***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Some individuals with moderate/severe persistent asthma develop irreversible airway obstruction . These individuals present with dyspnoea , exercise intolerance and impaired quality of life ( QOL ) , all of which could potentially be alleviated with exercise training . Objective : To investigate whether exercise training improves functional exercise capacity and QOL in middle-aged and older adults with fixed airway obstruction asthma ( FAOA ) . Methods : 35 subjects aged 67.8 ± 10.6 years , with FEV1 59 ± 16 % of predicted , were r and omised to a 6-week  ‘ intervention ’ period of supervised exercise training ( n = 20 ) or usual care ( n = 15 ) . This period was preceded by a 3-week run-in period during which asthma control was assessed weekly . Functional exercise capacity ( 6-min walk distance , 6MWD ) and QOL ( Asthma QOL Question naire , AQLQ ) were measured before , immediately following and 3 months after the intervention period . Results : 34 subjects ( exercise group , n = 19 , and control group , n = 15 ) completed the intervention period . Relative to the control group , the exercise group had greater improvements immediately following and 3 months after the intervention in the AQLQ symptom domain ( 0.61 , p = 0.001 , and 0.57 points per item , p = 0.005 ) and AQLQ activity limitation domain ( 0.43 , p = 0.04 , and 0.55 points per item , p = 0.04 ) . 6MWD increased ( 36 ± 37 m , p < 0.01 ) in the exercise group immediately following training and remained elevated ( 34 ± 45 m , p < 0.01 ) at the 3-month follow-up . The magnitude of change in 6MWD between groups was not significant , despite no change in the control group . Conclusions : Supervised exercise training improves symptoms and QOL in adults with FAOA Background : There are few data in asthma relating airway physiology , inflammation and remodelling and the relative effects of inhaled corticosteroid ( ICS ) treatment on these parameters . A study of the relationships between spirometric indices , airway inflammation , airway remodelling , and bronchial hyperreactivity ( BHR ) before and after treatment with high dose inhaled fluticasone propionate ( FP 750 μg bd ) was performed in a group of patients with relatively mild but symptomatic asthma . Methods : A double blind , r and omised , placebo controlled , parallel group study of inhaled FP was performed in 35 asthmatic patients . Bronchoalveolar lavage ( BAL ) and airway biopsy studies were carried out at baseline and after 3 and 12 months of treatment . Twenty two normal healthy non-asthmatic subjects acted as controls . Results : BAL fluid eosinophils , mast cells , and epithelial cells were significantly higher in asthmatic patients than in controls at baseline ( p<0.01 ) . Subepithelial reticular basement membrane ( rbm ) thickness was variable , but overall was increased in asthmatic patients compared with controls ( p<0.01 ) . Multiple regression analysis explained 40 % of the variability in BHR , 21 % related to rbm thickness , 11 % to BAL epithelial cells , and 8 % to BAL eosinophils . The longitudinal data corroborated the cross sectional model . Forced expiratory volume in 1 second improved after 3 months of treatment with FP with no further improvement at 12 months . PD20 improved throughout the study . BAL inflammatory cells decreased following 3 months of treatment with no further improvement at 12 months ( p<0.05 v placebo ) . Rbm thickness decreased in the FP group , but only after 12 months of treatment ( mean change –1.9 , 95 % CI –3 to –0.7 μm ; p<0.01 v baseline , p<0.05 v placebo ) . A third of the improvement in BHR with FP was associated with early changes in inflammation , but the more progressive and larger improvement was associated with the later improvement in airway remodelling . Conclusion : Physiology , airway inflammation and remodelling in asthma are interrelated and improve with ICS . Changes are not temporally concordant , with prolonged treatment necessary for maximal benefit in remodelling and PD20 . Determining the appropriate dose of inhaled steroids only by reference to symptoms and lung function , as specified in current international guidelines , and even against indices of inflammation may be over simplistic . The results of this study support the need for early and long term intervention with ICS , even in patients with relatively mild asthma Summary Recent studies have shown the relevance of air humidity to the provocation of bronchoconstriction by running . The present study was undertaken to ascertain whether the humid air breathed during swimming could explain the protective effect of swimming on the asthmatic . Nine asthmatic children 9–15 years old swam while inspiring dry ( 25–35 % R. H. ) or humid ( 80–90 % R. H. ) air administered in a r and om order , a week separating the two sessions . The exercise challenge was an 8-min tethered swim at a metabolic rate ( $ $ \dot V$$ O2 ) of 29 ml·kg−1·min−1 , minute ventilation ( VE ) of 34 L·min−1 , and a heart rate ( HR ) of 161 beats·min−1 . Ambient air and water temperature were 28±2‡ C and 27±2‡ C , respectively . Pulmonary functions were tested pre and post swimming . Exercise VE , VO2 and HR were similar under the two conditions . No reduction in any of the pulmonary functions ( FVC , FEV1.0 , MMEFR , MBC ) was found after 5 and 10 minutes following the swimming exercise in either of the conditions . In contrast , a treadmill run of similar metabolic and ventilatory intensity induced bronchoconstriction when room air was dried to 25–30 % R. H. It is suggested that , unlike running , swimming is of low asthmogenicity even when inspired air is dried to 25–30 % at neutral temperatures We studied the effects of prone immersion on pulmonary function in children with asthma . Twelve children with asthma were subjected to prone immersion ( WET ) and st and ing upright on l and ( DRY ) under controlled conditions regarding temperature and relative humidity of the inhaled air , minute ventilation , respiratory frequency , tidal volume , and the concentration of carbon dioxide in the exhaled air . Eight minutes of isocapnic hyperpnea was performed in r and om order either in the swimming pool ( prone ) or on l and ( upright ) , with the temperature and relative humidity of the inhaled air kept at 20 + /- 2 degrees C and 10 + /- 2 % , respectively . The average accumulated ventilation for the 8 min of hyperpnea was 3151 for the WET treatment and 3101 for the DRY ( P > 0.1 ) . Average heart rates were 101 + /- 11 and 115 + /- 17 beats.min-1 for the WET and DRY treatments , respectively ( P < 0.05 ) . The decrease in FEV1 ( delta FEV1 ) was 26.3 + /- 16.7 % after the WET treatment ( compared with pretreatment FEV1 ) , and 26.4 + /- 11.3 % after the DRY treatment ( P > 0.1 between WET and DRY delta FEV1 ) , with similar trend ( insignificant differences between treatments ) , for delta FVC , delta PEF 50 % , and delta PEF 25 - 75 % . It is concluded that airway hyperactivity is not alleviated by whole body prone immersion OBJECTIVE To investigate the medium-term benefits of a swimming program in schoolchildren and adolescents with moderate persistent atopic asthma ( MPAA ) . METHODS A r and omized , prospect i ve study of children and adolescents ( age 7 - 18 years ) with MPAA was carried out at the Hospital de Clínicas of Universidade Estadual de Campinas ( UNICAMP ) , Campinas , Brazil . After a 1-month run-in period , 61 patients ( 34 female ) were r and omized into two groups , a swimming group ( n = 30 ) and a control group ( n = 31 ) , and followed for 3 months . Both patient groups received inhaled fluticasone ( dry powder , 250 mcg twice a day ) and salbutamol as needed . The swim training program consisted of two weekly classes over a 3-month period for a total of 24 sessions . Both groups underwent  spirometric assessment  and methacholine challenge test -- provocative concentration of methacholine causing a 20 % fall in FEV1 (PC₂₀)--before and after the study period . Maximal inspiratory pressure ( MIP ) and maximal expiratory pressure ( MEP ) were measured only in the swimming group . RESULTS Significant increases in PC₂₀ ( pre-training , 0.31±0.25 ; post-training , 0.63±0.78 ; p = 0.008 ) , MIP ( pre-training , 67.08±17.13 cm H₂O ; post-training 79.46±18.66 ; p < 0.001 ) , and MEP ( pre-training , 71.69±20.01 cm H₂O ; post-training , 78.92±21.45 cm H₂O ; p < 0.001 ) were found in the swimming group . CONCLUSION Children and adolescents with MPAA subjected to a swim training program experienced a significant decrease in bronchial hyperresponsiveness , as determined by increased PC₂₀ values , when compared with asthmatic controls who did not undergo swim training . Participants in the swimming group also showed improvement in elastic recoil of the chest wall In a programme to examine the effect of 5 months of swimming training on school-children with asthma , 46 children swam a total distance of 3608 km ( 2242 miles ) during 2806 training sessions . On post-training re-examination , nonspecific effects of physical conditioning were detected including improved posture and fitness , reduced fat folds , and enhanced swimming ability . Continuous monitoring of asthma and medication showed significant decreases in both parameters during the final phases of the study between children who continued to swim regularly and those who did not . The frequency and severity of exercise-induced asthma ( after running ) was unchanged by swimming training . Post-training question naires indicated a high degree of enthusiasm and acceptance of the programme by children and parents . No significant adverse effects were observed or reported during the study The effects of a 3-month physical training programme on airway inflammation and clinical outcomes were studied in school-aged children with asthma . Subjects with persistent allergic asthma ( aged 12.7±3.4 yrs ; n = 34 ) were r and omly allocated into training and control groups . Exercise consisted of twice-weekly 50-min sessions for 12 weeks . Inflammation was assessed by levels of exhaled nitric oxide , blood eosinophils , eosinophil cationic protein , C-reactive protein , and total and mite-specific immunoglobulin (Ig)E. Lung volumes and bronchial responsiveness to methacholine were determined . The Paediatric Asthma Quality of Life Question naire and Paediatric Asthma Caregiver 's Quality of Life Question naire were used to evaluate activity restrictions , symptoms and emotional stress . The efficacy of the training was assessed by accelerometry . Following the programme , the exercise group spent twice as much time as the controls undertaking moderate-to-vigorous activities . No differences in changes were seen between groups for asthma outcomes . However , total IgE decreased more in the exercise group , as did mite-specific IgE. Training did not increase inflammation in children with persistent asthma , and may have decreased both total and allergen-specific immunoglobulin E levels . It is concluded that there is no reason to discourage asthmatic children with controlled disease to exercise Fitness improvement was used to compare morning with afternoon exercise periods for asthmatic children . Children with persistent moderate asthma ( according to GINA criteria ) , 8 to 11 years old , were divided into 3 groups : morning training group ( N = 23 ) , afternoon training group ( N = 23 ) , and non-training group ( N = 23 ) . The program was based on twice a week 90-min sessions for 4 months . We measured the 9-min running distance , resting heart rate and abdominal muscle strength ( sit-up number ) before and after the training . All children took budesonide , 400 microg/day , and an on dem and inhaled ss-agonist . The distance covered in 9 min increased ( mean + /- SEM ) from 1344 + /- 30 m by 248 + /- 30 m for the morning group , from 1327 + /- 30 m by 162 + /- 20 m for the afternoon group , and from 1310 + /- 20 m by 2 + /- 20 m for the control group ( P < 0.05 for the comparison of morning and afternoon groups with the control group by ANOVA and P > 0.05 for morning with afternoon comparison ) . The reduction of resting heart rate from 83 + /- 1 , 85 + /- 2 and 86 + /- 1 bpm was 5.1 + /- 0.8 bpm in the morning group , 4.4 + /- 0.8 bpm in the afternoon group , and -0.2 + /- 
    Output:
    
No statistically significant effects were seen in studies comparing swimming training with usual care or another physical activity for the primary outcomes ; quality of life , asthma control , asthma exacerbations or use of corticosteroids for asthma .
Based on limited data , there were no adverse effects on asthma control or occurrence of exacerbations .
This review indicates that swimming training is well-tolerated in children and adolescents with stable asthma , and increases lung function ( moderate strength evidence ) and cardio-pulmonary fitness ( high strength evidence ) .
There was no evidence that swimming training caused adverse effects on asthma control in young people 18 years and under with stable asthma of any severity .