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Paed Asthma – Reducing inflammatory blood markers

Evidence Summary
A small number of studies have looked at inflammatory marker response in asthmatics to a physical activity intervention. Serum markers and fractional exhaled nitric oxide (FeNO) being most commonly used. There were a wide range of serum markers assessed including CRP, plasma cytokines, mite-specific IgE, malondialdehyde, glutathione peroxidase (GSH-Px), and superoxide dismutase. Improvement in levels were found in some studies within the groups exercising as well as the groups who had their medication optimised however not all studies showed this. Fractional exhaled nitric oxide (FeNO) when breathed out in high levels is thought to be related to lung inflammation and poorly controlled asthma. The one study assessing FeNO showed a statistically significant decrease in this reading post exercise intervention.


Quality of Evidence
: B – moderate quality.
Strength of Recommendation
1C. Strong recommendation, low quality evidence


Conclusion
Some studies have shown that some markers of inflammation in the blood and exhaled breath can be reduced with exercise and regular physical activity however the published data is limited. It is not known which serum inflammatory markers most reliably assess asthma severity or symptom control. No study showed a worsening of any inflammatory markers after exercising.


References
Andrade, L. B., M. C. Britto, N. Lucena-Silva, R. G. Gomes and J. N. Figueroa (2014). “The efficacy of aerobic training in improving the inflammatory component of asthmatic children. Randomized trial.” Respir Med 108(10): 1438-1445.
Gunay, O., E. Onur, O. Yilmaz, P. E. Dundar, C. Tikiz, A. Var and H. Yuksel (2012). “Effects of physical exercise on lung injury and oxidant stress in children with asthma.” Allergol Immunopathol (Madr) 40(1): 20-24.
Joschtel, B., S. R. Gomersall, S. Tweedy, H. Petsky, A. B. Chang and S. G. Trost (2018). “Effects of exercise training on physical and psychosocial health in children with chronic respiratory disease: a systematic review and meta-analysis.” BMJ Open Sport Exerc Med 4(1): e000409.
Onur, E., C. Kabaroglu, O. Gunay, A. Var, O. Yilmaz, P. Dundar, C. Tikiz, Y. Guvenc and H. Yuksel (2011). “The beneficial effects of physical exercise on antioxidant status in asthmatic children.” Allergol Immunopathol (Madr) 39(2): 90-95.

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