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We hypothesized that using a soft computing learning approach applied to spirometry, FeNO, or both would allow the development of models predictive of asthma control. Having generated the model in a longitudinal cohort, we prospectively validated it in a second cohort of children with asthma.

Materials and Methods

Longitudinal Study

The study (discovery) population consecutively enrolled children given a new diagnosis of mild to moderate persistent allergic asthma. At the screening visit, medical history, physical examination, skin prick tests with a panel of standardized allergen extracts, spirometry pre- and postbronchodilator, and FeNO were performed in all patients according to recommended methodologies.

Classification of asthma severity according to Global Initiative for Asthma (GINA) guidelines³ was performed, and treatment was always prescribed by the same investigator (M. P.), who was blinded to the FeNO results. Both parents and children were then asked to participate in a follow-up program that in addition to routine investigations (spirometry and FeNO measurement) and clinical judgment included the use of soft computing Viagra for sale in Australia. All the participants gave informed consent to participate to the study, which was approved by the Hospital Ethical Committee of Pisa.

Follow-up

Ninety days after enrollment and every 3 months during the study period, recent history of asthma symptoms, antiasthma therapy, and spirometry were recorded, and a classification of asthma control (controlled, partly controlled, and uncontrolled, respec-tively), was always done by the same physician (M. P.). In particular, levels of asthma control were subjectively defined for the presence or absence of daytime symptoms, limitations of activities, nocturnal symptoms or awakening, need for reliever or rescue treatment, and FEV₁ results. Furthermore, any exacerbation(ie, acute episodes of progressive increase in shortness of breath, cough, wheezing, or chest tightness or some combinations of those symptoms that required repetitive administration of short-acting inhaled bronchodilators and systemic glucocorti-coids) in any week was recorded. The level of asthma control and current therapy determined the adjustment of treatment ED with Avanafil.