human
***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 Ample evidence suggests a dose-response relationship between increasing weight and level of asthma risk or reduced asthma control . To establish reversibility , several r and omized controlled trials ( RCTs ) have recently been published to investigate the impact of weight management on asthma . This systematic review synthesizes evidence from these RCTs on the effects of weight management ( weight loss , weight maintenance , maintenance of lost weight , or weight gain prevention ) interventions on  asthma outcomes in both adult and pediatric population s. METHODS We search ed Medline , CINAHL , PsychInfo , and Cochrane for studies published between 1950 and November 2014 . Two research ers independently rated the included studies using the quality assessment tool for RCTs as outlined in the 2013 Obesity Treatment Guideline . Discrepancies were resolved by consensus after discussion between the raters and , if needed , with the senior author . RESULTS Four RCTs in adults and 3 in children and adolescents were included . The adult studies seem to consistently support the benefit of substantial weight loss , but a threshold effect may exist such that only weight loss beyond a minimal amount will likely lead to clinical ly important improvement in asthma outcomes . Three of them suggest that the threshold may lie between 5 - 10 % of weight loss . RCTs in youth suggest that modest calorie reductions alone or combined with increased physical activity , or even a healthy normocaloric diet , may lead to improved asthma outcomes . However , most RCTs review ed were limited by small sample size , short intervention duration s , and short follow-up periods . CONCLUSION Trial evidence shows the promise of weight loss interventions for asthma control in adults and youth . More adequately-powered , long-term RCTs are needed to eluci date the role of weight loss and other weight management interventions in asthma control and prevention . Definitive data are needed to guide clinical and public health practice to effectively address the dual epidemic of obesity and asthma BACKGROUND AND OBJECTIVE While weight loss has been shown to reduce obesity-related comorbidity , many weight loss treatments fail . Factors that enhance weight loss success are unknown , particularly in those with asthma . The aim of the study was to identify patient characteristics that predict weight loss success in adults with asthma . METHODS Baseline and change in asthma characteristics and eating behaviours were investigated for relationships with  weight loss and fat loss  using multiple linear regression , in 38 overweight and obese adults with asthma r and omized to  dietary , exercise or combined interventions targeting weight loss for 10 weeks . RESULTS Mean ± st and ard deviation weight loss was 6.6 ± 5.1 kg . Greater % weight loss and % fat loss was achieved in those with poorer asthma-related quality of life at baseline ( ( rs = 0.398 , P = 0.015 ) and ( rs = 0.455 , P = 0.005 ) respectively ) , with 1.7 % greater absolute weight loss at week 10 corresponding to each one unit reduction in the asthma-related quality of life score at baseline . Furthermore , a lower baseline forced expiratory volume in 1 s/forced vital capacity correlated with greater weight loss ( rs = 0.398 , P = 0.015 ) . Male sex was associated with a 3.6 kg greater weight loss ( P = 0.087 ) . Reducing emotional eating during the programme was associated with greater weight loss in women ( rs = 0.576 , P = 0.010 ) . CONCLUSIONS This study demonstrates that individuals with more severe asthma at baseline are more successful in achieving weight loss , which could be a consequence of greater motivation and could be used as a motivational tool within the clinical setting . Gender tailoring of weight loss programmes may be useful to enhance weight loss success . Future studies are urgently needed to establish predictors of long-term weight loss maintenance in those with asthma Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background There is increasing evidence that obesity is related to asthma development and severity . However , it is largely unknown whether weight reduction can influence asthma management , especially in children . Objective To determine the effects of a multifactorial weight reduction intervention on asthma management in overweight/obese children with ( a high risk of developing ) asthma . Methods An 18-month weight-reduction r and omized controlled trial was conducted in 87 children with overweight/obesity and asthma . Every six months , measurements of anthropometry , lung function , lifestyle parameters and inflammatory markers were assessed . Analyses were performed with linear mixed models for longitudinal analyses . Results After 18 months , the body mass index-st and ard deviation score decreased by -0.14±0.29 points ( p<0.01 ) in the intervention group and -0.12±0.34 points ( p<0.01 ) in the control group . This change over time did not differ between groups ( p>0.05 ) . Asthma features ( including asthma control and asthma-related quality of life ) and lung function indices ( static and dynamic ) improved significantly over time in both groups . The FVC% predicted improved over time by 10.1 ± 8.7 % in the intervention group ( p<0.001 ) , which was significantly greater than the 6.1 ± 8.4 % in the control group ( p<0.05 ) . Conclusions & clinical relevance Clinical ly relevant improvements in body weight , lung function and asthma features were found in both the intervention and control group , although some effects were more pronounced in the intervention group ( FVC , asthma control , and quality of life ) . This implies that a weight reduction intervention could be clinical ly beneficial for children with asthma . Trial Registration Clinical Trials.gov Abstract Objective : To investigate the influence of weight reduction on obese patients with asthma . Design : Open study , two r and omised parallel groups . Setting : Private out patients centre , Helsinki , Finl and . Participants : Two groups of 19 obese patients with asthma ( body mass index ( kg/m2 ) 30 to 42 ) recruited through newspaper advertisements . Intervention : Supervised weight reduction programme including 8 week very low energy diet . Main outcome measures : Body weight , morning peak expiratory flow ( PEF ) , forced vital capacity ( FVC ) , forced expiratory volume in one second ( FEV1 ) ; and also asthma symptoms , number of acute episodes , courses of oral steroids , health status ( quality of life ) . Results : At the end of the weight reducing programme , the participants in the treatment group had lost a mean of 14.5 % of their pretreatment weight , the controls 0.3 % . The corresponding figures after one year were 11.3 % and a weight gain of 2.2 % . After the 8 week dieting period the difference in changes in percentage of predicted FEV1 from baseline in the treatment and control groups was 7.2 % ( 95 % confidence interval 1.9 % to 12.5 % , P=0.009 ) . The corresponding difference in the changes in FVC was 8.6 % ( 4.8 % to 12.5 % , P<0.0001 ) . After one year the differences in the changes in the two groups were still significant : 7.6 % for FEV1 ( 1.5 % to 13.8 % , P=0.02 ) and 7.6 % for FVC ( 3.5 % to 11.8 % , P=0.001 ) . By the end of the weight reduction programme , reduction in dyspnoea was 13 mm ( on a visual analogue scale 0 mm to 100 mm ) in the treatment group and 1 mm in the control group ( P=0.02 ) . The reduction of rescue medication was 1.2 and 0.1 doses respectively ( P=0.03 ) . After one year the differences in the changes between the two groups were −12 for symptom scores ( range −1 to −22 , P=0.04 ) and −10 for total scores ( −18 to −1 , P=0.02 ) . The median number of exacerbations in the treatment group was 1 ( 0–4 ) and in the controls 4 ( 0–7 ) , P=0.001 . Conclusion : Weight reduction in obese patients with asthma improves lung function , symptoms , morbidity , and health status Studies on the effects of weight loss in patients with asthma are scarce . No studies have been performed in patients with severe asthma . Therefore , the aim of the present study was to assess the impact of weight loss  in patients with severe asthma associated with obesity . This was an open , prospect i ve , r and omised study of two parallel groups , in patients with severe uncontrolled asthma and moderate obesity . The primary outcome was the level of asthma control 6 months after initiation of the  weight reduction programme  , quantified using the Asthma Control Question naire ( ACQ ) . We evaluated clinical parameters , lung function , markers of airway inflammation and circulating cytokines .  22 patients were r and omised to undergo treatment for obesity and 11 to the control group .  The weight reduction programme was associated with significant improvements in asthma control ( mean±se ACQ score 3.02±0.19 to 2.25±0.28 in the treatment group versus 2.91±0.25 to 2.90±0.16 in the controls , p=0.001 ) . This improvement was not accompanied by changes in markers of airway inflammation or bronchial reactivity , but by an increase in forced vital capacity . Our results suggest  that weight reduction in obese patients with severe asthma improves asthma outcomes by mechanisms not related to airway inflammation . Weight loss improves outcomes in severely asthmatic obese patients ; poor control results from obesity-related factors The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials RATIONALE The effect of weight loss on asthma in obese adults warrants rigorous investigation . OBJECTIVES To examine an evidence -based , practical , and comprehensive lifestyle intervention targeting modest weight loss and increased physical activity for asthma control . METHODS The trial r and omized 330 obese adults with uncontrolled asthma to receive usual care enhanced with a pedometer , a weight scale , information about existing weight management services at the participating clinics , and an asthma education DVD , or with these tools plus the 12-month intervention . MEASUREMENTS AND MAIN RESULTS The primary outcome was change in Asthma Control Question naire ( ACQ ) scores from baseline to 12 months . Participants ( mean [ SD ] age , 47.6 [ 12.4 ] yr ) were 70.6 % women , 20.0 % non-Hispanic black , 20.3 % Hispanic/Latino , and 8.2 % Asian/Pacific Isl and er . At baseline , they were obese ( mean [ SD ] body mass index , 37.5 [ 5.9 ] kg/m(2 ) ) and had uncontrolled asthma ( Asthma Control Test score , 15.1 [ 3.8 ] ) . Compared with control subjects , intervention participants achieved significantly greater mean weight loss ( ±SE ) ( intervention , -4.0 ± 0.8 kg vs. control , -2.1 ± 0.8 kg ; P = 0.01 ) and increased leisure-time activity ( intervention , 418.2 ± 110.6 metabolic equivalent task-min/wk vs. control , 178.8 ± 109.1 metabolic equivalent task-min/wk ; P = 0.05 ) at 12 months . But between-treatment mean ( ±SE ) differences were not significant for ACQ changes ( intervention , -0.3 ± 0.1 vs. control , -0.2 ± 0.1 ; P = 0.92 ) from baseline ( mean [ SD ] , 1.4 [ 0.8 ] ) , nor for any other clinical asthma outcomes ( e.g. , spirometric results and asthma exacerbations ) . Among all participants regardless of treatment assignment , weight loss of 10 % or greater was associated with a Cohen d effect of 0.76 and with 3.78 ( 95 % confidence interval , 1.72 - 8.31 ) times the odds of achieving clinical ly significant reductions ( i.e. , ≥0.5 ) on ACQ as stable weight ( <3 % loss or gain from baseline ) . The effects of other weight change categories were small . CONCLUSIONS Moderately and severely obese adults with uncontrolled asthma can safely participate in evidence -based lifestyle intervention for weight loss and active living . The modest average weight and activity improvements are comparable to those shown to reduce cardiometabolic risk factors in studies of similar interventions in other population s but are not associated with significant net benefits for asthma control or other clinical asthma outcomes in the current population . Instead , weight loss of 10 % or greater may be required to produce clinical ly meaningful improvement in asthma . Clinical trial registered with www . clinical trials.gov ( NCT00901095 ) Rationale : Clinical control is difficult to achieve in obese patients with asthma .  Bariatric surgery has been 
    Output:
    
agent
***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 Ample evidence suggests a dose-response relationship between increasing weight and level of asthma risk or reduced asthma control . To establish reversibility , several r and omized controlled trials ( RCTs ) have recently been published to investigate the impact of weight management on asthma . This systematic review synthesizes evidence from these RCTs on the effects of weight management ( weight loss , weight maintenance , maintenance of lost weight , or weight gain prevention ) interventions on  asthma outcomes in both adult and pediatric population s. METHODS We search ed Medline , CINAHL , PsychInfo , and Cochrane for studies published between 1950 and November 2014 . Two research ers independently rated the included studies using the quality assessment tool for RCTs as outlined in the 2013 Obesity Treatment Guideline . Discrepancies were resolved by consensus after discussion between the raters and , if needed , with the senior author . RESULTS Four RCTs in adults and 3 in children and adolescents were included . The adult studies seem to consistently support the benefit of substantial weight loss , but a threshold effect may exist such that only weight loss beyond a minimal amount will likely lead to clinical ly important improvement in asthma outcomes . Three of them suggest that the threshold may lie between 5 - 10 % of weight loss . RCTs in youth suggest that modest calorie reductions alone or combined with increased physical activity , or even a healthy normocaloric diet , may lead to improved asthma outcomes . However , most RCTs review ed were limited by small sample size , short intervention duration s , and short follow-up periods . CONCLUSION Trial evidence shows the promise of weight loss interventions for asthma control in adults and youth . More adequately-powered , long-term RCTs are needed to eluci date the role of weight loss and other weight management interventions in asthma control and prevention . Definitive data are needed to guide clinical and public health practice to effectively address the dual epidemic of obesity and asthma BACKGROUND AND OBJECTIVE While weight loss has been shown to reduce obesity-related comorbidity , many weight loss treatments fail . Factors that enhance weight loss success are unknown , particularly in those with asthma . The aim of the study was to identify patient characteristics that predict weight loss success in adults with asthma . METHODS Baseline and change in asthma characteristics and eating behaviours were investigated for relationships with  weight loss and fat loss  using multiple linear regression , in 38 overweight and obese adults with asthma r and omized to  dietary , exercise or combined interventions targeting weight loss for 10 weeks . RESULTS Mean ± st and ard deviation weight loss was 6.6 ± 5.1 kg . Greater % weight loss and % fat loss was achieved in those with poorer asthma-related quality of life at baseline ( ( rs = 0.398 , P = 0.015 ) and ( rs = 0.455 , P = 0.005 ) respectively ) , with 1.7 % greater absolute weight loss at week 10 corresponding to each one unit reduction in the asthma-related quality of life score at baseline . Furthermore , a lower baseline forced expiratory volume in 1 s/forced vital capacity correlated with greater weight loss ( rs = 0.398 , P = 0.015 ) . Male sex was associated with a 3.6 kg greater weight loss ( P = 0.087 ) . Reducing emotional eating during the programme was associated with greater weight loss in women ( rs = 0.576 , P = 0.010 ) . CONCLUSIONS This study demonstrates that individuals with more severe asthma at baseline are more successful in achieving weight loss , which could be a consequence of greater motivation and could be used as a motivational tool within the clinical setting . Gender tailoring of weight loss programmes may be useful to enhance weight loss success . Future studies are urgently needed to establish predictors of long-term weight loss maintenance in those with asthma Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background There is increasing evidence that obesity is related to asthma development and severity . However , it is largely unknown whether weight reduction can influence asthma management , especially in children . Objective To determine the effects of a multifactorial weight reduction intervention on asthma management in overweight/obese children with ( a high risk of developing ) asthma . Methods An 18-month weight-reduction r and omized controlled trial was conducted in 87 children with overweight/obesity and asthma . Every six months , measurements of anthropometry , lung function , lifestyle parameters and inflammatory markers were assessed . Analyses were performed with linear mixed models for longitudinal analyses . Results After 18 months , the body mass index-st and ard deviation score decreased by -0.14±0.29 points ( p<0.01 ) in the intervention group and -0.12±0.34 points ( p<0.01 ) in the control group . This change over time did not differ between groups ( p>0.05 ) . Asthma features ( including asthma control and asthma-related quality of life ) and lung function indices ( static and dynamic ) improved significantly over time in both groups . The FVC% predicted improved over time by 10.1 ± 8.7 % in the intervention group ( p<0.001 ) , which was significantly greater than the 6.1 ± 8.4 % in the control group ( p<0.05 ) . Conclusions & clinical relevance Clinical ly relevant improvements in body weight , lung function and asthma features were found in both the intervention and control group , although some effects were more pronounced in the intervention group ( FVC , asthma control , and quality of life ) . This implies that a weight reduction intervention could be clinical ly beneficial for children with asthma . Trial Registration Clinical Trials.gov Abstract Objective : To investigate the influence of weight reduction on obese patients with asthma . Design : Open study , two r and omised parallel groups . Setting : Private out patients centre , Helsinki , Finl and . Participants : Two groups of 19 obese patients with asthma ( body mass index ( kg/m2 ) 30 to 42 ) recruited through newspaper advertisements . Intervention : Supervised weight reduction programme including 8 week very low energy diet . Main outcome measures : Body weight , morning peak expiratory flow ( PEF ) , forced vital capacity ( FVC ) , forced expiratory volume in one second ( FEV1 ) ; and also asthma symptoms , number of acute episodes , courses of oral steroids , health status ( quality of life ) . Results : At the end of the weight reducing programme , the participants in the treatment group had lost a mean of 14.5 % of their pretreatment weight , the controls 0.3 % . The corresponding figures after one year were 11.3 % and a weight gain of 2.2 % . After the 8 week dieting period the difference in changes in percentage of predicted FEV1 from baseline in the treatment and control groups was 7.2 % ( 95 % confidence interval 1.9 % to 12.5 % , P=0.009 ) . The corresponding difference in the changes in FVC was 8.6 % ( 4.8 % to 12.5 % , P<0.0001 ) . After one year the differences in the changes in the two groups were still significant : 7.6 % for FEV1 ( 1.5 % to 13.8 % , P=0.02 ) and 7.6 % for FVC ( 3.5 % to 11.8 % , P=0.001 ) . By the end of the weight reduction programme , reduction in dyspnoea was 13 mm ( on a visual analogue scale 0 mm to 100 mm ) in the treatment group and 1 mm in the control group ( P=0.02 ) . The reduction of rescue medication was 1.2 and 0.1 doses respectively ( P=0.03 ) . After one year the differences in the changes between the two groups were −12 for symptom scores ( range −1 to −22 , P=0.04 ) and −10 for total scores ( −18 to −1 , P=0.02 ) . The median number of exacerbations in the treatment group was 1 ( 0–4 ) and in the controls 4 ( 0–7 ) , P=0.001 . Conclusion : Weight reduction in obese patients with asthma improves lung function , symptoms , morbidity , and health status Studies on the effects of weight loss in patients with asthma are scarce . No studies have been performed in patients with severe asthma . Therefore , the aim of the present study was to assess the impact of weight loss  in patients with severe asthma associated with obesity . This was an open , prospect i ve , r and omised study of two parallel groups , in patients with severe uncontrolled asthma and moderate obesity . The primary outcome was the level of asthma control 6 months after initiation of the  weight reduction programme  , quantified using the Asthma Control Question naire ( ACQ ) . We evaluated clinical parameters , lung function , markers of airway inflammation and circulating cytokines .  22 patients were r and omised to undergo treatment for obesity and 11 to the control group .  The weight reduction programme was associated with significant improvements in asthma control ( mean±se ACQ score 3.02±0.19 to 2.25±0.28 in the treatment group versus 2.91±0.25 to 2.90±0.16 in the controls , p=0.001 ) . This improvement was not accompanied by changes in markers of airway inflammation or bronchial reactivity , but by an increase in forced vital capacity . Our results suggest  that weight reduction in obese patients with severe asthma improves asthma outcomes by mechanisms not related to airway inflammation . Weight loss improves outcomes in severely asthmatic obese patients ; poor control results from obesity-related factors The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials RATIONALE The effect of weight loss on asthma in obese adults warrants rigorous investigation . OBJECTIVES To examine an evidence -based , practical , and comprehensive lifestyle intervention targeting modest weight loss and increased physical activity for asthma control . METHODS The trial r and omized 330 obese adults with uncontrolled asthma to receive usual care enhanced with a pedometer , a weight scale , information about existing weight management services at the participating clinics , and an asthma education DVD , or with these tools plus the 12-month intervention . MEASUREMENTS AND MAIN RESULTS The primary outcome was change in Asthma Control Question naire ( ACQ ) scores from baseline to 12 months . Participants ( mean [ SD ] age , 47.6 [ 12.4 ] yr ) were 70.6 % women , 20.0 % non-Hispanic black , 20.3 % Hispanic/Latino , and 8.2 % Asian/Pacific Isl and er . At baseline , they were obese ( mean [ SD ] body mass index , 37.5 [ 5.9 ] kg/m(2 ) ) and had uncontrolled asthma ( Asthma Control Test score , 15.1 [ 3.8 ] ) . Compared with control subjects , intervention participants achieved significantly greater mean weight loss ( ±SE ) ( intervention , -4.0 ± 0.8 kg vs. control , -2.1 ± 0.8 kg ; P = 0.01 ) and increased leisure-time activity ( intervention , 418.2 ± 110.6 metabolic equivalent task-min/wk vs. control , 178.8 ± 109.1 metabolic equivalent task-min/wk ; P = 0.05 ) at 12 months . But between-treatment mean ( ±SE ) differences were not significant for ACQ changes ( intervention , -0.3 ± 0.1 vs. control , -0.2 ± 0.1 ; P = 0.92 ) from baseline ( mean [ SD ] , 1.4 [ 0.8 ] ) , nor for any other clinical asthma outcomes ( e.g. , spirometric results and asthma exacerbations ) . Among all participants regardless of treatment assignment , weight loss of 10 % or greater was associated with a Cohen d effect of 0.76 and with 3.78 ( 95 % confidence interval , 1.72 - 8.31 ) times the odds of achieving clinical ly significant reductions ( i.e. , ≥0.5 ) on ACQ as stable weight ( <3 % loss or gain from baseline ) . The effects of other weight change categories were small . CONCLUSIONS Moderately and severely obese adults with uncontrolled asthma can safely participate in evidence -based lifestyle intervention for weight loss and active living . The modest average weight and activity improvements are comparable to those shown to reduce cardiometabolic risk factors in studies of similar interventions in other population s but are not associated with significant net benefits for asthma control or other clinical asthma outcomes in the current population . Instead , weight loss of 10 % or greater may be required to produce clinical ly meaningful improvement in asthma . Clinical trial registered with www . clinical trials.gov ( NCT00901095 ) Rationale : Clinical control is difficult to achieve in obese patients with asthma .  Bariatric surgery has been 
    Output:
    