Asthma Management Handbook

Managing lifestyle factors that could affect asthma management

Recommendations

For those who smoke, advise quitting and support them to quit.

How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Zwar et al. 20111

Repeatedly offer help to quit smoking, whether or not the person shows interest in quitting.

How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Zwar et al. 20111

Provide advice about lifestyle (e.g. smoking, nutrition, physical activity, healthy weight) and manage lifestyle risk factors that affect asthma management.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Encourage healthy eating for all patients with asthma. Explain that there is emerging evidence that some healthy eating habits may also help with lung health:

  • eating plenty of fruit and vegetables every day
  • minimising intake of processed and take-away foods that are high in saturated fats.
How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available), with particular reference to the following source(s):

  • Wood et al. 20112
  • Wood et al. 20123

Recommend physical training to adults and children with asthma, as part of overall asthma management, for its beneficial effect on quality of life.

How this recommendation was developed

Evidence-based recommendation (Grade A)

Based on systematic literature review 

Clinical question for literature search:

Does planned physical activity (e.g. structured physical activity programs, exercise training/intervention such as swimming, running, cycling) improve asthma outcomes (e.g. lung function, asthma control, quality of life, effect on exercise-induced bronchoconstriction), compared with no planned physical activity (e.g. usual clinical care, treatment regimens that do not included planned physical activity) in children and adults with asthma?

Key evidence considered:

  • Arandelovic et al. 20074
  • Basaran et al. 20065
  • Chandratilleke et al. 20126
  • Onur et al. 20117
  • Shaw and Shaw, 20118
  • Shaw and Shaw, 20119
  • Singh et al. 201210
  • Turner et al. 201111

Advise patients that having asthma does not prevent them doing physical activity, including exercise training.

How this recommendation was developed

Evidence-based recommendation (Grade A)

Based on systematic literature review.

Clinical question for literature search:

Does planned physical activity (e.g. structured physical activity programs, exercise training/intervention such as swimming, running, cycling) improve asthma outcomes (e.g. lung function, asthma control, quality of life, effect on exercise-induced bronchoconstriction), compared with no planned physical activity (e.g. usual clinical care, treatment regimens that do not included planned physical activity) in children and adults with asthma?

Key evidence considered:

  • Chandratilleke et al. 20126
  • Turner et al. 201111

Advise people with asthma who are obese that weight loss might help control their asthma.

How this recommendation was developed

Consensus following inconclusive literature search

Based on clinical experience and expert opinion, after systematic literature review yielded insufficient evidence for an evidence-based recommendation: studies that met the inclusion criteria were not suitable for consideration due to unreliability (e.g. small number of participants, inappropriate study design or unacceptable risk of bias).

Clinical question for literature search:

Does weight loss improve asthma control in overweight/obese patients with asthma?

  • Does a weight loss intervention or program (e.g. diet, exercise, physical activity) improve asthma outcomes in obese/overweight patients (adults/children) with asthma, compared with usual care?
  • Does surgically induced weight loss (e.g. gastric bypass, gastric banding, bariatric surgery) improve asthma outcomes in obese patients with asthma, compared with usual care?

Recommendation informed by the following source:

  • Adeniyi and Young, 201212

Support obese or overweight people with asthma to lose weight by following current national guidelines for the management of obesity and overweight, including referral for bariatric surgery, if indicated.

How this recommendation was developed

Consensus following inconclusive literature search

Based on clinical experience and expert opinion, after systematic literature review yielded insufficient evidence for an evidence-based recommendation: studies that met the inclusion criteria were not suitable for consideration due to unreliability (e.g. small number of participants, inappropriate study design or unacceptable risk of bias).

Clinical question for literature search:

Does weight loss improve asthma control in overweight/obese patients with asthma?

  • Does a weight loss intervention or program (e.g. diet, exercise, physical activity) improve asthma outcomes in obese/overweight patients (adults/children) with asthma, compared with usual care?
  • Does surgically induced weight loss (e.g. gastric bypass, gastric banding, bariatric surgery) improve asthma outcomes in obese patients with asthma, compared with usual care?

Recommendation informed by the following sources:

  • Adeniyi and Young, 201212
  • Jensen et al. 201313
  • Juel et al. 201214
  • Lombardi et al. 201115
  • Reddy et al. 201116
  • Scott et al. 201317

More information

Healthy living and asthma
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References

  1. Zwar N, Richmond R, Borland R, et al. Supporting smoking cessation: a guide for health professionals. Updated 2012. The Royal Australian College of General Practitioners (RACGP), Melbourne, 2011. Available from: http://www.racgp.org.au/your-practice/guidelines/
  2. Wood LG, Garg ML, Gibson PG. A high-fat challenge increases airway inflammation and impairs bronchodilator recovery in asthma. J Allergy Clin Immunol. 2011; 127: 1133-40. Available from: http://www.jacionline.org/article/S0091-6749(11)00125-4/fulltext
  3. Wood LG, Garg ML, Smart JM, et al. Manipulating antioxidant intake in asthma: a randomized controlled trial. Am J Clin Nutr. 2012; 96: 534-43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/22854412
  4. Cheelo, M., Lodge, C. J., Dharmage, S. C., et al. Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: a systematic review and meta-analysis. Arch Dis Child. 2015; 100: 81-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25429049
  5. Eyers, S, Weatherall, M, Jefferies, S, Beasley, R. Paracetamol in pregnancy and the risk of wheezing in offspring: a systematic review and meta-analysis. Clin Exp Allergy. 2011; 41: 482-489.
  6. Chandratilleke MG, Carson KV, Picot J, et al. Physical training for asthma. Cochrane Database Syst Rev. 2012; Issue 5: CD001116. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001116.pub3/full
  7. Onur E, Kabaro, Günay O, et al. The beneficial effects of physical exercise on antioxidant status in asthmatic children. Allergol Immunopathol (Madr). 2011; 39: 90-5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21242022
  8. Boyle, R. J., Ierodiakonou, D., Khan, T., et al. Hydrolysed formula and risk of allergic or autoimmune disease: systematic review and meta-analysis. BMJ. 2016; 352: i974. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26956579
  9. Shaw BS, Shaw I. Static standing posture and pulmonary function in moderate-persistent asthmatics following aerobic and diaphragmatic breathing training. Pak J Med Sci. 2011; 27: 549. Available from: http://www.pjms.com.pk/index.php/pjms/article/viewArticle/1427
  10. Singh S, Soni R, Singh KP, Tandon OP. Effect of yoga practices on pulmonary function tests including transfer factor of lung for carbon monoxide (TLCO) in asthma patients. Indian J Physiol Pharmacol. 2012; 56: 63-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23029966
  11. Turner LA, Mickleborough TD, McConnell AK, et al. Effect of inspiratory muscle training on exercise tolerance in asthmatic individuals. Med Sci Sports Exerc. 2011; 43: 2031-2038. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21502887
  12. Adeniyi FB, Young R. Weight loss interventions for chronic asthma. Cochrane Database Syst Rev. 2012; 7: CD009339. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009339.pub2/full
  13. Jensen ME, Gibson PG, Collins CE, et al. Diet-induced weight loss in obese children with asthma: a randomized controlled trial. Clin Exp Allergy. 2013; 43: 775-84. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23786284
  14. Juel CT, Ali Z, Nilas L, Ulrik CS. Asthma and obesity: does weight loss improve asthma control? a systematic review. J Asthma Allergy. 2012; 5: 21-6. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392696/
  15. Kero, J., Gissler, M., Gronlund, M. M., et al. Mode of delivery and asthma -- is there a connection?. Pediatr Res. 2002; 52: 6-11. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12084840
  16. Almqvist, C., Cnattingius, S., Lichtenstein, P., Lundholm, C.. The impact of birth mode of delivery on childhood asthma and allergic diseases--a sibling study. Clin Exp Allergy. 2012; 42: 1369-76. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22925323
  17. Scott HA, Gibson PG, Garg ML, et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial. Clin Exp Allergy. 2013; 43: 36-49. Available from: http://onlinelibrary.wiley.com/doi/10.1111/cea.12004/full