Dear Dr. Alaparthi,

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PLOS ONE

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Additional Editor Comments:

The authors have written a well written manuscript but, as noted by reviewers, need to clarify their methodology including method of recruitment. Their discussion should also incorporate why they believe their findings are similar and different from the literature, and why they believe there are some contradictions with clinical evidence.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Dear authors

Thank you very much for your valuable contribution

I have some minor concerns:

1. In the asbtract and full text, you only should say cross sectional study (correlational study is not familiar and acceptable term)

2. On page 3, sentence (A study exploring the

relationship between pulmonary function and postural balance revealed a limited understanding of this subject) with reference number 10 should be placed at the last paragraph of introduction where you mention current evidence limitations in asthma

3. Before the aim of the study, it should be clearly stated what the study will contribute to the literature. Was it only the objective measurements related to balance or posture that were missing in young asthma?

4. You can say determine rather than describe in the aim. Also you can say matched groups in terms of physical measures. You repeat age, gender, body weight and height for two times.

5. Onpage 5, the sentence should be removed (Statistical analysis was performed at the Augusto Motta University Center, Brazil.)

6. You should add years after ages in the full paper.

7. I think you should use healthy or control not both of them

8. On page 5 you only say age and gender matched opposite to introduction part. You should check.

9. In the assesment part, you should only give the order of assesment and total duration of assesments. Details about measurement were placed in the detailed description of all outcomes seperately

10. On page 7, you should mention you interpreted respiratory muscle results as percentage of expected values

11. On page 9, sample size section should be embedded into statistical analysis section

12. On page 10, for pearson correlation analysis you should say to investigate correlation of dynamic balance and body posture with respiratory function measures.

13. You should add flow chart in the results section.

14. After full corrections, full paper should be checked with a grammer edit programme.

15. The clinical significance and contribution of these results should be stated in the last part of the first paragraph of the discussion.

16. 'These findings contradict clinical evidence suggesting alterations in postural balance and body posture among young adults with mild to moderate asthma' sentence should be embedded in to discusssion with reasons

17. On second paragraph, the difference in expiratory muscle strength should be discusssed in detail. (you only mention MİP values)

18. I think other limitations of the study that not generalisability for severe asthma you should add.

19. At the end of conclusion, you should give advice for pulmonary rehabilitation clinics and academicians for future studies. You only repeat your results.

20. Figure 2 is not understandable, it should either be removed or details should be given.

21. Significant values in the tables should be written in bold or expressed with a symbol.

sincerely

18.

Reviewer #2: Numbering the lines in the manuscript would be helpful.

Abstract

- Please better state the results obtained in the abstract.

Introduction

- The introduction needs to be supported by more current references from last years.

- “A study exploring the relationship between pulmonary function and postural balance revealed a limited understanding of this subject” - Please clarify this issue.

- In my opinion Authors should emphasize the novelty of their work.

- The authors should be better specified, at the end of the introduction section, the rationale of the study and the aim of the study.

- State the hypothesis of the study at the end of the introduction.

Material and Methods

- Where and how were participants recruited?

- Provide the measurement reliability of the MIR-Spiro Lab Spirometer and the other used tools.

- Please better organize the description of the measurements conducted, for example, by including them in a shared subsection such as 'Outcomes'.

- The duration of the balance measurement was set at 20 seconds. Why exactly this duration?

- Please add manufacturer and country next to the devices (The Biodex Balance System, DIERS Formetric 4D® sensors).

- Was the distribution of the assessed variables examined?

Discussion

- “These findings contradict clinical evidence suggesting alterations in postural balance and body posture among young adults with mild to moderate asthma.” - What could be the cause of this discrepancy in the results?

- “Hyperinflation in asthma may lead to the flattening of the diaphragm, resulting in mechanical disadvantages and reduced function of the inspiratory muscles.” – Please add references.

- “The asthma group exhibited lower postural balance compared to the healthy control group, particularly evident during the double leg support, and eye closed condition, as indicated by lower scores in the overall stability index, anterior-posterior stability index, and medial-lateral stability index. This impairment in postural balance among asthma patients may be attributed to the degree of hyperinflation, which could lead to increased activation of trunk muscles and subsequent rigidity. This heightened muscular activation may diminish the significance of trunk motion and force moments in balance control” - The results should not be overinterpreted. The differences between the groups were not statistically significant, and the effect size was trivial.

- “Another potential explanation for decreased postural balance in asthma patients is their heightened reliance on visual input for balance control on a mobile platform.” - Please explain this hypothesis.

- “Recent studies have highlighted the occurrence of hyperinflation even in medicated and asymptomatic patients with mild to moderate asthma, suggesting that disease stabilization through symptom management does not necessarily mitigate hyperinflation, which may contribute to body postural alterations.” - please add references.

- Similar to the introduction, the innovation of this work should be emphasized. What gap in knowledge do the study fill?

- Please state the practical implications of your study.

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Reviewer #1: Yes:  Ebru Calik Kutukcu

Reviewer #2: No

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Pulmonary function, body posture and balance in young adults with asthma: A cross-sectional study

PONE-D-24-33304R1

Dear Dr. Alaparthi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Barry Kweh

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have significantly improved the structure of their manuscripts. The primary objective of investigating asthma's effect on young adults in various domains is clearly stated. Several methodological queries raised by the reviewers have been addressed, the discussion is more expansive and limitations are now more clearly acknowledged.

Reviewers' comments: