Effect of pulmonary rehabilitation in an allergen safe outdoor environment on children and adolescents with mild to moderate persistent allergic asthma.

BACKGROUND: Environmental interactions are very complex in childhood asthma, and we hypothesized that even a short-term exposure to an allergy safe outdoor environment (AllSOE) combined with pulmonary rehabilitation program (PRP) could exert significant beneficial effects. Our aim was to test the effects of 2-week PRP provided in an AllSOE in children with mild to moderate asthma. METHODS: 110 children (aged 7.5-17 years, 46% girls), with partially or totally controlled asthma, attended the PRP at the Island of Losinj (Croatia) supervised by a multidisciplinary team (pediatric pulmonologist, sports medicine specialist, physiotherapist and kinesiologist). Each child had an adjusted intensity of physical activity with at least 2 h of exercise per day. Body height and weight, spirometry, fraction of exhaled nitric oxide (FeNO), running distance during free running test (FRT) and the decline in lung function after FRT (exercise-induced bronchoconstriction- EIB) were measured at baseline and after PRP. RESULTS: A significant improvement in running distance (from 903 ± 272 m to 968 ± 289 m; p < 0.001), a decrease of FeNO (from 37 ± 32 ppb to 25 ± 17 ppb; p < 0.001) were determined after PRP. There were no significant changes in lung function and EIB, except EIB in the fourth quartile (significant EIB at baseline) where EIB significantly decreased (p < 0.001) after PRP. CONCLUSION: Two weeks of PRP in an AllSOE significantly improved exercise capacity and reduced airway inflammation and airway hyperreactivity showing that even a short-term PRP within a proper environment could be effective and affordable management strategy for children and adolescents with mild to moderate asthma.

Monitoring of Peak Expiratory Flow Rates during Asthmatic Children's Winter Camp / 소아알레르기및호흡기학회지

PURPOSE: It is important in asthmatic children to encourage ordinary physical activity. However physical activities in winter are limited excessively by their parents for fear of bronchospasm by cold air and exercise. Children's asthma camps help them to learn about asthma management, make new friends with other asthmatic children, have positive attitude about the disease and have a more active lifestyle. But there have been few asthma camps and appropriate asthma camp programs have not been developed in Korea. Our study was done to see how camp programs influenced on asthma patient by measuring of PEFR during camp programs and thereby to have the data be used for future development of asthma camp programs. METHODS: From January 19th to 22th 1998, we recruited for camp 17 asthmatic patients and 31 normal children who had no history of admission due to respiratory infection. The main camp programs consisted of skiing and sledding. PEFR was checked 5 times a day and we analyzed variation of PEFR in relation to daily activities, temperature, humidity of atmosphere. RESULTS: 1) The mean age was 8 years with a range of 5 years to 11 years with male predominance (male/female : 2.4/1) in asthma group and the mean age was 10 years with a range of 5 years to 16 years with female predominance (male/female: 1/2) in control group. 2) The mean PEFR (% predicted) was checked early morning, prior to breakfast, lunchtime, supper and at the end of the day's activities (before sleeping) were 90.43+/-24.15%, 93.48+/-19.42%, 98.99+/-25.89%, 96.77+/-21.23%, 100.9+/-20.86% in asthma group and 93.69+/-16.41%, 94.49+/-17.13%, 94.15+/-17.28%, 96.84+/-16.44%, 96.52+/-16.24% in control group. All values were within normal range and there was no significant change of the mean PEFR value in relation to daily activity. The values of PEFR were low at early morning. We have observed a significant difference of PEFR between early morning and before sleeping in asthma group (P<0.05). 3) In the asthma group, 2 cases had respiratory difficulty prior to lunchtime but symptoms were resolved after bronchodilator nebulization. CONCLUSION: We recommend ski or sledding to be safe as one of the programs for asthma camp but control of asthma attack is needed because lung function is decreased at night and appropriate warming up is needed before cold air sports.

A Model of Camp Program for Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: Asthma prevalence, morbidity, and mortality have been increasing in the whole world in recent years, especially among children. The estimated prevalence of asthma among children in the United States has been increased by almost 40% from 1981 to 1988, making asthma a predominant cause of morbidity in childhood. Recognition of the continued significant social and economic impact of asthma has led the medical community to consider new management strategies emphasizing patient education. Educating asthmatic children about the disease can have demonstrable long-term benefits, including improved independence and compliance as well as better control of asthma symptoms. The specialized asthma summer camps were developed in the late 1960s to provide pleasant camping experiences for the children perceived to be too ill to participate in regular camps. Despite the usefulness and the need of the asthma camp programs, there are a few asthma camp programs developed in Korea. METHODS: As an effort to develop the Korean camp programs for childhood asthma, this study proposes a model of 4-days-camp program for 20 patients who diagnosed as asthma. RESULTS: This successful exercise the model will achieve better control of childhood asthma by leading the patients to participate actively in their asthma treatment. CONCLUSION: Further studies are needed to investigate empirically the positive effects of asthma education programs in camp settings in terms of asthma exacerbations and school day absences due to asthma.