma controller medication use (p-interaction = 0.73). Markers of recent PAH exposure was positively associated with SABA or systemic corticosteroid use, across various urine dilution adjustment methods. It is important to ensure appropriate temporality between exposures and outcomes in cross-sectional studies. • PAH urine metabolites can serve as an indicator for recent air pollution exposure. • PAH exposure was associated with use of medications that treat asthma symptoms. • Our results were robust across various urine creatinine dilution adjustment methods. [ABSTRACT FROM AUTHOR]

Background: Toluene diisocyanate (TDI) is an imperative chemical substance used in the production of polyurethane foams, elastomers, paints and coatings that cause a variety of health problems in workers who are exposed in work places. This study aimed to determine the asthma symptoms and serum specific IgE levels in TDI exposed workers and comparing the results with healthy control group.Methods: All the plants that use TDI in the manufacturing of paint and glue in the west of Tehran Province entered to the study and all the workers (550) completed modified initial questionnaire of the NIOSH, the questions were consisted of asthma symptoms. For each symptomatic exposed worker one healthy, sex and age matched control selected. Total IgE and Specific TDI IgE tests were done for each case and control groups.Results: Among 550 TDI exposed workers, 26(4.7%) had asthma symptoms. Nine (34.6%) of symptomatic workers who were exposed to TDI were active cigarette consumer versus 3(11.5%) unexposed workers, P=0.049(CI= 0.953-17.29) OR=4.059. Nine (34.6%) workers had positive family history of atopy versus 1(3.8%) unexposed workers, P=0.0138 (CI= 1.45-305.41) OR=13.24. TDI specific IgE was found in 2 TDI exposed workers and 1 unexposed worker (P=0.5). Mean of total IgE was 339.05 in exposed workers (P=0.201).Conclusion: This study provides clinical and paraclinical data of workers exposed to TDI and points to a relation between atopy and smoking habit with asthma symptoms that offer preventing recommendations for TDI exposed workers and their heath administrators.