Table 1:

Clinical studies on paediatric asthma risk and management.

Reference	Study type	Sample	Method	Results	Conclusion
Roncada et al.,⁶ 2018	Cross-sectional study	154 parents of children with asthma. Parents of children with asthma in remission and healthy children were also selected (control group).	The NAKQ was applied to assess the level of knowledge of parents.	Only 30.5% of parents had acceptable levels of knowledge about asthma. The mean score in NAKQ was higher in the asthma group. Surprisingly, the parents with mild and moderate asthmatic children scored higher than those of children with severe asthma (p=0.02).	Parents of asthmatic children have mediocre knowledge about asthma, which reinforces the need for changes in public asthma education and management programmes.
Frémont et al.,⁷ 2018	Prospective cross-over randomised	113 babies aged 6–47 months treated with an ICS therapy. Parents who claimed that their child was not complying during therapy were asked to participate.	Children were observed during the delivery of ICS with either an animated cartoon or a black screen video. The median percentage of time of non-cooperation was compared.	Parents of 44% children reported un-cooperative children during treatment delivery. The median percentages of time of non-cooperation were significantly lower during the distraction periods (p=0.008).	Un-cooperative attitude among young asthmatic children can be amended using animated cartoons, which can increase cooperation up to 97%.
Lu et al.,⁸ 2018	Case control study	37 infants with recurrent wheezing gathered from outpatient clinics, and 113 healthy infants from a longitudinal birth cohort.	Infants underwent multiple breath washout, forced expiratory flows, and body plethysmography when they were clinically stable.	LCI z-scores were higher in infants with recurrent wheeze versus healthy infants (p<0.001). 19% of recurrently wheezing infants had LCI values that were above the upper limit of normal.	Clinically stable infants with recurrent wheezing can have ventilation inhomogeneity.
Lee et al.,⁹ 2018	Prospective study	1,305 elementary school children from the CHEER study.	A 4-year prospective follow-up study with 2-year intervals. Total serum IgE and percentage of blood eosinophils were measured, and allergy work-up including methacholine challenge tests and questionnaires were performed at each survey.	Early onset BHR phenotypes were associated with increased risk of newly diagnosed asthma. Late-onset BHR phenotype was associated with increased risks of allergic rhinitis symptoms at baseline and later sensitisation against inhalant allergens.	High atopic burden associates with early-onset persistent BHR phenotypes in school-aged children.
Wang et al.¹⁰ 2018	Observational study	60 children admitted and treated in a single hospital for asthma attacks.	Comparisons among asthma patients with high/low 25-(OH)D levels and healthy children were performed based on biochemical indexes, humoral immunity, TNF-α and IL-6 levels, and pulmonary function indexes.	Serum IL-6 and TNF-α levels in the high 25-(OH)D group were lower than those in the low 25-(OH)D group at 3 days after treatment (p<0.05). 25-(OH)D had a positive correlation with pulmonary function indexes (p<0.05), while TNF-α and IL-6 were negatively associated with pulmonary function indexes (p<0.05). Serum 25-(OH)D levels in asthmatic children were negatively associated with TNF-α and IL-6 levels.	Children with asthma attacks have lower levels of 25-(OH)D, which is associated with inflammatory mediators levels as well as pulmonary function index. Thus, 25-(OH)D could be used as a test indicator for prevention and control of childhood asthma.
Neophytou et al.,¹¹ 2018	Observational study	1,172 Hispanic and African-American children with asthma from the mainland USA and Puerto Rico.	Association of cotinine levels ≥0.05ng/mL with asthma exacerbations were analysed via logistic regression analysis.	Chances of asthma exacerbation were higher in children when exposed to SHS.	The dose-responses observed show that odds of asthma exacerbation mounts with increasing exposure, even at cotinine levels associated with light SHS exposure.
Strzelak et al.,¹² 2018	Review article	ETS exposure associations with asthma and allergy in children.	Molecular mechanisms associated with inflammatory profiles aggravating inflammation, promoting infection, inducing tissue damage and promoting allergy in subjects with ETS exposure are discussed in the review.	Oxidative stress is responsible for increased mucosal inflammation and expression of inflammatory cytokines (IL-8, IL-6, and TNF-α). ETS exposure disturbs the oxidant/antioxidant balance, which results in oxidative stress.	ETS affects epithelial cells by increasing permeability, mucus overproduction, impaired mucociliary clearance, increased pro-inflammatory cytokines, enhanced recruitment of macrophages and neutrophils, and lymphocyte imbalance towards Th2.
Buelo et al.¹³ 2018	Review article	Data from six databases (over 16,000 records, including 68 papers [28 cohort, 4 case-control, and 36 cross-sectional studies]).	Two reviewers independently selected studies and extracted data to perform a heterogeneity precluded meta-analysis. Weighting was undertaken by an expert panel who independently assessed each variable for degree of risk and confidence and then achieved consensus by discussion.	The risk for asthma was found greatly increased with previous asthma attacks, persistent symptoms, and poor access to care; moderately increased with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity, poverty level, and vitamin D deficiency. ETS exposure, younger age, obesity, and low parental education were associated with slightly increased risk.	Clinical, demographic, and population level factors may help clinicians tailor management strategies for individual patients, as well as health service professionals and policymakers target healthcare initiatives considering population risk factors.

BHR: bronchial hyper-responsiveness; ETS: environmental tobacco smoke; ICS: inhaled corticosteroid; LCI: lung clearance index; NAKQ: Newcastle Asthma Knowledge Questionnaire; SHS: second hand smoking.