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Brown E, Foster K, Gover I, Powell A, Hardie WD. Comparison of Exercise Protocols for Diagnosing Pediatric Unexplained Dyspnea on Exertion. Pediatr Exerc Sci 2024:1-6. [PMID: 39384168 DOI: 10.1123/pes.2024-0047] [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: 03/19/2024] [Revised: 06/12/2024] [Accepted: 07/07/2024] [Indexed: 10/11/2024]
Abstract
PURPOSE Clinicians evaluating pediatric patients with unexplained dyspnea on exertion (DOE) often obtain exercise testing with a treadmill-based exercise-induced bronchospasm (EIB) protocol measuring only changes in spirometry. We modified the EIB protocol to collect metabolic and lung volume endpoints as obtained in a cardiopulmonary exercise test (CPET). We tested the hypothesis that measuring metabolic data with the EIB protocol (EIB-CPET) would yield greater diagnostic information than the EIB protocol. METHODS Exercise test diagnosis for healthy children with DOE referred to the pulmonary exercise lab from January 2011 through July 2023 were retrospectively compared between those performing either the EIB or EIB-CPET protocols. RESULTS One hundred and twenty-seven patients with unexplained DOE were analyzed. Of the 72 patients tested on the EIB protocol, 49% had stridor and 5% with EIB. Of the 55 patients tested on the EIB-CPET protocol, 42% had stridor, 42% with normal physiologic limitation, 22% with dysfunctional breathing, 5% with deconditioning, 2% with EIB, and 2% with exercise-induced hypoxemia. Patients performing the EIB-CPET protocol had a significantly higher rate of any diagnosis compared with EIB (P = .0002). CONCLUSIONS There is a greater diagnostic yield in children with unexplained DOE performing the EIB-CPET protocol compared with patients performing the EIB protocol.
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Affiliation(s)
- Elliott Brown
- Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH,USA
| | - Karla Foster
- Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH,USA
| | - Iesha Gover
- Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH,USA
| | - Adam Powell
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH,USA
| | - William D Hardie
- Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH,USA
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2
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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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Veneroni C, Pompilio PP, Alving K, Janson C, Nordang L, Dellacà R, Johansson H, Malinovschi A. Self-reported exercise-induced dyspnea and airways obstruction assessed by oscillometry and spirometry in adolescents. Pediatr Allergy Immunol 2022; 33:e13702. [PMID: 34797002 PMCID: PMC9299675 DOI: 10.1111/pai.13702] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Self-reported exercise-induced dyspnea (EID) is common among adolescents. Possible underlying pathologies are exercise-induced bronchoconstriction (EIB) and laryngeal obstruction (EILO). The forced oscillation technique (FOT) may evaluate exercise-induced changes in airway caliber. AIM To investigate in adolescents the relationship between EID, EIB (post-exercise fall in forced expiratory volume in 1s (FEV1 )≥10%), EILO, and post-exercise challenge changes in FOT parameters. METHODS One hundred and forty-three subjects (97 with EID) of 13-15 years old underwent a standardized exercise challenge with FOT measurement and spirometry repeatedly performed between 2 and 30 min post-exercise. EILO was studied in a subset of 123 adolescents. Subjects showing greater changes than the healthy subgroup in the modulus of the inspiratory impedance were considered FOT responders. RESULTS EID-nonEIB subjects presented similar post-exercise changes in all FOT parameters to nonEID-nonEIB adolescents. Changes in all FOT parameters correlated with FEV1 fall. 45 of 97 EID subjects responded neither by FEV1 nor FOT to exercise. 19 and 18 subjects responded only by FEV1 (onlyFEV1 responders) or FOT (onlyFOTresponders), respectively. Only a lower baseline forced vital capacity (FVC)%predicted and a higher FEV1 /FVC distinguished the onlyFEV1 responders from onlyFOTresponders. FOT parameters did not present specific post-exercise patterns in EILO subjects. CONCLUSION FOT can be used to identify post-exercise changes in lower airway function. However, EID has a modest relation with both FEV1 and FOT responses, highlighting the need for objective testing. More research is needed to understand whether onlyFEV1 responders and onlyFOTresponders represent different endotypes.
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Affiliation(s)
- Chiara Veneroni
- TechRes Lab, Department of Electronics, Information and Biomedical Engineering (DEIB), Politecnico di Milano University, Milan, Italy
| | - Pasquale Pio Pompilio
- TechRes Lab, Department of Electronics, Information and Biomedical Engineering (DEIB), Politecnico di Milano University, Milan, Italy
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine, Sleep and Allergy, Uppsala University, Uppsala, Sweden
| | - Leif Nordang
- Dept of Surgical Sciences, Otorhinolaryngology, and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Raffaele Dellacà
- TechRes Lab, Department of Electronics, Information and Biomedical Engineering (DEIB), Politecnico di Milano University, Milan, Italy
| | - Henrik Johansson
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
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4
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Sandnes A, Andersen T, Clemm HH, Hilland M, Heimdal JH, Halvorsen T, Røksund OD, Vollsæter M. Clinical responses following inspiratory muscle training in exercise-induced laryngeal obstruction. Eur Arch Otorhinolaryngol 2021; 279:2511-2522. [PMID: 34954812 PMCID: PMC8986676 DOI: 10.1007/s00405-021-07214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/03/2021] [Indexed: 11/09/2022]
Abstract
Purpose Exercise-induced laryngeal obstruction (EILO) is relatively common in young people. Treatment rests on poor evidence; however, inspiratory muscle training (IMT) has been proposed a promising strategy. We aimed to assess laryngeal outcomes shortly after IMT, and to compare self-reported symptoms with a control group 4–6 years later. Methods Two groups were retrospectively identified from the EILO-register at Haukeland University Hospital, Norway; one group had received only information and breathing advice (IBA), and another additionally IMT (IBA + IMT). At diagnosis, all participants performed continuous laryngoscopy during exercise (CLE), with findings split by glottic and supraglottic scores, and completed a questionnaire mapping exercise-related symptoms. After 2–4 weeks, the IBA + IMT-group was re-evaluated with CLE-test. After 4–6 years, both groups were re-assessed with a questionnaire. Results We identified 116 eligible patients from the EILO-register. Response rates after 4–6 years were 23/58 (40%) and 32/58 (55%) in the IBA and IBA + IMT-group, respectively. At diagnosis, both groups rated symptoms similarly, but laryngeal scores were higher in the IBA + IMT-group (P = 0.003). After 2–4 weeks, 23/32 in the IBA + IMT-group reported symptom improvements, associated with a decrease of mainly glottic scores (1.7–0.3; P < 0.001), contrasting unchanged scores in the 9/32 without symptom improvements. After 4–6 years, exercise-related symptoms and activity levels had decreased to similar levels in both groups, with no added benefit from IMT; however, full symptom resolution was reported by only 8/55 participants. Conclusion Self-reported EILO symptoms had improved after 4–6 years, irrespective of initial treatment. Full symptom resolution was rare, suggesting individual follow-up should be offered. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-021-07214-5.
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Affiliation(s)
- Astrid Sandnes
- Department of Internal Medicine, Innlandet Hospital Trust, Gjøvik, Norway. .,Institute of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Tiina Andersen
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway.,Thoracic Department, Norwegian Advisory Unit on Home Mechanical Ventilation, Bergen, Norway.,The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hege Havstad Clemm
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Magnus Hilland
- Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - John-Helge Heimdal
- Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway.,Institute of Surgical Science, University of Bergen, Bergen, Norway
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ola Drange Røksund
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Department of Otolaryngology/Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,The Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Maria Vollsæter
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Bergen, Norway.,Thoracic Department, Norwegian Advisory Unit on Home Mechanical Ventilation, Bergen, Norway
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5
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Hardie WD, Kercsmar CM. Exercise induced laryngeal obstruction: a step in the right direction. J Allergy Clin Immunol 2021; 149:1216-1217. [PMID: 34953793 DOI: 10.1016/j.jaci.2021.12.773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Affiliation(s)
- William D Hardie
- University of Cincinnati College of Medicine, Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center
| | - Carolyn M Kercsmar
- University of Cincinnati College of Medicine, Department of Pediatrics, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center.
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6
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Hengeveld VS, van der Kamp MR, Thio BJ, Brannan JD. The Need for Testing-The Exercise Challenge Test to Disentangle Causes of Childhood Exertional Dyspnea. Front Pediatr 2021; 9:773794. [PMID: 35071131 PMCID: PMC8770982 DOI: 10.3389/fped.2021.773794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Exertional dyspnea is a common symptom in childhood which can induce avoidance of physical activity, aggravating the original symptom. Common causes of exertional dyspnea are exercise induced bronchoconstriction (EIB), dysfunctional breathing, physical deconditioning and the sensation of dyspnea when reaching the physiological limit. These causes frequently coexist, trigger one another and have overlapping symptoms, which can impede diagnoses and treatment. In the majority of children with exertional dyspnea, EIB is not the cause of symptoms, and in asthmatic children it is often not the only cause. An exercise challenge test (ECT) is a highly specific tool to diagnose EIB and asthma in children. Sensitivity can be increased by simulating real-life environmental circumstances where symptoms occur, such as environmental factors and exercise modality. An ECT reflects daily life symptoms and impairment, and can in an enjoyable way disentangle common causes of exertional dyspnea.
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Affiliation(s)
- Vera S Hengeveld
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - Mattiènne R van der Kamp
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands.,Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Boony J Thio
- Department of Pediatrics, Medisch Spectrum Twente, Enschede, Netherlands
| | - John D Brannan
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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7
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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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8
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Johansson H, Emtner M, Janson C, Nordang L, Malinovschi A. The course of specific self-reported exercise-induced airway symptoms in adolescents with and without asthma. ERJ Open Res 2020; 6:00349-2020. [PMID: 33263020 PMCID: PMC7680906 DOI: 10.1183/23120541.00349-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022] Open
Abstract
Airway symptoms in conjunction with exercise can take on many forms and can have several contributory factors such as exercise-induced bronchoconstriction (EIB), exercise-induced laryngeal obstruction or hyperventilation [1]. Previous longitudinal studies on self-reported exercise-induced airway symptoms among adolescents have primarily studied single symptoms, focusing on dyspnoea or wheeze, often as a way to investigate the prevalence of asthma [2, 3]. To the best of our knowledge, there are, as yet, no population-based studies investigating the difference between adolescents with and without current asthma regarding the development of different specific exercise-induced airway symptoms. Therefore, we studied the natural course of self-reported exercise-induced dyspnoea, throat tightness, wheeze, chest tightness, cough, stridor and hoarseness over a 5-year period among adolescents with and without current asthma. In a general population, the prevalence of exercise-induced cough, dyspnoea, throat and chest tightness, wheeze, and stridor increases from adolescence to young adulthood among individuals without asthma in contrast to individuals with asthmahttps://bit.ly/3hR57OX
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Affiliation(s)
- Henrik Johansson
- Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden.,Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.,Dept of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Margareta Emtner
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Dept of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Leif Nordang
- Dept of Surgical Sciences, Otorhinolaryngology, and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Dept of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
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9
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Pedersen ESL, de Jong CCM, Ardura-Garcia C, Mallet MC, Barben J, Casaulta C, Hoyler K, Jochmann A, Moeller A, Mueller-Suter D, Regamey N, Singer F, Goutaki M, Kuehni CE. Reported Symptoms Differentiate Diagnoses in Children with Exercise-Induced Respiratory Problems: Findings from the Swiss Paediatric Airway Cohort (SPAC). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:881-889.e3. [PMID: 32961313 DOI: 10.1016/j.jaip.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exercise-induced breathing problems with similar clinical presentations can have different etiologies. This makes distinguishing common diagnoses such as asthma, extrathoracic and thoracic dysfunctional breathing (DB), insufficient fitness, and chronic cough difficult. OBJECTIVE We studied which parent-reported, exercise-induced symptoms can help distinguish diagnoses in children seen in respiratory outpatient clinics. METHODS This study was nested in the Swiss Paediatric Airway Cohort, an observational study of children aged 0 to 17 years referred to pediatric respiratory outpatient clinics in Switzerland. We studied children aged 6 to 17 years and compared information on exercise-induced symptoms from parent-completed questionnaires between children with different diagnoses. We used multinomial regression to analyze whether parent-reported symptoms differed between diagnoses (asthma as base). RESULTS Among 1109 children, exercise-induced symptoms were reported for 732 (66%) (mean age: 11 years, 318 of 732 [43%] female). Among the symptoms, dyspnea best distinguished thoracic DB (relative risk ratio [RRR]: 5.4, 95% confidence interval [CI]: 1.3-22) from asthma. Among exercise triggers, swimming best distinguished thoracic DB (RRR: 2.4, 95% CI: 1.3-6.2) and asthma plus DB (RRR: 1.8, 95% CI: 0.9-3.4) from asthma only. Late onset of symptoms was less common for extrathoracic DB (RRR: 0.1, 95% CI: 0.03-0.5) and thoracic DB (RRR: 0.4, 95% CI: 0.1-1.2) compared with asthma. Localization of dyspnea (throat vs chest) differed between extrathoracic DB (RRR: 2.3, 95% CI: 0.9-5.8) and asthma. Reported respiration phase (inspiration or expiration) did not help distinguish diagnoses. CONCLUSION Parent-reported symptoms help distinguish different diagnoses in children with exercise-induced symptoms. This highlights the importance of physicians obtaining detailed patient histories.
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Affiliation(s)
- Eva S L Pedersen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Carmen C M de Jong
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | | | - Maria Christina Mallet
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Juerg Barben
- Division of Paediatric Pulmonology, Children's Hospital St. Gallen, St. Gallen, Switzerland
| | - Carmen Casaulta
- Division of Paediatric Pulmonology, Children's Hospital Chur, Chur, Switzerland
| | - Karin Hoyler
- Division of Paediatric Pulmonology, Private Paediatric Practice Horgen, Horgen, Switzerland
| | - Anja Jochmann
- Division of Paediatric Pulmonology, University Children's Hospital, University of Basel, Basel, Switzerland
| | - Alexander Moeller
- Division of Paediatric Pulmonology, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Nicolas Regamey
- Division of Paediatric Pulmonology, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Florian Singer
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland; PedNet, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland.
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10
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Norlander K, Johansson H, Emtner M, Janson C, Nordvall L, Nordang L. Differences in laryngeal movements during exercise in healthy and dyspnoeic adolescents. Int J Pediatr Otorhinolaryngol 2020; 129:109765. [PMID: 31706111 DOI: 10.1016/j.ijporl.2019.109765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To compare glottic and supraglottic movements in healthy adolescents and adolescents experiencing dyspnoea during strenuous exercise. METHODS Using the continuous laryngoscopy exercise (CLE)-test laryngeal movements during exercise were analysed in healthy controls (n = 28) and compared to subjects with exercise induced bronchoconstriction (EIB) (n = 10), exercise induced laryngeal obstruction (EILO) (n = 10) and subjects experiencing exercise-induced dyspnoea without having any of these diagnoses (n = 31). Images from the video recordings were assessed regarding glottic angle, glottic area and supraglottic area using the software measuring tool EILOMEA. RESULTS No significant differences were detected between controls, the dyspnoea group without a diagnosis of EIB or EILO and the EIB group regarding glottis angle, glottis area or supraglottic area at maximum effort. All three parameters differed significantly in the EILO group compared to the other groups (p=<0.001). In the group with EILO all but one had supraglottic obstruction (corresponding to a CLE-test score ≥2). Movement of the laryngeal structures, corresponding to a CLE-test score of 1, at glottic and/or supraglottic level was seen in 26 of 35 (74%) of controls, 34 out of 41 (83%) of patients in the dyspnoea group, and in 25 of 38 (66%) of EIB-subjects. CONCLUSION Minor movements at both glottic and supraglottic level are equally common in healthy controls as among adolescents with exercise induced dyspnoea without EIB or EILO and adolescents with EIB. Adolescents with EILO had a statistically significant more pronounced supraglottic obstruction than the other groups.
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Affiliation(s)
- Katarina Norlander
- Department of Surgical Sciences, Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Henrik Johansson
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden.
| | - Margareta Emtner
- Department of Neuroscience, Physiotherapy, Uppsala University, Box 593 BMC, 751 24, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Lennart Nordvall
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Leif Nordang
- Department of Surgical Sciences, Otorhinolaryngology and Head & Neck Surgery, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
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11
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The Prevalence of Asthma and Respiratory Symptoms among Cross-Country Skiers in Early Adolescence. Can Respir J 2019; 2019:1514353. [PMID: 31636769 PMCID: PMC6766134 DOI: 10.1155/2019/1514353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/26/2019] [Accepted: 08/09/2019] [Indexed: 12/02/2022] Open
Abstract
Objective To determine the prevalence of asthma and respiratory symptoms among Swedish cross-country skiers in early adolescence in comparison to a population-based reference group of similar ages. Methods A postal questionnaire on asthma, asthma medication, allergy, respiratory symptoms, and physical activity was distributed to Swedish competitive cross-country skiers aged 12–15 years (n = 331) and a population-based reference group (n = 1000). The level of asthma control was measured by the Asthma Control Test. Results The response rate was 27% (n = 87) among skiers and 29% (n = 292) in the reference group. The prevalence of self-reported asthma (physician-diagnosed asthma and use of asthma medication in the last 12 months) and the prevalence of reported wheezing during the last 12 months were 23% and 25%, respectively, among skiers, which were significantly higher than the values reported in the reference group (12% and 14%). Skiers exercised more hours/week than the reference group. Among adolescents with self-reported asthma, neither the usage of asthma medications nor the level of asthma control according to the Asthma Control Test differed between skiers and the reference group. Conclusions Adolescent competitive cross-country skiers have an increased prevalence of respiratory symptoms and asthma compared to nonskiers.
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12
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Increased prevalence of exercise-induced airway symptoms - A five-year follow-up from adolescence to young adulthood. Respir Med 2019; 154:76-81. [PMID: 31226623 DOI: 10.1016/j.rmed.2019.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/11/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Exercise-induced airway symptoms are common in adolescents. Little is known about the development of symptoms from adolescence to early adulthood. Therefore, we studied the prevalence, incidence, and remission of exercise-induced airway symptoms (including wheeze, cough, chest and throat tightness, hoarseness, and stridor) in adolescents, over a five-year period. METHODS In 2011, all adolescents aged 12-13 years in Uppsala (n = 3 838) were invited to answer a questionnaire on exercise-induced airway symptoms. All responding adolescents (n = 2 309) were invited to answer the same questionnaire again after five years. In total, 1 002 adolescents responded (43.4%). RESULTS The prevalence of exercise-induced airway symptoms increased from 25% at baseline to 49% at follow-up (p < 0.001). More females than males reported symptoms at both time points. The incidence of airway symptoms was 42.2%, with no sex differences. More males than females reported symptom remission (20.2 vs. 10.7%, p < 0.001). Females reported a higher asthma prevalence at follow-up than at baseline (7.6 vs. 15.2%), while males did not (10.9 vs. 8.0%), leading to a sex difference in prevalence at follow-up (p < 0.001). Smoking and baseline respiratory symptoms were associated with an increased risk of reporting symptoms at follow-up. CONCLUSIONS A twofold increase in the prevalence of exercise-induced airway symptoms over a five-year period was found in this cohort. Females were more likely to report symptoms at both time points. Knowledge of these age-related changes in symptoms and their association to female gender is useful for future studies and healthcare providers.
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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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Abstract
This essay expounds on fundamental, quantitative elements of the exercise ventilation in children, which was the subject of the Tom Rowland Lecture given at the NASPEM 2018 Conference. Our knowledge about how much ventilation rises during aerobic exercise is reasonably solid; our understanding of its governance is a work in progress, but our grasp of dyspnea and ventilatory limitation in children (if it occurs) remains embryonic. This manuscript summarizes ventilatory mechanics during dynamic exercise, then proceeds to outline our current understanding of mechanisms of dyspnea, particularly during exercise (exertional dyspnea). Most research in this field has been done in adults, and the vast majority of these studies in patients with chronic obstructive pulmonary disease. To what extent conclusions drawn from this literature apply to children and adolescents-both healthy and those with cardiopulmonary disease-will be discussed. The few, recent, pertinent, pediatric studies will be reviewed in an attempt to provide an empirical basis for proposing a hypothetical model to study exertional dyspnea in youth. Just as somatic growth will have consequences for ventilatory and exercise capacity, so too will neural developmental plasticity and experience affect perception of dyspnea. Our path to understand how these evolving inputs and influences summate during a child's life will be Columbus' India.
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Albuquerque Rodrigues Filho ED, Rizzo JÂ, Gonçalves AV, Correia Junior MADV, Sarinho ESC, Medeiros D. Exercise-induced bronchospasm in children and adolescents with allergic rhinitis by treadmill and hyperventilation challenges. Respir Med 2018; 138:102-106. [PMID: 29724380 DOI: 10.1016/j.rmed.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/18/2018] [Accepted: 04/01/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Respiratory complaints after exercise are common in patients with rhinitis. Exercise-induced bronchospasm (EIB) may be one of the causes. OBJECTIVES To evaluate EIB prevalence in a group of children and adolescents with allergic rhinitis, to compare the treadmill running (TR) and eucapnic voluntary hyperventilation (EVH) challenge methods as diagnostic tools and to assess the association between respiratory complaints on exercise and EIB. METHODS Patients aged between 10 and 20 years were studied at the Pulmonology Department of the Hospital das Clínicas -UFPE- Recife, Brazil. The severity of symptoms of rhinitis and exercise-related respiratory complaints in the past year were evaluated. Challenges were performed in random sequence, no more than 72 h apart and followed international guidelines. Forced expiratory volume in the first second (FEV1) was determined before and 3, 5, 7, 10, 15 and 30 min after each challenge. A >10% reduction in FEV1 from baseline at two points after the challenge was considered sufficient to diagnose EIB. RESULTS Of the thirty-five subjects evaluated, thirteen (37%) showed EIB, six by both methods, three only after TR and four only after EVH (Coens' Kappa = 0.489). There was no association between respiratory complaints after exercise and EIB (p = 0.74). CONCLUSION A high prevalence of EIB was found in this population but only moderate agreement between the challenges used to diagnose EIB. Caution should be adopted when comparing these methods or interpreting their results interchangeably. There was no association between reported respiratory symptoms after exercise and EIB.
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Affiliation(s)
- Edil de Albuquerque Rodrigues Filho
- Health Sciences Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - José Ângelo Rizzo
- Health Sciences Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Pneumology Department, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil; Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil; Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
| | - Adriana Velozo Gonçalves
- Health Sciences Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Marco Aurélio de Valois Correia Junior
- Health Sciences Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil; Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Postgraduate Course in Hebiatrics and Physical Education at the University of Pernambuco, Recife, Pernambuco, Brazil
| | - Emanuel Sávio Cavalcanti Sarinho
- Health Sciences Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil; Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Décio Medeiros
- Health Sciences Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil; Center for Research in Allergy and Clinical Immunology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil; Child and Adolescent Health Postgraduate Course, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Johansson H, Berglund M, Holmbäck U. Subjective and objective assessment of physical activity - Influence of newly diagnosed exercise induced bronchoconstriction and gender. Respir Med 2017; 131:205-209. [PMID: 28947031 DOI: 10.1016/j.rmed.2017.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Abstract
AIM To investigate if occurrence of newly diagnosed exercise induced bronchoconstriction (EIB) would affect adolescents' ability to assess their physical activity. METHODS 99 selected adolescents with and 47 adolescents without self-reported exercise induced dyspnea were included. All of the 146 adolescents then performed a standardized exercise challenge test on a treadmill with dry-air inhalation to detect EIB. Free living physical activity was assessed during seven days with both accelerometer (objective assessment) and a validated activity diary (subjective assessment). Height, weight and subjective sleep were recorded. RESULTS Out of the 146 adolescents 49 were diagnosed with EIB. Forty-six of the adolescents with EIB (35 girls and 11 boys) and 84 of the control adolescents (45 girls and 39 boys) had complete 7 day activity diary and accelerometer data. There were no differences in age, BMI and sleep between EIB and control adolescents. Boys with EIB overestimated subjective assessment compared to objective assessment more than girls with EIB. No difference was seen between control boys and girls. Furthermore, boys with EIB reported a much higher frequency of high intensity exercise than girls with EIB, but no difference was observed between control boys and girls. CONCLUSION Adolescent boys with newly diagnosed EIB overestimated their physical activity compared to EIB girls. Caution may thus be used when choosing methods measuring level of physical activity in this group and especially when investigating gender differences.
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Affiliation(s)
- Henrik Johansson
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Lung- Allergy- and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Marie Berglund
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Ulf Holmbäck
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
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Colwell KL, Bhatia R. Calculated versus Measured MVV-Surrogate Marker of Ventilatory Capacity in Pediatric CPET. Med Sci Sports Exerc 2017; 49:1987-1992. [PMID: 28489684 DOI: 10.1249/mss.0000000000001318] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Maximum voluntary ventilation (MVV), a surrogate marker of maximum ventilatory capacity, allows for measuring ventilatory reserve during cardiopulmonary exercise testing (CPET), which is necessary to assess ventilatory limitation. MVV can be measured directly during a patient maneuver or indirectly by calculating from forced expiratory volume in 1 s (FEV1 × 40). We investigated for a potential difference between calculated MVV and measured MVV in pediatric subjects, and which better represents maximum ventilatory capacity during CPET. METHODS Data were collected retrospectively from CPET conducted in pediatric subjects for exercise-induced dyspnea from January 2014 to June 2015 at Akron Children's Hospital. Subjects with neuromuscular weakness, morbid obesity, and suboptimal effort during the testing were excluded from the study. RESULTS Thirty-five subjects (mean ± SD, age = 13.8 ± 2.7 yr, range = 7-18 yr) fulfilled the criteria. Measured MVV was significantly lower than calculated MVV (89.9 ± 26.4 vs 122.4 ± 34.5 L·min; P < 0.01). The ventilatory reserve based on measured MVV was also significantly lower than ventilatory reserve based on calculated MVV (12.4% ± 19.6% vs 36.1% ± 13.2%; P < 0.01). Calculated MVV (as well as ventilatory reserve based on calculated MVV) was significantly correlated with ventilatory parameters. By contrast, no significant correlations were found between measured MVV (or ventilatory reserve based on measured MVV) and ventilatory parameters except for peak ventilation (peak V˙E). CONCLUSIONS The measured MVV was significantly lower than the calculated MVV in our pediatric subjects. The calculated MVV was a better surrogate of maximum ventilatory capacity as shown by significant correlation to other ventilatory parameters during CPET.
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Affiliation(s)
- Kelly L Colwell
- Division of Pulmonology, Department of Pediatrics, Akron Children's Hospital, Akron, OH
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Depiazzi J, Everard ML. Dysfunctional breathing and reaching one's physiological limit as causes of exercise-induced dyspnoea. Breathe (Sheff) 2016; 12:120-9. [PMID: 27408630 PMCID: PMC4933621 DOI: 10.1183/20734735.007216] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Key points This review provides an overview of the spectrum of conditions that can present as exercise-induced breathlessness experienced by young subjects participating in sport and aims to promote understanding of the need for accurate assessment of an individual’s symptoms. We will highlight the high incidence of nonasthmatic causes, which simply require reassurance or simple interventions from respiratory physiotherapists or speech pathologists. Breathlessness: accurate assessment and diagnosis is essential in order to provide correct advice and assistancehttp://ow.ly/4nrW8z
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Affiliation(s)
- Julie Depiazzi
- Physiotherapy Dept, Princess Margaret Hospital, Subiaco, Australia
| | - Mark L Everard
- Dept of Respiratory Medicine, Princess Margaret Hospital, Subiaco, Australia; University of Western Australia, Crawley, Australia
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19
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Johansson H, Norlander K, Janson C, Malinovschi A, Nordang L, Emtner M. The relationship between exercise induced bronchial obstruction and health related quality of life in female and male adolescents from a general population. BMC Pulm Med 2016; 16:63. [PMID: 27117559 PMCID: PMC4847200 DOI: 10.1186/s12890-016-0226-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 04/14/2016] [Indexed: 11/14/2022] Open
Abstract
Background Previous studies have observed that exercise-induced bronchoconstriction (EIB) is more common and more strongly related to exercise related breathing problems in female adolescents than male adolescents. However, few studies have investigated the association between EIB and health related quality of life (HRQoL) from a gender perspective. The aim of this study was to examine the association between EIB and HRQoL and physical activity level in female and male adolescents with and without EIB. Methods From a population based study on exercise-induced breathing problems among adolescents (13–15 years, n = 3838) a cross sectional study with prospective data collection was carried out in a random subsample of 140 adolescents. The subjects in the sample were tested for EIB with a standardised exercise test, of which 49 adolescents were tested positive. HRQoL was assessed with the Pediatric Quality of Life Inventory (PedsQL) and the adolescents’ physical activity levels were measured objectively with accelerometer. Results The female subjects with EIB reported a lower HRQoL, both in total score (p = 0.03) and physical functioning score (p = 0.009) and had a lower baseline FEV1 compared to females without EIB (88 vs. 94 % predicted, p = 0.001). No differences were found in HRQoL or baseline lung function between males with or without EIB. There were no differences in minutes of moderate to vigorous physical activity per day between females or males with and without EIB. Conclusion In a general population, the female adolescents with EIB had lower HRQoL and poorer baseline lung function compared to counterparts without EIB. These differences were not observed in males. EIB does not appear to affect the level of daily physical activity neither in females nor males.
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Affiliation(s)
- Henrik Johansson
- Neuroscience/Physiotherapy, Uppsala University, Uppsala, Sweden.
| | - Katarina Norlander
- Surgical Sciences: Otolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Medical Sciences, Lung- allergy- and sleep research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Leif Nordang
- Surgical Sciences: Otolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
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Consentino CLM, Furtado-Alle L, da Silva LR, Lopes WA, Tureck LV, Milano GE, Lazarotto L, Cavaglieri CR, Leite N. Influence of polymorphisms of the beta-2 adrenergic receptor on the presence of exercise-induced bronchospasm in adolescents. REVISTA PAULISTA DE PEDIATRIA (ENGLISH EDITION) 2016. [PMID: 26684442 PMCID: PMC4795718 DOI: 10.1016/j.rppede.2015.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective: To determine the influence of polymorphisms of the beta-2 adrenergic receptor
(ADRB2) in triggering exercise-induced bronchospasm (EIB) in adolescents. Methods: The subjects were divided into two groups: present EIB (EIB+) (n=45) and absent
EIB (EIB−) (n=115). The bronchial provocation test with exercise was performed
with a protocol that consisted of walking/running for at least eight minutes at
high intensity, i.e., >85% of maximum heart rate, considering EIB+ as a 10%
decrease in forced expiratory volume in one second (FEV1). The
genotyping of the ADRB2 gene was performed by the Taqman method,
using the Step One Plus system. Independent t-test, Mann–Whitney
and Chi-square tests, as well as Spearman's correlation coefficient were used for
the statistical analysis. Results: Age, body weight, height, FEV1, FVC and FEV1/FVC ratio were
lower in the EIB+ group when compared to EIB− (p<0.05). There
were no significant differences in the proportion of the allele at position 27 and
Arg16Gly and Gln27Glu genotypes between the
EIB+ and EIB− groups (p=0.26; p=0.97 and
p=0.43, respectively). However, there was a trend toward
statistical significance regarding the greater proportion of the Gly16 allele for
the EIB+ when compared to the EIB− group (p=0.08). Conclusions: The presence of polymorphisms associated with the Glu27 allele and
Arg16Gly and Gln27Glu genotypes had no
influence on EIB. However, the statistical trend toward greater frequency of the
Gly16 allele in individuals with EIB+ can be considered
evidence of the influence of polymorphisms of the ADBR2 gene on
EIB in adolescents.
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Johansson H, Norlander K, Alving K, Hedenström H, Janson C, Malinovschi A, Nordang L, Emtner M. Exercise test using dry air in random adolescents: Temporal profile and predictors of bronchoconstriction. Respirology 2015; 21:289-96. [PMID: 26588807 DOI: 10.1111/resp.12682] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/14/2015] [Accepted: 08/25/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Guidelines recommend exercise tests using dry air to diagnose exercise-induced bronchoconstriction (EIB). Lung function changes subsequent to these tests have not been investigated in a general adolescent population, and it remains unknown whether signs of airway inflammation, measured using exhaled nitric oxide (FeNO), can predict a positive response. The aim of this study was to investigate the temporal aspect of decline in forced expiratory volume in 1 s (FEV1 ) after an exercise test using dry air, and to investigate predictors of EIB. METHODS From a cross-sectional study on adolescents aged 13-15 years (n = 3838), a random subsample of 146 adolescents (99 with and 47 without self-reported exercise-induced dyspnoea) underwent standardized treadmill exercise tests for EIB while breathing dry air. RESULTS Of the adolescents, 34% had a positive EIB test (decline of ≥10% in FEV1 from baseline) within 30 min. Of the subjects with EIB, 53% showed the greatest decline in FEV1 at 5 to 10 min (mean decline 18.5%), and the remaining 47% of the subjects showed the greatest decline at 15 to 30 min (mean decline 18.9%) after exercise. Increased FeNO (>20 ppb), female gender and self-reported exercise-induced dyspnoea were independently associated with a positive EIB test. CONCLUSION When assessing general adolescents for EIB with exercise test using dry air, there is a temporal variation in the greatest FEV1 decline after exercise. Therefore, lung function should be measured for at least 30 min after the exercise. Increased FeNO, female gender and self-reported exercise-induced dyspnoea can be predictors of a positive EIB test.
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Affiliation(s)
- Henrik Johansson
- Neuroscience/Physiotherapy and Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Katarina Norlander
- Surgical Sciences: Otolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hans Hedenström
- Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Leif Nordang
- Surgical Sciences: Otolaryngology and Head and Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Margareta Emtner
- Neuroscience/Physiotherapy and Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
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Lövström L, Emtner M, Alving K, Nordvall L, Borres MP, Janson C, Malinovschi A. High levels of physical activity are associated with poorer asthma control in young females but not in males. Respirology 2015; 21:79-87. [PMID: 26581686 DOI: 10.1111/resp.12671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 07/02/2015] [Accepted: 07/06/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Earlier studies on the levels of physical activity in asthma patients compared with controls have yielded varying results. We have previously reported that high versus moderate levels of physical activity were associated with higher prevalence of wheezing, especially in females. Here we studied the levels of physical activity in young patients with asthma and healthy subjects and their effect on asthma control. METHODS Four hundred eight physician-diagnosed patients with asthma and 118 controls (10-34 years) answered questions concerning frequency and/or duration of physical activity and undertook the Asthma Control Test (ACT), spirometry, methacholine challenges and exhaled nitric oxide measurements. RESULTS Asthma patients were more frequently physically active (P = 0.01) and for longer durations (P = 0.002) than controls. Highly versus moderately physically active patients with asthma had a higher prevalence of not well-controlled asthma (ACT < 20) when physical activity was assessed by frequency (40.6% vs 24.1%, P = 0.001) or duration (39.0% vs 21.7%, P < 0.001). This was only seen in females who had reduced ACT items (P < 0.05). Frequently versus moderately active females had an odds ratio of 4.81 (2.43, 9.51) to have ACT < 20, while no such effect was found in males (OR 1.18 (0.61, 2.30)) and this interaction was statistically significantly associated with gender (P = 0.003). No differences in fraction of exhaled nitric oxide or methacholine reactivity were found between moderately and highly physically active females with asthma. CONCLUSION Young asthma patients were more active than controls. High levels of physical activity were associated with poor asthma control as judged by the ACT in females, but not in males, and this appears unrelated to airway inflammation or responsiveness.
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Affiliation(s)
- Ludvig Lövström
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Margareta Emtner
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.,Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Lennart Nordvall
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Magnus P Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
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[Influence of polymorphisms of the beta-2 adrenergic receptor on the presence of exercise-induced bronchospasm in adolescents]. REVISTA PAULISTA DE PEDIATRIA 2015; 34:24-9. [PMID: 26684442 DOI: 10.1016/j.rpped.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/05/2015] [Accepted: 06/09/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the influence of polymorphisms of the beta-2 adrenergic receptor (ADRB2) in triggering exercise-induced bronchospasm (EIB) in adolescents. METHODS The subjects were divided into two groups: present EIB (EIB+) (n=45) and absent EIB (EIB-) (n=115). The bronchial provocation test with exercise was performed with a protocol that consisted of walking/running for at least eight minutes at high intensity, i.e., >85% of maximum heart rate, considering EIB+ as a 10% decrease in forced expiratory volume in one second (FEV1). The genotyping of the ADRB2 gene was performed by the Taqman method, using the Step One Plus system. Independent t-test, Mann-Whitney and Chi-square tests, as well as Spearman's correlation coefficient were used for the statistical analysis. RESULTS Age, body weight, height, FEV1, FVC and FEV1/FVC ratio were lower in the EIB+ group when compared to EIB- (p<0.05). There were no significant differences in the proportion of the allele at position 27 and Arg16Gly and Gln27Glu genotypes between the EIB+ and EIB- groups (p=0.26; p=0.97 and p=0.43, respectively). However, there was a trend towards statistical significance regarding the greater proportion of the Gly16 allele for the EIB+ when compared to the EIB- group (p=0.08). CONCLUSIONS The presence of polymorphisms associated with the Glu27 allele and Arg16Gly and Gln27Glu genotypes had no influence on EIB. However, the statistical trend towards greater frequency of the Gly16 allele in individuals with EIB+ can be considered evidence of the influence of polymorphisms of the ADBR2 gene on EIB in adolescents.
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Sánchez-García S, Rodríguez del Río P, Escudero C, García-Fernández C, Ibáñez MD. Exercise-induced bronchospasm diagnosis in children. Utility of combined lung function tests. Pediatr Allergy Immunol 2015; 26:73-9. [PMID: 25444583 DOI: 10.1111/pai.12319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The diagnosis of exercise-induced asthma or bronchospasm (EIB) is a complex dare in daily clinical practice. The consensus is that if bronchial hyper-responsiveness (BHR) is demonstrated in a patient with symptoms consistent with EIB, then that patient can be diagnosed with exercise-induced bronchospasm. The aim of this study was to determine which BHR test is the most efficient to diagnose EIB. METHODS Children under 16, without previous asthma diagnosis, or with stable asthma, complaining of asthma-like symptoms triggered by exercise were included. Bronchodilator, methacholine, mannitol, and exercise tests were performed on all patients, following established protocols. The performance of single and combined tests was determined. RESULTS Of 46 patients (median age: 12 yr, ranged 8-16 y.o.) were recruited, 30 (70%) previously diagnosed of asthma. BHR was detected in 93.47% of the children. The exercise challenge test detected BHR in 11 of 46 (23.90%) patients, bronchodilator test in 10 of 46 (21.70%), mannitol in 36 of 45 (80%) and methacholine in 41 of 45 (91.11%). The total number of patients with BHR was detected using a combination of the methacholine and mannitol tests. A combination of the methacholine test performed first, followed by the mannitol test, was able to diagnose BHR in 100% of children with lower number of tests (n = 45) than if the order was reversed (n = 50). CONCLUSIONS Methacholine and mannitol tests detect BHR in most children with suspected EIB. Bronchodilator and exercise tests show a low positivity rate. A combination of the methacholine test, followed by the mannitol test, gives the highest return to identify BHR in children for the diagnosis of EIB.
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Affiliation(s)
- Silvia Sánchez-García
- Allergy Section, Niño Jesús University Children's Hospital, Madrid, Spain; Instituto de Investigación Sanitaria - IIS, Princesa University Hospital, Madrid, Spain
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Johansson H, Norlander K, Berglund L, Janson C, Malinovschi A, Nordvall L, Nordang L, Emtner M. Prevalence of exercise-induced bronchoconstriction and exercise-induced laryngeal obstruction in a general adolescent population. Thorax 2014; 70:57-63. [PMID: 25380758 DOI: 10.1136/thoraxjnl-2014-205738] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Exercise-induced respiratory symptoms are common among adolescents. Exercise is a known stimulus for transient narrowing of the airways, such as exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (EILO). Our aim was to investigate the prevalence of EIB and EILO in a general population of adolescents. METHODS In this cross-sectional study, a questionnaire on exercise-induced dyspnoea was sent to all adolescents born in 1997 and 1998 in Uppsala, Sweden (n=3838). A random subsample of 146 adolescents (99 with self-reported exercise-induced dyspnoea and 47 without this condition) underwent standardised treadmill exercise tests for EIB and EILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease of ≥10% in FEV1 from baseline. EILO was investigated using continuous laryngoscopy during exercise. RESULTS The estimated prevalence of EIB and EILO in the total population was 19.2% and 5.7%, respectively. No gender differences were found. In adolescents with exercise-induced dyspnoea, 39.8% had EIB, 6% had EILO and 4.8% had both conditions. In this group, significantly more boys than girls had neither EIB nor EILO (64.7% vs 38.8%; p=0.026). There were no significant differences in body mass index, lung function, diagnosed asthma or medication between the participants with exercise-induced dyspnoea who had or did not have a positive EIB or EILO test result. CONCLUSIONS Both EIB and EILO are common causes of exercise-induced dyspnoea in adolescents. EILO is equally common among girls and boys and can coexist with EIB.
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Affiliation(s)
- Henrik Johansson
- Department of Neuroscience/Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Katarina Norlander
- Surgical Sciences: Otolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Lars Berglund
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | | | | | - Lennart Nordvall
- Women's and Children's Health: Pediatrics, Uppsala University, Uppsala, Sweden
| | - Leif Nordang
- Surgical Sciences: Otolaryngology and Head & Neck Surgery, Uppsala University, Uppsala, Sweden
| | - Margareta Emtner
- Department of Neuroscience/Physiotherapy, Uppsala University, Uppsala, Sweden
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