Allergic diseases, affecting a variety of organs, have continuously increased both in developed and developing countries. Tobacco smoke exposure increases prevalence of allergic rhinitis (AR) and may affect allergic sensitization. This study was designed to compare indoor-aeroallergen sensitization between those not exposed and exposed to tobacco smoke in university students and staff with allergic rhinitis. A cross-sectional descriptive study among university students and staff with allergic rhinitis was performed from February 1, 2018, to March 31, 2019. Questionnaires regarding demography, clinical symptoms, and tobacco smoke exposure were implemented. A current smoker was defined as using, at least, 1 cigarette per day for, at least, 1 month. A secondhand smoker was defined as the one who never smoked, but lived with a current smoker, at least, for 1 month. A skin prick test for eight common indoor aeroallergens, Dermatophagoides pteronyssinus, Dermatophagoides farinae, Periplaneta americana, cat dander, dog dander, para grass, careless weed, and Cladosporium spp., was performed. Sensitization was defined as positivity to, at least, 1 aeroallergen. One hundred and twenty-eight adult patients were eligible participants for the study, and 68 cases (53.10%) were classified as having tobacco smoke exposure. Among these, most of them were secondhand smokers (50 cases, 73.50%). There was no statistically significant difference between exposure and nonexposure to tobacco smoke and indoor aeroallergen sensitization, except for the Periplaneta americana antigen (p=0.013). Most of those in the nonexposure group (34 cases, 56.70%) were classified as having intermittent allergic rhinitis, whereas the tobacco exposure group had significantly more prevalence of severe clinical symptoms. In conclusion, tobacco smoke exposure did not appear to have much influence on aeroallergen sensitization for 7 of the 8 antigens examined. However, for the Periplaneta americana antigen, there was a highly significant correlation with patients experiencing worsened allergic rhinitis symptoms. Overall, it was observed that allergic rhinitis patients exposed to tobacco smoke had more severe clinical symptoms. Future studies should look for other potential antigens of interest, such as mould. Implementation of public health practices reducing exposure to tobacco smoke could have benefits in allergic rhinitis patients.

Medical adherence among children with asthma is a challenging problem. Mobile health applications have been increasingly used to improve adherence and clinical outcomes. Here, we compared clinical outcomes by using a mobile health application (Asmon application) with those receiving usual care, assessed the patient’s satisfaction and the usability of this tool. Methods: We conveniently allocated children with persistent asthma aged 4‒15 years and a guardian to receive the Asmon application or a usual care for 6 months. Assessments were performed at baseline and at the 6-month follow-up. Outcomes were the asthma control test score (ACT), dose of inhaled corticosteroids (ICS), acute exacerbation, and asthma-related quality of life. Participants’ satisfaction and reasons for unengaging in long-term use of the application were also analyzed. Results: The overall drop-out rate was 24.1% (intervention 13, 16.5%; control 6, 7.6%). The mean ACT scores had increased in both groups from baseline to the 6 months follow-up (intervention, p < 0.001; control p = 0.001), but did not differ significantly between groups (p = 0.784). Among those with poorly controlled asthma at baseline, the intervention group showed possibly higher improvement than the control (37.5% vs 16.7%) even though the value was not significantly different (p = 0.128). Acute exacerbation, median dose of ICS usage, and asthma-related quality of life were not significantly different between groups (p = 0.554, 0.555, and 0.627, respectively). Approximately one-third of the intervention group never used the application, while 40.5% ever used only 1‒7 times during the study period. Perception regarding the application was hard-to-use, self-judged ICS discontinuation, and change in guardians were the main obstacles for regular engagement. Nevertheless, the satisfaction score on the rating scale was high (4.5/5.0).Conclusion: The interactive Asmon application potentially improved disease control only in children with poorly controlled asthma at baseline. Acute exacerbation rate, dose of ICS, and asthma-related quality of life were not impacted by the intervention. Healthcare providers should thoroughly consider participants’ and guardians’ background characteristics before implementing an mHealth application in the real-world daily practices.

A fractional exhaled nitric oxide (FeNO) device has been developed for the evaluation of clinical control in asthmatic patients, instead of for uses in only analyzing clinical data and spirometry. The implementation of the FeNO device in daily practice has demonstrated both positive and negative results. Community hospital settings in Thailand have never used this method for the evaluation of disease control in asthmatics. The aim of this study was to assess the correlation between FeNO levels and asthma control, as determined by physicians. We recruited asthmatic patients aged from 4-15-years-old (after informed consent approval was obtained from their guardians) from May 15, 2018, to July 20, 2019. All of the patients had already been diagnosed as having asthma by physicians and had been prescribed inhaled corticosteroid medications. After routine visits, skin prick tests with 8 aeroallergens were performed. If a positive result was shown for at least 1 allergen, then the FeNO device was applied for the assessment of the level of inflammation. Data were analyzed by using SPSS Statistics version 21.0. Agreement index and Kruskal Wallis tests were used to measure the correlations. From 178 asthmatic patients, the mean age was 94.9 AE 36.75 months, and 59% of them were male. The educational levels of the guardians of the patients mostly consisted of primary school, and the household income was less than 333 US dollars per month. Inhaled corticosteroids were prescribed among the patients for disease control. The correlation between the FeNO level and the control level demonstrated a high agreement (accuracy index: 91.57%). The medians of the mean wheal diameters of Dermatophagoids pteronyssinus, Dermatophagoids farinae and Cladosporium spp. were significantly related to the FeNO level (with p-values of 0.024, 0.003 and 0.045, respectively). Conversely, a number of positive skin responses to aeroallergens were not related with the FeNO level. In conclusion, a lower level of FeNO correlates with good asthma control level in pediatric allergic asthma. The medians of the mean wheal diameters of Dermatophagoids pteronyssinus, Dermatophagoids farinae and Cladosporium spp. correlated with higher FeNO levels. A device assessing FeNO seems beneficial for evaluating the level of disease control among childhood asthmatic patients in a primary care setting.

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