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Grandinetti R, Mussi N, Rossi A, Zambelli G, Masetti M, Giudice A, Pilloni S, Deolmi M, Caffarelli C, Esposito S, Fainardi V. Exercise-Induced Bronchoconstriction in Children: State of the Art from Diagnosis to Treatment. J Clin Med 2024; 13:4558. [PMID: 39124824 PMCID: PMC11312884 DOI: 10.3390/jcm13154558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is a common clinical entity in people with asthma. EIB is characterized by postexercise airway obstruction that results in symptoms such as coughing, dyspnea, wheezing, chest tightness, and increased fatigue. The underlying mechanism of EIB is not completely understood. "Osmotic theory" and "thermal or vascular theory" have been proposed. Initial assessment must include a specific work-up to exclude alternative diagnoses like exercise-induced laryngeal obstruction (EILO), cardiac disease, or physical deconditioning. Detailed medical history and clinical examination must be followed by basal spirometry and exercise challenge test. The standardized treadmill running (TR) test, a controlled and standardized method to assess bronchial response to exercise, is the most adopted exercise challenge test for children aged at least 8 years. In the TR test, the goal is to reach the target heart rate in a short period and maintain it for at least 6 min. The test is then followed by spirometry at specific time points (5, 10, 15, and 30 min after exercise). In addition, bronchoprovocation tests like dry air hyperpnea (exercise and eucapnic voluntary hyperpnea) or osmotic aerosols (inhaled mannitol) can be considered when the diagnosis is uncertain. Treatment options include both pharmacological and behavioral approaches. Considering medications, the use of short-acting beta-agonists (SABA) just before exercise is the commonest option strategy, but daily inhaled corticosteroids (ICS) can also be considered, especially when EIB is not controlled with SABA only or when the patients practice physical activity very often. Among the behavioral approaches, warm-up before exercise, breathing through the nose or face mask, and avoiding polluted environments are all recommended strategies to reduce EIB risk. This review summarizes the latest evidence published over the last 10 years on the pathogenesis, diagnosis using spirometry and indirect bronchoprovocation tests, and treatment strategies, including SABA and ICS, of EIB. A specific focus has been placed on EIB management in young athletes, since this condition can not only prevent them from practicing regular physical activity but also competitive sports.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy; (R.G.); (N.M.); (A.R.); (G.Z.); (M.M.); (A.G.); (S.P.); (M.D.); (C.C.); (S.E.)
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Tikkakoski AP, Reini M, Sipilä K, Kivistö JE, Karjalainen J, Kähönen M, Tikkakoski A, Lehtimäki L. Association of temperature and absolute humidity with incidence of exercise-induced bronchoconstriction in children. Acta Paediatr 2024; 113:1942-1948. [PMID: 38780114 DOI: 10.1111/apa.17295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 04/21/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
AIM Exercise test outdoors is widely used to diagnose asthma in children, but it is unclear how much outdoor air factors affect the results. METHODS We analysed 321 outdoor exercise challenge tests with spirometry in children 6-16 years conducted due to suspicion of asthma or for assessing the effect of medication on asthma. We studied the association of FEV1 decrease and incidence of exercise-induced bronchoconstriction (EIB) with temperature, relative humidity (RH) and absolute humidity (AH). RESULTS Asthma was diagnosed in 57% of the subjects. AH ≥5 g/m3, but not RH or temperature, was associated with the EIB incidence (p = 0.035). In multivariable logistic regression, AH ≥5 g/m3 was negatively associated (OR = 0.51, 95% CI [0.28─0.92], p = 0.026) while obstruction before exercise (OR = 2.11, 95% CI [1.16─3.86], p = 0.015) and IgE-mediated sensitisation were positively associated with EIB (OR = 2.24, 95% CI [1.11─4.51], p = 0.025). AH (r = -0.12, p = 0.028) and temperature (r = -0.13, p = 0.023) correlated with decrease in FEV1. In multivariable linear regression, only AH was associated with FEV1 decrease (coefficient = -0.044, 95% CI [-0.085 to -0.004], p = 0.033). CONCLUSION AH of outdoor air associates with occurrence and severity of EIB in outdoor exercise tests in children. Care should be taken when interpreting negative outdoor exercise test results if AH of air is high.
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Affiliation(s)
- Anna P Tikkakoski
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Markus Reini
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Juho E Kivistö
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Mika Kähönen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, Tampere, Finland
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
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Klain A, Giovannini M, Pecoraro L, Barni S, Mori F, Liotti L, Mastrorilli C, Saretta F, Castagnoli R, Arasi S, Caminiti L, Gelsomino M, Indolfi C, Del Giudice MM, Novembre E. Exercise-induced bronchoconstriction, allergy and sports in children. Ital J Pediatr 2024; 50:47. [PMID: 38475842 DOI: 10.1186/s13052-024-01594-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 03/14/2024] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is characterized by the narrowing of airways during or after physical activity, leading to symptoms such as wheezing, coughing, and shortness of breath. Distinguishing between EIB and exercise-induced asthma (EIA) is essential, given their divergent therapeutic and prognostic considerations. EIB has been increasingly recognized as a significant concern in pediatric athletes. Moreover, studies indicate a noteworthy prevalence of EIB in children with atopic predispositions, unveiling a potential link between allergic sensitivities and exercise-induced respiratory symptoms, underpinned by an inflammatory reaction caused by mechanical, environmental, and genetic factors. Holistic management of EIB in children necessitates a correct diagnosis and a combination of pharmacological and non-pharmacological interventions. This review delves into the latest evidence concerning EIB in the pediatric population, exploring its associations with atopy and sports, and emphasizing the appropriate diagnostic and therapeutic approaches by highlighting various clinical scenarios.
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Affiliation(s)
- Angela Klain
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy.
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
- Department of Health Sciences, University of Florence, 50139, Florence, Italy
| | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126, Verona, Italy
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
| | - Lucia Liotti
- Pediatric Unit, Department of Mother and Child Health, Salesi Children's Hospital, 60123, Ancona, Italy
| | - Carla Mastrorilli
- Pediatric and Emergency Department, Pediatric Hospital Giovanni XXIII, AOU Policlinic of Bari, 70126, Bari, Italy
| | - Francesca Saretta
- Pediatric Department, Latisana-Palmanova Hospital, Azienda Sanitaria Universitaria Friuli Centrale, 33100, Udine, Italy
| | - Riccardo Castagnoli
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100, Pavia, Italy
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Stefania Arasi
- Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, 00165, Rome, Italy
| | - Lucia Caminiti
- Allergy Unit, Department of Pediatrics, AOU Policlinico Gaetano Martino, 98124, Messina, Italy
| | - Mariannita Gelsomino
- Department of Life Sciences and Public Health, Pediatric Allergy Unit, University Foundation Policlinico Gemelli IRCCS, Catholic University of the Sacred Heart, 00168, Rome, Italy
| | - Cristiana Indolfi
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Michele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80138, Naples, Italy
| | - Elio Novembre
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139, Florence, Italy
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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5
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Spivak I, Gut G, Hanna M, Gur M, Shallufi G, Ben-David Y, Nir V, Hakim F, Bentur L, Bar-Yoseph R. The effect of nose clip on exercise-induced bronchoconstriction in adolescents. Pediatr Pulmonol 2023; 58:2647-2655. [PMID: 37378471 DOI: 10.1002/ppul.26569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Oral breathing is considered to increase hyper-responsiveness of the airways. Data on the need for nose clip (NC) during exercise challenge test (ECT) in children and adolescents is scarce. Ouraim was to evaluate the role of NC during ECT in children and adolescents. METHODS A prospective, cohort study; children referred for ECT were evaluated on two separate visits, with and without a NC. Demographic, clinical data and measurements of lung functions were recorded. Allergy and asthma control were evaluated by Total Nasal Symptoms Score (TNSS) and Asthma Control Test (ACT) questionnaires. RESULTS Sixty children and adolescents (mean age 16.7 ± 1.1 years, 38% Female,) performed ECT with NC and 48 (80%) completed visit 2 (ECT without NC), 8.7 ± 7.9 days after visit 1. Following exercise, 29/48 patients (60.4%) with NC had a decline of ≥12% in forced expiratory volume in the first second (FEV1 ) (positive ECT) compared to only 16/48 (33.3%) positive tests without NC (p = 0.0008). Test result was changed in 14 patients from positive ECT (with NC) to negative ECT (no NC) and in only one patient from negative to positive. The use of NC resulted in greater FEV1 decline (median 16.3% predicted, IQR 6.0-19.1% predicted vs. median 4.5% predicted, IQR 1.6-18.4% predicted, p = 0.0001), and better FEV1 increase after bronchodil at or inhalation compared to ECT without NC. Higher TNSS scores did not predict higher probability to positive ECT. CONCLUSIONS The use of NC during ECT increases detection rate of exercise induced bronchoconstriction during ECT in the pediatric population. These findings strengthen the recommendation of nasal blockage during ECT in children and adolescents.
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Affiliation(s)
- Ilia Spivak
- Department of Pediatrics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - George Shallufi
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yael Ben-David
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Fahed Hakim
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
- The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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6
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Goossens J, Jonckheere AC, Seys SF, Dilissen E, Decaesteker T, Goossens C, Peers K, Vanbelle V, Stappers J, Aertgeerts S, De Wilde B, Leus J, Verelst S, Raes M, Dupont L, Bullens DM. Activation of epithelial and inflammatory pathways in adolescent elite athletes exposed to intense exercise and air pollution. Thorax 2023; 78:775-783. [PMID: 36927754 PMCID: PMC10359548 DOI: 10.1136/thorax-2022-219651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/07/2023] [Indexed: 03/18/2023]
Abstract
RATIONALE Participation in high-intensity exercise in early life might act as stressor to the airway barrier. OBJECTIVES To investigate the effect of intense exercise and associated exposure to air pollution on the airway barrier in adolescent elite athletes compared with healthy controls and to study exercise-induced bronchoconstriction (EIB) in this population. METHODS Early-career elite athletes attending 'Flemish-Elite-Sports-Schools' (12-18 years) of 4 different sport disciplines (n=90) and control subjects (n=25) were recruited. Presence of EIB was tested by the eucapnic voluntary hyperventilation (EVH) test. Markers at mRNA and protein level; RNA-sequencing; carbon load in airway macrophages were studied on induced sputum samples. RESULTS 444 genes were differentially expressed in sputum from athletes compared with controls, which were related to inflammation and epithelial cell damage and sputum samples of athletes contained significantly more carbon loaded airway macrophages compared with controls (24%, 95% CI 20% to 36%, p<0.0004). Athletes had significantly higher substance P (13.3 pg/mL, 95% CI 2.0 to 19.2) and calprotectin (1237 ng/mL, 95% CI 531 to 2490) levels as well as IL-6, IL-8 and TNF-α mRNA levels compared with controls (p<0.05). The incidence of EIB in athletes was 9%. The maximal fall in forced expiratory volume in 1 s (%) after EVH test in athletes was significantly associated with prior PM10 and PM2.5 exposure. CONCLUSION Early-career elite athletes showed increased markers of air pollution exposure, epithelial damage and airway inflammation compared with controls. Acute exposure to increased air pollution PM10 levels was linked to increased airway hyper-reactivity. TRIAL REGISTRATION NUMBER NCT03587675.
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Affiliation(s)
- Janne Goossens
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Anne-Charlotte Jonckheere
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Sven F Seys
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Ellen Dilissen
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Tatjana Decaesteker
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Camille Goossens
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Koen Peers
- Sport Medical Advice Centre, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Sven Aertgeerts
- Academic Centre for General Practitioners, Catholic University, Leuven, Belgium
| | | | - Jasmine Leus
- Pediatric Allergy, AZ Maria Middelares, Sint-Niklaas, Belgium
- Clinical Division of Paediatrics, Katholieke Universiteit, Leuven, Flanders, Belgium
| | - Sophie Verelst
- Clinical Division of Paediatrics, Katholieke Universiteit, Leuven, Flanders, Belgium
- Pediatrics, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium
| | - Marc Raes
- Clinical Division of Paediatrics, Katholieke Universiteit, Leuven, Flanders, Belgium
- Pediatrics, Jessa Hospital Campus Virga Jesse, Hasselt, Belgium
| | - Lieven Dupont
- Department of Respiratory Medicine, University Hospital Gasthuisberg, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Dominique M Bullens
- Allergy and Clinical Immunology Research Group, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Clinical Division of Paediatrics, Katholieke Universiteit, Leuven, Flanders, Belgium
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Chaves Quirino PG, Rizzo JÂ, Hunter S, de Albuquerque Rodrigues Filho E, Sarinho E, de Almeida Santos CM, Medeiros D, Costa EC, Silva AS, Farah BQ, de Valois Correia Júnior MA. Is there cardiac autonomic dysfunction in children and adolescents with exercise-induced bronchospasm? Expert Rev Respir Med 2023; 17:823-831. [PMID: 37795708 DOI: 10.1080/17476348.2023.2265819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The pulmonary impairment in patients with bronchoconstriction induced by eucapnic voluntary hyperpnea(EVH) goes beyond the respiratory system, also impairing autonomic nervous modulation. This study aimed to evaluate the behavior of cardiac autonomic modulation in young asthmatics with and without EIB after the EVH test. RESEARCH DESIGN AND METHODS A cross-sectional study design using 54 asthmatics(51.9% female), aged between 10 and 19 years, investigated with the EVH test. Forced expiratory volume in one second(FEV1) was measured at 5, 10, 15, and 30 min after EVH. Heart rate variability(HRV) measures of time were assessed pre and 30 min-post EVH. The diagnosis of Exercise-Induced bronchoconstriction with underlying clinical asthma(EIBA) was confirmed by a fall in FEV1 ≥10% compared to baseline. RESULTS Thirty(55.5%) asthmatics had EIBA. Subjects with EIBA have reduced mean of the R-R intervals in relation to baseline until 15 minutes after EVH. Individuals without EIBA had increased parasympathetic activity compared to baseline(rMSSD) from 5 min after EVH(p < 0.05). This parasympathetic activity increase in relation to baseline was seen in individuals with EIBA after 25 minutes (rMSSD = 49.9 ± 5.3 vs 63.5 ± 7.2, p < 0.05). CONCLUSION Young asthmatics with EIBA present a delay in the increase of the parasympathetic component after EVH when compared to asthmatics without EIBA.
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Affiliation(s)
- Polyanna Guerra Chaves Quirino
- Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - José Ângelo Rizzo
- Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil
| | - Steve Hunter
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
| | | | - Emanuel Sarinho
- Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil
| | - Camila Matias de Almeida Santos
- Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Decio Medeiros
- Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil
| | - Emilia Chagas Costa
- Postgraduate Program in Nutrition, Universidade Federal de Pernambuco, Recife, Brazil
| | - Alexandre Sérgio Silva
- Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Breno Quintella Farah
- Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil
| | - Marco Aurélio de Valois Correia Júnior
- Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
- Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil
- Postgraduate Program in Hebiatrics, Universidade de Pernambuco, Recife, Brazil
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8
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Malewska-Kaczmarek K, Podlecka D, Mańkowski T, Jerzyńska J, Stelmach I. Exercise-Induced Bronchoconstriction in Children: A Comparison between Athletes and Non-Athletes. Healthcare (Basel) 2023; 11:healthcare11091349. [PMID: 37174890 PMCID: PMC10177973 DOI: 10.3390/healthcare11091349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/17/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023] Open
Abstract
Exercise-induced bronchoconstriction (EIB) is a dysfunction of the respiratory tract consisting of transient airflow obstruction. This study is a retrospective analysis of two prospective studies concerning EIB symptoms in two adolescent populations. Our study group included 400 non-athletes and 101 athletes. Due to the similarity of indoor exercise conditions, an analysis was performed on the basis of where training took place. The study aims to assess the EIB prevalence in the following groups of adolescent children: non-athletes and athletes. In "indoor" athletes, the EIB prevalence was 22.4%. Among non-athletes, EIB was diagnosed in 10.2% (p = 0.007). A history of asthma was found in 6.5% of non-athletes and 29.3% of indoor athletes (p < 0.001). The incidence of EIB without asthma was higher in indoor athletes (14.6%) than in non-athletes (9.9%). Athletes achieved higher mean values in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), and maximum expiratory flow rate at 25% (MEF25) parameters. In the group of non-athletes, higher results were observed in forced expiratory volume in one second % of vital capacity (FEV1%VC), MEF50, and MEF75. The findings of the study present the complexity of the EIB diagnosis among children training in an indoor environment.
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Affiliation(s)
- Kamila Malewska-Kaczmarek
- Korczak Pediatric Center, Department of Pediatrics and Allergology, Medical University of Lodz, al. Pilsudskiego 71, 92-328 Lodz, Poland
| | - Daniela Podlecka
- Korczak Pediatric Center, Department of Pediatrics and Allergology, Medical University of Lodz, al. Pilsudskiego 71, 92-328 Lodz, Poland
| | - Tymoteusz Mańkowski
- Department of Radiology, Nicolaus Copernicus Regional Multi-Specialty, Oncology and Trauma Centre in Lodz, 93-513 Lodz, Poland
| | - Joanna Jerzyńska
- Korczak Pediatric Center, Department of Pediatrics and Allergology, Medical University of Lodz, al. Pilsudskiego 71, 92-328 Lodz, Poland
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9
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Souza Silva BRV, da Silva GAS, de Albuquerque Rodrigues Filho E, Peixoto DM, de Almeida Santos CM, Quirino PGC, Rizzo JÂ, de Valois Correia Junior MA. Can physical exercise assist in controlling and reducing the severity of exercise-induced bronchospasm in children and adolescents? A systematic review. THE CLINICAL RESPIRATORY JOURNAL 2022; 17:3-12. [PMID: 36463836 PMCID: PMC9829622 DOI: 10.1111/crj.13559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/28/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE The aim of this study was to analyze whether physical exercise can contribute to improving the control and severity of exercise-induced bronchospasm (EIB) in children and adolescents. METHOD This is a systematic review that used PubMed/Medline and Scopus databases as a search source, and using descriptors indexed to DeCS/Mesh. The articles were analyzed in three stages in the selection process. Methodological quality was assessed using the TESTEX scale. RESULT AND DISCUSSION A total of 5867 articles were filtered in the initial search; however, only eight of these were included after the eligibility criteria. All presented improvements in cardiorespiratory fitness. Only two followed the international EIB diagnostic guidelines. Of these, only one described a reduction in FEV1 and considered that this improvement may influence the EIB response in children and adolescent athletes with a non-asthmatic sample. CONCLUSION The studies analyzed in this review did not enable drawing a conclusion regarding the influence of physical exercise on EIB in asthmatics. The lack of clinical trials on EIB and physical exercise, as well as the difficulty in methodological standardization for EIB diagnosis evidence the lack of scientific knowledge in this area, serving as a stimulus for researchers to find more consolidated answers.
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10
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Goossens J, Decaesteker T, Jonckheere AC, Seys S, Verelst S, Dupont L, Bullens DMA. How to detect young athletes at risk of exercise-induced bronchoconstriction? Paediatr Respir Rev 2022; 44:40-46. [PMID: 34740520 DOI: 10.1016/j.prrv.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
Exercise-induced bronchoconstriction (EIB) is a prevalent condition in elite athletes caused by transient airway narrowing during or after exercise. Young athletes nowadays start early to perform high level exercise, highlighting the need to screen for EIB in a younger population. The purpose of this review is to evaluate current evidence of pre-tests with high probability to predict a positive provocation test in young and adolescent athletes, aged 12-24 years and thus indicate whether a young athlete is at risk of having EIB. Up to now, there is no validated screening test available to increase the pre-test probability of a provocation test of EIB in young and adolescent athletes. We would recommend that a clinical guideline committee might consider the development of a flow chart to screen for EIB in adolescent athletes. It could be composed of a symptom-based questionnaire focusing on wheezing during exercise, atopic state, reversibility test (to exclude EIB with asthma) and completed with markers in blood/serum. However, more research is necessary.
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Affiliation(s)
- Janne Goossens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven 3000, Belgium.
| | - Tatjana Decaesteker
- KU Leuven, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven 3000, Belgium
| | - Anne-Charlotte Jonckheere
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven 3000, Belgium
| | - Sven Seys
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven 3000, Belgium
| | - Sophie Verelst
- UZ Leuven, Clinical Division of Paediatrics, Leuven 3000, Belgium
| | - Lieven Dupont
- KU Leuven, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Leuven 3000, Belgium; UZ Leuven, Clinical Division of Respiratory Medicine, Leuven 3000, Belgium
| | - Dominique M A Bullens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven 3000, Belgium; UZ Leuven, Clinical Division of Paediatrics, Leuven 3000, Belgium
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11
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Gupta S, Mukherjee A, Gupta S, Jat KR, Sankar J, Lodha R, Kabra SK. Impulse Oscillometry (IOS) for Detection of Exercise Induced Bronchoconstriction in Children with Asthma Ages 6-15 years. J Asthma 2022; 60:1336-1346. [PMID: 36336903 DOI: 10.1080/02770903.2022.2145219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the discriminatory value of various impulse oscillometry (IOS) parameters, and to find the cutoff value of the appropriate parameter for identifying exercise-induced bronchoconstriction (EIB) in children with asthma. METHODS This cross-sectional study was conducted in India from October 2016 to March 2018 in children with asthma who were 6-15 years of age. One hundred and five children were enrolled and subjected to pre-exercise IOS and spirometry followed by free running treadmill test as an exercise challenge. All children could achieve minute ventilation >17.5-21 times of FEV1 during the exercise challenge test. Then, IOS and spirometry were performed at 10 ± 2, 20 ± 2, and 30 ± 2 min post-exercise challenge. EIB was defined as reduction of FEV1 ≥10% within 30 min of exercise. For purposes of analysis, the children were grouped into two categories: "EIB Present" or "EIB Absent". RESULTS The prevalence of EIB in our study was 20.95% (n = 22). ΔR5max percentage within 30 min post-exercise (AUC 0.74; 95% CI: 0.64, 0.84) had the best discriminating capacity among all IOS parameters for identifying EIB. A cutoff value of 14.1% increase in R5 within 30 min post-exercise was obtained for detection of EIB (sensitivity-95.45%, specificity-50.6%, PPV-33.87% and NPV-97.67%). CONCLUSIONS A percentage change in R5 with a cutoff value of 14.1% increase post-exercise had the best discriminatory capacity among all IOS parameters for detection of EIB in children with asthma. However, low positive predictive value (PPV) with high negative predictive value (NPV) made this cutoff value more apt to rule out EIB.
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Affiliation(s)
- Samriti Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
- Department of Pediatrics, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
| | - Aparna Mukherjee
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
- Clinical Studies, Trials and Projection Unit, Indian Council of Medical Research, India
| | - Sumita Gupta
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kana Ram Jat
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
| | - SK Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India
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12
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Correia Junior MADV, Filho EDAR, Tenório RCE, Albuquerque CGD, Barbosa LC, Quirino PGC, Sarinho E, Medeiros D, Rizzo JÂ. Comparison between impulse oscillometry parameters and spirometry for the diagnosis of exercise-induced bronchoconstriction in asthmatic children and adolescents. Pediatr Pulmonol 2022; 57:2398-2404. [PMID: 35791702 DOI: 10.1002/ppul.26046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/31/2022] [Accepted: 06/25/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Impulse oscillometry (IOS) parameters are obtained more easily and effortlessly in comparison to forced expiratory volume in the first second (FEV1). OBJECTIVE To compare IOS parameters to FEV1 in exercise-induced bronchoconstriction (EIB) diagnosis. METHODS Seventy-four (60.8% male; 39.2 female) young asthmatics aged between 7 and 17 years (mean 12.6 ± 2.8 years) were evaluated. EIB was defined as a reduction in FEV1 ≥ 10% compared with basal after standardized challenge by treadmill running (TR). IOS parameters and FEV1 were obtained at baseline and 5,15, and 30 min after TR. The area under the receiver operator characteristic curve (AUC) was calculated from the reduction in FEV1 ≥ 10% to evaluate the best psychometric characteristics of IOS parameters. RESULTS Twenty-four individuals (32.4%) were diagnosed with EIB. A moderate inverse correlation was found between the IOS and FEV1 variables immediately after the TR, with resistance at 5 Hz (R5Hz), resonant frequency (Fres), and reactance area (AX), (r = -0.64, r = -0.53 and r = -0.69, respectively, all with p < 0.05). An increase of 25 kPa/l/s in R5 Hz, of 19k Pa/l/s in AX and 21 Hz in Fres were found to best correlate with EIB diagnosis by FEV1 (sensitivity 67% and specificity 62%, sensitivity 84% and specificity 50%, and sensitivity 84% and specificity 60%, respectively). CONCLUSION IOS parameters have a significant inverse correlation with FEV1. This study presents cut-off points for EIB diagnosis for R5Hz, AX, and Fres, however, the findings in IOS parameters should be used and interpreted carefully if the goal is to replace spirometry.
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Affiliation(s)
- Marco Aurélio de Valois Correia Junior
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Hebiatrics, Universidade de Pernambuco, Recife, Brazil.,Postgraduate Associated Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Edil de Albuquerque Rodrigues Filho
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Associated Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil.,Multicenter Postgraduate Program in Physiological Sciences, Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Vitória de Santo Antão, Brazil
| | | | - Claudio Gonçalves de Albuquerque
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Laienne Carla Barbosa
- Postgraduate Program in Hebiatrics, Universidade de Pernambuco, Recife, Brazil.,Postgraduate Associated Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Polyanna Guerra Chaves Quirino
- Postgraduate Program in Hebiatrics, Universidade de Pernambuco, Recife, Brazil.,Postgraduate Associated Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Emanuel Sarinho
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Décio Medeiros
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - José Ângelo Rizzo
- Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.,Postgraduate Program in Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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13
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Adolescent Athletes at Risk of Exercise-Induced Bronchoconstriction: A Result of Training or Pre-Existing Asthma? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159119. [PMID: 35897509 PMCID: PMC9367722 DOI: 10.3390/ijerph19159119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 12/01/2022]
Abstract
Exercise may trigger bronchoconstriction, especially in a group of athletes in whom bronchospasm during exercise is reported to occur more frequently than in nonathletes. The aim of this study was to determine the prevalence and environmental risk factors contributing to exercise-induced bronchoconstriction (EIB) in adolescent athletes. A prospective study was conducted among a group of 101 adolescent athletes who underwent spirometry, exercise challenge, fractional exhaled nitric oxide (FeNO) measurements, and allergy assessment. The study group was divided into three subgroups of athletes based on the most common sports environments: swimmers, “indoor” athletes, and “outdoor” athletes. The clinical evaluation demonstrated a high frequency of EIB in the study group. Moreover, a large proportion of the athletes in whom EIB was observed reported no pre-existing symptoms suggestive of bronchospasm or asthma. Among patients without a previous diagnosis of asthma, clinical evaluation confirmed 22% with positive exercise challenges, compared with 77% of adolescents with negative test results. Moreover, among the athletes with a history of asthma, 39% had positive exercise challenges. Both EIB and asthma are common conditions that affect adolescent athletes. Physicians should pay particular attention to this group, as the symptoms can lead to under- and overdiagnosis.
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14
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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Brandão JTS, Nelo EMDA, Correia Júnior JL, Santos HFA, Lima Júnior JPD, Freitas-Dias RD, Moraes JFVND. Analysis of the association between exercise induced bronchospasm, cardiorespiratory fitness, and physical activity levels of adolescents. FISIOTERAPIA E PESQUISA 2022. [DOI: 10.1590/1809-2950/21024929012022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study aims to verify the association between exercise-induced bronchospasm (EIB), cardiorespiratory fitness, and physical activity levels in adolescents. To do so, we evaluated 202 healthy adolescents aged from 13 to 18 years, out of which 94 (46.5%) were females and 108 (53.5%) males. Participants performed a bronchial challenge test in a treadmill (Master Super ATL, Inbramed®) to evaluate bronchial hyper-responsiveness; a spirometric test (Microquark, Cosmed®) to evaluate lung function; answered the Baecke’s Questionnaire of Habitual Physical Activity; and performed the progressive aerobic cardiovascular endurance run test. Data were analyzed using Spearman’s correlation, chi-square test, and odds ratio. The significance level adopted was p<0.05. No statistically significant correlations were found between the decrease of the forced expiratory volume in the first second (FEV1), cardiorespiratory fitness, and physical activity levels. Likewise, the chi-squared test revealed no significant differences between classifications of cardiorespiratory fitness (low or adequate) and EIB (presence or absence) (χ2=0.155; p=0.694). Finally, odds ratio showed no increased chances of the presence of EIB in participants who presented low cardiorespiratory fitness (OR=1.130; CI: 0.616-2.073). We concluded that cardiorespiratory fitness and physical activity levels are not associated with the decrease of FEV1 and that there is no relation between the presence of EIB and the classification of cardiorespiratory fitness of adolescents.
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16
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Lagiou O, Fouzas S, Lykouras D, Sinopidis X, Karatza A, Karkoulias K, Dimitriou G, Anthracopoulos MB. Exercise Limitation in Children and Adolescents with Mild-to-Moderate Asthma. J Asthma Allergy 2022; 15:89-98. [PMID: 35082501 PMCID: PMC8785132 DOI: 10.2147/jaa.s335357] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Children with uncontrolled asthma are less tolerant to exercise due to ventilatory limitation, exercise-induced bronchoconstriction (EIB), or physical deconditioning. The contribution of these factors in children with controlled mild-to-moderate asthma is unknown. OBJECTIVE To explore the underlying mechanisms of reduced exercise capacity in children with controlled mild-to-moderate asthma. METHODS This was a cross-sectional study of 45 children and adolescents (age 8-18 years) with controlled mild-to-moderate asthma (asthma control test score 21-25) and 61 age-matched healthy controls. All participants completed a physical activity questionnaire and performed spirometry and cardiopulmonary exercise testing (CPET; maximal incremental protocol). Spirometric indices and CPET parameters were compared between the two groups. The effect of EIB (FEV1 decrease >10% post CPET), ventilatory limitation and physical deconditioning on maximum oxygen uptake (O2peak), was assessed by multivariable linear regression. RESULTS 62.2% of children with asthma and 29.5% of controls (P = 0.002) were categorized as inactive. Reduced exercise capacity (O2peak <80%) was noted in 53.3% of asthmatics and 16.4% of controls (P < 0.001). EIB was documented in 11.1% of participants with asthma. Physical deconditioning was noted in 37.8% of children with asthma and in 14.8% of controls (P = 0.013). Physical deconditioning emerged as the only significant determinant of O2peak, irrespective of asthma diagnosis, body mass index, ventilatory limitation and EIB. CONCLUSION Children with controlled mild-to-moderate asthma are less tolerant to strenuous exercise than their healthy peers. The decreased exercise capacity in this population should mainly be attributed to physical deconditioning, while the contribution of ventilatory limitation and EIB is rather small.
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Affiliation(s)
- Olga Lagiou
- Pediatric Respiratory Unit, University of Patras Medical School, Patras, Greece
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Sotirios Fouzas
- Pediatric Respiratory Unit, University of Patras Medical School, Patras, Greece
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Dimosthenis Lykouras
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Xenophon Sinopidis
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Ageliki Karatza
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Kiriakos Karkoulias
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
| | - Gabriel Dimitriou
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
| | - Michael B Anthracopoulos
- Pediatric Respiratory Unit, University of Patras Medical School, Patras, Greece
- Department of Pediatrics, University of Patras Medical School, Patras, Greece
- Correspondence: Michael B Anthracopoulos Pediatric Respiratory Unit, University of Patras Medical School, Patras, 26504, GreeceTel +30 2610999716 Email
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17
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Lanz MJ, Gilbert IA, Gandhi HN, Goshi N, Tkacz JP, Lugogo NL. Demographics, Treatment Patterns, and Morbidity in Patients with Exercise-Induced Bronchoconstriction: An Administrative Claims Data Analysis. J Asthma Allergy 2021; 14:1485-1495. [PMID: 34924763 PMCID: PMC8674669 DOI: 10.2147/jaa.s338447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Exercise-induced bronchoconstriction (EIB) is generally treated with short-acting β2-agonists (SABA) before exercising, to prevent symptoms. Real-world data on treatments and outcomes for patients with EIB alone (EIBalone), or with asthma (EIBasthma), in the USA are limited. This study compared demographics, treatment patterns, morbidity, and costs of treating EIB between these two groups of patients. PATIENTS AND METHODS Administrative claims from US IBM® MarketScan® Research databases were analyzed retrospectively. Patients aged ≥4 years filling a SABA claim between 1/1/2011 and 12/31/2016 were evaluated. Patients were indexed on a random SABA claim and required to have 12 months' continuous eligibility pre- and post-index, ≥1 maintenance medication and/or SABA fill post-index, and were designated EIBalone or EIBasthma according to diagnostic codes (EIB only or EIB plus asthma, respectively). Descriptive statistics were used. RESULTS In total, 13,480 patients had EIBalone and 14,862 had EIBasthma. Compared with EIBasthma, the EIBalone group was older (mean[SD] 20.4[13.6] vs 17.8[13.6] years), had more females (60.7% vs 54.7%), and filled fewer SABA claims (1.9[1.4] vs 2.5[2.2]) (all p<0.001). A smaller proportion of patients in the EIBalone than EIBasthma group had maintenance therapy claims (79.9% vs 90.6%, p<0.001). The EIBalone group also had a lower proportion of patients with oral or injectable corticosteroid claims (29.4% vs 32.0%) and asthma and/or EIB-related emergency department (1.0% vs 13.0%) or outpatient visits (65.1% vs 72.3%; all p<0.0001). Annual days' supply of oral corticosteroids was similar between groups (mean[SD] EIBalone: 20.7[30.8] vs EIBasthma: 19.8[28] days). CONCLUSION Individuals with EIBalone or EIBasthma demonstrate considerable morbidity. New treatment paradigms may be needed to optimize outcomes for both patient groups.
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Affiliation(s)
- Miguel J Lanz
- Allergy and Asthma, AAADRS Clinical Research Center, Coral Gables, FL, USA
| | - Ileen A Gilbert
- BioPharmaceuticals Medical – US, AstraZeneca, Wilmington, DE, USA
| | - Hitesh N Gandhi
- BioPharmaceuticals Medical – US, AstraZeneca, Wilmington, DE, USA
| | - Nadia Goshi
- BioPharmaceuticals Global Medicines Development – US, AstraZeneca, Wilmington, DE, USA
| | | | - Njira L Lugogo
- Pulmonary Clinic, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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18
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Rizzo JÂ, Rodrigues Filho EDA, Gonçalves AV, Albuquerque LCBDB, Albuquerque EMD, Albuquerque CGD, Almeida AHSD, Peixoto DM, Correia Junior MADV. Reproducibility of eucapnic voluntary hyperpnoea for exercise-induced bronchoconstriction diagnosis in asthmatic children and adolescents. Pediatr Allergy Immunol 2021; 32:1700-1708. [PMID: 34324737 DOI: 10.1111/pai.13610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Respiratory symptoms after exercise are frequently reported by asthmatic patients, and exercise-induced bronchoconstriction (EIB) is a frequent cause, which requires objective testing for diagnosis. Eucapnic voluntary hyperpnea (EVH) is recommended as a surrogate stimulus for this purpose. Its short-term reproducibility is not yet established in children and young adolescents with asthma. OBJECTIVE To evaluate the short-term test-retest agreement and reproducibility of FEV1 changes after EVH in this population. METHODS Asthmatic patients aged between 10 and 20 years underwent EVH for EIB diagnosis on two occasions 2-4 days apart at a specialized university clinic. FEV1 was measured at 5, 15, and 30 min after EVH with a target ventilation rate 21 times the baseline FEV1 . EIB was diagnosed as a decrease ≥10% in FEV1 from baseline. RESULTS A total of 26 of 62 recruited individuals tested positive for EIB on both visits (positive group) and 17 on one visit only (divergent group), while 19 tested negative on both visits (negative group). The overall agreement was 72.5% (95%CI 61.6%, 83.6%), and Cohen's kappa coefficient was 0.452. Low bias (0.87%) and high intra-class correlation coefficient (0.854, 95%CI 0.758,0.912; p < .001) for FEV1 response between test days were found, but with wide limits of agreement (±20.72%). There were no differences in pre-challenge FEV1 or achieved ventilation rate between visits either between groups (p = .097 and p = .461) or within groups (p = .828 and p = .780). There were no safety issues. CONCLUSIONS More than one EVH test should be performed in children and young adolescents with asthma to exclude EIB and minimize misdiagnosis and mistreatment.
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Affiliation(s)
- Jose Ângelo Rizzo
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.,Infant and adolescent health post-graduation program, Universidade Federal de Pernambuco, Recife, Brazil
| | - Edil de Albuquerque Rodrigues Filho
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.,Infant and adolescent health post-graduation program, Universidade Federal de Pernambuco, Recife, Brazil
| | - Adriana Velozo Gonçalves
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Laienne Carla Barbosa De Barros Albuquerque
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.,Hebiatrics post-graduation program, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Eduardo Martins de Albuquerque
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.,Hebiatrics post-graduation program, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - Cláudio Gonçalves de Albuquerque
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.,Infant and adolescent health post-graduation program, Universidade Federal de Pernambuco, Recife, Brazil
| | - Anderson Henrique Souza de Almeida
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Decio Medeiros Peixoto
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.,Infant and adolescent health post-graduation program, Universidade Federal de Pernambuco, Recife, Brazil
| | - Marco Aurelio de Valois Correia Junior
- Center for allergy and clinical immunology research and pulmonology department at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil.,Hebiatrics post-graduation program, Universidade de Pernambuco, Recife, Pernambuco, Brazil.,Physical Education post-graduation program, Universidade de Pernambuco, Recife, Pernambuco, Brazil
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19
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Nelo EMDA, Correia JL, Santos HFA, de Lima JP, Brandão JTS, de Moraes JFVN, Correia MADV, de Freitas-Dias R. Impact of climate variability on exercise-induced bronchospasm in adolescents living in a semi-arid region. EINSTEIN-SAO PAULO 2021; 19:eAO5744. [PMID: 34586155 PMCID: PMC8448549 DOI: 10.31744/einstein_journal/2021ao5744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/26/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To examine the impact of climate variability on the occurrence of exercise-induced bronchospasm in the rainy and dry seasons of a Brazilian semi-arid region. METHODS This sample comprised 82 adolescents aged 15 to 18 years, who were submitted to exercise-induced bronchospasm assessment on a treadmill and outdoors, during the rainy and the dry season. Anthropometric variables, sexual maturity and forced expiratory volume in the first second were analyzed. Air temperature and humidity, decline in forced expiratory volume in the first second (%) and frequency of bronchospasm were compared between seasons using the independent Student's t test, the Wilcoxon and McNemar tests, respectively. The level of significance was set at p<0.05. RESULTS The mean age was 15.65±0.82 years. Air temperature, air humidity and decline in forced expiratory volume in the first second (%) differed between seasons, with higher air temperature and humidity in the rainy season (29.6ºC±0.1 and 70.8%±0.6 versus 28.5ºC±0.2 and 48.5%±0.6; p<0.05). The decline in forced expiratory volume in the first second (%) was greater in the dry season (9.43%±9.97 versus 12.94%±15.65; p<0.05). The frequency of bronchospasm did not differ between seasons. CONCLUSION The dry season had a negative impact on forced expiratory volume in the first second in adolescents, with greater decrease detected during this period. Findings of this study suggested bronchospasm tends to be more severe under low humidity conditions.
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Affiliation(s)
| | - Jânio Luiz Correia
- Universidade de PernambucoPetrolinaPEBrazilUniversidade de Pernambuco, Petrolina, PE, Brazil.
| | | | - José Pereira de Lima
- Universidade Federal do Vale do São FranciscoPetrolinaPEBrazilUniversidade Federal do Vale do São Francisco, Petrolina, PE, Brazil.
| | - Jéssica Thayani Santos Brandão
- Universidade Federal do Vale do São FranciscoPetrolinaPEBrazilUniversidade Federal do Vale do São Francisco, Petrolina, PE, Brazil.
| | | | - Marco Aurélio de Valois Correia
- Universidade de PernambucoPrograma de Pós-Graduação em HebiatriaCamaragibePEBrazilPrograma de Pós-Graduação em Hebiatria, Universidade de Pernambuco, Camaragibe, PE, Brazil.
| | - Ricardo de Freitas-Dias
- Universidade de PernambucoPrograma de Pós-Graduação em HebiatriaCamaragibePEBrazilPrograma de Pós-Graduação em Hebiatria, Universidade de Pernambuco, Camaragibe, PE, Brazil.
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20
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Bar-Yoseph R, Gur M, Zuckerman S, Gut G, Hanna M, Toukan Y, Nir V, Masarweh K, Bentur L. Short- and long-term effects of fluticasone furate/vilaterol in exercising asthmatic adolescents: a randomized and open label trial. Basic Clin Pharmacol Toxicol 2021; 129:369-375. [PMID: 34359097 DOI: 10.1111/bcpt.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/22/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Relvar® (Fluticasone furoate (FF)/Vilanterol (VI)) is a once-daily inhaler with bronchodilator effect lasting 24 hours. Our aim was to investigate the short- and long-term effects of FF/VI on exercise-induced asthma (EIA) in adolescents. METHODS Ninety-three adolescent asthmatics aged 12-18 years were referred for evaluation of EIA. Following a positive exercise challenge test (ECT), 22/44 were allocated to a single administration of salbutamol (400 μg) and 22/44 to FF/VI (92/22 μg) in a double-blind method. Thirty-five subjects were reassessed by repeat ECT 30-60 days of FF/VI. RESULTS Median FEV1 change post-ECT at baseline was -22.8% predicted (IQR -26.1 and -18.0) for salbutamol and -21.0 (IQR -30.7 and -16.8) for FF/VI. Following bronchodilator, FEV1 improved similarly in both groups. Repeat ECT following 30-60 days of FF/VI resulted in negative exercise challenge test in 33/35 subjects; the median decrease in FEV1 of these 35 subjects was 22.6% predicted (IQR 29-18) before, and 4.6% predicted (IQR 8.7-2.5) after 30-60 days of FF/VI treatment; p<0.0001). CONCLUSIONS FF/VI is effective in reversing EIA after 15 minutes in adolescents and in protecting EIA after 30-60 days in adolescents. Larger studies are needed to assess the effect of FF/VI on EIA.
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Affiliation(s)
- Ronen Bar-Yoseph
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Gur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shalev Zuckerman
- Department of Pediatrics, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Moneera Hanna
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Yazeed Toukan
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Vered Nir
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Kamal Masarweh
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Lea Bentur
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel.,Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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21
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Brannan JD, Kippelen P. Bronchial Provocation Testing for the Identification of Exercise-Induced Bronchoconstriction. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2156-2164. [PMID: 32620430 DOI: 10.1016/j.jaip.2020.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 01/26/2023]
Abstract
Exercise-induced bronchoconstriction (EIB) occurs in patients with asthma, children, and otherwise healthy athletes. Poor diagnostic accuracy of respiratory symptoms during exercise requires objective assessment of EIB. The standardized tests currently available are based on the assumption that the provoking stimulus to EIB is dehydration of the airway surface fluid due to conditioning large volumes of inhaled air. "Indirect" bronchial provocation tests that use stimuli to cause endogenous release of bronchoconstricting mediators from airway inflammatory cells include dry air hyperpnea (eg, exercise and eucapnic voluntary hyperpnea) and osmotic aerosols (eg, inhaled mannitol). The airway response to different indirect tests is generally similar in patients with asthma and healthy athletes with EIB. Furthermore, the airway sensitivity to these tests is modified by the same pharmacotherapy used to treat asthma. In contrast, pharmacological agents such as methacholine, given by inhalation, act directly on smooth muscle to cause contraction. These "direct" tests have been used traditionally to identify airway hyperresponsiveness in clinical asthma but are less useful to diagnose EIB. The mechanistic differences between indirect and direct tests have helped to elucidate the events leading to airway narrowing in patients with asthma and elite athletes, while improving the clinical utility of these tests to diagnose and manage EIB.
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Affiliation(s)
- John D Brannan
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton, NSW, Australia.
| | - Pascale Kippelen
- Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, Uxbridge, United Kingdom; Division of Sport, Health and Exercise Sciences, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
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22
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Venckunas T, Balsys D. Pulmonary function as a limiting factor of middle distance race performance. J Sports Med Phys Fitness 2021; 62:1-8. [PMID: 33565755 DOI: 10.23736/s0022-4707.21.12042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Exercise induced bronchoconstriction (EIB) is common and underdiagnosed phenomenon of yet largely unknown etiology. This study aimed to estimate prevalence of EIB in response to highly demanding skyscraper race and to test its association with race performance and hypothetical predisposing factors. Healthy participants (26 males, 8 females; 31.5 +/- 6.3 years) from mostly running-based amateur sports were measured for forced expiratory volume in first 1 s (FEV1) before and then repeatedly within 10 min after the completion of the 114 m skyscraper upstairs race. Allergy questionnaire (AQUA) data were collected and post-exercise blood lactate was measured. Over 40% of the participants developed >10% decrement in FEV1 shortly after all-out exercise. While EIB response was not associated with questionnaire-based atopic status, training background, gender, age, anthropometrics, pacing and exertion (estimated from the accumulated blood lactate values), participants exhibiting <10% decrement in FEV1 were faster, especially over the later stages of the race. In conclusion, nearly every other participant of the skyscraper race develops EIB not associated with training, demographic, anthropometric and atopic status, pacing and exertion (estimated from postexercise blood lactate), but the responders (FEV1 decrement >10%) were slower indicative of poorer fitness due to EIB developing during the exercise already.
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Affiliation(s)
- Tomas Venckunas
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania -
| | - Domantas Balsys
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
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23
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Faleiro RC, Mancuzo EV, Lanza FC, Queiroz MVNP, de Oliveira LFL, Ganem VO, Lasmar LB. Exercise Limitation in Children and Adolescents With Severe Refractory Asthma: A Lack of Asthma Control? Front Physiol 2021; 11:620736. [PMID: 33574767 PMCID: PMC7870485 DOI: 10.3389/fphys.2020.620736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022] Open
Abstract
Background Patients with severe refractory asthma (SRA), even when using high doses of multiple controller medications in a regular and appropriate way, can have persistent complaints of exercise limitation. Methods This was a cross-sectional study involving patients with SRA (treated with ≥ 800 μg of budesonide or equivalent, with ≥ 80% adherence, appropriate inhaler technique, and comorbidities treated), who presented no signs of a lack of asthma control other than exercise limitation. We also evaluated healthy controls, matched to the patients for sex, age, and body mass index. All participants underwent cardiopulmonary exercise testing (CPET) on a cycle ergometer, maximum exertion being defined as ≥ 85% of the predicted heart rate, with a respiratory exchange ratio ≥ 1.0 for children and ≥ 1.1 for adolescents. Physical deconditioning was defined as oxygen uptake (VO2) < 80% of predicted at peak exercise, without cardiac impairment or ventilatory limitation. Exercise-induced bronchoconstriction (EIB) was defined as a forced expiratory volume in one second ≥ 10% lower than the baseline value at 5, 10, 20, and 30 minutes after CPET. Results We evaluated 20 patients with SRA and 19 controls. In the sample as a whole, the mean age was 12.9 ± 0.4 years. The CPET was considered maximal in all participants. In terms of the peak VO2 (VO2 peak), there was no significant difference between the patients and controls, (P = 0.10). Among the patients, we observed isolated EIB in 30%, isolated physical deconditioning in 25%, physical deconditioning accompanied by EIB in 25%, and exercise-induced symptoms not supported by the CPET data in 15%. Conclusion and Clinical Relevance Physical deconditioning, alone or accompanied by EIB, was the determining factor in reducing exercise tolerance in patients with SRA and was not therefore found to be associated with a lack of asthma control.
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Affiliation(s)
- Rita C Faleiro
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Eliane V Mancuzo
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda C Lanza
- School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mônica V N P Queiroz
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciano F L de Oliveira
- School of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vinicius O Ganem
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Laura B Lasmar
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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24
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Ersson K, Mallmin E, Malinovschi A, Norlander K, Johansson H, Nordang L. Prevalence of exercise-induced bronchoconstriction and laryngeal obstruction in adolescent athletes. Pediatr Pulmonol 2020; 55:3509-3516. [PMID: 33002318 PMCID: PMC7702091 DOI: 10.1002/ppul.25104] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/25/2020] [Accepted: 09/26/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To study the prevalence of exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO) in adolescent athletes. METHODS All adolescents (n = 549) attending first year at a sports high school in 2016 and 2017, were invited to answer a questionnaire on respiratory symptoms. The 367 responding participants were divided into two groups based on whether they reported exercise-induced dyspnea (dyspnea group) or not (nondyspnea group). Randomly selected participants in each group were invited to undergo two standardized exercise tests, an EIB test and a continuous laryngoscopy exercise (CLE) test, to investigate EILO. RESULTS In total, 98 participants completed an EIB test, 75 of whom also completed a CLE test. Positive EIB tests: eight of 41 in the dyspnea group and 16 of 57 in the nondyspnea group. Positive CLE tests: 5 of 34 in the dyspnea group and three of 41 in the nondyspnea group. The estimated prevalence of EIB was 23.1% (95% confidence interval [CI]: 14.5-33.8) and of EILO 8.1% (95% CI: 2.5-18.5) in the whole study population. No differences in prevalence of EIB or EILO were found between the dyspnea and the nondyspnea groups. CONCLUSION EIB was highly prevalent in this cohort of adolescent athletes. EILO was less prevalent, but represents an important differential diagnosis to EIB. Self-reported exercise-induced dyspnea is a weak indicator for both EIB and EILO and standardized testing should be provided.
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Affiliation(s)
- Karin Ersson
- Department of Medical Sciences, Uppsala University, Sweden.,Department of Neuroscience, Uppsala University, Sweden
| | | | | | | | - Henrik Johansson
- Department of Medical Sciences, Uppsala University, Sweden.,Department of Neuroscience, Uppsala University, Sweden
| | - Leif Nordang
- Department of Surgical Sciences, Uppsala University, Sweden
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25
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Bonini M, Cilluffo G, La Grutta S, Boccabella C, Usmani O, Viegi G, Palange P. Anti-muscarinic drugs as preventive treatment of exercise-induced bronchoconstriction (EIB) in children and adults. Respir Med 2020; 172:106128. [PMID: 32911137 DOI: 10.1016/j.rmed.2020.106128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023]
Abstract
Regular physical activity is strongly recommended to prevent chronic respiratory diseases, including asthma. On the other hand, vigorous physical training may trigger airway symptoms and bronchoconstriction. The transient airway narrowing occurring because of exercise is named exercise-induced bronchoconstriction (EIB). Despite management according to guidelines, a significant proportion of patients experiences uncontrolled EIB, which thus represents a relevant unmet medical need. In particular, although prevention and treatment of EIB are effectively based on the use of beta-2 bronchodilator drugs, high heterogeneity in individual responses has been reported. Furthermore, even though beta-2 adrenergic drugs remain the mainstay of EIB management, occurrence of tolerance and side effects, as well as doping concerns have been reported with their use. In regard to this, inhaled antimuscarinics could represent an alternative or additional effective and safe bronchodilator therapeutic option for achieving optimal EIB control and minimize adverse events. The present systematic review aims to collect and provide the most updated and evidence-based literature findings on the efficacy and safety of short- and long-acting inhaled anti-muscarinic drugs for the preventive treatment of EIB in both children and adults. Take-Home Message: Anti-muscarinic drugs are effective and safe in preventing EIB, despite response variability is reported. Further studies should focus on long-acting molecules, chronic administration and phenotype-driven effects.
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Affiliation(s)
- Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy; National Heart and Lung Institute (NHLI), Royal Brompton Hospital & Imperial College London, UK
| | - Giovanna Cilluffo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Palermo, Italy.
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Palermo, Italy
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica Del Sacro Cuore, Rome, Italy
| | - Omar Usmani
- National Heart and Lung Institute (NHLI), Royal Brompton Hospital & Imperial College London, UK
| | - Giovanni Viegi
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Palermo, Italy; Unità di Ricerca di Epidemiologia Ambientale Polmonare, Istituto di Fisiologia Clinica (IFC), CNR, Pisa, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy
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26
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Souza de Almeida AH, Rodrigues Filho EDA, Lubambo Costa E, de Albuquerque CG, Sarinho ESC, Medeiros Peixoto D, Dela Bianca ACC, Correia Júnior MAV, Rizzo JÂ. Obesity is a risk factor for exercise-induced bronchospasm in asthmatic adolescents. Pediatr Pulmonol 2020; 55:1916-1923. [PMID: 32462822 DOI: 10.1002/ppul.24875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 05/26/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Exercise-induced bronchospasm (EIB) is common in young asthmatics and obesity is becoming an epidemic in this population. Both conditions can give rise to or worsen respiratory symptoms upon exercise and may interfere with recreational and sports activities. OBJECTIVE To investigate the association between obesity and the risk and severity of EIB in asthmatic children and adolescents. METHODS This study included data from asthmatic patients aged between 7 and 19 years undergoing treadmill running tests to evaluate EIB, defined as a reduction greater than or equal to 10% in forced expiratory volume in the first second (FEV1 ) compared to baseline. Eutrophic, obese, and overweight individuals were categorized according to body mass index z-score (eutrophic, -0.5 < z ≤ 1; overweight, 1 < z < 2; and obese, z ≥ 2). RESULTS Of the 156 individuals studied (42% female), 58% were eutrophic, 22% overweight, and 19% obese. Seventy-three individuals (47%) presented with EIB, with higher risk among obese (OR, 2.86; 95% CI, 1.00-8.14; P = .05). Asthma severity was another independent risk factor for EIB (OR, 2.95; 95% CI, 1.36-6.42; P = .006). The number of patients in whom FEV1 returned to baseline values (difference less than 10% from baseline) at the 13th minute after challenge was lower in obese individuals compared to eutrophic and overweight ones (P = .04). Baseline FEV1 , gender, or age were not found to be risk factors for EIB in any of the groups. CONCLUSION Obese youngsters with asthma present a greater risk for EIB with slower recovery than their nonobese peers. Clinicians should be aware of this association, especially in those with more severe disease, for adequate recognition and treatment.
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Affiliation(s)
- Anderson H Souza de Almeida
- Health Sciences Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Edil de Albuquerque Rodrigues Filho
- Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Infant and Adolescent Health Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Eduarda Lubambo Costa
- Health Sciences Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Cláudio G de Albuquerque
- Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Infant and Adolescent Health Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Emanuel S C Sarinho
- Health Sciences Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Infant and Adolescent Health Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Décio Medeiros Peixoto
- Health Sciences Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Infant and Adolescent Health Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Ana C C Dela Bianca
- Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Infant and Adolescent Health Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Marco A V Correia Júnior
- Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Hebiatrics and Physical Education Post-graduation Program, Universidade de Pernambuco, Recife, Pernambuco, Brazil
| | - José Â Rizzo
- Health Sciences Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Center for Allergy and Clinical Immunology Research at Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.,Infant and Adolescent Health Post-graduation Program, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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27
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Jacobsen CL, Dagnegård J, Hermansen MN, Larsen S, Hansen KS, Chawes BL. Predictors of completion and outcome of exercise challenge tests in childhood asthma. Pediatr Allergy Immunol 2020; 31:574-578. [PMID: 32043663 DOI: 10.1111/pai.13224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Christina L Jacobsen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Johan Dagnegård
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Primary Care Health Clinic Oxie, Region Skåne, Oxie, Sweden
| | - Mette N Hermansen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Larsen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kirsten S Hansen
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Allergy Clinic, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo L Chawes
- Department of Pediatric and Adolescent Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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28
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Takken T, Sonbahar Ulu H, Hulzebos EHJ. Clinical recommendations for cardiopulmonary exercise testing in children with respiratory diseases. Expert Rev Respir Med 2020; 14:691-701. [PMID: 32252564 DOI: 10.1080/17476348.2020.1752195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) quantitates and qualitates the integrated physiological response of a person to incremental exercise and provides additional information compared to static lung function tests alone. AREAS COVERED This review covers rationale for the use of CPET parameters beyond the usual parameters like peak oxygen uptake and peak minute ventilation in children with respiratory disease. EXPERT OPINION CPET provides a wealth of data from rest, submaximal and maximal exercise and data during recovery from exercise. In this review, an interpretative approach is described for analyzing CPET data in children with respiratory disease.
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Affiliation(s)
- Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Hazal Sonbahar Ulu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University , Samanpazari/Ankara, Turkey
| | - Erik H J Hulzebos
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands
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29
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Lopes WA, Porto FE, Leite N. EFFECT OF PHYSICAL TRAINING ON EXERCISE-INDUCED BRONCHOSPASM IN YOUNG ASTHMATICS. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-869220202601201675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
ABSTRACT Introduction: Asthma is the most common chronic disease in childhood and its prevalence has increased in recent years. Although regular physical activity (PA) is considered to be beneficial for the health of asthmatics, especially children and adolescents, it can also be one of the elements that triggers asthma. This is known as exercise-induced bronchospasm (EIB), and is considered one of the factors that limits asthmatics’ participation in PA. Objective: This study aims to review the effects of physical conditioning on EIB in asthmatic children and adolescents. Methods: A systematic review was carried out on the Pubmed, Bireme and Web of Science databases, considering publications from 1998 to April 2019. Results: Eight articles were retrieved; five of the articles presented no significant difference in EIB parameters after physical training, and three demonstrated significant benefits in EIB. Conclusion: There is insufficient evidence that physical training helps reduce the frequency and severity of EIB in young asthmatics. There are still few studies that seek to show the effect of a physical training program on the improvement of EIB in children and adolescents. It is suggested that further randomized clinical trials be conducted, to investigate the effects of physical training on EIB parameters in children and adolescents. Level of Evidence II; Systematic review.
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Keskin O, Ozkars MY, Gogebakan B, Kucukosmanoglu E, Keskin M, Bayram H. Exhaled TGF-β1 levels before and after an exercise challenge in asthmatic and healthy children, and during exacerbation. J Asthma 2019; 58:316-325. [PMID: 31709879 DOI: 10.1080/02770903.2019.1689261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is conflicting data regarding the role of transforming growth factor-β1 (TGF-β1) in the pathogenesis of airway hyper-reactivity and asthma exacerbation. OBJECTIVE To investigate the role of exhaled-TGF-β1 in exercise-induced bronchospasm (EIB) in asthmatic and nonasthmatic healthy children, and in asthma exacerbation and asthma control. METHODS The exhaled-TGF-β1 levels of 56 stable asthmatic children and 15 nonasthmatic healthy children were evaluated before and 30 min after an exercise challenge. The exhaled-TGF-β1 levels of 20 additional children with asthma exacerbation were evaluated. RESULTS While no significant difference in the exhaled-TGF-β1 levels was found at the baseline, exhaled-TGF-β1 levels after the exercise challenge were significantly higher in the non-EIB (n = 31) asthmatics when compared to the asthmatic children with EIB (n = 25) (p = 0.04). Although there was a statistically significant increase in the concentration of the exhaled-TGF-β1 after the exercise challenge in the non-EIB asthmatics (p = 0.008), the concentration of the TGF-β1 was not increased after the exercise challenge in EIB + asthmatics. The exhaled-TGF-β1 was significantly correlated with the ACT score (p = 0.01, r = 0.49) and the baseline FEV1 level (p = 0.02, r = 0.35). The exhaled-TGF-β1 levels were significantly higher in the stable asthmatic children when compared to the nonasthmatic children (p < 0.0001). There was no significant difference in exhaled-TGF-β1 levels after the exercise challenge in the nonasthmatics. The exhaled-TGF-β1 levels were significantly lower in those children with asthma exacerbation when compared to the stable asthmatic children (p = 0.0003). CONCLUSION Our results suggest that TGF-β1 may play a role in suppressing airway reactivity and its deficiency is associated with asthma exacerbation.
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Affiliation(s)
- Ozlem Keskin
- Paediatric Allergy and Immunology Department, Gaziantep University Hospital, Gaziantep, Turkey
| | - Mehmet Yasar Ozkars
- Paediatric Allergy and Immunology Department, Gaziantep University Hospital, Gaziantep, Turkey
| | - Bulent Gogebakan
- Pulmonology Department, Gaziantep University Hospital, Gaziantep, Turkey
| | - Ercan Kucukosmanoglu
- Paediatric Allergy and Immunology Department, Gaziantep University Hospital, Gaziantep, Turkey
| | - Mehmet Keskin
- Department of Paediatrics, Gaziantep University Hospital, Gaziantep, Turkey
| | - Hasan Bayram
- Pulmonology Department, Gaziantep University Hospital, Gaziantep, Turkey
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Jonckheere AC, Seys S, Dilissen E, Schelpe AS, Van der Eycken S, Corthout S, Verhalle T, Goossens J, Vanbelle V, Aertgeerts S, Troosters T, Peers K, Dupont L, Bullens D. Early-onset airway damage in early-career elite athletes: A risk factor for exercise-induced bronchoconstriction. J Allergy Clin Immunol 2019; 144:1423-1425.e9. [PMID: 31356920 DOI: 10.1016/j.jaci.2019.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Anne-Charlotte Jonckheere
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - Sven Seys
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - Ellen Dilissen
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - An-Sofie Schelpe
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - Sarah Van der Eycken
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - Steffie Corthout
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - Tulasi Verhalle
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | - Janne Goossens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium
| | | | - Sven Aertgeerts
- KU Leuven, Academic Centre for General Practitioners, Leuven, Belgium
| | | | - Koen Peers
- UZ Leuven, Sport Medical Advice Centre, Leuven, Belgium
| | - Lieven Dupont
- KU Leuven, Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Pneumology, Leuven, Belgium; UZ Leuven, Clinical Division of Respiratory Medicine, Leuven, Belgium
| | - Dominique Bullens
- KU Leuven, Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, Leuven, Belgium; UZ Leuven, Clinical Division of Paediatrics, Leuven, Belgium.
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Abstract
Exercise-induced dyspnea in children and adolescents can occur for many reasons. Although asthma is the common cause, failure to prevent exercise-induced asthma by pretreatment with a bronchodilator, such as albuterol, indicates that other etiologies should be considered. Other causes of exercise-induced dyspnea include exercise-induced vocal cord dysfunction, exercise-induced laryngomalacia, exercise-induced hyperventilation, chest wall restrictive abnormalities, cardiac causes, and normal physiologic limitation. When exercise-induced dyspnea is not from asthma, cardiopulmonary exercise testing with reproduction of the patient's dyspnea is the means to identify the other causes. Cardiopulmonary exercise testing monitors oxygen use, carbon-dioxide production, end-tidal pCO2 (partial pressure of carbon dioxide), and electrocardiogram. Additional components to testing are measurement of blood pH and pCO2 when symptoms are reproduced, and selective flexible laryngoscopy when upper airway obstruction is observed to specifically identify vocal cord dysfunction or laryngomalacia. This approach is a highly effective means to identify exercise-induced dyspnea that is not caused by asthma. [Pediatr Ann. 2019;48(3):e121-e127.].
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