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 The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common . Objective : to determine whether a secondary -screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective . Method R and omly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in , or rule-out , a correct diagnosis of asthma . Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained . Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects . Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars . Results Of 540 r and omly selected patients with physician diagnosed asthma 150 ( 28 % ; 95%CI 19 - 37 % ) did not have asthma when objective ly studied . 71 % of these misdiagnosed patients were on some asthma medications . Incorporating the incremental cost of secondary -screening for the diagnosis of asthma , we found that the average cost savings per 100 individuals screened was $ 35,141 ( 95%CI $ 4,588-$69,278 ) . Conclusion Cost savings primarily result ed from lifetime costs of medication use averted in those who had been misdiagnosed The clinical and physiological effects of a medically supervised , indoor physical training programme were investigated in 36 asthmatic subjects aged 16 - 40 years . After clinical evaluation , lung function assessment , and progressive incremental exercise testing subjects were r and omly allocated to control and training groups . The measurements were repeated after a six week run in period and after a further three months in which those in the training group underwent an indoor training programme . The measurements made at three months were compared with those at the end of the run in period . There was no significant change in anthropometric characteristics , blood lipid profiles , or the provocative concentration of histamine causing a 20 % fall in FEV1 ( histamine PC20 ) in the group who underwent training . After training there were significant increases in mean maximal oxygen uptake ( ml kg-1 min-1 ) from 23 ( 5 ) to 28 ( 6 ) , oxygen pulse ( ml/beat ) from 8.8 ( 2.3 ) to 10.8 ( 2.4 ) , and anaerobic threshold ( 1/min ) from 1.11 ( 0.27 ) to 1.38 ( 0.33 ) . These changes were significantly greater in the group undergoing training than in the control group . There was also a significant fall in breathlessness scores ( Borg ratings ) , blood lactate , carbon dioxide output , and minute ventilation during submaximal exercise in the training group , with no change in the control group . The subject 's motivation , the initial level of fitness , and the symptom score at the time of training were the most important factors influencing improvements in cardiorespiratory fitness . Thus submaximal physical exercise of controlled intensity , sustained for three months , produced significant improvements in fitness and cardiorespiratory performance that should be advantageous to the exercising asthmatic patient . The availability of medical supervision throughout the exercise programme appears to have contributed to the successful outcome Global asthma control levels are suboptimal . The influence of regular exercise on asthma control is unclear . We assessed the effects of a 12-week supervised exercise intervention followed by 12 weeks of self-administered exercise on adults with partially controlled asthma ( n = 21 ) and matched controls ( n = 15 ) . Assessment s were conducted at baseline and week 12 for both the exercise and control group , and again at week 24 for the exercise group . There was a significant treatment effect on asthma control in the exercise group , as measured by the Asthma Control Question naire ( ACQ ) , from baseline to week 12 , compared with the control group . A clinical ly significant improvement ( 0.5 increase in ACQ score ) was observed for asthma quality of life and ACQ in the exercise group from baseline to week 12 . There was a significant improvement in aerobic fitness from baseline to week 24 in the exercise group . In conclusion , a 12-week supervised exercise intervention led to improvements in asthma control and quality of life in partially controlled asthmatics motivated to exercise . These improvements were maintained , while aerobic fitness and perceived asthma control significantly improved over an additional 12 weeks of self-administered exercise . These findings indicate that a structured exercise intervention can improve asthma control BACKGROUND Aerobic training has a number of well known beneficial effects in both normal and asthmatic children . However , the impact of training on the clinical management of the underlying bronchial asthma remains controversial , particularly in the most severe patients . METHODS Clinical evaluation , spirometric tests , symptom limited maximum exercise testing , and exercise challenge tests were performed in a group of children with stable moderate to severe asthma . Forty two patients ( 24 boys ) aged 8–16 were evaluated twice : before and after supervised aerobic training ( group 1 , n = 26 ) and two months apart ( untrained group 2 , n = 16 ) . RESULTS Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 ( p<0.05 ) but medication and clinical scores and the occurrence of exercise induced bronchospasm ( EIB ) did not differ between the two groups . Aerobic improvement with training ( maximal oxygen uptake and /or anaerobic threshold increment > 10 % and 100 ml ) was inversely related to the baseline level of fitness and was independent of disease severity . Although the clinical score and the occurrence of EIB did not change after training , aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids ( p<0.05 ) . CONCLUSIONS Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids , independent of the severity of the disease Background There is a substantial body of evidence on the efficacy of yoga in the management of  bronchial asthma .  Many studies have reported , as the effects of yoga on bronchial asthma , significant improvements in pulmonary functions , quality of life and reduction in airway hyper-reactivity , frequency of attacks and medication use . In addition , a few studies have attempted to underst and the effects of yoga on exercise-induced bronchoconstriction ( EIB ) or exercise tolerance capacity . However , none of these studies has investigated any immunological mechanisms by which yoga improves these variables in bronchial asthma . Methods The present r and omized controlled trial ( RCT ) was conducted on 57 adult subjects with mild or moderate bronchial asthma who were allocated r and omly to either the yoga ( intervention ) group ( n = 29 ) or the wait-listed control group ( n = 28 ) . The control group received only conventional care and the yoga group received an intervention based on yoga , in addition to the conventional care . The intervention consisted of 2-wk supervised training in lifestyle modification and stress management based on yoga followed by closely monitored continuation of the practice s at home for 6-wk . The outcome measures were assessed in both the groups at 0 wk ( baseline ) , 2 , 4 and 8 wk by using Generalized Linear Model ( GLM ) repeated measures followed by post-hoc analysis . Results In the yoga group , there was a steady and progressive improvement in pulmonary function , the change being statistically significant in case of the first second of forced expiratory volume ( FEV1 ) at 8 wk , and peak expiratory flow rate ( PEFR ) at 2 , 4 and 8 wk as compared to the corresponding baseline values . There was a significant reduction in EIB in the yoga group . However , there was no corresponding reduction in the urinary prostagl and in D2 metabolite ( 11β prostagl and in F2α ) levels in response to the exercise challenge . There was also no significant change in serum eosinophilic cationic protein levels during the 8-wk study period in either group . There was a significant improvement in Asthma Quality of Life ( AQOL ) scores in both groups over the 8-wk study period . But the improvement was achieved earlier and was more complete in the yoga group . The number-needed-to-treat worked out to be 1.82 for the total AQOL score . An improvement in total AQOL score was greater than the minimal important difference and the same outcome was achieved for the sub-domains of the AQOL . The frequency of rescue medication use showed a significant decrease over the study period in both the groups . However , the decrease was achieved relatively earlier and was more marked in the yoga group than in the control group . Conclusion The present RCT has demonstrated that adding the mind-body approach of yoga to the predominantly physical approach of conventional care results in measurable improvement in subjective as well as objective outcomes in bronchial asthma . The trial supports the efficacy of yoga in the management of bronchial asthma . However , the preliminary efforts made towards working out the mechanism of action of the intervention have not thrown much light on how yoga works in bronchial asthma . Trial registration Current Controlled Trials IS RCT 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 OBJECTIVE The objectives of our study were to compare patient characteristics and severity of disease in obese and normal-weight-confirmed people with asthma and to explore reasons for misdiagnosis of asthma , including potential interactions with obesity . METHODS We r and omly selected patients with physician-diagnosed asthma from eight Canadian cities . Asthma diagnosis was confirmed via a sequential lung function testing algorithm . Logistic analysis was conducted to compare obese and normal-weight-confirmed people with asthma and to assess characteristics associated with misdiagnosis of asthma . Interaction with obesity was investigated . RESULTS Complete assessment s were obtained on 496 subjects who reported physician-diagnosed asthma ( 242 obese and 254 normal-weight subjects ) ; 346 had asthma confirmed with sequential lung testing , and in 150 subjects a diagnosis of asthma was ruled out . Obese subjects with asthma were significantly more likely to be men , have a history of hypertension and gastroesophageal reflux disease , and have a lower FEV(1 ) compared with normal-weight subjects with asthma . Older subjects , men , and subjects with higher FEV(1 ) were more likely to have received misdiagnoses of asthma . Obesity was not an independent predictor of misdiagnosis , however there was an interaction between obesity and urgent visits for respiratory symptoms . The odds ratio for receiving a misdiagnosis of asthma for obese individuals as compared with normal-weight individuals was 4.08 ( 95 % CI , 1.23 - 13.5 ) for those with urgent visits in the past 12 months . CONCLUSIONS Obese people with asthma have lower lung function and more comorbidities compared with normal-weight people with asthma . Obese individuals who make urgent visits for respiratory symptoms are more likely to receive a misdiagnosis of asthma BACKGROUND In 2010 , the Canadian Thoracic Society ( CTS ) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older , and adults , including an up date d Asthma Management Continuum . The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline up date process , focusing , in this first iteration , on topics of controversy and ⁄or gaps in the previous guidelines . METHODS Four clinical questions were identified as a focus for the up date d guideline : the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy ; the initiation of adjunct therapy to inhaled corticosteroids ( ICS ) for uncontrolled asthma ; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever , and as a reliever and a controller ; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan . The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics . In addition , literature search es were performed to identify relevant systematic review s and r and omized controlled trials . The panel formally assessed and grade d the evidence , and made 34 recommendations . RESULTS The up date d guideline recommendations outline a role for inclusion of assessment of sputum e 
    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 The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common . Objective : to determine whether a secondary -screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective . Method R and omly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in , or rule-out , a correct diagnosis of asthma . Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained . Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects . Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars . Results Of 540 r and omly selected patients with physician diagnosed asthma 150 ( 28 % ; 95%CI 19 - 37 % ) did not have asthma when objective ly studied . 71 % of these misdiagnosed patients were on some asthma medications . Incorporating the incremental cost of secondary -screening for the diagnosis of asthma , we found that the average cost savings per 100 individuals screened was $ 35,141 ( 95%CI $ 4,588-$69,278 ) . Conclusion Cost savings primarily result ed from lifetime costs of medication use averted in those who had been misdiagnosed The clinical and physiological effects of a medically supervised , indoor physical training programme were investigated in 36 asthmatic subjects aged 16 - 40 years . After clinical evaluation , lung function assessment , and progressive incremental exercise testing subjects were r and omly allocated to control and training groups . The measurements were repeated after a six week run in period and after a further three months in which those in the training group underwent an indoor training programme . The measurements made at three months were compared with those at the end of the run in period . There was no significant change in anthropometric characteristics , blood lipid profiles , or the provocative concentration of histamine causing a 20 % fall in FEV1 ( histamine PC20 ) in the group who underwent training . After training there were significant increases in mean maximal oxygen uptake ( ml kg-1 min-1 ) from 23 ( 5 ) to 28 ( 6 ) , oxygen pulse ( ml/beat ) from 8.8 ( 2.3 ) to 10.8 ( 2.4 ) , and anaerobic threshold ( 1/min ) from 1.11 ( 0.27 ) to 1.38 ( 0.33 ) . These changes were significantly greater in the group undergoing training than in the control group . There was also a significant fall in breathlessness scores ( Borg ratings ) , blood lactate , carbon dioxide output , and minute ventilation during submaximal exercise in the training group , with no change in the control group . The subject 's motivation , the initial level of fitness , and the symptom score at the time of training were the most important factors influencing improvements in cardiorespiratory fitness . Thus submaximal physical exercise of controlled intensity , sustained for three months , produced significant improvements in fitness and cardiorespiratory performance that should be advantageous to the exercising asthmatic patient . The availability of medical supervision throughout the exercise programme appears to have contributed to the successful outcome Global asthma control levels are suboptimal . The influence of regular exercise on asthma control is unclear . We assessed the effects of a 12-week supervised exercise intervention followed by 12 weeks of self-administered exercise on adults with partially controlled asthma ( n = 21 ) and matched controls ( n = 15 ) . Assessment s were conducted at baseline and week 12 for both the exercise and control group , and again at week 24 for the exercise group . There was a significant treatment effect on asthma control in the exercise group , as measured by the Asthma Control Question naire ( ACQ ) , from baseline to week 12 , compared with the control group . A clinical ly significant improvement ( 0.5 increase in ACQ score ) was observed for asthma quality of life and ACQ in the exercise group from baseline to week 12 . There was a significant improvement in aerobic fitness from baseline to week 24 in the exercise group . In conclusion , a 12-week supervised exercise intervention led to improvements in asthma control and quality of life in partially controlled asthmatics motivated to exercise . These improvements were maintained , while aerobic fitness and perceived asthma control significantly improved over an additional 12 weeks of self-administered exercise . These findings indicate that a structured exercise intervention can improve asthma control BACKGROUND Aerobic training has a number of well known beneficial effects in both normal and asthmatic children . However , the impact of training on the clinical management of the underlying bronchial asthma remains controversial , particularly in the most severe patients . METHODS Clinical evaluation , spirometric tests , symptom limited maximum exercise testing , and exercise challenge tests were performed in a group of children with stable moderate to severe asthma . Forty two patients ( 24 boys ) aged 8–16 were evaluated twice : before and after supervised aerobic training ( group 1 , n = 26 ) and two months apart ( untrained group 2 , n = 16 ) . RESULTS Spirometric and maximal exercise variables in the initial evaluation were significantly reduced in group 1 ( p<0.05 ) but medication and clinical scores and the occurrence of exercise induced bronchospasm ( EIB ) did not differ between the two groups . Aerobic improvement with training ( maximal oxygen uptake and /or anaerobic threshold increment > 10 % and 100 ml ) was inversely related to the baseline level of fitness and was independent of disease severity . Although the clinical score and the occurrence of EIB did not change after training , aerobic improvement was associated with a significant reduction in the medication score and the daily use of both inhaled and oral steroids ( p<0.05 ) . CONCLUSIONS Aerobic improvement with training in less fit asthmatic children is related to a short term decrease in the daily use of inhaled and oral steroids , independent of the severity of the disease Background There is a substantial body of evidence on the efficacy of yoga in the management of  bronchial asthma .  Many studies have reported , as the effects of yoga on bronchial asthma , significant improvements in pulmonary functions , quality of life and reduction in airway hyper-reactivity , frequency of attacks and medication use . In addition , a few studies have attempted to underst and the effects of yoga on exercise-induced bronchoconstriction ( EIB ) or exercise tolerance capacity . However , none of these studies has investigated any immunological mechanisms by which yoga improves these variables in bronchial asthma . Methods The present r and omized controlled trial ( RCT ) was conducted on 57 adult subjects with mild or moderate bronchial asthma who were allocated r and omly to either the yoga ( intervention ) group ( n = 29 ) or the wait-listed control group ( n = 28 ) . The control group received only conventional care and the yoga group received an intervention based on yoga , in addition to the conventional care . The intervention consisted of 2-wk supervised training in lifestyle modification and stress management based on yoga followed by closely monitored continuation of the practice s at home for 6-wk . The outcome measures were assessed in both the groups at 0 wk ( baseline ) , 2 , 4 and 8 wk by using Generalized Linear Model ( GLM ) repeated measures followed by post-hoc analysis . Results In the yoga group , there was a steady and progressive improvement in pulmonary function , the change being statistically significant in case of the first second of forced expiratory volume ( FEV1 ) at 8 wk , and peak expiratory flow rate ( PEFR ) at 2 , 4 and 8 wk as compared to the corresponding baseline values . There was a significant reduction in EIB in the yoga group . However , there was no corresponding reduction in the urinary prostagl and in D2 metabolite ( 11β prostagl and in F2α ) levels in response to the exercise challenge . There was also no significant change in serum eosinophilic cationic protein levels during the 8-wk study period in either group . There was a significant improvement in Asthma Quality of Life ( AQOL ) scores in both groups over the 8-wk study period . But the improvement was achieved earlier and was more complete in the yoga group . The number-needed-to-treat worked out to be 1.82 for the total AQOL score . An improvement in total AQOL score was greater than the minimal important difference and the same outcome was achieved for the sub-domains of the AQOL . The frequency of rescue medication use showed a significant decrease over the study period in both the groups . However , the decrease was achieved relatively earlier and was more marked in the yoga group than in the control group . Conclusion The present RCT has demonstrated that adding the mind-body approach of yoga to the predominantly physical approach of conventional care results in measurable improvement in subjective as well as objective outcomes in bronchial asthma . The trial supports the efficacy of yoga in the management of bronchial asthma . However , the preliminary efforts made towards working out the mechanism of action of the intervention have not thrown much light on how yoga works in bronchial asthma . Trial registration Current Controlled Trials IS RCT 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 OBJECTIVE The objectives of our study were to compare patient characteristics and severity of disease in obese and normal-weight-confirmed people with asthma and to explore reasons for misdiagnosis of asthma , including potential interactions with obesity . METHODS We r and omly selected patients with physician-diagnosed asthma from eight Canadian cities . Asthma diagnosis was confirmed via a sequential lung function testing algorithm . Logistic analysis was conducted to compare obese and normal-weight-confirmed people with asthma and to assess characteristics associated with misdiagnosis of asthma . Interaction with obesity was investigated . RESULTS Complete assessment s were obtained on 496 subjects who reported physician-diagnosed asthma ( 242 obese and 254 normal-weight subjects ) ; 346 had asthma confirmed with sequential lung testing , and in 150 subjects a diagnosis of asthma was ruled out . Obese subjects with asthma were significantly more likely to be men , have a history of hypertension and gastroesophageal reflux disease , and have a lower FEV(1 ) compared with normal-weight subjects with asthma . Older subjects , men , and subjects with higher FEV(1 ) were more likely to have received misdiagnoses of asthma . Obesity was not an independent predictor of misdiagnosis , however there was an interaction between obesity and urgent visits for respiratory symptoms . The odds ratio for receiving a misdiagnosis of asthma for obese individuals as compared with normal-weight individuals was 4.08 ( 95 % CI , 1.23 - 13.5 ) for those with urgent visits in the past 12 months . CONCLUSIONS Obese people with asthma have lower lung function and more comorbidities compared with normal-weight people with asthma . Obese individuals who make urgent visits for respiratory symptoms are more likely to receive a misdiagnosis of asthma BACKGROUND In 2010 , the Canadian Thoracic Society ( CTS ) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older , and adults , including an up date d Asthma Management Continuum . The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline up date process , focusing , in this first iteration , on topics of controversy and ⁄or gaps in the previous guidelines . METHODS Four clinical questions were identified as a focus for the up date d guideline : the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy ; the initiation of adjunct therapy to inhaled corticosteroids ( ICS ) for uncontrolled asthma ; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever , and as a reliever and a controller ; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan . The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics . In addition , literature search es were performed to identify relevant systematic review s and r and omized controlled trials . The panel formally assessed and grade d the evidence , and made 34 recommendations . RESULTS The up date d guideline recommendations outline a role for inclusion of assessment of sputum e 
    Output:
    