The diagnosis and classification of asthma was based on clinical history, physical examination, and pulmonary function parameters, which were measured according to international guidelines. Children with asthma who were treated with steroids received maintenance therapy with low to medium doses of ICSs (budesonide fluticasone propionate) at a constant dose for at least 2 months. The overall average daily dose of ICS was 300 pg/d. Thirteen steroid-treated asthmatic children also received treatment with long-acting p₂-agonists (salmeterol, 100 pg/d), whereas steroid-naive asthmatic children received no drugs.

Atopy was assessed by means of skin-prick tests for common allergens (eg, house dust mite, grass pollen, Parietaria, Artemisia, Alternaria, and cat). Patients had experienced no upper respiratory tract infections in the previous 3 weeks. Patients were excluded from the study if they had used oral steroids in the last 4 weeks or nonsteroidal anti-inflammatory drugs in the last 2 weeks.

Twelve healthy children without a history of asthma and atopy were recruited. They had negative results of skin-prick tests, normal pulmonary function parameters, and no history of respiratory infections in the previous 4 weeks.

Study Design

The type of study was cross-sectional. Children attended the Pulmonology/Allergy Outpatient Clinic of the Department of Pediatrics of the University of Padova on one occasion for clinical examination, FeNO measurement, EBC collection, and spirometry. Informed consent was obtained from parents, and the study was approved by the Ethics Committee of the University of Padova.

Pulmonary Function

FEV₁, FVC, and midexpiratory phase of forced expiratory flow (FEF_25-75) were measured by means of a 10-L bell spirometer (Biomedin; Padova, Italy), and the best value of three maneuvers, expressed as the percentage of predicted values, was chosen.

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EBC samples were collected in a specially designed condenser consisting of a glass chamber cooled by ice that was suspended in a larger glass chamber, as described previously. EBC was collected between the two glass surfaces. Children were instructed to breath tidally through a mouthpiece connected to the condenser for 15 min without noseclip.

Here too, the disease could be influenced by social changes in the West, such as increased numbers of sexual partners. Atopic diseases are more common in subjects with HIV. Whether this is a matter of one disease increasing susceptibility to the other or a matter of common factors favoring transmission is worth questioning.

In epidemiologic studies in the late 1950s and early 1960s, we found a small, but significantly increased, risk for nonallergic canadian viagra online pharmacy, family history-negative adults who married partners with hay fever or asthma (Table 1). To our knowledge, this situation never has been explored further. Because the proposition met with so much skepticism, further work was dropped. However, we had an opportunity to perform a pilot study by joining psychiatrist colleagues in adding our detailed questionnaire when they interviewed numbers of 367 adoptive families. Adoptive parents with asthma or allergic rhinitis, especially an adoptive mother with asthma, posed a high risk for hay fever or asthma in the adoptee (mother asthma/adoptee asthma, 31%; rhinitis, 24%), which was comparable to that posed by asthma in a natural mother. Other prospective studies should be performed.

Two studies of pulmonary therapists compared with physiotherapists and radiology technicians found that 7.1% of the pulmonary therapists with a negative personal and family history had developed asthma since beginning their profession, compared with 2.4% of those in a control group. The low, but very significantly increased, risk for pulmonary therapists and marital partners seemed to indicate substantial immunity in the adult population. Well-planned prospective studies are needed.

To sum up, there is enough circumstantial evidence to warrant performing studies that would be carried out if the idea of an infectious cause were not considered to be impossible.