This study supports the hypothesis that upper respiratory viral infections are associated with 80-85% of asthma exacerbations in school age children.

We have shown that viruses are associated with 80 to 85% of asthma exacerbations in school-age children in the community. We hypothesize that viral infections are also associated with severe attacks of asthma precipitating hospital admissions. To investigate this, we conducted a time-trend analysis, comparing the seasonal patterns of respiratory infections and hospital admissions for asthma in adults and children. During a 1-yr study in the Southampton area of the United Kingdom, 108 school-age children monitored upper and lower respiratory symptoms and took peak expiratory flow rate (PEFR) recordings. From children reporting a symptomatic episode or a decrease in PEFR, samples were taken for detection of viruses and atypical bacteria. A total of 232 respiratory viruses and four atypical bacteria were detected. The half-monthly rates of upper respiratory infection were compared with the half-monthly rates for hospital admissions for asthma (International Classification of Diseases [ICD] code 493) for the same time period for the hospitals serving the areas from which the cohort of schoolchildren was drawn. The relationships of upper respiratory infections and hospital admissions for asthma with school attendance were studied. Strong correlations were found between the seasonal patterns of upper respiratory infections and hospital admissions for asthma (r = 0.72; p < 0.0001). This relationship was stronger for pediatric (r = 0.68; p < 0.0001) than for adult admissions (r = 0.53; p < 0.01). Upper respiratory infections and admissions for asthma were more frequent during periods of school attendance (87% of pediatric and 84% of total admissions), than during school holiday periods (p < 0.001). These relationships remained significant when allowance was made for linear trend and seasonal variation using multiple regression analysis (p < 0.01). Not surprisingly, school attendance, because it is a major factor in respiratory virus transmission, was found to be a major confounding variable in children. This study demonstrates that upper respiratory viral infections are strongly associated in time with hospital admissions for asthma in children and adults. Rhinoviruses were the major pathogen implicated, and the majority of viral infections and asthma admissions occurred during school attendance.

The purpose of this research was to test expansion of the Exercise and Self-Esteem Model (EXSEM) to include two levels of perceived physical competence as operationalized by the Physical Self-Perception Profile (PSPP). Female aerobic dancers (N = 216, age M = 38.4) were administered a Self-Esteem scale (SE), the PSPP to assess a general Physical Self-Worth (PSW), and more specific subdomains of perceived Sport Competence (Sport), Physical Condition (Cond), Attractive Body (Body), and Strength (Stren). Subjects also completed self-efficacy scales for jogging, sitting, and aerobic dancing. Confirmatory factor analysis supported model measurement as hypothesized, %2 = 1,154.88, df = 681, comparative fit index (CFI) = .913, root mean square residual (RMSR) = .047. Structural equation modeling (SEM) supported EXSEM component relationships as proposed. Further SEM associating two exercise self-reports with EXSEM again displayed satisfactory fit indices and explained up to 27.6% of exercise variance. It was concluded that exercise in adult female aerobic dancers is associated with positive evaluations of their physical condition and with negative evaluations of their bodies.

The contribution of nonspecific bronchial reactivity to the day-to-day clinical expression of asthma is uncertain. We have examined this relationship in a longitudinal study of eight children and 12 adults. Measurements of reactivity to methacholine were made every 2 to 3 wk over a period of 12 to 18 months, deriving the dose that caused a 20% fall in FEV1 (PD20). Throughout the study, all patients kept a daily record of symptoms and treatment and twice daily measurements of peak expiratory flow (PEF). A significant relationship was found between subjects' overall reactivity (median PD20) and both their average day-to-day variation in morning PEF (Spearman's rho = -0.53, p = 0.016) and diurnal variation in PEF (Spearman's rho = -0.60, p = 0.004). However, examining the temporal relationship between reactivity and asthma within subjects, individual PD20 measurements were not consistently related to concurrent asthma severity: in only six subjects did changes in PD20 generally reflect simultaneous trends in symptoms or PEF. In several patients, exacerbations of asthma occurred in the absence of bronchial hyperreactivity (PD20 greater than 12.8 mumol). We conclude that nonspecific bronchial reactivity is only one mechanism underlying airflow obstruction in asthma, and that its relationship to the clinical state of asthma is not sufficiently close to be of practical clinical use.

Background: Asthma attacks are common, serious, and costly. Individual factors associated with attacks, such as poor symptom control, are not robust predictors. Objective: We investigated whether the rich data available in UK electronic medical records could identify patients at risk of recurrent attacks. Methods: We analyzed anonymized, longitudinal medical records of 118,981 patients with actively treated asthma (ages 12-80 years) and ≥3 years of data. Potential risk factors during 1 baseline year were evaluated using univariable (simple) logistic regression for outcomes of ≥2 and ≥4 attacks during the following 2-year period. Predictors with significant univariable association (P<.05) were entered into multiple logistic regression analysis with backwards stepwise selection of the model including all significant independent predictors. The predictive accuracy of the multivariable models was assessed. Results: Independent predictors associated with future attacks included baseline-year markers of attacks (acute oral corticosteroid [OCS] courses, emergency visits), more frequent reliever use and healthcare utilization, worse lung function, current smoking, blood eosinophilia, rhinitis, nasal polyps, eczema, gastroesophageal reflux disease, obesity, older age, and being female. The number of OCS courses had the strongest association. The final cross-validated models incorporated 19 and 16 risk factors for ≥2 and ≥4 attacks over 2 years, respectively, with areas under the curve of 0.785 (95% CI 0.780-0.789) and 0.867 (0.860-0.873 EDITOR'S SPECIFIC COMMENTS:Thank you for submitting your revised manuscript to JACI: In Practice. As you know, we want to publish your work. However, your responses have not satisfied our biostatistical (Reviewer #3). We will accept your paper for publication after the biostatistical reviewer comments have been adequately addressed in a further revision. RESPONSE:We thank the Editor for the opportunity to address the additional comments from Reviewer 3 regarding our manuscript. Our point-by-point response to the comments is provided below. We hope that you will now find this second revised version of our manuscript suitable for publication in JACI: In Practice. Many thanks for your reconsideration. Best wishes, John Blakey, for the authors Reviewer #1: The authors have responded very well to reviewer input in their revised manuscript. RESPONSE: Thank you.Reviewer #3 (Biostatistical Reviewer) 3.1. COMMENT: The authors have presented some strong analyses due to sample sizes. There are still a few important points to address and revisions needed to the presentation and discussion of analyses to improve this submission. Many of these issues were identified on the first review but not addressed. RESPONSE:We thank the Reviewer for these additional comments and suggestions. We hope the following responses address these concerns to the satisfaction of the editorial team. COMMENT-Methods section:-I do not really understand the study design regarding how the years were selected and why...