Research Doctorate - Doctor of Philosophy (PhD) / Airway inflammation is a key feature of asthma. Currently, airway inflammation can be detected through both invasive and non- invasive methods. Non invasive methods are safe, feasible and a potentially useful way to assess airway inflammatory markers in both healthy children and children with asthma. In this thesis, a variety of non-invasive markers (induced sputum, exhaled nitric oxide, and exhaled breath condensate) was used to investigate childhood asthma. The aim of the first study was to compare and contrast the different airway markers between healthy children and children with asthma. The second study described the different airway inflammatory phenotypes in children with asthma, and examined clinical predictors of these phenotypes; whereas the third study investigated the effects of environmental tobacco smoke (ETS) exposure on airway inflammation in childhood asthma. The final study assessed the knowledge and attitudes of parents of children with asthma towards passive smoking. The studies used both cross- sectional and longitudinal designs. Children with stable asthma aged between 7 - 17 years underwent clinical assessment, spirometry, exhaled nitric oxide (FeNO), exhaled breath condensate and sputum induction. Urinary cotinine was assayed to assess tobacco smoke exposure. These studies have found that children with asthma show differences in both clinical pattern and pathological pattern compared to healthy children. These differences were apparent with elevated FeNO and sputum eosinophils. In children with asthma, there was heterogeneity of airway inflammation. There were 2 stable inflammatory patterns: eosinophilic asthma and paucigranulocytic asthma. Unlike adult asthma, these phenotypes have different clinical features, which may facilitate detection of the phenotypes in clinical practice. ETS exposure in children with asthma was common and associated with a non- eosinophilic pattern of airway inflammation. In children who had a change in ETS exposure, sputum eosinophils were decreased whereas sputum neutrophils were increased during ETS exposure compared to a non- ETS exposure period. Fractional exhaled nitric oxide levels were decreased after exposure to ETS compared to those at the time of non- ETS exposure. The severity of asthma was increased in children living with parents who smoked. As a result, parents of children with asthma, especially smoking parents should be more aware about the harmful effects of smoking on their children’s health and themselves. Health risk awareness about tobacco smoke helps parental smokers alter their smoking behavior as well as protecting children from ETS exposure. In conclusion, the important findings of this thesis are the description of the inflammatory phenotypes in childhood asthma, the identification of clinical predictors of these phenotypes and the determination of the effects of ETS exposure on airway inflammatory patterns in childhood asthma. These results should facilitate understanding and management of childhood asthma and prompt treatment studies based on markers of airway inflammation.

The thesis deals with a swimming training of asthmatic children and its impact on this disease. The work is divided into two parts. In the theoretical part the focus is on the description of the bronchial asthma, causes o fit as well as on the symptoms, diagnosis and treatment. Furthermore, the importance of swimming for asthmatic children and how the water environment affects their health impairments are measured. The practical part is focused on swimming training of children who have been diagnosed with asthma. Various physiological parameters of children are being monitored during the training. These parameters include the frequency of breathing, heart rate, frequency of asthma attacks during swimming lessons from the first one to the last one. The last measured parameter is the of improvement or worsening of the conditions of swimmers (number of meters swimmed depending on time) - asthmatics, dependent on the swimming training. Keywords bronchial asthma, children diagnosed with asthma, spirometry, swimming, swimming training

In the United States, asthma remains a major cause of frequent urgent care visits, hospitalizations, and preventable deaths among children. Nationwide, the chronic disease continues to fall disproportionately on minorities, mostly residing in urban localities. When a child is diagnosed with asthma, the parents are typically tasked with managing the child's condition. Establishing a collaborative partnership between parents and their child's primary physician is significant for improving asthma self-management among youth. Using the theory of reasoned action as a theoretical framework, this mixed-methods study examined whether a relationship exists between parental perceptions of physician cultural sensitivity and parental care in asthma treatment adherence. Phenomenology was used to explore the real-world experiences of study five ethnic minority parents and one guardian grandparent of asthmatic children aged 0–17 who shared similar perspectives. Descriptive surveys were used in combination with in-depth interviews to develop an understanding of parental perceptions on physician cultural sensitivity related to asthma treatment adherence. Overall, 108 minority parents were eligible to complete the survey. The study findings revealed that parents who feel recognized, valued, and respected by their child's physician were more likely to be engaged in shared decision-making about treatment. The findings support the potential for positive social change in terms of modifying the health care behaviors of minority parents with asthmatic children, increasing parental self-efficacy in managing their child's asthma, and improving the cultural sensitivity of physicians who serve the needs of diverse minority families.