asthma is a chronic inflammatory disorder of the airways , associated with airway obstruction and hyper - responsiveness . asthma is a multifactorial disease and interactions between genetic and environmental factors play roles in its pathogenesis . a meta - analysis suggested that il131112c / t and + 2044a / g polymorphisms were associated with increased pediatric asthma risk . some studies revealed that the genetic pathogenic variants may be responsible for the reduced immunity , reporting low cellular eosinophilic response and relatively low expression of il-12 , ifn- , and tnf- in children in remission . it has also been suggested that the consequent prolonged psychological stress can disturb recovery from asthma and may contribute to the development of chronic asthma in children . asthma is not only associated with multiple markers of chronic systemic inflammation , but also with increased risk of atherogenesis . chronic inflammation via common inflammatory pathways   is associated with atherosclerosis , endothelial dysfunction , arterial stiffness , and subsequent adverse cardiovascular events . some studies reported that peripheral arterial stiffness is related to atherosclerosis and adverse cardiovascular outcomes . elevated arterial stiffness is associated with myocardial infarction , heart failure , renal disease , stroke , and increased total mortality rates in adults . arterial stiffness is a mechanical property related to vascular impedance and the afterload presented to the left ventricle . reduction in arterial distensibility leads to increased pulse pressure , and impedance of arterial flow and pulsatile cardiac workload . the present case - control study was designed to measure arterial stiffness , distensibility , and strain from different peripheral arteries in asthmatic children and to compare these to healthy control subjects to determine the impact of asthma on cardiovascular outcome . we studied 22 pediatric patients ( 14 male and 8 female ) selected randomly from those with bronchial asthma , and 18 healthy subjects . the individuals who met the criteria for bronchial asthma ( 1 ) diagnosis were included in the study . exclusion criteria were : comorbid diseases , such as upper or lower respiratory infection , allergic rhinitis , gastroesophageal reflux , or obesity ; chronic cardiovascular or pulmonary diseases ; acute asthma attack during the last 4 weeks ; a history of chronic inflammation / rheumatological disorders , diabetes , hypertension , or hypercholesterolemia ; and with autoimmune diseases and smoking exposure . the control group consisted of 18 healthy children chosen from the population referred to the pediatric cardiology out - patient clinics . after approval of the ethics committee of the institution , informed consents signed by the parents were obtained . present and past history , symptoms , and signs of all patients were recorded by the same physician . heart rate ( hr ) and blood pressure ( bp ) of all children were recorded . after 12-hour fasting , the blood samples of the patients were measured for glucose , total cholesterol , triglyceride , high - density lipoprotein ( hdl ) , and low - density lipoprotein ( ldl ) . all asthmatic patients involved in this study were receiving inhaled corticosteroids treatment for various periods of time and in various doses bp measurements were performed after 15 minutes of rest ; the right brachial artery pressure was measured by sphygmomanometer with an appropriate cuff . both systolic ( ps ) and diastolic blood pressure ( pd ) were measured , and after 3 measurements , the mean value was recorded . pulse pressure ( pp ) distensibility , strain , and stiffness were calculated as follows : carotid arteries were measured from 1 cm proximal to the bifurcation level , brachial arteries were measured in the middle of the plane arm , and renal arteries were measured 1 cm from the origin of the abdominal aorta . arterial measurements were made by use of a ge logic 7s duplex ultrasonography device with probe at a frequency of 3.110 mhz for b scan . the arithmetic average of radiological measurements of asthmatic and healthy children was compared with the independent t test . the important parameters according to the independent t test were evaluated by using multiple ancova analysis . the mean age of controls ( mean age , 9.09 years ) was higher than asthmatic children ( mean age , 12.15 years ) . ancova analysis was performed in asthma and control groups as fixed factors and age variables as covariate variable . the arithmetic average of radiological measurements of asthmatic and healthy children was compared with the independent t test . the important parameters according to the independent t test were evaluated by using multiple ancova analysis . the mean age of controls ( mean age , 9.09 years ) was higher than asthmatic children ( mean age , 12.15 years ) . ancova analysis was performed in asthma and control groups as fixed factors and age variables as covariate variable . there was no difference between the groups in terms of ps , pd , pulse pressure , ( hr ) , fasting glucose , or cholesterols . the mean age was higher in the control group than in asthmatic patients ( table 1 ) . we evaluated stiffness , distensibility , and strain from carotid , renal , and brachial arteries . carotid arteries measurements showed statistically significant differences regarding stiffness , distensibility and strain ( table 2 ) . the mean values of distensibility and strain of right and left brachial arteries were higher , whereas stiffness was lower in asthmatic children than in controls ( table 3 ) . in comparison with the healthy individuals , the right and left renal arteries means had higher distensibility and strain and lower stiffness in the asthmatic group ( table 4 ) . when the age factor was considered as covariates in ancova analysis ( table 5 ) , the right and left brachial artery distensibility and strain were approximately 2 times higher in the asthmatic group than in controls . approximately one - quarter of the difference ( 22.228.5% ) was due to asthma for both left and right arteries . the distensibility and strain of the right renal artery were higher , whereas right renal artery stiffness was lower in asthmatic children ; 19.2% the differences in right renal artery distensibility and 15.7% of the differences in the right artery strain were due to asthma . a very small portion of the change in the right renal artery stiffness ( 7.9% ) was associated with asthma ; 26.4% of the differences in left renal artery distensibility and 23.4% of the differences in strain in the same artery were due to age , not associated with asthma . the results of the analyses that were not statistically significant are not included in the table 5 . the multiple ancova analysis revealed that approximately one - fifth of the change in left and right brachial arteries distensibility , strain and right renal artery distensibility , strain , and stiffness were associated with asthma . in contrast , left renal artery distensibility , strain , and stiffness were not associated with asthma . this study aimed to assess the elasticity properties of various arteries in children with asthma . on the basis of the association between chronic inflammation and atherosclerosis , we hypothesized that the impaired elasticity in children with asthma could increase the risk of atherosclerotic disease . for this purpose , left and right brachial arteries , left and right renal arteries , and left and right carotid arteries were assessed as markers of atherosclerosis . during the atherosclerotic process , increased arterial stiffness and decreased arterial distensibility and strain have been reported among adults . our results showed increased distensibility and strain in renal and brachial arterial structures , while stiffness was reduced . we believe that these results probably are due to the use of inhaled corticosteroids in these children with asthma . therefore , it appears that inhaled corticosteroids may have a protective effect against atherosclerosis . in this study the results of multiple ancova analysis showed that almost one - fifth of the changes in both left and right brachial arteries distensibility and strain and right renal artery distensibility , strain , and stiffness were associated with asthma . there is little published data on the association between childhood - onset asthma and atherosclerosis and few studies have evaluated elasticity in asthmatic children . using carotid - femoral pulse wave velocity measurements , steinman et al weiler et al . examined the arterial stiffness in peripheral large arteries and small arteries and found no difference between asthmatic adults and control subjects . these authors also reported a positive correlation between the small arterial elasticity index and forced expiratory volume at 1 second ( fev1 ) . brachial - ankle pulse wave velocity measurements were performed to assess the arterial stiffness in a study by sun et al . , where an increased arterial stiffness was found among adult asthmatic patients with stable disease as compared to the healthy controls . in that study , a negative correlation between brachial - ankle pulse wave velocity and fev1 was found . in a recent study by ulger et al . , a difference between asthmatic children and control subjects was found in terms of aortic stiffness parameters , and inhaled steroids were reported as a possible reason for decreasing aortic stiffness . ayer et al . suggested that the reduction in lung volume during the early childhood could be associated with increased arterial stiffness . on the other hand , bhatt et al . reported no significant difference between the markers of systemic inflammation and arterial stiffness in patients with chronic obstructive pulmonary disease . in the current study we found that using inhaled corticosteroids may have protective effects against atherosclerosis . many previous studies have also found a tendency toward decreased arterial stiffness with the use of inhaled corticosteroids / long - acting beta agonists , and there was a more marked decrease in stiffness in adult patients with higher arterial stiffness [ 2123 ] . a proposed mechanism that may explain the decrease in arterial stiffness involves nitric oxide synthesis and vasodilation . they found decreased carotid atherosclerosis and concluded that the inhaled corticosteroids may provide protection against atherosclerosis . since inhaled corticosteroids exert a strong anti - inflammatory effect on airways , they are the most effective agents for long - term disease control . on the other hand , corticosteroids also have some potential pro - atherogenic and metabolic effects , such as the induction or worsening of hypertension , hyperglycemia , hypercholesterolemia , and hypertriglyceridemia . clinicians must also be careful in prescribing steroids to patients who live in endemic areas . for instance , alsharif et al . diagnosed a woman , who lived mexico , with hyperinfection syndrome due to strongyloides stercoralis , most probably exacerbated by prednisone given for asthma . steroid was discontinued and she improved with treatment . due to such effects , it has been proposed that the use of corticosteroids may be associated with the development of atherosclerosis , although until now this connection has not been clearly established . also , since there is an increased risk of atherosclerosis in inflammatory conditions , it can be suggested that corticosteroids may somehow alleviate the atherosclerotic vascular diseases through their anti - inflammatory properties . a cohort study from the uk indicated that treatment with oral corticosteroids was associated with risk of myocardial infarction , whereas inhaled corticosteroids were not associated with increased risk of myocardial infarction in the general population . on the other hand , another study showed inhaled corticosteroids were associated with decreased the risk of acute myocardial infarction in asthmatic patients . these findings indicate that inhaled corticosteroids might have properties that protect against atherosclerosis , whereas oral corticosteroids might increase risk of atherosclerosis . several studies suggest the utility of aortic distensibility as a non - invasive method in the detection early atherosclerosis among adults . studied the aorta and carotid arteries in children and found that aortic and carotid distensibility decreased with age and this decrease was more pronounced in boys than in girls . increased stiffness leads to decreased diastolic blood pressure and increased pulse pressure , causing increased left ventricular afterload and a wear - and - tear effect on the arterial wall tissue . we failed to find any study evaluating renal , brachial , and carotid arteries distensibility , strain , and stiffness together in childhood - onset asthma patients ; therefore , we were unable to compare our results with other studies in children . we found decreased stiffness and increased distensibility and strain in some peripheral arteries in asthmatic children . the use of inhaled corticosteroids in this group of asthmatic children could have provided certain protective effects . further studies with larger sample sizes are warranted to better elucidate the association of stiffness , distensibility , and strain in childhood asthma .
backgroundwe hypothesized that since asthma is a chronic inflammatory disease , it could lead to the early development of atherosclerosis in childhood - onset asthma . 
 the aim of this study was to investigate arterial stiffness , distensibility , and strain of different peripheral arteries , the parameters of which can be used to detect atherosclerosis in asthmatic children.material/methodswe studied 22 pediatric patients with asthma and 18 healthy children . 
 fasting blood glucose and cholesterol levels were evaluated to exclude children with diabetes and hyperlipidemia , which are risk factors for atherosclerosis . 
 renal , carotid , and brachial arteries diameters were measured . 
 using the measured data , stiffness , distensibility , and strain of the arteries of all children were calculated.resultspulse pressure , systolic and diastolic blood pressure , heart rate , cholesterols , and glucose levels of the obese individuals were similar to the controls . in carotid arteries 
 there were no statistical differences regarding stiffness , distensibility , and strain . according to multiple ancova analysis , distensibility and strain of right and left brachial arteries and right renal artery were higher , whereas right renal artery stiffness was lower in asthmatic children than in controls . 
 approximately one - fifth of the change in the left and right brachial arteries and right renal artery distensibility and strain and a small portion of the change in the right renal artery stiffness were associated with asthma . in contrast , left renal artery distensibility , strain , and stiffness were not associated with asthma.conclusionsperipheral arteries had higher distensibility and strain , and lower stiffness in asthmatic children than in controls .