Tsang Wing Tai. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (leaves 132-157). / Abstracts in English and Chinese. / Contents --- p.i / Abstract - English --- p.iv / Abstract - Chinese --- p.vi / Statement of Originality --- p.viii / Acknowledgements --- p.ix / List of Figures --- p.x / List of Tables --- p.xii / Abbreviations --- p.xiii / Chapter Chapter 1: --- Objectives and planning of studies in this thesis --- p.1 / Chapter Chapter 2: --- Literature Reviews / Chapter 2.1 --- Definition of asthma --- p.2 / Chapter 2.2 --- Diagnosis and classification of asthma in children --- p.5 / Chapter 2.3 --- Assessment of asthma in school-age children --- p.7 / Chapter 2.4 --- The use of HSCSI in clinical trial --- p.27 / Chapter 2.5 --- Problems of sputum induction in children --- p.32 / Chapter 2.6 --- Conclusion --- p.34 / Chapter Chapter 3: --- HSCSI - Methodology and Materials / Chapter 3.1 --- Introduction --- p.35 / Chapter 3.2 --- HSCSI - Methodology --- p.37 / Chapter 3.3 --- Protocol for combined HSCSI --- p.45 / Chapter 3.4 --- Practical considerations in HSCSI --- p.49 / Chapter 3.5 --- Expression of airway response --- p.50 / Chapter 3.6 --- Safety issue in HSCSI --- p.52 / Chapter 3.7 --- Approach in our studies --- p.54 / Chapter 3.8 --- Sputum processing --- p.55 / Chapter 3.9 --- Interpretation of sputum differential cell counts --- p.68 / Chapter 3.10 --- Conclusion --- p.73 / Chapter Chapter 4: --- Factors predicting successful sputum induction / Chapter 4.1 --- Introduction --- p.74 / Chapter 4.2 --- Methods --- p.76 / Chapter 4.3 --- Results --- p.80 / Chapter 4.4 --- Discussion --- p.82 / Chapter 4.5 --- Conclusion --- p.88 / Chapter Chapter 5: --- Use of once-daily fluticasone propionate in children with stable asthma -Study on airway inflammatory markers / Chapter 5.1 --- Introduction --- p.89 / Chapter 5.2 --- Methods --- p.92 / Chapter 5.3 --- Results --- p.97 / Chapter 5.4 --- Discussion --- p.101 / Chapter 5.5 --- Conclusion --- p.105 / Chapter Chapter 6 --- Assessment of cough frequency in children with stable asthma -Study on airway inflammatory markers / Chapter 6.1 --- Introduction --- p.106 / Chapter 6.2 --- Cough Monitoring Machine LR 102 --- p.109 / Chapter 6.3 --- Methods --- p.114 / Chapter 6.4 --- Results --- p.119 / Chapter 6.5 --- Discussion --- p.123 / Chapter 6.6 --- Conclusions --- p.127 / Chapter Chapter 7 --- Overall summary and conclusion --- p.128 / References --- p.132 / Appendix I Assessment form 226}0ؤ HSCSI

Doctor of Philosophy / Asthma can be a chronic disorder requiring regular medications if the symptoms are persistent. The regimen is often complex, involving a number of drugs and a variety or routes of administration. Although drug therapy may not alter the natural history of asthma it can improve lung function enabling those with asthma to lead as near a normal life as possible. Thus medication compliance is an important factor in the managemnt of asthma. (Note : Special enclosures (Publication reprints) at end of thesis have been removed for digital submission, with permission of author)

Thesis (Ph. D.)--West Virginia University, 2001. / Title from document title page. Document formatted into pages; contains vii, 60 p. : ill. Includes abstract. Includes bibliographical references (p. 39-42).

Thesis (M. Ed.)--University of Canterbury, 2008. / Typescript (photocopy). "September 2008." Includes bibliographical references (p. 75-84). Also available via the World Wide Web.

Background: Data from many studies suggest that traffic exposure can influence asthma among children. Most of these studies were conducted in Europe and America. However, there is less information on the association between traffic exposure and asthmatic children in China. This study investigated whether asthma severity in children was related with living near to major road in Guangzhou, China. Methods: The study method was case-control study. In this study, cases were with diagnosed asthma by physician and they aged between 1 and 14 years old. Controls were children without asthma in the same age range. Traffic exposure was measured as the distance from the nearest major road to home and to school weighted by the proportion of time spent in each location. Result: The longer the time-weighted distance being near to major roads, the lower the risks were associated with asthmatic children (OR=0.693 [0.504-0.953]). The other risk factors of asthma includes male compared with female (OR=2.696, [1.271-5.721]), age (OR=1.224 [1.078-1.391]), secondhand smoke exposure at home (OR=2.074 [0.985-4.364]), breastfeeding duration<6 months (OR= 1.423 [0.681-2.974] but also presence of pet (OR=0.508 [0.162-1.588]) and mold at home (OR=0.326 [0.152-0.697]). We also found the distance of home and school near to major roads were associated with asthma only among boys(OR=0.598 [0.373-0.957])，but not among girls(OR=0.802 [0.504-1.278]). The second hand smoke exposure was associated with asthma in boys (OR=3.459 [1.274-9.391]), but not in girls (OR=1.041 [0.306-3.539]). The estimated risk factors were not associated with the level of asthma severity except the time-weighted distance. After adjusted with other risk factors, the time-weighted distance had negative trend with the level of asthma severity (p-value=0.030). The time-weighted distance had no association with lung function (p-vale=0.779). Conclusion: The results show that the time-weighted distance near to main roads is associated with the risk of having childhood asthma. And it may be harmful for the asthma children lung function. The sex and second hand smoke exposure are also risk factors of asthma. / published_or_final_version / Public Health / Master / Master of Public Health

Objective Large quantities of epidemiological studies manifest that indoor and outdoor air pollutants may trigger and aggravate asthma symptoms, whose mechanism, however, has not been completely made clear yet. As shown by the result of the experiment in which in-vitro cells and animals are exposed to high-density air pollution, the triggering effect of air pollution on asthma is associated with inflammatory reaction, IgE expression and regulation pathways. However, there is a lack of evidence from population studies to support that association. This study plans to conduct continuous monitoring over indoor and outdoor air pollutants facing the asthmatic children from Beijing with a view to carry out an overall assessment of their exposure to air pollutants. Meanwhile, biomarkers which are directly reflecting airway inflammation as well as the signal molecules which are related to IgE expression and regulation are monitored. The next step is to establish an exposure-effect relationship to explore the trigger effect of air pollutants on childhood asthma. Methods 1. Questionnaires were used to collect general information (including age, drug use, indoor home decoration, passive smoking, diet during the study, indoor mildew, allergic history, history of diseases and family heredity history) in 60 asthmatic children (males, Han nationality, aged 5 to 14 years)from Beijing who were recruited into this study. 2. A comprehensive evaluation was conducted on their exposure levels of air pollutants by continuous monitoring of indoor PM2.5, black carbon, benzene, toluene, xylene and formaldehyde in their houses and collecting monitoring data with respect to PM2.5, PM10, NO2and SO2at air quality monitoring sites near their houses. Benzene, toluene and xylene were measured by two-stage thermal desorption-gas chromatography (GC), formaldehyde by AHMT spectrophotometry, mass concentration of PM2.5by gravimetric method, black carbon in PM2.5by multi-wavelength absorption spectroscopy. The concentration data of ambient outdoor air pollutants were available from the real-time air quality publishing platform of Beijing Municipal Environmental Monitoring Center. 3. Exhaled FeNO of asthmatic children were taken as biomarkers reflecting their airway inflammation. FeNO was measured by electrochemical method (off-line monitoring). 4. Trigger effect of air pollution on IgE signaling pathway of asthmatic children was investigated by determining signal molecules of two signaling pathways related to IgE expression and regulation in peripheral serum. Signal molecules were determined by ELISA. 5. Confounding factors were controlled by stratification analysis and multiple linear regression model, and a comprehensive analysis was conducted of the triggering effect of air pollution on children asthma. Results 1. During the research, as for subjects, concentrations of indoor PM2.5, BC, formaldehyde, benzene, toluene, m-, p-and o-xylenes were 55.3±29.9 μg/m3, 3.8±1.4 μg/m3,62.2±42.7 μg/m3, 13.1±15.9 μg/m3, 18.7±16.7 μg/m3, 7.9±7.9 μg/m3and 3.1±5.0 μg/m3, respectively. The7-day weighted average concentrations of outdoor PM2.5, PM10, SO2and NO2were 101.3±87.6μg/m3, 152.8±88.4μg/m3, 48.6±39.8 μg/m3and 63.1±27.7μg/m3, respectively. There was a significant correlation between 7-day weighted average concentrations of indoor and outdoor PM2.5 simultaneously (r=0.697, P<0.001), with a indoor/outdoor PM2.5concentration ratio (I/O ratio) of 0.86±0.39 (P25-P75ranging from 0.62 to 1.01). 2. After adjusting for such influencing factors as age, types of asthma, and season, analysis of all subjects found that FeNO was significantly positively correlated with either benzene in indoor air, or PM2.5, SO2and NO2 in ambient outdoor air. Separate analysis of subjects untreated with inhaled corticosteroids (ICSs) found that FeNO was significantly positively correlated with PM2.5, SO2and NO2 in ambient outdoor air, while this correlation was not significant in the ICS-treated group. 3. In serum, there was a significantly positive correlation between signal molecules in the two regulatory pathways of IgE expression. After adjusting for such influencing factors as age, types of asthma, and passive smoking. No effect of air pollutants on level of signaling molecule was observed in this study. Conclusion Monitoring results of indoor and outdoor air pollutants show that, at a high level of exposure to air pollutants, exposure of asthmatic children to indoor and outdoor air pollutants may cause or aggravate the airway inflammation. Administration of ICSs can control or attenuate the airway inflammation caused by air pollutants in asthmatic children, while the level of signaling molecule in the regulatory pathway of IgE expression in serum may not be an ideal marker for reflecting the trigger effect of air pollution on children asthma. / published_or_final_version / Public Health / Master / Master of Public Health

Nobody can live without oxygen. What happens when you have a chronic disorder that prevents the oxygen from reaching your lungs? This condition is called asthma and affects millions of people. Symptoms might be from a wheezing to a severe asthma attack with airways obstruction. It is difficult, above all for children, to accept a condition that might unexpectedly come anytime.   The Super-air inhaler is thought as a Super Hero, the worship the child has for the Hero will make the child feel strong and he will not feel ashamed of using it when having an attack. The inhaler has also been designed to make it easy for the child to take his medicine during the day and at night time too.

The purpose of this study was to determine if exercise-induced asthma (EIA) could be prevented in an outdoor environment in asthmatic children attending a summer camp 3 hours after their usual dose of medication. Most studies that test for ETA are done in a controlled environment which may make results not applicable to asthmatic children who spend a lot of their time outside. The relationship of aerobic fitness and level of activity to the severity of EIA were also examined. A total of 25 subjects (10.9+0.9 yrs, M±SD) were tested. Subjects were instructed to run around a grass field circular course (0.1 mile) for 5 minutes. The subjects could stop at any time. Baseline measurements of heart rate, respiratory rate and peak flow were determined before the test and at 1, 5, and 10 minutes following the end of the run. A fall in peak flow of >10% from baseline was considered positive for EIA. A total of 14 subjects experienced EIA following the run. There were no significant differences between the group who experienced EIA and those who did not in terms of heart rate, respiratory rate, or distance run. There was a significant difference between peak flow recordings as expected. Aerobic fitness and physical activity were not related to the severity of EIA. The results of this study suggests that additional medications may be needed to prevent EIA in these children in order to allow participation in activities which may produce EIA. Moreover, 3 hours may be beyond the protection time limit for some asthmatic children. / School of Physical Education

[Truncated abstract] Asthma affects millions of people worldwide and places a substantial burden on the healthcare system. Despite advances in our understanding of disease mechanisms and the role of respiratory viruses in asthma exacerbations, there is little known regarding the role of the epithelium in commonly observed structural changes in the airway wall. The epithelium of the airways provides an essential protective barrier between the environment and underlying structures and is responsible for the secretion of diverse compounds. Since it is likely that dysregulated epithelial characteristics and function in childhood asthma are critical determinants of disease progression in adults, it is pertinent to investigate the cellular mechanisms involved in paediatric asthma. However, full comprehension of paediatric respiratory diseases and the childhood antecedents of adult respiratory disease are currently hampered by the difficulty in obtaining relevant target organ tissue and most of the data to date have been generated from studies involving adults or commercially derived cell lines. This laboratory has successfully developed methodologies of obtaining and studying samples of paediatric primary airway epithelial cells (pAECs) and has identified significant biochemical and functional differences between healthy non-atopic (pAECHNA) and atopic asthmatic (pAECAA) airway cells, which have assisted in the identification of potential mechanisms responsible for abnormal epithelial function. Stevens 2009 ... Exposure of pAECs with RV resulted in elevated PAI-1 mRNA expression and reduced MMP-9 release in both pAECAA and pAECHNA samples. Collectively, the data presented indicate that RV exposure induces a pronounced antiproliferative and retardative repair effect in pAECAA and that the presence of virus may have a role in the PAI-1 and MMP expression witnessed in these cells. In conclusion, this investigation has further characterised the essential role the airway epithelium plays in childhood asthma by demonstrating for the first time that pAECs from asthmatic children lack the ability to successfully repair mechanically induced wounds. This investigation also showed that PAI-1 is elevated in pAECAA and has a functional role in the pAEC proliferative and regenerative processes. It was demonstrated that MMP-2 and MMP-9 activities and the MMP-9/TIMP-1 as well as MMP2/TIMP2 ratios were significantly reduced in pAECAA thereby providing additional evidence that there is a dysregulation in the mechanisms that monitor the turnover of the ECM in childhood asthma. Furthermore, this study has shown for the first time that pAECs from untreated mild atopic-asthmatic children are more sensitive to the pathogenic effects of RV than healthy control cells and that RV exposure delays cellular proliferation and repair. Ultimately, these findings support the hypothesis postulated and provide evidence that indeed the dysregulated epithelial functional characteristics seen in childhood mild asthma may be a critical determinant of disease progression in adults.

Doctor of Philosophy / Asthma can be a chronic disorder requiring regular medications if the symptoms are persistent. The regimen is often complex, involving a number of drugs and a variety or routes of administration. Although drug therapy may not alter the natural history of asthma it can improve lung function enabling those with asthma to lead as near a normal life as possible. Thus medication compliance is an important factor in the managemnt of asthma. (Note : Special enclosures (Publication reprints) at end of thesis have been removed for digital submission, with permission of author)