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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: 6] [Impact Index Per Article: 6.0] [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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Abstract
Bronchial asthma is characterized by chronic airway inflammation, which manifests clinically as variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma may induce airway remodeling and become intractable. The prevalence of asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of asthma are fundamental to its treatment. Asthma is managed by four steps of pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled corticosteroid, which may vary from low to high. Long-acting β2-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs, while anti-immunoglobulin E antibodies and other biologics, and oral steroids are reserved for very severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β2-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for asthma based on the severity of the exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in asthma therapy.
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Bekos C, Zimmermann M, Unger L, Janik S, Mitterbauer A, Koller M, Fritz R, Gäbler C, Didcock J, Kliman J, Klepetko W, Ankersmit HJ, Moser B. Exercise-induced bronchoconstriction, temperature regulation and the role of heat shock proteins in non-asthmatic recreational marathon and half-marathon runners. Sci Rep 2019; 9:4168. [PMID: 30862844 PMCID: PMC6414620 DOI: 10.1038/s41598-019-39983-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 02/07/2019] [Indexed: 12/17/2022] Open
Abstract
Exercise is the most common trigger of bronchospasm. Heat shock protein (HSP) expression was linked to asthmatic patients. The prevalence and pathophysiology of exercise-induced bronchoconstriction (EIB) in non-professional non-asthmatic runners is unknown. We sought to investigate the frequency of EIB and cytokine changes in non-professional non-asthmatic marathon and half marathoners with and without EIB. Testing was performed before the marathon (baseline), immediately post-marathon at the finish area (peak), and 2–7 days after the marathon (recovery): immunosorbent assays for measurement of HSP70, blood count analysis, spirometry and temperature measurements. We experienced a decline in FEV1 of ≥10% in 35.29% of marathon and 22.22% of half marathon runners. Runners with EIB had significantly higher HSP70 serum concentrations at baseline than those without EIB (987.4 ± 1486.7 vs. 655.6 ± 1073.9; p = 0.014). Marathoners with EIB had significantly increased WBC before participating in the competition (7.4 ± 1.7 vs. 6.0 ± 1.5; p = 0.021). After recovery we found increased HSP70 serum concentrations in marathoners with EIB compared to those without (2539.2 ± 1692.5 vs. 1237.2 ± 835.2; p = 0.032), WBC (7.6 ± 1.8 vs. 6.4 ± 1.6; p = 0.048) and PLT (273.0 ± 43.0 vs 237.2 ± 48.3; p = 0.040). At all measured skin sites skin temperatures in runners were significantly lower immediately after participating in the competition when compared to temperature before the race (skin temperature baseline vs. peak: abdominal: 33.1 ± 0.2 vs. 30.0 ± 0.4; p < 0.001; upper arm: 31.6 ± 0.2 vs. 29.4 ± 0.3; p < 0.001; upper leg: 30.7 ± 0.3 vs. 29.4 ± 0.2; p = 0.014; lower leg: 30.6 ± 1.0 vs. 30.2 ± 1.5; p = 0.007). We found a higher than expected number of non-professional athletes with EIB. HSP70 serum concentrations and elevated WBC could indicate a predisposition to EIB.
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Affiliation(s)
- Christine Bekos
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria.,Medical University of Vienna, Comprehensive Cancer Center, Department of Obstetrics and Gynecology, Division of General Gynecology and Gynecologic Oncology, Vienna, Austria
| | - Matthias Zimmermann
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria
| | - Lukas Unger
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria
| | - Stefan Janik
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria
| | - Andreas Mitterbauer
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria
| | | | - Robert Fritz
- Sportordination, Alserstraße 28, Vienna, Austria
| | | | - Jessica Didcock
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria
| | - Jonathan Kliman
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria
| | - Walter Klepetko
- Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Hendrik Jan Ankersmit
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria.,Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Vienna, Austria
| | - Bernhard Moser
- Christian Doppler Laboratory for Cardiac and Thoracic Diagnosis and Regeneration, Vienna, Austria. .,Department of Surgery, Division of Thoracic Surgery, Medical University Vienna, Vienna, Austria.
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Weiler JM, Brannan JD, Randolph CC, Hallstrand TS, Parsons J, Silvers W, Storms W, Zeiger J, Bernstein DI, Blessing-Moore J, Greenhawt M, Khan D, Lang D, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Tilles SA, Wallace D. Exercise-induced bronchoconstriction update-2016. J Allergy Clin Immunol 2016; 138:1292-1295.e36. [PMID: 27665489 DOI: 10.1016/j.jaci.2016.05.029] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/13/2016] [Accepted: 05/25/2016] [Indexed: 12/26/2022]
Abstract
The first practice parameter on exercise-induced bronchoconstriction (EIB) was published in 2010. This updated practice parameter was prepared 5 years later. In the ensuing years, there has been increased understanding of the pathogenesis of EIB and improved diagnosis of this disorder by using objective testing. At the time of this publication, observations included the following: dry powder mannitol for inhalation as a bronchial provocation test is FDA approved however not currently available in the United States; if baseline pulmonary function test results are normal to near normal (before and after bronchodilator) in a person with suspected EIB, then further testing should be performed by using standardized exercise challenge or eucapnic voluntary hyperpnea (EVH); and the efficacy of nonpharmaceutical interventions (omega-3 fatty acids) has been challenged. The workgroup preparing this practice parameter updated contemporary practice guidelines based on a current systematic literature review. The group obtained supplementary literature and consensus expert opinions when the published literature was insufficient. A search of the medical literature on PubMed was conducted, and search terms included pathogenesis, diagnosis, differential diagnosis, and therapy (both pharmaceutical and nonpharmaceutical) of exercise-induced bronchoconstriction or exercise-induced asthma (which is no longer a preferred term); asthma; and exercise and asthma. References assessed as relevant to the topic were evaluated to search for additional relevant references. Published clinical studies were appraised by category of evidence and used to document the strength of the recommendation. The parameter was then evaluated by Joint Task Force reviewers and then by reviewers assigned by the parent organizations, as well as the general membership. Based on this process, the parameter can be characterized as an evidence- and consensus-based document.
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Pedersen BK, Saltin B. Exercise as medicine - evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports 2016; 25 Suppl 3:1-72. [PMID: 26606383 DOI: 10.1111/sms.12581] [Citation(s) in RCA: 1637] [Impact Index Per Article: 204.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2015] [Indexed: 12/12/2022]
Abstract
This review provides the reader with the up-to-date evidence-based basis for prescribing exercise as medicine in the treatment of 26 different diseases: psychiatric diseases (depression, anxiety, stress, schizophrenia); neurological diseases (dementia, Parkinson's disease, multiple sclerosis); metabolic diseases (obesity, hyperlipidemia, metabolic syndrome, polycystic ovarian syndrome, type 2 diabetes, type 1 diabetes); cardiovascular diseases (hypertension, coronary heart disease, heart failure, cerebral apoplexy, and claudication intermittent); pulmonary diseases (chronic obstructive pulmonary disease, asthma, cystic fibrosis); musculo-skeletal disorders (osteoarthritis, osteoporosis, back pain, rheumatoid arthritis); and cancer. The effect of exercise therapy on disease pathogenesis and symptoms are given and the possible mechanisms of action are discussed. We have interpreted the scientific literature and for each disease, we provide the reader with our best advice regarding the optimal type and dose for prescription of exercise.
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Affiliation(s)
- B K Pedersen
- The Centre of Inflammation and Metabolism and The Center for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Saltin
- The Copenhagen Muscle Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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7
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Pillard F, Lavit M, Cances VL, Rami J, Houin G, Didier A, Rivière D. Medical and pharmacological approach to adjust the salbutamol anti-doping policy in athletes. Respir Res 2015; 16:155. [PMID: 26704899 PMCID: PMC4699378 DOI: 10.1186/s12931-015-0315-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 12/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Salbutamol abuse detection by athletes is based on a urinary upper threshold defined by the World Anti-Doping Agency (WADA). However, this threshold was determined in healthy, untrained individuals and after a dose of salbutamol inhaled that might not really mirror the condition of asthmatic athletes and the experts's guidelines for asthma management. We aimed to revise this threshold in accordance with recommended clinical practice (that appear to be different from the actual WADA recommendation) and in exercise conditions. METHODS For the present open-label design study, we included 12 trained male cyclists (20 to 40 y/o) with asthma. Differently from the previous pharmacokinetic study supporting the actual salbutamol urinary upper threshold, we decided to administer a close to recommended clinical practice daily dose of 3x200 μg.d(-1) inhaled salbutamol (instead of 1600 μg.d(-1) as authorized by the anti-doping policy). Urine salbutamol concentration was quantified by liquid chromatography-tandem ion trap mass spectrometry and corrected for urine density, at rest and after a 90-min cycling effort at 70-80 % of the maximal aerobic power. RESULTS The maximum urine salbutamol concentration value peaked after the cycling effort and was 510 ng.mL(-1). That is twice lower than the actual WADA threshold to sanction salbutamol abuse, this "legal" threshold being based on pharmacokinetic data after a daily dose that is 8 fold the total dose sequentially administrated in our study. Considering its 95 % confidence interval, this threshold value could be more stringent. CONCLUSION By using conditions in accordance with the experts' clinical and safety guidelines for asthma management in athletes undergoing an intense exercise bout, our study suggests that the urine salbutamol concentration threshold could be lowered to redefine the rule supporting the decision to sanction an athlete for salbutamol abuse.
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Affiliation(s)
- Fabien Pillard
- Respiratory Function Exploration and Sport Medicine Department, Larrey Hospital, 24 Chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex 9, France.
- Exercise Physiology Department, Medical School, Paul Sabatier University, Toulouse, France.
- INSERM, U858-Adipolab Unit, Institute of Molecular Medicine, Toulouse, France.
| | - Michel Lavit
- Pharmacokinetic and Toxicologic Laboratory, Institute of Biology, Purpan Hospital, Toulouse, France
| | | | - Jacques Rami
- Respiratory Function Exploration and Sport Medicine Department, Larrey Hospital, 24 Chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex 9, France
| | - Georges Houin
- Pharmacokinetic and Toxicologic Laboratory, Institute of Biology, Purpan Hospital, Toulouse, France
| | - Alain Didier
- Department of Respiratory Diseases, Larrey Hospital, Toulouse, France
| | - Daniel Rivière
- Respiratory Function Exploration and Sport Medicine Department, Larrey Hospital, 24 Chemin de Pouvourville, TSA 30030, 31059, Toulouse Cedex 9, France
- Exercise Physiology Department, Medical School, Paul Sabatier University, Toulouse, France
- INSERM, U858-Adipolab Unit, Institute of Molecular Medicine, Toulouse, France
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[Inhaled therapy in asthma]. Med Clin (Barc) 2015; 146:316-23. [PMID: 26683076 DOI: 10.1016/j.medcli.2015.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 09/25/2015] [Accepted: 09/30/2015] [Indexed: 11/20/2022]
Abstract
Because of its advantages, inhaled administration of aerosolized drugs is the administration route of choice for the treatment of asthma and COPD. Numerous technological advances in the devices used in inhaled therapy in recent decades have boosted the appearance of multiple inhalers and aerosolized drugs. However, this variety also requires that the prescribing physician is aware of their characteristics. The main objective of the present review is to summarize the current state of knowledge on inhalers and inhaled drugs commonly used in the treatment of asthma. The review ranges from theoretical aspects (fundamentals and available devices and drugs) to practical and relevant aspects for asthma care in the clinical setting (therapeutic strategies, education, and adherence to inhalers).
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Ohta K, Ichinose M, Nagase H, Yamaguchi M, Sugiura H, Tohda Y, Yamauchi K, Adachi M, Akiyama K. Japanese Guideline for Adult Asthma 2014. Allergol Int 2015; 63:293-333. [PMID: 25178175 DOI: 10.2332/allergolint.14-rai-0766] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Indexed: 11/20/2022] Open
Abstract
Adult bronchial asthma (hereinafter, asthma) is characterized by chronic airway inflammation, reversible airway narrowing, and airway hyperresponsiveness. Long-standing asthma induces airway remodeling to cause intractable asthma. The number of patients with asthma has increased, and that of patients who die from asthma has decreased (1.5 per 100,000 patients in 2012). The aim of asthma treatment is to enable patients with asthma to lead a normal life without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management with antiasthmatic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high. Long-acting 02-agonists, leukotriene receptor antagonists, and sustained-release theophylline are recommended as concomitant drugs, while anti-immunoglobulin E antibody therapy has been recently developed for the most severe and persistent asthma involving allergic reactions. Inhaled 02-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and others are used as needed in acute exacerbations by choosing treatment steps for asthma exacerbations depending on the severity of attacks. Allergic rhinitis, chronic obstructive pulmonary disease, aspirin-induced asthma, pregnancy, asthma in athletes, and coughvariant asthma are also important issues that need to be considered.
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Affiliation(s)
- Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Masakazu Ichinose
- Department of Respiratory Disease, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hiroyuki Nagase
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Masao Yamaguchi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Disease, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kinki University School of Medicine, Osaka, Japan
| | - Kohei Yamauchi
- Division of Pulmonary Medicine, Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Iwate, Japan
| | - Mitsuru Adachi
- Department of Clinical Research Center, International University of Health and Welfare/Sanno Hospital, Tokyo, Japan
| | - Kazuo Akiyama
- National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
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Cysteinyl leukotriene receptor-1 antagonists as modulators of innate immune cell function. J Immunol Res 2014; 2014:608930. [PMID: 24971371 PMCID: PMC4058211 DOI: 10.1155/2014/608930] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 12/20/2022] Open
Abstract
Cysteinyl leukotrienes (cysLTs) are produced predominantly by cells of the innate immune system, especially basophils, eosinophils, mast cells, and monocytes/macrophages. Notwithstanding potent bronchoconstrictor activity, cysLTs are also proinflammatory consequent to their autocrine and paracrine interactions with G-protein-coupled receptors expressed not only on the aforementioned cell types, but also on Th2 lymphocytes, as well as structural cells, and to a lesser extent neutrophils and CD8+ cells. Recognition of the involvement of cysLTs in the immunopathogenesis of various types of acute and chronic inflammatory disorders, especially bronchial asthma, prompted the development of selective cysLT receptor-1 (cysLTR1) antagonists, specifically montelukast, pranlukast, and zafirlukast. More recently these agents have also been reported to possess secondary anti-inflammatory activities, distinct from cysLTR1 antagonism, which appear to be particularly effective in targeting neutrophils and monocytes/macrophages. Underlying mechanisms include interference with cyclic nucleotide phosphodiesterases, 5′-lipoxygenase, and the proinflammatory transcription factor, nuclear factor kappa B. These and other secondary anti-inflammatory mechanisms of the commonly used cysLTR1 antagonists are the major focus of the current review, which also includes a comparison of the anti-inflammatory effects of montelukast, pranlukast, and zafirlukast on human neutrophils in vitro, as well as an overview of both the current clinical applications of these agents and potential future applications based on preclinical and early clinical studies.
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Quirce S, Bobolea I, Barranco P. [Asthma: therapeutic update]. Med Clin (Barc) 2013; 142:317-22. [PMID: 24029450 DOI: 10.1016/j.medcli.2013.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 07/01/2013] [Accepted: 07/01/2013] [Indexed: 01/23/2023]
Affiliation(s)
- Santiago Quirce
- Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España.
| | - Irina Bobolea
- Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Pilar Barranco
- Servicio de Alergología, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, España
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12
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Laslovich SM, Laslovich JM. Exercise and Asthma. Strength Cond J 2013. [DOI: 10.1519/ssc.0b013e31829d232f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Parsons JP, Hallstrand TS, Mastronarde JG, Kaminsky DA, Rundell KW, Hull JH, Storms WW, Weiler JM, Cheek FM, Wilson KC, Anderson SD. An Official American Thoracic Society Clinical Practice Guideline: Exercise-induced Bronchoconstriction. Am J Respir Crit Care Med 2013; 187:1016-27. [DOI: 10.1164/rccm.201303-0437st] [Citation(s) in RCA: 370] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hayden ML, Stoloff SW, Colice GL, Ostrom NK, Eid NS, Parsons JP. Exercise-induced bronchospasm: a case study in a nonasthmatic patient. ACTA ACUST UNITED AC 2012; 24:19-23. [PMID: 22243677 PMCID: PMC3378720 DOI: 10.1111/j.1745-7599.2011.00691.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose To provide an overview of the clinical presentation, diagnosis, and management of exercise-induced bronchospasm (EIB) without underlying asthma. Data sources Case presentation and review of the EIB Landmark Survey. Conclusions EIB is a common and well-described occurrence in patients with asthma, as well as in patients with no overt respiratory condition. Treatment with a short-acting beta-agonist before starting exercise is effective, yet this treatment approach is underutilized in the majority of patients with asthma. Implications for practice This case highlights the implications of undermanaged EIB and the disconnect between healthcare provider recommendations and the beliefs and behaviors in patients with EIB. Inhaled short-acting beta-agonists can attenuate EIB in 80%–95% of patients and are effective during 2–3 h of exercise. Patients with a compromised level of physical activity because of EIB who do not respond to conventional treatment strategies should be referred to a respiratory specialist for diagnostic evaluation and confirmation of underlying asthma. Nurse practitioners should remain vigilant to identify untreated EIB and ensure that affected patients understand the condition and appropriate treatment options.
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Affiliation(s)
- Mary Lou Hayden
- University of Virginia, Charlottesville, Virginia 22908, USA.
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Küpper T, Goebbels K, Kennes LN, Netzer NC. Cromoglycate, reproterol, or both--what's best for exercise-induced asthma? Sleep Breath 2011; 16:1229-35. [PMID: 22198635 DOI: 10.1007/s11325-011-0638-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 12/14/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE International guidelines recommend short- (SABA) or long-acting b-agonists for the prevention of bronchoconstriction after exercise (EIB) in patients with exercise-induced asthma (EIA). However, other drugs are still in discussion for the prevention of EIB. We investigated the efficacy of a combination of inhaled sodium cromoglycate and the β-mimetic drug reproterol versus inhaled reproterol alone and both versus inhaled placebo in subjects with exercise-induced asthma (EIA). METHODS The study aimed to prove the preventive effect of a combination of 1-mg reproterol and 2-mg disodium cromoglycate (DSCG) and its single components vs. placebo, measuring the decrease of FEV1 after a standardized treadmill test in 11 patients with recorded EIA. The study medication was twice as high as those of drugs which are commercially available (e.g., Allergospasmin®, Aarane®). RESULTS The results revealed that the combination of reproterol and DSCG was significantly effective against a decrease of FEV1 after a standardized exercise challenge test (ECT) compared to placebo. The short-acting b-agonist reproterol alone had almost the same effectiveness as the combination of reproterol and DNCG. The difference between the combination with DNCG and reproterol alone was less than 10% and insignificant (p 0.48). DNCG alone did not show a difference in the effectiveness compared to placebo. CONCLUSION Prevention of EIA with the combination of reproterol and DSCG or with reproterol only is effective. An exclusive recommendation in favor of the combination cannot be given due to the low difference in the effectiveness versus reproterol alone. Due to the limited number of subjects and some probands showing protection under DSCG, it cannot be completely excluded that there is some preventive power of DSCG in individual cases.
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Affiliation(s)
- T Küpper
- Institute of Occupational and Social Medicine, RWTH Aachen University, Aachen, Germany
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Silva LOE, Silva PLD, Nogueira AMOC, Silva MB, Luz GCP, Narciso FV, Carvalho EMD, Cheik NC. Avaliação do broncoespasmo induzido pelo exercício avaliado pelo Peak Flow Meter em adolescentes obesos. REV BRAS MED ESPORTE 2011. [DOI: 10.1590/s1517-86922011000600004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Crianças e adolescentes com excesso de peso apresentam maior prevalência de broncoespasmo induzido pelo exercício (BIE), quando comparados a eutróficos. A espirometria e o peak flow meter são importantes métodos avaliativos da função pulmonar. Porém, a aplicabilidade do medidor do pico de fluxo expiratório (peak flow meter) na detecção do BIE em crianças e adolescentes com excesso de peso não é conhecida, o que justifica o desenvolvimento desta pesquisa. OBJETIVOS: Avaliar e comparar o desencadeamento de broncoespasmo induzido pelo exercício (BIE) em crianças e adolescentes não asmáticos com excesso de peso, avaliados pela espirometria e pelo peak flow meter (PFE). CASUÍSTICA E MÉTODOS: Participaram do estudo 39 voluntários acima do percentil 85º (OB) e 30 eutróficos (EU), de oito a 15 anos. A avaliação da função pulmonar pré e pós-teste de broncoprovocação foi realizada pela espirometria e peak flow meter, de acordo com o protocolo de Del Río-Navarro et al., (2000). O BIE foi considerado positivo quando o voluntário apresentou uma redução > 10% do VEF1 basal ou redução > 20% do PFE PFM e/ou PFE E. RESULTADOS: Na detecção do BIE, a prevalência do grupo obeso foi de 26% avaliado pelo peak flow meter (PFEPFM) e 23% pelo VEF1. O tempo do BIE ocorreu nos primeiros 15 minutos pós-exercício em ambos os parâmetros: (PFE PFM) e VEF1. CONCLUSÃO: Os voluntários obesos apresentaram tempo e prevalências similares de BIE, quando avaliados por ambos os métodos de avaliação pulmonar. O fácil manejo e o baixo custo facilitam a maior acessibilidade para a população geral do peak flow meter, o que demonstra sua importância como parte integrante de um programa educacional no diagnóstico inicial do BIE em vias aéreas de grande calibre.
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Finnoff JT, Willick S, Akau CK, Harrast MA, Storm SA. Sports and performing arts medicine: 4. Events coverage. PM R 2011; 1:S73-7. [PMID: 19627976 DOI: 10.1016/j.pmrj.2009.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This self-directed learning module highlights medical coverage of sports events and artistic performances. It is part of the study guide on sports and performing arts medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on performance anxiety, exercise-associated collapse, exercise-induced asthma, transient quadriparesis, stingers/burners and anterior glenohumeral joint dislocations. The goal of this article is to improve the learner's ability to formulate and implement an appropriate evaluation and treatment algorithm for certain conditions associated with sports and performing arts events.
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Affiliation(s)
- Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55902, USA.
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Pasaje CFA, Kim JH, Park BL, Cheong HS, Park TJ, Lee JS, Kim Y, Bae JS, Kim JM, Park JS, Park CS, Shin HD. Association of the variants in AGT gene with modified drug response in Korean aspirin-intolerant asthma patients. Pulm Pharmacol Ther 2011; 24:595-601. [PMID: 21624492 DOI: 10.1016/j.pupt.2011.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 12/17/2010] [Accepted: 05/14/2011] [Indexed: 11/30/2022]
Abstract
The angiotensinogen (AGT) gene enhances the effect of several bronchoconstrictors and produces a peptide that is accumulated in the airways of asthma patients; events that may underpin the pathogenesis of aspirin-intolerant asthma (AIA). To carry out a case-control analysis between AGT and aspirin-induced bronchospasm following treatment with an anti-asthma drug, montelukast (MLK), 38 single nucleotide polymorphisms (SNPs) in AGT were genotyped in 56 AIA cohort. Genotyping was performed with TaqMan assay and haplotypes were inferred using PHASE algorithm ver. 2.0. Statistical analyses of each SNPs and haplotypes were performed using SAS version 9.1. Among 13 variants displaying significant signals, two SNPs (+2401C>G and +2476C>T) in the intronic region of AGT were significantly associated with modification of drug response even after correction for multiple testing (P=0.0009-0.002; P(corr)=0.02-0.03). Furthermore, the two variants also exhibited associations with MLK response rate (P=0.0003-0.0006; P(corr)=0.006-0.01). Although our results are preliminary and further replication in a larger-scale group of subjects should be warranted, these observations provide evidence that AGT variants might be one of genetic factors involved in the response of anti-asthma drugs in AIA patients.
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Weiler JM, Anderson SD, Randolph C, Bonini S, Craig TJ, Pearlman DS, Rundell KW, Silvers WS, Storms WW, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Spector SL, Tilles SA, Wallace D, Henderson W, Schwartz L, Kaufman D, Nsouli T, Shieken L, Rosario N. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol 2011; 105:S1-47. [PMID: 21167465 DOI: 10.1016/j.anai.2010.09.021] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/26/2010] [Indexed: 02/06/2023]
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Asthma: Pathophysiology and Diagnosis. ASTHMA, HEALTH AND SOCIETY 2010. [PMCID: PMC7176227 DOI: 10.1007/978-0-387-78285-0_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although asthma is a common disorder affecting approximately 7.8% of the United States population (Schiller et al. 2006) or 23 million Americans, the pathogenesis of this disease remains to be fully elucidated. Extensive research over the last few decades has yielded a better understanding of asthma. We know that the basic features of asthma include episodic airways inflammation, airways hyperresponsiveness, and mucous hypersecretion. Although we understand the basic clinical features of asthma, the links between symptoms, physical signs, and underlying pathophysiological mechanisms are still being delineated. Asthma is a heterogeneous disease process with varying phenotypes and presentations. In this chapter, we will briefly explore some major theories of asthma pathogenesis, both new and old. We will also explore how understanding the pathophysiology of asthma can help us to understand the symptoms and presentation of asthma, as well as the best strategies for diagnosing this disease.
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Anderson SD, Charlton B, Weiler JM, Nichols S, Spector SL, Pearlman DS. Comparison of mannitol and methacholine to predict exercise-induced bronchoconstriction and a clinical diagnosis of asthma. Respir Res 2009; 10:4. [PMID: 19161635 PMCID: PMC2644668 DOI: 10.1186/1465-9921-10-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 01/23/2009] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Asthma can be difficult to diagnose, but bronchial provocation with methacholine, exercise or mannitol is helpful when used to identify bronchial hyperresponsiveness (BHR), a key feature of the disease. The utility of these tests in subjects with signs and symptoms of asthma but without a clear diagnosis has not been investigated. We investigated the sensitivity and specificity of mannitol to identify exercise-induced bronchoconstriction (EIB) as a manifestation of BHR; compared this with methacholine; and compared the sensitivity and specificity of mannitol and methacholine for a clinician diagnosis of asthma. METHODS 509 people (6-50 yr) were enrolled, 78% were atopic, median FEV1 92.5% predicted, and a low NAEPPII asthma score of 1.2. Subjects with symptoms of seasonal allergy were excluded. BHR to exercise was defined as a > or = 10% fall in FEV1 on at least one of two tests, to methacholine a PC20 < or = 16 mg/ml and to mannitol a 15% fall in FEV1 at < or = 635 mg or a 10% fall between doses. The clinician diagnosis of asthma was made on examination, history, skin tests, questionnaire and response to exercise but they were blind to the mannitol and methacholine results. RESULTS Mannitol and methacholine were therapeutically equivalent to identify EIB, a clinician diagnosis of asthma, and prevalence of BHR. The sensitivity/specificity of mannitol to identify EIB was 59%/65% and for methacholine it was 56%/69%. The BHR was mild. Mean EIB % fall in FEV1 in subjects positive to exercise was 19%, (SD 9.2), mannitol PD15 158 (CI:129,193) mg, and methacholine PC20 2.1(CI:1.7, 2.6) mg/ml. The prevalence of BHR was the same: for exercise (43.5%), mannitol (44.8%), and methacholine (41.6%) with a test agreement between 62 & 69%. The sensitivity and specificity for a clinician diagnosis of asthma was 56%/73% for mannitol and 51%/75% for methacholine. The sensitivity increased to 73% and 72% for mannitol and methacholine when two exercise tests were positive. CONCLUSION In this group with normal FEV1, mild symptoms, and mild BHR, the sensitivity and specificity for both mannitol and methacholine to identify EIB and a clinician diagnosis of asthma were equivalent, but lower than previously documented in well-defined populations. TRIAL REGISTRATION This was a multi-center trial comprising 25 sites across the United States of America.
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Affiliation(s)
- Sandra D Anderson
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050, Australia
| | - Brett Charlton
- Pharmaxis Ltd, 2/10 Rodborough Rd, Frenchs Forest, NSW 2086, Australia
| | - John M Weiler
- CompleWare Corporation, PO Box 3090, Iowa City, IA 52244-3090 and University of Iowa, Iowa City, IA 52242, USA
| | - Sara Nichols
- CompleWare Corporation, PO Box 3090, Iowa City, IA 52244-3090, USA
| | - Sheldon L Spector
- California Allergy and Asthma Medical Group, 11645 Wilshire Blvd., Ste. 1155, Los Angeles, CA 90025, USA
| | - David S Pearlman
- Colorado Allergy & Asthma Centers, PC, 125 Rampart Way, Suite 150, Denver, CO 80230-6405, USA
| | - A305 Study Group
- Colorado Allergy & Asthma Centers, PC, 125 Rampart Way, Suite 150, Denver, CO 80230-6405, USA
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Abstract
The main goals of this review are to help the reader to recognize the common symptoms and signs of exercise-induced asthma and the common objective tests used to confirm or rule out the diagnosis and to understand that different forms and intensities of exercise have different asthmagenicity. The review also aims to help the reader to recognize some of the theories of exercise-induced asthma's pathogenesis, to recognize management strategies (including medications), and to be able to identify medications placed on the 2008 prohibited list by the World Anti-Doping Agency and their therapeutic exemptions. It is also important to understand that respiratory symptoms associated with exercise are not necessarily asthma and that through safe participation in physical exercise, athletic asthmatics can excel in competitive sports.
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Abstract
This review will encompass definition, history, epidemiology, pathogenesis, diagnosis, and management of exercise -induced bronchospasm in the pediatric individual with and without known asthma. Exercise induced asthma is the conventional term for transient airway narrowing in a known asthma in association with strenuous exercise usually lasting 5-10 minutes with a decline in pulmonary function by at least 10%. Exercise induced asthma will be referred to as exercise induced bronchospasm in an asthmatic. Exercise-induced bronchospasm (EIB ) is the same phenomenon in an individual without known asthma. EIB can be seen in healthy individuals including children as well as defense recruits and competitive or elite athletes. The diagnosis with objective exercise challenge methods in conjunction with history is delineated. Management is characterized with pharmacotherapy and non pharmacotherapeutic measures for underlying asthma as well as exercise induced bronchospasm and inhalant allergy. Children can successfully participate in all sports if asthma is properly managed.
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Affiliation(s)
- Chris Randolph
- Center for Allergy, Asthma, Immunology, 1389 West Main Street, Suite 205, Waterbury, CT 06708, USA.
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Geyser MM, Rheeder P. Risk factors precipitating exacerbations in adult asthma patients presenting at Kalafong Hospital, Pretoria. S Afr Fam Pract (2004) 2008. [DOI: 10.1080/20786204.2008.10873743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Milgrom H, Dockhorn RJ. Management of Exercise-Induced Bronchospasm in Children:Role of Long-Acting β2-Adrenergic Receptor Agonists. ACTA ACUST UNITED AC 2008. [DOI: 10.1089/pai.2007.0023.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sorace P. Exercise, Athletes, and Allergies. Strength Cond J 2008. [DOI: 10.1519/ssc.0b013e3181638467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Weiler JM, Bonini S, Coifman R, Craig T, Delgado L, Capão-Filipe M, Passali D, Randolph C, Storms W. American Academy of Allergy, Asthma & Immunology Work Group report: exercise-induced asthma. J Allergy Clin Immunol 2007; 119:1349-58. [PMID: 17433829 DOI: 10.1016/j.jaci.2007.02.041] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 02/20/2007] [Indexed: 11/23/2022]
Affiliation(s)
- John M Weiler
- CompleWare Corporation, Iowa Clinical Research Corporation and Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
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Abstract
Considerable knowledge has accumulated in recent decades concerning the significance of physical activity in the treatment of a number of diseases, including diseases that do not primarily manifest as disorders of the locomotive apparatus. In this review we present the evidence for prescribing exercise therapy in the treatment of metabolic syndrome-related disorders (insulin resistance, type 2 diabetes, dyslipidemia, hypertension, obesity), heart and pulmonary diseases (chronic obstructive pulmonary disease, coronary heart disease, chronic heart failure, intermittent claudication), muscle, bone and joint diseases (osteoarthritis, rheumatoid arthritis, osteoporosis, fibromyalgia, chronic fatigue syndrome) and cancer, depression, asthma and type 1 diabetes. For each disease, we review the effect of exercise therapy on disease pathogenesis, on symptoms specific to the diagnosis, on physical fitness or strength and on quality of life. The possible mechanisms of action are briefly examined and the principles for prescribing exercise therapy are discussed, focusing on the type and amount of exercise and possible contraindications.
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Affiliation(s)
- B K Pedersen
- The Centre of Inflammation and Metabolism, Department of Infectious Diseases, Copenhagen, Denmark.
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Komarow HD, Postolache TT. Seasonal allergy and seasonal decrements in athletic performance. Clin Sports Med 2006; 24:e35-50, xiii. [PMID: 15892916 PMCID: PMC7119062 DOI: 10.1016/j.csm.2004.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Hirsh D Komarow
- Laboratory of Allergic Disease, National Institute of Allergy and Infectious Disease, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
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Abstract
Asthma presents special challenges to both the athletes who have it and to their health care providers. This article briefly reviews the problem of asthma--especially exercise-induced asthma--in the competitive athlete, and then describes treatments that are effective in controlling asthma. Drug-doping regulations are explained, as is the worldwide impact of drug doping on competitive athletes who have asthma. This review concludes with recommendations for competitive athletes and their health care providers regarding how to deal with asthma in this patient population.
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Affiliation(s)
- John M Weiler
- University of Iowa and CompleWare Corporation, Iowa City, IA, USA.
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Ngai SP, Hui-Chan CW, Jones AY. A Short Review of Acupuncture and Bronchial Asthma — Western and Traditional Chinese Medicine Concepts. Hong Kong Physiother J 2006. [DOI: 10.1016/s1013-7025(07)70006-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kunz LIZ, van Rensen ELJ, Sterk PJ. Inhaled hyaluronic acid against exercise-induced bronchoconstriction in asthma. Pulm Pharmacol Ther 2005; 19:286-91. [PMID: 16140028 DOI: 10.1016/j.pupt.2005.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2004] [Revised: 04/07/2005] [Accepted: 04/27/2005] [Indexed: 10/25/2022]
Abstract
Hyaluronic acid (HA) is a polysaccharide that is present in human tissues and body fluids. HA has various functions, including a barrier effect, water homeostasis, stabilizing the extracellular matrix, increased mucociliary clearance and elastin injury prevention. It may therefore exert prophylactic activity in the treatment of asthma. We tested the hypothesis that HA inhalation will prevent exercise-induced bronchoconstriction (EIB) in a randomised double-blinded placebo-controlled crossover study. Sixteen asthmatic patients with EIB were included in the study (mean (SD)) (age 24.5 (7.3) yr, FEV1 88.6 (11.3) %predicted, PC20 methacholine (g-mean (SD in DD)) 0.4 (1.5) mg/ml). On two separate visits an exercise challenge was performed 15 min post-inhalation of either HA (3 ml 0.1% in PBS) or placebo (3 ml PBS). The maximum fall in FEV1 and the AUC 30 min post-exercise were used as outcomes. After inhalation of both HA and placebo, baseline FEV1 decreased significantly (HA 4.1 (3.1)%, placebo 2.9 (4.1)%, P<0.017). The maximum fall in FEV1 following exercise challenge was not significantly different between HA versus placebo (median HA 22.50%, placebo 27.20%, P=0.379), as was the AUC (median HA 379.3 min*%fall, placebo 498.9 min*%fall, P=0.501). We conclude that at the current dose, inhaled HA does not significantly protect against EIB. This suggests that HA is not effective as a prophylaxis for EIB in patients with asthma.
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Affiliation(s)
- L I Z Kunz
- Department of Pulmonology, C3-P, Leiden University Medical Center, P.O. Box 9600, NL-2300 RC Leiden, Leiden, The Netherlands
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Role of leukotriene receptor antagonists in the treatment of exercise-induced bronchoconstriction: a review. Allergy Asthma Clin Immunol 2005; 1:60-4. [PMID: 20529226 PMCID: PMC2877068 DOI: 10.1186/1710-1492-1-2-60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Asthma is a very common disorder that still causes significant morbidity and mortality. A high percentage of individuals with asthma also experience exercise-induced bronchoconstriction (EIB). This article reviews the current literature and updates the reader on the safety, efficacy, and clinical applications of leukotriene modifiers in the treatment of EIB.
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