Bronchoconstriction

This study is designed to assess the validity and reliability of the Turkish version of the Brompton Breathing Pattern Assessment Tool (BPAT). BPAT is a well-established tool used to assess the breathing patterns of individuals with respiratory conditions. In this study, a group of asthma patients will be evaluated using the BPAT to determine its applicability and consistency in the Turkish-speaking population. The reliability of the tool will be tested through repeated measurements, and its validity will be assessed by comparing BPAT results with other validated asthma assessment tools. The data will be analyzed to evaluate the internal consistency, test-retest reliability, and construct validity of the BPAT in a clinical asthma population. The linguistic validation process will be conducted following the ISPOR Task Force guidelines, including forward translation, reconciliation, back-translation, and cognitive debriefing. The psychometric properties of the tool, including internal consistency, test-retest reliability, and construct validity, will be evaluated according to the COSMIN checklist standards. Additionally, participant eligibility will be defined as individuals who are diagnosed with asthma and can understand and respond to questions in Turkish. The study will also explore any cultural adaptations necessary for the Turkish version of the BPAT to ensure its cultural relevance and accuracy in assessments.

This study focuses on the markers that are derived from the interaction of 129Xe with pulmonary capillary red blood cells (RBCs). Specifically, the investigators focus on RBC transfer MRI, cardiogenic oscillations in 129Xe-RBC signal amplitude, and the 129Xe-RBC chemical shift. In addition to healthy volunteers, the population to be studied will consist of patients scheduled to undergo either transfusion or phlebotomy, those with dyspnea, those with a physician diagnosis of interstitial lung disease (ILD), idiopathic pulmonary fibrosis (IPF), non-specific interstitial pneumonias (NSIP), chronic hypersensitivity pneumonitis (cHP), and sarcoid, as well as those with either chronic thromboembolic pulmonary hypertension (CTEPH) and acute pulmonary embolism.

The 3TR Consortium is the overall generator behind the 3TR-ABC study. The 3TR Consortium consists of 15 European countries and a total of 69 partners who collaborate on seven different autoimmune, inflammatory, and allergic diseases: chronic obstructive pulmonary disease, asthma, Crohn's disease, ulcerative colitis, multiple sclerosis, systemic lupus erythematosus, rheumatoid arthritis. The ambition of the consortium is to accelerate precision medicine by fundamentally increasing the knowledge of molecular pathways and mechanisms related to response and non-response to therapy. To date, the 3TR Consortium is the largest immunology project funded by the Innovative Medicine Initiative (IMI). The 3TR-ABC platform study is anchored in the so-called work package 8 (WP8) within the 3TR Consortium and will contribute with knowledge about the effect of biological therapies in severe asthma: With the advent of highly targeted biological therapies for severe asthma, several important questions arise; what determines a good clinical response versus non-response? Can we induce remission of severe asthma, and improve long-term outcomes? The 3TR-ABC study platform is a clinical trial platform and network, in which intervention-specific studies on different biologics are conducted. Via the 3TR-ABC study platform, conducting advanced translational studies in a real-life cohort of asthma patients is made possible, in collaboration with key opinion leaders and scientific experts in the field from across Europe. The 3TR-ABC study design includes a core study visit structure, which can be expanded or amended per study to suit individual focus points. Overall, the study design includes enrollment of bio-naïve patients with severe asthma, who have been assessed with systematic assessment, and who meet the criteria for commencing a biologic, according to national criteria in each country. Patients are then followed from the time of starting a biological treatment for three years, during which time they are followed at set time points as well as at the time of exacerbations, with sampling consisting of a core package and expanded packages, depending on the site. By using a range of state-of-the-art and novel methods for assessing immune activation, and applying advanced bioinformatics analysis methods, The investigators expect to be able to identify immune activation patterns and response profiles that will further our understanding of disease drivers in the treatment of refractory severe asthma. Furthermore, healthy participants and patients with mild/moderate controlled asthma will be acting as controls for baseline markers thus constituting a healthy as well as mild/moderate controlled asthma reference population. Benralizumab Cohort Study: The AIR-BIO-OCT study Allocation to biologicals occurs by means of asthma phenotyping including clinical parameters including OCS use and blood or sputum / bronchoalveolar lavage (BAL) eosinophils (reflecting Th2 high - Th2 low inflammation). It is unclear if and how biologics impact on airway remodeling and how they act within the airway wall and which airway cells are targeted in vivo, directly or indirectly by a reduction in eosinophils. Important pathophysiological features of asthma that relate to disease severity and prognosis are airway inflammation and remodeling, including an increase in airway smooth muscle (ASM) and extracellular matrix (ECM) alterations. Therefore, with the AIR-BIO-OCT substudy as part of the 3TR-ABC Study, next to performing a complete unbiased multi-omics approach the investigators also have some already identified multi-omics phenotypes within severe asthma that the investigators would like to investigate in a cohort of benralizumab users. As such extensive phenotyping before and after treatment, by combining exhaled breath VOCs (GC-MS and eNose) technology with minimal invasive omics (molecular) and innovative imaging technology by OCT, including polarization-sensitive OCT PS-OCT (impact of benralizumab on remodeling). Primary Objective Determine baseline biomarkers of remission after 1 year of biological therapy, defined as ACQ-5 \<1.5, post-bronchodilator FEV1 percent predicted ≥80% OR \>10% improvement as well as no exacerbations, or use of maintenance steroids for the past 12 months ("remission on treatment"). Secondary Objectives Determine baseline biomarkers of remission after 3 years of biological therapy. Additionally, i) Change in biomarker profiles in remission versus non-remission groups, ii) baseline and change in biomarker profile for a) each response outcome individually, b) Global evaluation treatment efficacy (GETE), patient and physician rated response, and c) 3TR agreed on a composite assessment of response, iii) determine the change in all response variables against baseline biomarker data and change in biomarkers as continuous variables. Exploratory Objectives: Novel analytical science approaches including but not limited to network and cluster analyses and partial least-squared discriminate analysis (PLSDA), topographical discriminant analysis of omic data derived from the biosamples collected at planned visits as well as daily FENO to determine possible novel biomarker signatures (including FENO) and relate to asthma remission, clinical response, interactomes of the multi-omic and clinical data, host-microbiome interactions. AIR-BIO-OCT substudy objectives Primary Objective: * To identify and measure an eNose/ volatile organic compound (VOC)- multi-omics extensive severe asthma phenotyping strategy before treatment with biologicals to reveal add-on response characteristics to better predict treatment response. * To identify and measure minimal invasive predicting "signature" of biological treatment response in severe eosinophilic asthma by extensive asthma pheno-endotyping using innovative minimal invasive exhaled breath technologies including eNose/VOCs and omics. Secondary Objective(s) * To measure airway remodeling (extracellular matrix and airway smooth muscle) after treatment with Benralizumab * Establish the reduction of extracellular matrix (ECM) and airway smooth muscle (ASM) by the standard - polarization-sensitive (PS) - OCT and endobronchial biopsy analyses after 6 months - 1 year of Benralizumab treatment. Study Design The 3TR-ABC study is a multicentre observational prospective cohort study that follows patients with severe asthma from the time of commencement of biological therapy and three years onwards. Healthy individuals and patients with mild/moderate controlled asthma are included as reference groups and will undergo the same baseline visit as patients with severe asthma. Informed Consent must be obtained from all participants who accept enrollment in the study in order to allow the collection of data and biological materials for the database and biobank, respectively. The study follows each patient with severe asthma at six visits over a period of three years. The first visit is the so-called baseline visit and is performed before the beginning of a biological treatment. This visit consists of a standard examination package, a site-specific extended package (i.e., tests in this package will only be done at specific sites), and an optional extended package (i.e., the participant decides). The remaining five visits are so-called follow-up visits and are made respectively 4 weeks, 16 weeks, 52 weeks, 2 years, and 3 years after the baseline visit. These visits consist of a follow-up sampling package and a site-specific extended package. An optional extended package is furthermore possible for the 4 weeks, 52 weeks, 2 years, and 3 years visits. Between scheduled visits, patients with severe asthma are asked to come for an extra visit if they experience a sudden exacerbation. Participants in the control groups will only be invited for the baseline visit. The AIR-BIO-OCT study is a sub-study within the 3TR-ABC Study performed in the Netherlands that will select severe eosinophilic asthma patients that start treatment with Benralizumab and will phenotype those patients (combining exhaled breath analysis and OCT technology) before and after 16 weeks and additional 52 weeks from the start of the biological. In the Netherlands, the AIR-Bio-OCT substudy consists of two parts: the first, aligned with the 3TR - ABC study, where samples of the abovementioned packages will be collected (n=34) and merged with the Benralizumab subjects recruited within the 3TR consortium (total 60-90 patients). The second part, additional bronchoscopy with standard and PS-OCT before and after 6 months-1 year will be performed (n=15).

Acute asthma (or asthma exacerbation) is common and costly. In the USA, acute asthma accounts for approximately 2 million emergency department (ED) visits per year; approximately 10-20% of patients are admitted and, among those discharged, approximately 15-20% relapse (i.e., return to the ED for further treatment of their index exacerbation). A 2000 Cochrane review evaluated if starting inhaled corticosteroids (ICS) at ED discharge would lower risk of relapse during the 2-3 weeks after the ED visit. The meta-analysis included three randomized controlled trials (RCTs) and found borderline significant evidence that ICS initiation lowered risk of relapse during the 2-3 weeks after ED discharge (total n=909 patients; OR 0.68; 95%CI 0.46-1.02). For decades, asthma experts have tried to increase ED-based prescribing of ICS to ED patients with asthma but uptake has been slow. In addition to reluctance among ED clinicians to prescribe a "lifelong" medication, a challenge has been patients' perception that they do not receive any immediate symptom relief from the new (ICS only) inhaler - i.e., "it does not work as well" as their regular (albuterol) inhaler. FDA approval of Airsupra (with both albuterol and budesonide in one inhaler) provides a unique opportunity to introduce ICS (along with albuterol) to ED patients with acute asthma. The proposed trial is a cluster randomized, open-label, intervention vs usual care, controlled study on the effect of ED initiation of Airsupra on acute asthma recurrence at 3 months (primary outcome) - i.e., a combination of acute asthma "relapse" (by 3 weeks) plus subsequent exacerbations. The trial is powered to assess a 33% reduction in recurrence at 3 months and will have ample power to explore asthma control, both overall and in important subgroups (e.g., stratified by age, sex, race/ethnicity, BMI, current asthma medications, and number of ED visits for acute asthma in the past year). Randomization of sites will be stratified by US region to increase likelihood that the two groups are similar at baseline. Patients will be enrolled by members of the Multicenter Asthma Research Collaboration (MARC), within the Emergency Medicine Network (EMNet). This research network was founded in 1996 with the original goal of performing clinical research on acute asthma. Massachusetts General Hospital is the EMNet Coordinating Center and will not participate in patient enrollment. Patient inclusion criteria include: acute asthma (i.e., fulfill American Thoracic Society criteria for asthma; age 18-54 years (to minimize contamination by COPD and to permit testing of effect modification by age); decision by ED attending to discharge patient to home on short course of systemic corticosteroids (to "validate" that patient truly had an asthma exacerbation); and informed consent. Patient exclusion criteria include: prior diagnosis of COPD, use of systemic corticosteroids in the past 2 weeks (to avoid enrollment of severe persistent asthma or patients presenting to ED with an acute asthma relapse, rather than their index presentation of acute asthma); comorbid complications (e.g., concurrent pneumonia); lack of a working cell phone and working email address (having both is common today and will increase follow-up rates); expected lack of availability for text and/or telephone follow-up at approximately 3, 6, and 12 weeks after the ED visit; or prior enrollment in this study. All patients will undergo a short, structured interview in the ED and a focused ED chart review, using previously developed instruments for ED-based asthma research. Site investigators will enter these data into a REDCap database created and managed at the EMNet Coordinating Center in Boston. Based on their random site assignment (intervention vs usual care), intervention sites will put enrolled patients on a short course of systemic corticosteroids (e.g., prednisone 50 mg daily x 5 days) and Airsupra PRN (rescue inhaler). Usual care sites will manage patients per usual care. All patients will receive a brief educational handout about asthma. At approximately 3, 6, and 12 weeks after the ED discharge, EMNet staff will follow-up with patients about their clinical course (including acute asthma relapse, asthma control, medication use), and potential adverse effects from any of the medications prescribed at ED discharge. Most follow-up assessments will be by telephone interview, but texts will be used per patient preference and/or to increase completeness of follow-up. Asthma control will be assessed using the AirQ, a 10-item instrument. EMNet staff will enter data into the REDCap database. Patients will sign medical release forms so that EMNet staff in Boston can collect medical records for the 12 months before enrollment and the first 3 months after enrollment. These records will come from the enrolling hospital or hospital system/network, along with the patient's primary care provider and, when applicable, their asthma specialist (allergist/immunologist, pulmonologist, asthma center). EMNet staff will review these medical records to identify repeat asthma exacerbations (ie, recurrence) and the patient's current medications at the end of the 3-month follow-up period. EMNet staff will enter data into the REDCap database. The primary outcome is acute asthma "recurrence" (i.e., any urgent or unscheduled visit to a clinician for worsening asthma symptoms) during the 3 months after the ED visit. This outcome differs from acute asthma "relapse" which is typically assessed during the 3 weeks after the ED visit; prior research indicates that symptoms of an exacerbation typically resolve by 1-2 weeks while biochemical evidence of the exacerbation resolves by 3 weeks. The frequency of recurrence in this unique, ED-based population is not known - but the investigators' best estimate for the usual care group is approximately 33% (i.e., they will experience 15% relapse in the first 3 weeks then additional events during the 9 weeks of fall/winter that follow.) The main secondary outcome will be asthma control at 3 months after the ED visit. Other secondary outcomes include acute asthma relapse (3 weeks) and post-ED initiation of Airsupra (any time during follow-up). Data analysis will describe patient characteristics, overall and in the two randomly allocated groups (15 intervention sites, 15 usual care sites). The primary outcome (acute asthma recurrence at 3 months after the index ED visit) will be analyzed using time-to-event data, in both unadjusted and multivariable models. Covariates will be major sociodemographic factors (e.g., age, sex, race/ethnicity, insurance) and clinical factors with an observed association (P\<0.20) with the recurrence outcome. The main secondary outcome (3-month asthma control) will be compared using t-test or Mann-Whitney U-test, as appropriate. Repeated measures are not necessary since the investigators will focus on 3-month asthma control; asthma control at baseline is non-interpretable in the context of the index exacerbation. The investigators will not do an interim analysis given the relatively short study enrollment, across 30 centers, and given the demonstrated safety of Airsupra (per FDA approval). Power calculations, based on acute asthma recurrence at 3 months (with an estimated intra-cluster correlation \[ICC\] of 0.02), suggest that 1290 patients are needed to detect a 33% reduction in recurrence (e.g., 22% recurrence in the Airsupra group vs. 33% recurrence in the usual care group). The main secondary outcome, asthma control, will require fewer patients. The investigators anticipate 70% follow-up of enrolled patients at 3 months and, therefore, have increased the target sample size to 1860 total patients (930 per arm; 62 per site). Based on experience with ED-based asthma research since the 1990s, the investigators believe that each site, over 4-5 months (August to December), can enroll at least 62 adult patients with acute asthma. (30 sites x 62 patients/site = 1860)

The three different doses of Atectura inhalation capsule via Breezhaler will be prescribed according to the approved label information in Korea, and the investigation for any additional diagnostic or monitoring will be not conducted for this study

The two different doses of Enerzair inhalation capsule via Breezhaler will be prescribed according to the approved label information in Korea, and the investigation for any additional diagnostic or monitoring will be not conducted for this study.

A Phase II randomized, controlled, clinical trial analyzing the impact of increasing fiber intake and the gut microbiome for children with asthma. If eligible, (determined by inclusions/exclusion criteria as well as fiber intake assess by ASA 24) participants will be put into a fiber (Fruitafit Inulin) or placebo (Maltodextrin) group. Each participant will fil out an Asthma Control Questionnaire (ACQ), collect a nasal wash, and have their blood drawn. Their study medication will be available for them to pick up after their first visit, and they will receive counseling from the Pharmacist on how to implement it into their diet. They will also be sent home with three stool sample kits to be mailed to Northern Arizona University for microbiome and metabolomic analysis. The first kit will be sent within 7 days of their first visit. The second kit will be sent within 14 days (+/- 1 day) of their first visit. The second study visit will occur 25 days (+5 days) after the first visit. All the procedures will be repeated again including taking the ASA 24 questionnaire. The participant will send their final kit within 7 days of completing their last visit. Total study time is approx 30 days. This study is minimal risk which includes risk of fecal contamination, discomfort from collecting specimens, discomfort with answering some of the survey questions, and the risks associated with receiving a blood draw. Participants are compensated for their time and receive a portion of their dietary results. There may not be a direct benefit to the participant, but by participating in this research they may help people in the future with asthma.

The cohort for inflammatory respiratory diseases: from phenotyping to personalised medicine (The PALMIRE project) is a monocentric study conducted at the University Hospital of Reims, France. Study Population : Adult patients (\>18 year-old) followed at the University Hospital of Reims and diagnosed with asthma, COPD, bronchiectasis, CF, PCD, and IPF will be considered for inclusion. Patients will sign an informed consent for inclusion. Exclusion criteria include "subjects protected by the law" as required by the French authorities. Control patients with no respiratory diseases after clinical and pulmonary function tests assessment will also be included. The expected number of patients included is 470 (Asthma, n=100; COPD, n=150; bronchiectasis, n=50; CF, n=60; PCD, n=30; ILD, n=30; controls, n=50). Inclusion will be conducted for 60 months from July 2025 to July 2030. Study Procedures: For all asthma, COPD, bronchiectasis, CF, PCD, and IPF patients included, data will be registered at inclusion, and at follow-up visits for 10 years. Patients will be followed-up as usual care with no specific therapeutic intervention. For control patients, data will be registered at inclusion with no follow-up. The recorded data will include demographics, history of respiratory disease and comorbidities, respiratory symptoms, results of lung function tests and CT-scan, microbiological and pathological features of respiratory sampling when performed. Data Analysis: Data will be registered in a centralized anonymized database. The characteristics of the patients will be described as mean and standard deviation for quantitative data and as number and percentages for qualitative data. Comparisons and associations between groups and variables will be analyzed by Student, Wilcoxon, Chi2, Fischer exact, and Spearman tests as applicable. A p\<0.05 will be considered as significant. Multivariate and longitudinal statistical models will be used to identify clusters of patients with shared endotypes. Machine learning approaches will be employed to integrate multi-omic data and generate predictive models for disease trajectories and treatment responses. Significance: This study should help better understand the pathogenesis and heterogeneity of chronic respiratory diseases by integrating the analysis of phenotypic and endotypic characteristics of patients.

Asthma is an important respiratory disease. Asthma affects 1-18% of the population worldwide.The prevalence of asthma in adults ≥20 years old in China is 4.2% , numbering 45.7 million. An acute asthma exacerbation is defined as a rapid increase in symptoms such as wheezing, shortness of breath, chest tightness, and cough in a short period of time, and deterioration of lung function that requires additional reliever medications to treat. Acute asthma exacerbations are important events in the course of poorly controlled asthma, leading to increased mortality, decreased quality of life and extensive use of health care resources. Reducing the frequency of acute asthma exacerbations is an important principle of asthma treatment. It has been found that some patients with asthma are prone to acute exacerbations and these patients develop a stable phenotype. Compared to patients with infrequent acute exacerbations, asthma patients with frequent exacerbations are characterized by higher doses of inhaled glucocorticoids and/or oral hormones, poorer asthma control, lower quality of life, increased CRP and sputum eosinophils, more rapid decline in lung function, and a greater likelihood of continuing to have frequent acute exacerbations thereafter. A high proportion of patients with frequent acute exacerbations are present in patients with asthma of varying severity. Although treatment adherence and self-management skills are thought to be associated with acute asthma exacerbations, however, a higher proportion of asthma patients with good adherence and self-management skills still seem to be prone to acute exacerbations . Furthermore, reduction in asthma symptoms does not always correspond to the number or severity of acute attacks. Unlike what has been previously observed in severe asthma, there was no significant correlation between frequent acute exacerbations of asthma and asthma duration, age of onset, race, and socioeconomic background. The above studies suggest that frequent asthma exacerbations may represent a distinct asthma phenotype and that the underlying mechanisms of asthma severity and frequent acute exacerbations may be different. We need more research on the pathogenic mechanisms and treatments for frequent acute exacerbations. Studies on risk factors for frequent acute exacerbations of asthma have yielded inconsistent results. Some studies have shown that asthma severity is an independent risk factor for frequent acute asthma exacerbations. However, other findings show that when patients are compliant with treatment, there are no specific characteristics that distinguish frequent acute exacerbations from infrequent acute exacerbations of the same asthma severity. Poorly controlled asthma also greatly increases the risk of acute exacerbations, but inconsistencies between the current level of control and the risk of acute exacerbations have also been reported. A significant proportion of patients with mild to moderate asthma who have well controlled asthma have frequent exacerbations, suggesting that the underlying mechanisms of baseline disease control and acute exacerbations may be driven by different factors in patients with mild to moderate asthma, and that a reduction in asthma symptoms does not always coincide with the number or severity of acute exacerbations. The pathophysiological mechanisms that cause frequent asthma exacerbations are unclear, and a few studies have explored the inflammatory mechanisms underlying frequent asthma exacerbations, with a multicenter cohort study of severe asthma showing that blood eosinophils were associated with asthma with a predisposition to acute exacerbations. When asthma treatment is aimed at minimizing airway eosinophil counts, the occurrence of frequent exacerbations can be prevented in moderate to severe asthma.High FeNO levels are also a risk factor for frequent acute exacerbations. However, sputum eosinophil percentages below 2% have also been reported in patients with frequent exacerbations. Mechanisms related to viral infection may also play a role in frequent acute attacks. One study evaluated the concentrations of interferon-gamma protein 10 (IP-10) and neopterin, and the results compared to the stable phase suggested that these two biomarkers of inflammation involved in viral infection were increased during acute episodes. However, the study did not confirm a difference in the concentrations of the two biomarkers between frequent and infrequent acute episodes. There is still a need to identify biomarkers, which may help to predict frequent acute episodes. In summary, frequent acute exacerbations are likely to be a distinct asthma phenotype. Further studies are needed to identify risk factors for frequent acute exacerbations, but previous studies have mostly been cross-sectional studies at a single time point or prospective studies based on smaller sample sizes. Moreover, most of the studies on frequent acute exacerbations have been conducted in severe or refractory asthma, whereas a certain proportion of patients with nonsevere asthma may also have frequent acute exacerbations, and their risk factors still need to be further evaluated; in addition, previous studies have rarely looked at the effect of comorbidities on frequent acute exacerbations; furthermore, there have been no prospective studies to look at the prognosis of patients with frequent acute exacerbations and the response to treatments and prognostic factors associated with such attacks. Finally, the pathophysiologic mechanisms underlying frequent acute exacerbations of asthma require further investigation. Therefore, the main objectives of this study were to compare the baseline clinical, inflammatory, pathophysiologic, comorbid, and environmental characteristics of patients with frequent acute exacerbations and those with infrequent acute exacerbations, regardless of asthma severity, and to develop a predictive model for frequent acute exacerbations; and to develop a cohort of patients with frequent acute exacerbations of asthma, to observe their prognosis and response to therapy, and to search for prognostic-related factors. The successful implementation of this study will help early identification of patients with frequent acute exacerbations, clarify the factors associated with poor prognosis in this group of patients, and thus provide individualized solutions for the treatment and prevention of patients with this type of asthma; exploring the inflammatory mechanisms of frequent acute exacerbations of asthma will help to elucidate the pathogenesis of this subtype, and to discover new specific therapeutic targets for this subtype.

Asthma is a widespread condition that affects millions of people worldwide. It is characterized by symptoms such as difficulty breathing, coughing, and wheezing. Diagnosing asthma involves identifying certain indicators like airflow obstruction, airway sensitivity, and inflammation. However, different international guidelines, including those from organizations such as NICE (National Institute for Health and Care Excellence), GINA (Global Initiative for Asthma), and BTS (British Thoracic Society)/SIGN (Scottish Intercollegiate Guidelines Network), have varying criteria for diagnosis. This can lead to inconsistencies in identifying patients with asthma. This study aims to evaluate the effectiveness of different diagnostic approaches, including impulse oscillometry (IOS), in diagnosing asthma. IOS is a simple and non-invasive test that measures lung function. It has the potential to enhance the accuracy and ease of asthma diagnosis. Despite its promise, current research on the role of IOS in diagnosing asthma in adults is limited. To address these gaps in knowledge, the study will examine the data of patients attending the severe asthma service at Queen Alexandra Hospital in Portsmouth. With an "opt-out" consent process, routine outpatient lung function data will be analysed, paying special attention to the usefulness of IOS compared to other lung function indices in diagnosing asthma. By conducting this study, the aim is to contribute valuable insights to the field of asthma diagnosis. The study findings may help refine the methodology of diagnosing asthma and potentially expand the diagnostic toolkit to include IOS. This could improve the precision and ease of managing asthma, leading to better outcomes for patients.