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He L, Norris C, Palaguachi-Lopez K, Barkjohn K, Li Z, Li F, Zhang Y, Black M, Bergin MH, Zhang JJ. Nasal oxidative stress mediating the effects of colder temperature exposure on pediatric asthma symptoms. Pediatr Res 2024:10.1038/s41390-024-03196-2. [PMID: 38605092 DOI: 10.1038/s41390-024-03196-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/18/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Colder temperature exposure is a known trigger for pediatric asthma exacerbation. The induction of oxidative stress is a known pathophysiologic pathway for asthma exacerbation. However, the role of oxidative stress in linking colder temperature exposure and worsened pediatric asthma symptoms is poorly understood. METHODS In a panel study involving 43 children with asthma, aged 5-13 years old, each child was visited 4 times with a 2-week interval. At each visit, nasal fluid, urine, and saliva samples were obtained and measured for biomarkers of oxidative stress in the nasal cavity (nasal malondialdehyde [MDA]), the circulatory system (urinary MDA), and the oral cavity (salivary MDA). Childhood Asthma-Control Test (CACT) was used to assess asthma symptoms. RESULTS When ambient daily-average temperature ranged from 7 to 18 °C, a 2 °C decrement in personal temperature exposures were significantly associated with higher nasal MDA and urinary MDA concentrations by 47-77% and 6-14%, respectively. We estimated that, of the decrease in child-reported CACT scores (indicating worsened asthma symptoms and asthma control) associated with colder temperature exposure, 14-57% were mediated by nasal MDA. CONCLUSION These results suggest a plausible pathway that colder temperature exposure worsens pediatric asthma symptoms partly via inducing nasal oxidative stress. IMPACT The role of oxidative stress in linking colder temperature exposure and worsened asthma symptoms is still poorly understood. Lower temperature exposure in a colder season was associated with higher nasal and systemic oxidative stress in children with asthma. Nasal MDA, a biomarker of nasal oxidative stress, mediated the associations between colder temperature exposures and pediatric asthma symptoms. The results firstly suggest a plausible pathway that colder temperature exposure worsens pediatric asthma symptoms partly via inducing oxidative stress in the nasal cavity.
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Affiliation(s)
- Linchen He
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, PA, USA.
| | - Christina Norris
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kimberly Palaguachi-Lopez
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, PA, USA
| | - Karoline Barkjohn
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, USA
- Current Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, Durham, NC, USA
| | - Zhen Li
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | | | - Michael H Bergin
- Department of Civil and Environmental Engineering, Duke University, Durham, NC, USA
| | - Junfeng Jim Zhang
- Nicholas School of the Environment, Duke University, Durham, NC, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Duke Kunshan University, Kunshan, Jiangsu, China.
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Chavoshian S, Cao X, Thommandram A, Stanbrook MB, Tarlo SM, Fossat Y, Yadollahi A. Designing and validating an experimental protocol to induce airway narrowing in older adults with and without asthma. Biomed Eng Online 2024; 23:28. [PMID: 38448963 PMCID: PMC10916193 DOI: 10.1186/s12938-023-01197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/20/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Persons with asthma may experience excessive airway narrowing due to exercise or exposure to cold air, worsening their daily functionality. Exercise has several benefits for asthma control, but it may induce airway narrowing in some persons with asthma. When combined with cold temperatures, it introduces another layer of challenges. Therefore, managing this interaction is crucial to increase the quality of life in individuals with asthma. The purpose of this study was to develop a reliable experimental protocol to assess the effects of exercise and cold air on airway narrowing in adults with asthma in a controlled and safe environment. METHODS This study was a randomized cross-over study in adults with and without asthma. Participants underwent a protocol involving a 10-min seated rest, followed by a 10-min cycling on a stationary bike in different temperatures of 0, 10, or 20 ∘ C. The sequence of room temperatures was randomized, and there was a 30-min interval for recovery between each temperature transition. In each temperature, to measure lung function and respiratory symptoms, oscillometry and a questionnaire were used at 0 min (baseline), after 10 min of sitting and before starting biking (pre-exercise), and after 10 min of biking (post-exercise). At each room temperature, the changes in airway mechanics and asthma symptoms among baseline, pre-exercise, and post-exercise were compared with one-way repeated measures ANOVA or Friedman Rank Test. Within each arm, cardiac and thoraco-abdominal motion respiration signals were also measured continuously using electrodes and calibrated respiratory inductance plethysmographs, respectively. RESULTS A total of 23 persons with asthma (11 females, age: 56.3 ± 10.9 years, BMI: 27.4 ± 5.7 kg/m2) and 6 healthy subjects (3 females, age: 61.8 ± 9.1 years, BMI: 28.5 ± 3.1 kg/m2) were enrolled in the study. Cold temperature of 0∘ C induced airway narrowing in those with and without asthma after 10 and 20 min, respectively. Exercise intervention had significant changes in airway narrowing in participants with asthma in the range of 10-20∘ C. Our results showed that in asthma, changes in subjective respiratory symptoms were due to both cold temperatures of 0 and 10∘ C and exercise in the 0-20∘ C range. Respiratory symptoms were not noticed among the healthy participants. CONCLUSION In conclusion, our findings suggest that exposure to cold temperatures of 0∘ C could serve as a reliable method in the experimental protocol for inducing airway narrowing in asthma. The impact of exercise on airway narrowing was more variable among participants. Understanding these triggers in the experimental protocol is essential for the successful management of asthma in future studies.
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Affiliation(s)
- Shaghayegh Chavoshian
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto, M5G 2A2, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, M5S 3G9, ON, Canada
| | - Xiaoshu Cao
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto, M5G 2A2, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, M5S 3G9, ON, Canada
| | - Anirudh Thommandram
- Labs Department, Klick Health, Klick Inc, 175 Bloor St. East, Toronto, M4W 3R8, ON, Canada
| | - Matthew B Stanbrook
- Department of Medicine, University of Toronto, 164 College St., Toronto, M5S 3G9, ON, Canada
- Department of Medicine, University Health Network Toronto Western Hospital, 399 Bathurst St., Toronto, M5T 2S8, ON, Canada
| | - Susan M Tarlo
- Department of Medicine, University of Toronto, 164 College St., Toronto, M5S 3G9, ON, Canada
- Department of Medicine, University Health Network Toronto Western Hospital, 399 Bathurst St., Toronto, M5T 2S8, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, M5T 1P8, ON, Canada
| | - Yan Fossat
- Labs Department, Klick Health, Klick Inc, 175 Bloor St. East, Toronto, M4W 3R8, ON, Canada
| | - Azadeh Yadollahi
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto, M5G 2A2, ON, Canada.
- Institute of Biomedical Engineering, University of Toronto, 164 College St., Toronto, M5S 3G9, ON, Canada.
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He L, Evans S, Norris C, Barkjohn K, Cui X, Li Z, Zhou X, Li F, Zhang Y, Black M, Bergin MH, Zhang J(J. Associations between personal apparent temperature exposures and asthma symptoms in children with asthma. PLoS One 2023; 18:e0293603. [PMID: 37956155 PMCID: PMC10642815 DOI: 10.1371/journal.pone.0293603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
Ambient temperature and relative humidity can affect asthma symptoms. Apparent temperature is a measure of temperature perceived by humans that takes into account the effect of humidity. However, the potential link between personal exposures to apparent temperature and asthma symptoms has not been investigated. We conducted a panel study of 37 asthmatic children, aged 5-11 years, during an early spring season (average daily ambient temperature: 14°C, range: 7-18°C). Asthma symptoms were measured 4 times for each participant with a 2-week interval between consecutive measurements using the Childhood Asthma-Control Test (C-ACT). Average, minimum, and maximum personal apparent temperature exposures, apparent temperature exposure variability (TV), and average ambient temperature were calculated for the 12 hours, 24 hours, week, and 2 weeks prior to each visit. We found that a 10°C lower in 1-week and 2-week average & minimum personal apparent temperature exposures, TV, and average ambient temperature exposures were significantly associated with lower total C-ACT scores by up to 2.2, 1.4, 3.3, and 1.4 points, respectively, indicating worsened asthma symptoms. Our results support that personal apparent temperature exposure is potentially a stronger driver than ambient temperature exposures for the variability in asthma symptom scores. Maintaining a proper personal apparent temperature exposure could be an effective strategy for personalized asthma management.
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Affiliation(s)
- Linchen He
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Shoshana Evans
- Department of Community and Population Health, College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - Christina Norris
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Karoline Barkjohn
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina, United States of America
- Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina, United States of America
| | - Xiaoxing Cui
- Nicholas School of the Environment, Duke University, Durham, North Carolina, United States of America
| | - Zhen Li
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojian Zhou
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Li
- Department of Pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinping Zhang
- Department of Building Science, Tsinghua University, Beijing, China
- Beijing Key Laboratory of Indoor Air Quality Evaluation and Control, Beijing, China
| | - Marilyn Black
- Underwriters Laboratories, Inc, Marietta, Georgia, United States of America
| | - Michael H. Bergin
- Department of Civil and Environmental Engineering, Duke University, Durham, North Carolina, United States of America
| | - Junfeng (Jim) Zhang
- Nicholas School of the Environment, Duke University, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Kunshan University, Kunshan, Jiangsu Province, China
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Kennedy MD, Lenz E, Niedermeier M, Faulhaber M. Are Respiratory Responses to Cold Air Exercise Different in Females Compared to Males? Implications for Exercise in Cold Air Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186662. [PMID: 32933124 PMCID: PMC7559764 DOI: 10.3390/ijerph17186662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 11/24/2022]
Abstract
Research has shown that cold air exercise causes significant respiratory dysfunction, especially in female athletes. However, how female and male athletes respond to cold air exercise is not known. Thus, we aimed to compare acute respiratory responses (function, recovery and symptoms) in males and females after high-intensity cold air exercise. Eighteen (nine female) athletes completed two environmental chamber running trials at 0 °C and −20 °C (humidity 34 ± 5%) on different days in a randomized starting order. Spirometry was performed pre, 3, 6, 10, 15 and 20 min post. Respiratory symptoms were measured posttrial and heart rate and rating of perceived exertion were assessed during each trial. No significant differences in delta change (pre to post) were found at either temperature between sexes for FEV1, FVC, FEF50% and FEF25–75%. At −20 °C, FEV1 decreased similarly in both sexes (males: 7.5%, females: 6.3%) but not at 0 °C, p = 0.003. Postexertion respiratory function recovery and reported symptoms were not different between sexes at either temperature. These results indicate no sex-based differences in acute respiratory responses (function, recovery and symptoms) to cold air exercise. However, intense exercise at −20 °C is challenging to the respiratory system in both sexes and may lead to altered respiratory responses compared to mild winter conditions like 0 °C.
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Affiliation(s)
- Michael D. Kennedy
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada;
| | - Elisabeth Lenz
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (E.L.); (M.F.)
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (E.L.); (M.F.)
- Correspondence:
| | - Martin Faulhaber
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (E.L.); (M.F.)
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Hanstock HG, Ainegren M, Stenfors N. Exercise in Sub-zero Temperatures and Airway Health: Implications for Athletes With Special Focus on Heat-and-Moisture-Exchanging Breathing Devices. Front Sports Act Living 2020; 2:34. [PMID: 33345026 PMCID: PMC7739679 DOI: 10.3389/fspor.2020.00034] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 03/18/2020] [Indexed: 12/15/2022] Open
Abstract
Asthma is highly prevalent among winter endurance athletes. This "occupational disease" of cross-country skiers, among others, was acknowledged during the 1990s, with the pathogenesis attributed to repeated and prolonged exposure to cold, dry air combined with high rates of ventilation during exercise. Nevertheless, more than 25 years later, the prevalence of asthma among Scandinavian cross-country skiers is unchanged, and prevention remains a primary concern for sports physicians. Heat-and-moisture-exchanging breathing devices (HMEs) prevent exercise-induced bronchoconstriction in subjects with pre-existing disease and may have potential as a preventative intervention for healthy athletes undertaking training and competition in winter endurance sports. Herein we firstly provide an overview of the influence of temperature and humidity on airway health and the implications for athletes training and competing in sub-zero temperatures. We thereafter describe the properties and effects of HMEs, identify gaps in current understanding, and suggest avenues for future research.
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Affiliation(s)
- Helen G Hanstock
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
| | - Mats Ainegren
- Sports Tech Research Centre, Department of Quality Management and Mechanical Engineering, Mid Sweden University, Östersund, Sweden
| | - Nikolai Stenfors
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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6
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Frischhut C, Kennedy MD, Niedermeier M, Faulhaber M. Effects of a heat and moisture exchanger on respiratory function and symptoms post-cold air exercise. Scand J Med Sci Sports 2019; 30:591-601. [PMID: 31755166 PMCID: PMC7027737 DOI: 10.1111/sms.13603] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/24/2019] [Accepted: 11/11/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Exercise at temperatures below -15°C induces drying and cooling of lung airways which causes exercise-induced bronchoconstriction (EIB) and respiratory symptoms, especially in winter sport athletes. The objective of this study was to evaluate whether a heat and moisture exchanger (HME) worn during intense cold air exercise improves lung function and reduces respiratory symptoms in healthy winter sport athletes. METHODS Seven active males and six active females (maximum oxygen uptake 61.9 ± 6.9 and 52.2 ± 5.3 mL/kg/min), all active or former winter sport athletes, completed running trials with and without HME in random order on 2 days in an environmental chamber (-20°C temperature, humidity 46.2%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1 ), forced expiratory flow at 25%-75% (FEF25%-75% ), and FEF at 50% (FEF50% ) were measured pre- and post-exercise (3, 6, 10, 15, and 20 minutes). Respiratory symptoms were reported after exercise. RESULTS Significant interaction effects were observed for FEV1 and FEF25%-75% . Mean decrease of FVC (-5.9%, P ≤ .001) and FEV1 (-4.2%, P = .003) was largest 3 minutes post-exercise without HME. There was an increase of FEV1 , FEF25%-75% , and FEF50% post-exercise compared to pre-exercise with HME. More respiratory symptoms overall were reported without HME (P = .046). CONCLUSION Intense cold air exercise likely causes transient acute bronchoconstriction and symptoms of cough in individuals participating in winter sports. However, this study finds that the application of an HME during intense cold air exercise improves lung function and reduces prevalence of EIB-associated symptoms compared to unprotected intense cold air exercise.
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Affiliation(s)
- Clemens Frischhut
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Michael D Kennedy
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Martin Faulhaber
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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7
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Zeiger RS. Allergic and Nonallergic Rhinitis. Classification and Pathogenesis: Part II. Nonallergic Rhinitis. ACTA ACUST UNITED AC 2018. [DOI: 10.2500/105065889782009705] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Part I of this review classified and defined the causes of chronic rhinitis, describing in detail the etiology and pathophysiology of allergic rhinitis. Part II focuses on the nonallergic (non-IgE) causes of chronic rhinitis, concentrating on their clinical presentations, differential characteristics, and known or speculative pathophysiology. A comprehensive understanding of the allergic and nonallergic conditions associated with symptomatic rhinitis should aid the clinician in the appropriate diagnosis and treatment of patients with chronic rhinitis.
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Affiliation(s)
- Robert S. Zeiger
- Department of Allergy-Immunology, Kaiser Permanente Medical Center; University of California, San Diego, San Diego, San Diego, CA
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8
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Kennedy MD, Faulhaber M. Respiratory Function and Symptoms Post Cold Air Exercise in Female High and Low Ventilation Sport Athletes. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:43-51. [PMID: 29178677 PMCID: PMC5705483 DOI: 10.4168/aair.2018.10.1.43] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/19/2017] [Accepted: 07/31/2017] [Indexed: 12/04/2022]
Abstract
Purpose Cold weather exercise is common in many regions of the world; however, it is unclear whether respiratory function and symptom worsen progressively with colder air temperatures. Furthermore, it is unclear whether high-ventilation sport background exacerbates dysfunction and symptoms. Methods Seventeen active females (measure of the maximum volume of oxygen [VO2max]: 49.6±6.6 mL·kg-1·min-1) completed on different days in random order 5 blinded running trials at 0℃, -5℃, -10℃, -15℃, and -20℃ (humidity 40%) in an environmental chamber. Distance, heart rate, and rating of perceived exertion (RPE) were measured within each trial; forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory flow at 25%-75% (FEF25-75), and forced expiratory flow at 50% (FEF50) were measured pre- and post-test (3, 6, 10, 15, and 20 minutes). Respiratory symptoms and global effort were measured post-test spirometry. Results Mean decreases were found in FEV1 (4%-5% at 0℃, -5℃, -10℃, and -15℃; 7% at -20℃). FEF25-75 and FEF50 decreased 7% and 11% at -15℃ and -20℃, respectively. Post-exertion spirometry results were decreased most at 3 to 6 minutes, recovering back to baseline at 20 minutes. Respiratory symptoms and global effort significantly increased at -15℃ and -20℃ with decreased heart rate. High-ventilation sports decreased function more than low-ventilation participants but had fewer symptoms. Conclusions These results indicate that intense exercise at cold air temperatures up to -20℃ is achievable; however, greater effort along with transient acute bronchoconstriction and symptoms of cough after exercising in temperatures colder than -15℃ are likely. It is recommended that individuals cover their mouth and reduce exercise intensity to ameliorate the effects of cold weather exercise.
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Affiliation(s)
- Michael D Kennedy
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada.
| | - Martin Faulhaber
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
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Eucapnic Voluntary Hyperpnea: Gold Standard for Diagnosing Exercise-Induced Bronchoconstriction in Athletes? Sports Med 2017; 46:1083-93. [PMID: 27007599 PMCID: PMC4963444 DOI: 10.1007/s40279-016-0491-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In athletes, a secure diagnos
is of exercise-induced bronchoconstriction (EIB) is dependent on objective testing. Evaluating spirometric indices of airflow before and following an exercise bout is intuitively the optimal means for the diagnosis; however, this approach is recognized as having several key limitations. Accordingly, alternative indirect bronchoprovocation tests have been recommended as surrogate means for obtaining a diagnosis of EIB. Of these tests, it is often argued that the eucapnic voluntary hyperpnea (EVH) challenge represents the ‘gold standard’. This article provides a state-of-the-art review of EVH, including an overview of the test methodology and its interpretation. We also address the performance of EVH against the other functional and clinical approaches commonly adopted for the diagnosis of EIB. The published evidence supports a key role for EVH in the diagnostic algorithm for EIB testing in athletes. However, its wide sensitivity and specificity and poor repeatability preclude EVH from being termed a ‘gold standard’ test for EIB.
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Arakawa H, Hamasaki Y, Kohno Y, Ebisawa M, Kondo N, Nishima S, Nishimuta T, Morikawa A. Japanese guidelines for childhood asthma 2017. Allergol Int 2017; 66:190-204. [PMID: 28108245 DOI: 10.1016/j.alit.2016.11.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 10/20/2022] Open
Abstract
The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2017 (JAGL 2017) includes a minor revision of the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012 (JPGL 2012) by the Japanese Society of Pediatric Allergy and Clinical Immunology. The section on child asthma in JAGL 2017 provides information on how to diagnose asthma between infancy and adolescence (0-15 years of age). It makes recommendations for best practices in the management of childhood asthma, including management of acute exacerbations and non-pharmacological and pharmacological management. This guideline will be of interest to non-specialist physicians involved in the care of children with asthma. JAGL differs from the Global Initiative for Asthma Guideline in that JAGL emphasizes diagnosis and early intervention of children with asthma at <2 years or 2-5 years of age. The first choice of treatment depends on the severity and frequency of symptoms. Pharmacological management, including step-up or step-down of drugs used for long-term management based on the status of asthma control levels, is easy to understand; thus, this guideline is suitable for the routine medical care of children with asthma. JAGL also recommends using a control test in children, so that the physician aims for complete control by avoiding exacerbating factors and appropriately using anti-inflammatory drugs (for example, inhaled corticosteroids and leukotriene receptor antagonists).
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Bhandari SS, Koirala P, Lohani S, Phuyal P, Basnyat B. Breathlessness at High Altitude: First Episode of Bronchoconstriction in an Otherwise Healthy Sojourner. High Alt Med Biol 2017; 18:179-181. [PMID: 28398844 DOI: 10.1089/ham.2017.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bhandari, Sanjeeb Sudarshan, Pranawa Koirala, Sadichhya Lohani, Pratibha Phuyal, and Buddha Basnyat. Breathlessness at high altitude: first episode of bronchoconstriction in an otherwise healthy sojourner. High Alt Med Biol.. 18:179-181, 2017-High-altitude illness is a collective term for less severe acute mountain sickness and more severe high-altitude pulmonary edema (HAPE) and high-altitude cerebral edema, which we can experience while traveling to high altitude. These get better when we get down to the lower altitudes. People with many comorbidities also have been traveling to high altitudes from the dawn of civilization. Obstructive airway diseases can be confused with HAPE at high altitude. Asthma is one of those obstructive pulmonary diseases, but it is shown to get better with travel to the altitudes higher than the residing altitude. We present a case of 55-year-old nonsmoker, athletic, female, a lowland resident who developed difficulty breathing for the first time at high altitude. She did not get better with the descent to lower altitude and timely intake of acetazolamide. Her pulmonary function test showed obstructive airway pattern, which got better with salbutamol/ipratropium nebulization and oxygen.
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Affiliation(s)
| | - Pranawa Koirala
- 2 Mountain Medicine Society of Nepal, VT Carilion Clinic , Roanoke, Virginia
| | - Sadichhya Lohani
- 3 Mountain Medicine Society of Nepal, William Beaumont Hospital , Royal Oak, Michigan
| | - Pratibha Phuyal
- 4 Mountain Medicine Society of Nepal, Saint Vincent Medical Center , Bridgeport, Connecticut
| | - Buddha Basnyat
- 5 Oxford University Clinical Research Unit-Nepal, Centre for Tropical Medicine and Global Health, University of Oxford , Oxford, United Kingdom .,6 Nepal International Clinic , Kathmandu, Nepal
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Mediano O, Casitas R, Villasante C, Martínez-Cerón E, Galera R, Zamarrón E, García-Río F. Dynamic hyperinflation in patients with asthma and exercise-induced bronchoconstriction. Ann Allergy Asthma Immunol 2017; 118:427-432. [PMID: 28214133 DOI: 10.1016/j.anai.2017.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/17/2016] [Accepted: 01/06/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the behavior of operative lung volumes during exercise in patients with asthma and exercise-induced bronchoconstriction (EIB). OBJECTIVE To compare the presence of dynamic hyperinflation (DH) in patients with mild asthma with and without EIB and in healthy individuals and to relate the changes in end-expiratory lung volume (EELV) with postexercise airflow reduction. METHODS A total of 122 consecutive stable patients (>12 years of age) with mild asthma and 38 controls were studied. Baseline lung volumes were measured, and all patients performed an exercise bronchial challenge. At each minute of exercise, EELV and end-inspiratory lung volume (EILV) were estimated from inspiratory capacity measurements to align the tidal breathing flow-volume loops to within the maximal expiratory curve. RESULTS DH was more frequent in patients with asthma and EIB (76%) than in patients with asthma but without EIB (11%) or controls (18%). The EELV increased in patients with asthma and EIB and decreased in patients with asthma without EIB and controls during exercise. In the patients with asthma, the decrease in forced expiratory volume in 1 second after the exercise challenge correlated with age (r = -0.179, P = .05), baseline forced vital capacity (r = 0.255, P = .005), EELV increase (r = 0.447, P < .001), and EILV increase (r = 0.246, P = .007). Age, baseline forced vital capacity, and magnitude of DH were retained as independent predictors of EIB intensity. CONCLUSION In patients with asthma and EIB, the development of DH is very frequent and related to the intensity of postexercise bronchoconstriction. This finding could implicate DH in the development of EIB.
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Affiliation(s)
- Olga Mediano
- Respiratory Diseases Section, Guadalajara University Hospital, Guadalajara, Spain
| | - Raquel Casitas
- Respiratory Diseases Department, La Paz University Hospital, Madrid, Spain; CIBER of Respiratory Diseases, Madrid, Spain
| | - Carlos Villasante
- Respiratory Diseases Department, La Paz University Hospital, Madrid, Spain; CIBER of Respiratory Diseases, Madrid, Spain
| | - Elisabet Martínez-Cerón
- Respiratory Diseases Department, La Paz University Hospital, Madrid, Spain; CIBER of Respiratory Diseases, Madrid, Spain
| | - Raúl Galera
- Respiratory Diseases Department, La Paz University Hospital, Madrid, Spain; CIBER of Respiratory Diseases, Madrid, Spain
| | - Ester Zamarrón
- Respiratory Diseases Department, La Paz University Hospital, Madrid, Spain
| | - Francisco García-Río
- Respiratory Diseases Department, La Paz University Hospital, Madrid, Spain; CIBER of Respiratory Diseases, Madrid, Spain; Autonoma University of Madrid, Madrid, Spain.
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Anderson SD. 'Indirect' challenges from science to clinical practice. Eur Clin Respir J 2016; 3:31096. [PMID: 26908255 PMCID: PMC4764958 DOI: 10.3402/ecrj.v3.31096] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/25/2016] [Indexed: 12/17/2022] Open
Abstract
Indirect challenges act to provoke bronchoconstriction by causing the release of endogenous mediators and are used to identify airway hyper-responsiveness. This paper reviews the historical development of challenges, with exercise, eucapnic voluntary hyperpnoea (EVH) of dry air, wet hypertonic saline, and with dry powder mannitol, that preceded their use in clinical practice. The first challenge developed for clinical use was exercise. Physicians were keen for a standardized test to identify exercise-induced asthma (EIA) and to assess the effect of drugs such as disodium cromoglycate. EVH with dry air became a surrogate for exercise to increase ventilation to very high levels. A simple test was developed with EVH and used to identify EIA in defence force recruits and later in elite athletes. The research findings with different conditions of inspired air led to the conclusion that loss of water by evaporation from the airway surface was the stimulus to EIA. The proposal that water loss caused a transient increase in osmolarity led to the development of the hypertonic saline challenge. The wet aerosol challenge with 4.5% saline, provided a known osmotic stimulus, to which most asthmatics were sensitive. To simplify the osmotic challenge, a dry powder of mannitol was specially prepared and encapsulated. The test pack with different doses and an inhaler provided a common operating procedure that could be used at the point of care. All these challenge tests have a high specificity to identify currently active asthma. All have been used to assess the benefit of treatment with inhaled corticosteroids. Over the 50 years, the methods for testing became safer, less complex, and less expensive and all used forced expiratory volume in 1 sec to measure the response. Thus, they became practical to use routinely and were recommended in guidelines for use in clinical practice.
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Affiliation(s)
- Sandra D Anderson
- Sydney Medical School, Central Clinical School, University of Sydney, Sydney, NSW, Australia;
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Kennedy MD, Davidson WJ, Wong LE, Traves SL, Leigh R, Eves ND. Airway inflammation, cough and athlete quality of life in elite female cross-country skiers: A longitudinal study. Scand J Med Sci Sports 2015; 26:835-42. [PMID: 26283581 DOI: 10.1111/sms.12527] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2015] [Indexed: 01/04/2023]
Abstract
The aim of this study was to investigate the effect of a season of cross-country training and racing on airway inflammation, cough symptoms, and athlete quality of life in female skiers. Eighteen elite female skiers performed sputum induction and completed the Leicester Cough Questionnaire (LCQ) and the Recovery-Stress Questionnaire (REST-Q) at three time points (T1 - May/Jun, T2 - Oct/Nov, T3 - Jan-Mar) during the year. No changes were observed between T1 and T2. However, an increase in sputum eosinophils and lymphocytes (P < 0.05) and a significant change in all three domains of the LCQ were observed between T1 and T3 (P < 0.05). A significant association was found between the total yearly hours of training and the change in the total cell count (r(2) = 0.74; P = 0.006), and a number of other sputum cell counts between T1 and T3. No changes were observed for any domain of the REST-Q. The results of this study demonstrate that airway inflammation and cough symptoms are significantly increased in elite female cross-country skiers across a year of training and racing. The increase in airway inflammation is related to the total amount of training and is worse during the winter months when athletes are training and racing in cold, dry air.
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Affiliation(s)
- M D Kennedy
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - W J Davidson
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - L E Wong
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
| | - S L Traves
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R Leigh
- Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - N D Eves
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, British Columbia, Canada
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Hamasaki Y, Kohno Y, Ebisawa M, Kondo N, Nishima S, Nishimuta T, Morikawa A. Japanese Guideline for Childhood Asthma 2014. Allergol Int 2015; 63:335-356. [PMID: 25178176 DOI: 10.2332/allergolint.14-rai-0767] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Indexed: 11/20/2022] Open
Abstract
The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2013 (JAGL 2013) describes childhood asthma after the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012 (JPGL 2012) by the Japanese Society of Pediatric Allergy and Clinical Immunology. JAGL 2013 provides information on diagnosis by age group from infancy to puberty (0-15 years of age), treatment for acute exacerbations, long-term management by anti-inflammatory drugs, daily life guidance, and patient education to allow non-specialist physicians to refer to this guideline for routine medical treatment. JAGL differs from the Global Initiative for Asthma Guideline (GINA) in that JAGL emphasizes early diagnosis and intervention at <2 years and 2-5 years of age. A management method, including step-up or step-down of long-term management drugs based on the status of asthma control levels, as in JAGL, is easy to understand, and thus the Guideline is suitable as a frame of reference for routine medical treatment. JAGL has also introduced treatment and management using a control test on children, recommending that the physician aim at complete control by avoiding exacerbation factors and by appropriate use of anti-inflammatory drugs.
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Affiliation(s)
- Yuhei Hamasaki
- Department of Pediatrics, Faculty of Medicine, Saga University, Saga, Japan
| | | | - Motohiro Ebisawa
- Department of Allergy, Clinical Research Center for Allergology and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Kanagawa, Japan
| | - Naomi Kondo
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Sankei Nishima
- National Hospital Organization, Fukuoka National Hospital, Fukuoka, Japan
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Triki M, Rebai H, Aouichaoui C, Shamssain M, Masmoudi K, Fellmann N, Zouari H, Zouari N, Tabka Z. Comparative Study of Bronchial Hyperresponsiveness Between Football and Judo Groups in Prepubertal Boys. Asian J Sports Med 2015; 6:e24043. [PMID: 26448837 PMCID: PMC4592761 DOI: 10.5812/asjsm.6(2)2015.24043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 12/09/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Exercise induced bronchospasm (EIB) commonly occurs during exercise. The comparative effects of different sports on airway responsiveness among prepubertal boys remain to be determined. OBJECTIVES To assess differences in post exercise spirometry between footballers, judokas and a control group in prepubertal boys. PATIENTS AND METHODS A total of ninety six prepubertal boys were studied. Bronchial hyper responsiveness (BHR) to exercise challenge test was defined by a diagnosis of baseline spirometry, followed by an incremental exercise test. To date, the best test to confirm EIB may simply be standard pulmonary function testing before and after high-intensity exercise. A 10% or greater post-challenge fall in forced expiratory volume in FEV1 is used as a diagnostic criterion. RESULTS There was no significant difference in baseline spirometry between all groups (P > 0.05). The post exercise spirometry test revealed the presence of EIB in 16 of 32 (50%) footballers against 9 out of 32 (28.12%) in both judokas and control subjects at 5 min after the exercise. Also, there was a significantly higher decrease (P < 0.05) in mean FEV1 at 5 minuts in footballers (-9.60 ± 6.18) compared to judokas (-5.41 ± 5.85). CONCLUSIONS The footballers have more BHR than judokas, especially at 5min after the exercise. This may be due to prolonged hyperventilation, atopy and increased exposure to inhaled allergens and pollutants during training and competition.
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Affiliation(s)
- Moez Triki
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
| | - Haithem Rebai
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
| | - Chirine Aouichaoui
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
| | - Mohammed Shamssain
- Division School of Health Sciences, Darwin Building, University of Sunderland, Sunderland, UK
| | | | - Nicole Fellmann
- Laboratory of Sports Physiology and Biology, Faculty of medicine, University of Auvergne, Clermont-Ferrand, France
- G. Montpied Hospital, Clermont-Ferrand, France
| | - Hela Zouari
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
| | - Nouri Zouari
- Bourguiba Hospital of Sfax, University of Sfax, Sfax, Tunisia
| | - Zouhair Tabka
- Department of Physiology and Lung Function Testing, Faculty of Medicine, University of Sousse, Soussa, Tunisia
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What makes a difference in exercise-induced bronchoconstriction: an 8 year retrospective analysis. PLoS One 2014; 9:e87155. [PMID: 24498034 PMCID: PMC3907485 DOI: 10.1371/journal.pone.0087155] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 12/18/2013] [Indexed: 11/19/2022] Open
Abstract
Background Exercise-induced bronchoconstriction (EIB) was recently classified into EIB alone and EIB with asthma, based on the presence of concurrent asthma. Objective Differences between EIB alone and EIB with asthma have not been fully described. Methods We retrospectively reviewed who visited an allergy clinic for respiratory symptoms after exercise and underwent exercise bronchial provocation testing. More than a 15% decrease of forced expiratory volume in 1 second (FEV1) from baseline to the end of a 6 min free-running challenge test was interpreted as positive EIB. Results EIB was observed in 66.9% of the study subjects (89/133). EIB-positive subjects showed higher positivity to methacholine provocation testing (61.4% vs. 18.9%, p<0.001) compared with EIB-negative subjects. In addition, sputum eosinophilia was more frequently observed in EIB-positive subjects than in EIB-negative subjects (56% vs. 23.5%, p = 0.037). The temperature and relative humidity on exercise test day were significantly related with the EIB-positive rate. Positive EIB status was correlated with both temperature (p = 0.001) and relative humidity (p = 0.038) in the methacholine-negative EIB group while such a correlation was not observed in the methacholine-positive EIB group. In the methacholine-positive EIB group the time to reach a 15% decrease in FEV1 during exercise was significantly shorter than that in the methacholine-negative EIB group (3.2±0.7 min vs. 8.6±1.6 min, p = 0.004). Conclusions EIB alone may be a distinct clinical entity from EIB with asthma. Conditions such as temperature and humidity should be considered when performing exercise tests, especially in subjects with EIB alone.
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Chang CC, Incaudo GA, Gershwin ME. Sinusitis, Rhinitis, Asthma, and the Single Airway Hypothesis. DISEASES OF THE SINUSES 2014. [PMCID: PMC7121820 DOI: 10.1007/978-1-4939-0265-1_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The one airway, one disease hypothesis proposes that the upper and lower airways share the same physiology and histomorphology. Epidemiological clinical studies support a link between rhinosinusitis and asthma. The relationship can occur in both directions, with nasal allergen challenge leading to inflammatory changes in the lower airway and bronchoprovocation studies of the lower airway leading to inflammatory changes in the upper airway. In addition, both similarities and differences exist in the pathogenesis of nasal polyps and asthma. The mechanism for the connection between the upper and lower airways is a matter of great debate. It has been proposed that inflammatory changes in the lower airway may lead to systemic inflammatory effects that play a role in increased bronchial hyperresponsiveness. Similarly, lower airway inflammatory changes may affect nasal airway patency via systemic effects. Moreover, nasopharyngeal-bronchial reflexes may play a non-immunologic role in the interaction between the lower and upper airways. An example of the connection between the upper and lower airways is found in aspirin-exacerbated respiratory disease whereby leukotrienes play a role in the pathology of chronic rhinosinusitis with polyps and asthma. It is also been observed that the treatment of asthma is hindered by untreated rhinosinusitis.
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Affiliation(s)
- Christopher C. Chang
- Division of Allergy and Immunology, Department of Pediatrics, Thomas Jefferson University, Wilmington, Delaware USA
| | - Gary A. Incaudo
- Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
| | - M. Eric Gershwin
- The Jack and Donald Chia Distinguished Professor of Medicine, Division of Rheumatology, Allergy and Clinical Immunology, University of California School of Medicine, Davis, California USA
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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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Godfrey S, Fitch KD. Exercise-induced bronchoconstriction: celebrating 50 years. Immunol Allergy Clin North Am 2013; 33:283-97, vii. [PMID: 23830125 DOI: 10.1016/j.iac.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article examines in detail the history of more than half a century of investigations into elucidating the causation of exercise-induced bronchoconstriction. Despite earnest attempts by many researchers from many countries, answers to some pivotal questions await the next generation of investigators into exercise-induced bronchoconstriction.
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Ali Z, Norsk P, Ulrik CS. Mechanisms and management of exercise-induced asthma in elite athletes. J Asthma 2012; 49:480-6. [PMID: 22515573 DOI: 10.3109/02770903.2012.676123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE AND METHODS Asthma is often reported by elite athletes, especially endurance athletes. The aim of this article is to review current knowledge of mechanisms and management of exercise-induced asthma (EIA) in adult elite athletes. RESULTS The mechanisms underlying EIA is incompletely understood, but the two prevailing hypotheses are the hyper-osmolarity and the thermal hypothesis. Both hypotheses consider inflammation and activation of mast cells as being crucial for the development of EIA, although the assumed mechanisms triggering the inflammatory response differ. Objective testing is of utmost importance in the diagnosis of EIA in elite athletes. Management of EIA can be divided into pharmacologic and non-pharmacologic treatment. The basic principles for the treatment of EIA in elite athletes should be as for any asthmatic individual, including use of inhaled corticosteroids (ICS), β(2)-agonists, and leukotriene antagonists. However, evidence suggests that daily use of β(2)-agonists might lead to the development of tolerance. ICS therapy is, due to its anti-inflammatory effects, the recommended primary therapy for EIA also in elite athletes. All doctors treating individuals with asthma, especially elite athletes, should remain updated on doping aspects of asthma therapy. Non-pharmacologic management of EIA in elite athletes includes physical warm-up, which takes advantage of the refractory period following an attack of EIA, whereas high intake of antioxidants may reduce airway inflammation. Wearing heat masks, specially designed for outdoor winter athletes, might protect against bronchoconstriction triggered by inhalation of cold and dry air. CONCLUSION EIA in elite athletes should be managed as in any individual with asthma, but the risk of developing tolerance to bronchodilators as well as doping aspects should always be taken into account.
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Affiliation(s)
- Zarqa Ali
- University of Copenhagen, Copenhagen, Denmark
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Ouattara S, Balayssac-Siransy A, Konaté A, Tuo N, Keita M, Dah C, Bogui P. Bronchospasme induit par l’exercice chez des sportifs de compétition en milieu tropical humide. Sci Sports 2012. [DOI: 10.1016/j.scispo.2011.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Benarab-Boucherit Y, Mehdioui H, Nedjar F, Delpierre S, Bouchair N, Aberkane A. Prevalence rate of exercise-induced bronchoconstriction in Annaba (Algeria) schoolchildren. J Asthma 2011; 48:511-6. [PMID: 21548836 DOI: 10.3109/02770903.2011.578315] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND We studied the prevalence rate of exercise-induced bronchoconstriction (EIB) in Annaba schoolchildren. No previous assessment of this syndrome had ever been done in Algeria. METHODS EIB was evaluated using the 6 min free running test (6MFRT) on 286 children, 87.4% of whom were 10-12 years old. They performed the test in the morning, during the autumn-winter season. Peak expiratory flow rate (PEFR) was measured before, and then 5 and 10 min after the 6MFRT, a 15% or more decrease in post-exercise PEFR being defined as significant. RESULTS EIB was much more frequent in asthmatic than in nonasthmatic children (47.0% vs. 13.9%, p < .001) and the drop in PEFR was more marked among the former. EIB was observed more often in a cool temperature (<8°C). There were relatively more children who were either eutrophic or overweight among those presenting an EIB. Past histories of nocturnal wheezing and rhinoconjunctivitis presented respectively the best specificity (96.7%) and sensitivity (84.8%). Children of unemployed workers presented the highest occurrence of EIB. Passive smoking appeared as the only factor being related to EIB among the indoor pollutants. The prevalence rate of asthma (6.7%) was higher than in a previous cross-sectional epidemiological survey study performed in the Maghreb. The prevalence rate of EIB (13.9%) was situated in the upper range of the results given worldwide. CONCLUSIONS These features of a fairly high bronchial hyperresponsiveness could be facilitated by the polluted environment of the city.
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Affiliation(s)
- Yasmina Benarab-Boucherit
- Service de Physiologie et d'Explorations Fonctionnelles, CHU Ibn Rochd, Route de Zaâfrania, 23000 Annaba, Algérie
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Nishimuta T, Kondo N, Hamasaki Y, Morikawa A, Nishima S. Japanese guideline for childhood asthma. Allergol Int 2011; 60:147-69. [PMID: 21636964 DOI: 10.2332/allergolint.11-rai-0328] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Indexed: 11/20/2022] Open
Abstract
The Japanese Guideline for the Diagnosis and Treatment of Allergic Diseases 2010 (JAGL 2010) describes childhood asthma based on the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2008 (JPGL 2008) published by the Japanese Society of Pediatric Allergy and Clinical Immunology. JAGL 2010 provides information on diagnosis by age groups from infancy to puberty, treatment for acute exacerbations, long-term management by medication, daily life guidance, and patient education to allow physicians, not specialized in childhood asthma, to refer to this guideline for routine medical treatment. JAGL differs from the Global Initiative for Asthma Guideline (GINA) in that the former emphasizes long-term management of childhood asthma based on asthma severity and early diagnosis and intervention at <2 years and 2-5 years of age. However, a management method, including step-up or step-down of long-term management agents based on the status of asthma symptoms, is easy to understand and thus JAGL is suitable for routine medical treatment. JAGL also introduced treatment and management using a control test for children, recommending treatment and management aimed at complete control through avoiding exacerbation factors and appropriate use of antiinflammatory agents.
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Affiliation(s)
- Toshiyuki Nishimuta
- Department of Pediatrics, National Hospital Organization Shimoshizu National Hospital, Chiba, Japan.
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Abe T, Tokuda Y, Ohde S, Ishimatsu S, Nakamura T, Birrer RB. The relationship of short-term air pollution and weather to ED visits for asthma in Japan. Am J Emerg Med 2009; 27:153-9. [PMID: 19371521 DOI: 10.1016/j.ajem.2008.01.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 01/16/2008] [Accepted: 01/22/2008] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The incidence of asthma exacerbation has been increasing in many countries. Environmental factors may play an important role in this trend. We aimed to investigate the relationship of weather conditions and air pollution to significant exacerbation of asthma. METHODS The daily number of emergency department (ED) visits by ambulance for asthma was collected through records of the Tokyo Fire Department from January 1 to December 31, 2005. We also collected daily air pollution levels and meteorological data for Tokyo during the same period. Meteorological data included minimum temperature, maximum barometric pressure, maximum relative humidity, and precipitation. Measured air pollutants included sulfur dioxide, nitrogen monoxide, nitrogen oxides, suspended particulate matter, and carbon monoxide. We performed a time series analysis using multivariable-adjusted autoregressive integrated moving average model. The analysis was conducted separately among adults and among children (<15 years old). RESULTS Of a total of 643,849 patients who were transported to the ED by ambulance, there were 6447 patients with exacerbation of asthma. Among adults, lower minimum temperature was significantly associated with increased transport. Among children, there were no significant associations between exacerbation of asthmas requiring emergency transport and air pollutants or meteorological factors. The highest number of transports was found on October 11, the day after the National Sports Day in Japan. CONCLUSIONS Cold temperature is related to an increased risk of significant exacerbation of asthma in adults. Air pollution does not seem to play a major role in significant exacerbation of asthma requiring ambulance transports to ED.
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Affiliation(s)
- Toshikazu Abe
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo 104-8560, Japan.
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Nolen-Walston RD, Kuehn H, Boston RC, Mazan MR, Wilkins PA, Bruns S, Hoffman AM. Reproducibility of Airway Responsiveness in Horses Using Flowmetric Plethysmography and Histamine Bronchoprovocation. J Vet Intern Med 2009; 23:631-5. [DOI: 10.1111/j.1939-1676.2009.0307.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Shaaban R, Zureik M, Soussan D, Neukirch C, Heinrich J, Sunyer J, Wjst M, Cerveri I, Pin I, Bousquet J, Jarvis D, Burney PG, Neukirch F, Leynaert B. Rhinitis and onset of asthma: a longitudinal population-based study. Lancet 2008; 372:1049-57. [PMID: 18805333 DOI: 10.1016/s0140-6736(08)61446-4] [Citation(s) in RCA: 394] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND A close relation between asthma and allergic rhinitis has been reported by several epidemiological and clinical studies. However, the nature of this relation remains unclear. We used the follow-up data from the European Community Respiratory Health Survey to investigate the onset of asthma in patients with allergic and non-allergic rhinitis during an 8.8-year period. METHODS We did a longitudinal population-based study, which included 29 centres (14 countries) mostly in western Europe. Frequency of asthma was studied in 6461 participants, aged 20-44 years, without asthma at baseline. Incident asthma was defined as reporting ever having had asthma confirmed by a physician between the two surveys. Atopy was defined as a positive skin-prick test to mites, cat, Alternaria, Cladosporium, grass, birch, Parietaria, olive, or ragweed. Participants were classified into four groups at baseline: controls (no atopy, no rhinitis; n=3163), atopy only (atopy, no rhinitis; n=704), non-allergic rhinitis (rhinitis, no atopy; n=1377), and allergic rhinitis (atopy+rhinitis; n=1217). Cox proportional hazards models were used to study asthma onset in the four groups. FINDINGS The 8.8-year cumulative incidence of asthma was 2.2% (140 events), and was different in the four groups (1.1% (36), 1.9% (13), 3.1% (42), and 4.0% (49), respectively; p<0.0001). After controlling for country, sex, baseline age, body-mass index, forced expiratory volume in 1 s (FEV(1)), log total IgE, family history of asthma, and smoking, the adjusted relative risk for asthma was 1.63 (95% CI 0.82-3.24) for atopy only, 2.71 (1.64-4.46) for non-allergic rhinitis, and 3.53 (2.11-5.91) for allergic rhinitis. Only allergic rhinitis with sensitisation to mite was associated with increased risk of asthma independently of other allergens (2.79 [1.57-4.96]). INTERPRETATION Rhinitis, even in the absence of atopy, is a powerful predictor of adult-onset asthma.
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Affiliation(s)
- Rafea Shaaban
- Unit 700 Epidemiology, National Institute of Health and Medical Research (INSERM), Paris, France
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Asensio de la Cruz O, Cordón Martínez A, Elorz Lambarri J, Moreno Galdó A, Villa Asensi JR. [Respiratory function assessment in cooperative patients. Part II]. An Pediatr (Barc) 2007; 66:518-30. [PMID: 17517206 DOI: 10.1157/13102516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Analysis of bronchial hyperresponsiveness using bronchial provocation tests are a key feature in the diagnosis of asthma, as well as a valid tool for monitoring disease severity, clinical course, and treatment response. We review non-specific bronchial challenge tests, including pharmacological stimuli (methacholine, adenosine) and physical stimuli (exercise, hypertonic saline, cold air hyperventilation). Although there is some correlation among responses to the distinct tests, individual responses are also observed. The indication for a single test will depend on whether the procedure will be used for diagnostic or epidemiologic purposes, and on experience of its use. Frequently, complementary information will be obtained. Indirect airway challenges tests such as physical stimuli and adenosine are more specific for asthma diagnosis.
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Sandsund M, Reinertsen R, Holand B, Bjermer L. Thermoregulatory and respiratory responses in asthmatic and nonasthmatic subjects breathing cold and warm air during exercise in the cold. J Therm Biol 2007. [DOI: 10.1016/j.jtherbio.2006.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lucero PF, Nicholson KL, Haislip GD, Morris MJ. Increased airway hyperreactivity with the M40 protective mask in exercise-induced bronchospasm. J Asthma 2007; 43:759-63. [PMID: 17169828 DOI: 10.1080/02770900601031706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Exercise-induced bronchospasm (EIB) has a prevalence of 6% to 7% in United States Army personnel and 3% to 13% in professional athletes. There are reported concerns that military personnel with EIB will have increased airway hyperreactivity or significant dyspnea while wearing the standard military M40 protective mask. The objective of this study is to determine whether the M40 protective gas mask increases airway hyperreactivity in military personnel with exertional dyspnea and the diagnosis of EIB. METHODS Ten active duty military with EIB (defined as history of exertional dyspnea, normal spirometry, and reactive methacholine challenge test) and 10 normal control subjects were evaluated. Both the participants and control subjects underwent baseline exercise challenge testing (ECT) with and without the M40 protective mask. Forced expiratory volume in one second (FEV1) (percent predicted) post ECT was compared to baseline FEV1 within and between groups along with exercise time. RESULTS There was no statistical difference in between individuals and between groups wearing the M40 mask. None of the study group had a positive ECT exercising without the M40 mask while 20% of the study group with EIB had a positive ECT wearing the M40 mask. CONCLUSION Military personnel with EIB who exercised with the M40 protective mask did not overall have significantly increased airway hyperreactivity compared to control subjects. Screening ECT may be beneficial in identifying those susceptible persons who report symptoms while wearing the M40 protective mask.
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Affiliation(s)
- Pedro F Lucero
- Pulmonary Disease/Critical Care Service, Tripler Army Medical Center, Honolulu, Hawaii, USA
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32
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Larsson L, Hemminqsson P, Boëthius G. Self-reported obstructive airway symptoms are common in young cross-country skiers. Scand J Med Sci Sports 2007. [DOI: 10.1111/j.1600-0838.1994.tb00414.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Cough is a troublesome condition which affects many visitors to high altitude. Traditionally it has been attributed to the inspiration of the cold, dry air which characterizes the high altitude environment. This aetiology was brought into question by observations and experiments in long duration hypobaric chamber studies in which cough still occurred despite controlled temperature and humidity. Anecdotally however, exercise, possibly via the associated increase in ventilation, does appear to precipitate cough at altitude. It is likely that the term, altitude-related cough, covers a number of conditions and aetiologies. These aetiologies are discussed and include water loss from the respiratory tract; high altitude pulmonary oedema; acute mountain sickness; bronchoconstriction; respiratory tract infections; vasomotor rhinitis and post-nasal drip; and alterations in the central control of respiration. We hypothesize that there are two forms of altitude-related cough: a cough which may occur at relatively low altitudes and which is related to exercise and persists despite descent and a cough which does not occur at altitudes below 5000-6000 m and which improves rapidly with descent to lower altitude. The treatment of altitude-related cough is symptomatic and frequently ineffective. Further work is required to understand the nature and aetiology of the cough which occurs at high altitude before effective therapies can be developed.
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Affiliation(s)
- Nicholas P Mason
- Critical Care Medicine Directorate, University Hospital of Wales, Cardiff, UK.
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Beuther DA, Martin RJ. Efficacy of a heat exchanger mask in cold exercise-induced asthma. Chest 2006; 129:1188-93. [PMID: 16685008 DOI: 10.1378/chest.129.5.1188] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To determine the efficacy of a novel mask device in limiting cold air exercise-induced decline in lung function in subjects with a history of exercise-induced asthma (EIA). SETTING In spite of appropriate medical therapy, many asthma patients are limited in cold weather activities. DESIGN In study 1, 13 asthmatic subjects performed two randomized, single-blind treadmill exercise tests while breathing cold air (- 25 to - 15 degrees C) through a placebo or active heat exchanger mask. In study 2, five subjects with EIA performed three treadmill exercise tests while breathing cold air: one test using the heat exchanger mask, one test without the mask but with albuterol pretreatment, and one test with neither the mask nor albuterol pretreatment (unprotected exercise). For all studies, spirometry was performed before and at 5, 15, and 30 min after exercise challenge. PATIENTS For both studies, a total of 15 subjects with a history of asthma symptoms during cold air exercise were recruited. RESULTS In study 1, the mean decrease (+/- SE) in FEV1 was 19 +/- 4.9% with placebo, and 4.3 +/- 1.6% with the active device (p = 0.0002). The mean decrease in maximum mid-expiratory flow (FEF(25-75)) was 31 +/- 5.7% with placebo and 4.7 +/- 1.7% with the active device (p = 0.0002). In study 2, the mean decrease in FEV1 was 6.3 +/- 3.9%, 11 +/- 3.7%, and 28 +/- 10% for the heat exchanger mask, albuterol pretreatment, and unprotected exercises, respectively (p = 0.4375 for mask vs albuterol, p = 0.0625 for mask vs unprotected exercise). The mean decrease in FEF(25-75) was 10 +/- 4.8%, 23 +/- 6.0%, and 36 +/- 11%, respectively (p = 0.0625 for mask vs albuterol, p = 0.0625 for mask vs unprotected exercise). CONCLUSIONS This heat exchanger mask blocks cold exercise-induced decline in lung function at least as effectively as albuterol pretreatment.
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Affiliation(s)
- David A Beuther
- National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206, USA
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Stensrud T, Berntsen S, Carlsen KH. Humidity influences exercise capacity in subjects with exercise-induced bronchoconstriction (EIB). Respir Med 2006; 100:1633-41. [PMID: 16446080 DOI: 10.1016/j.rmed.2005.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 12/01/2005] [Accepted: 12/05/2005] [Indexed: 11/29/2022]
Abstract
RATIONALE Exercise-induced bronchoconstriction (EIB) increases in cold and dry air and decreases in humid air in subjects with asthma. Few reports have reported on the effect of humid environment upon exercise capacity in subjects with EIB. OBJECTIVE The primary aim of the present study was to examine the effect of changing the humidity of the environmental air upon exercise capacity measured by peak oxygen uptake (V O2 peak), peak ventilation (V Epeak) and peak running speed (V peak) and secondarily to assess the influence of environmental humidity upon EIB in subjects suffering from EIB. METHODS Twenty subjects (10-45 years old, male/female:13/7) with diagnosed EIB performed exercise testing under standardised, regular environmental conditions, 20.2 degrees C (+/- 1.1) and 40% (+/- 3.3) relative humidity [mean (+/- SD)], and under standardised humid environmental conditions; 19.9 degrees C (+/- 1.0) and 95% (+/- 1.7) relative humidity in random order on separate days. Lung function was measured before and 1, 3, 6, 10 and 15 min after exercise. Heart rate (HR), oxygen uptake (V O2), respiratory gas exchange ratio (RER), breathing frequency (BF) and minute ventilation (V E) were measured during exercise. RESULTS V O2 peak and V peak increased significantly from 40% to 95% relative humidity of the environmental air, 4.5% and 5.9%, respectively (P = 0.001). HRpeak increased significantly in the humid environment, while BF(peak) decreased significantly. RERpeak and V Epeak did not change significantly. Post-exercise reduction in FEV1 (DeltaFEV1) and FEF50 (forced expiratory flow at 50% of FVC) (DeltaFEF50) significantly decreased after exercise in a humid environment as compared to regular conditions, DeltaFEV1: 12% (7,17) vs. 24% (19,29) [mean (95% confidence intervals)], respectively, DeltaFEF50: 20% (12,29) vs. 38% (30,46), respectively (P < 0.001). CONCLUSION Exercise capacity (V O2 peak and V peak) markedly improved during exercise in humid air in subjects with EIB, whereas EIB was reduced to the half.
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Affiliation(s)
- T Stensrud
- Norwegian School of Sport Sciences, NO-0806 Oslo, Norway.
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36
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Abstract
Highly trained athletes are repeatedly and strongly exposed to cold air during winter training and to many inhalant irritants and allergens all year round. Asthma occurs most commonly in athletes engaging in endurance events such as cross-country skiing, swimming, or long-distance running. As well as the type of training, a major risk factor is atopic disposition. A mixed type of eosinophilic and neutrophilic airway inflammation has been shown to affect elite swimmers, ice-hockey players, and cross-country skiers. The inflammation may represent a form of repeated thermal, mechanical, or osmotic airway trauma resulting in a healing or remodelling process. Elite athletes commonly use antiasthma drugs to treat exercise-induced bronchial symptoms. Only a few controlled studies have been conducted on the effects of antiasthma drugs on asthma symptoms, bronchial hyperresponsiveness and airway inflammation in elite athletes. Inhaled beta(2)-adrenoceptor agonists are effective against exercise-induced bronchospasm. In contrast, airway inflammation, bronchial hyperresponsiveness and symptoms have responded poorly to inhaled corticosteroids and leukotriene antagonists. As discontinuing high-level exercise has proved effective in reducing eosinophilic airway inflammation, exercise or training should be restricted in athletes having troublesome symptoms and sputum eosinophilia. Switching training to less irritating environments should be considered whenever possible. It appears to be difficult to change the 'natural course' of asthma in athletes by anti-inflammatory treatment.
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Affiliation(s)
- Ilkka Helenius
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.
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Uçok K, Dane S, Gökbel H, Akar S. Prevalence of exercise-induced bronchospasm in long distance runners trained in cold weather. Lung 2005; 182:265-70. [PMID: 15742238 DOI: 10.1007/s00408-004-2503-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2004] [Indexed: 10/25/2022]
Abstract
We investigated whether regular training in cold weather has an effect on the development of exercise-induced bronchospasm. Nineteen sedentary males and 20 male long distance runners who were regularly training in Erzurum participated in this study. They had no history of asthma, atopy or allergic rhinitis. Pre- and post-exercise spirometry was performed in the participants in room temperature. EIB was defined as at least a > or =10% fall in FEV1 or a > or =15% fall in FEF(25-75%) or a > or =25% fall in PEFR. EIB was established in 7 of 20 athletes and in 1 of 19 sedentaries. Prevalence of EIB will be higher even if it is established in room temperature when training for the sports like long distance running which is not a cold weather sport. We conclude that it will be more convenient to establish EIB in room temperature and in the laboratory since the exercise test and spirometry can be performed more accurately under more standard conditions.
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Affiliation(s)
- Kağan Uçok
- Department of Physiology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
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38
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Dillard TA, Khosla S, Ewald FW, Kaleem MA. Pulmonary function testing and extreme environments. Clin Chest Med 2005; 26:485-507, vii. [PMID: 16140140 DOI: 10.1016/j.ccm.2005.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Millions of people worldwide engage in leisure or occupational activities in extreme environments. These environments entail health risks even for normal subjects. The presence of lung disease, or other conditions, further predisposes to illness or injury. Patients who have lung conditions should, but often do not, consult with their pulmonary clinicians before traveling. Normal subjects, including elderly or deconditioned adults, may be referred to pulmonologists for evaluation of risk prior to exposure. Other patients may present for consultations after complications occur. Pulmonary function testing before or after exposure can assist physicians counseling patients about the likelihood of complications.
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Affiliation(s)
- Thomas A Dillard
- Division of Pulmonary/Critical Care, Medical College of Georgia, BBR 5513, 1120 15th Street, Augusta, GA 30912-3135, USA.
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Coreno A, Skowronski M, West E, El-Ekiaby A, McFadden ER. Bronchoprotective Effects of Single Doses of Salmeterol Combined With Montelukast in Thermally Induced Bronchospasm. Chest 2005; 127:1572-8. [PMID: 15888830 DOI: 10.1378/chest.127.5.1572] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Salmeterol (S) and montelukast (M) individually inhibit the obstructive consequences of thermal stimuli such as exercise and hyperventilation (HV), but there is no information on whether these drugs can interact positively. DESIGN Randomized trial. SETTING University teaching hospital. PARTICIPANTS Atopic asthmatic patients with sensitivity to thermal provocations. INTERVENTIONS Eleven asthmatic patients generated stimulus-response curves to isocapnic HV while breathing frigid air without any interventions and then after pretreatment with 42 mug of S, 10 mg of M, and the combination. The order of testing was randomly determined. MEASUREMENTS AND RESULTS Minute ventilation (Ve) was increased in 20-L increments until FEV(1) fell >or= 15%. Measurements were obtained before and 1 h after drug administration, and then again 5 min after each bout of HV. In the nonintervention trial, the provocation commenced after the patients presented to the laboratory. In the control challenge, the mean (+/- SEM) FEV(1) decreased 24.6 +/- 1.7% from baseline. S and M both increased the mean prechallenge FEV(1) significantly (S, 10.4 +/- 1.7% [p < 0.01]; M, 4.1 +/- 1.3% [p = 0.02]; S + M, p = 0.01). The combination of S + M produced greater bronchodilatation (mean improvement, 12.4 +/- 2.3%) than M alone (p = 0.004), but not greater than S alone (p = 0.80). Both drugs blunted the obstructive response similarly (protection: M, 34.6 +/- 15.1%; S, 60 +/- 8.7%; p = 0.13). The benefits added arithmetically with the combined regimen (protection with S + M, 84.9 +/- 5.5%; p = 0.01 vs S alone; p = 0.003 vs M alone). CONCLUSION These data indicate that the concurrent administration of single standard doses of S and M appears to provide greater protection against thermal stimuli than does either drug alone. Further experimentation will be required to ascertain whether the combination will provide additional clinical benefits to patients over those of the single agents.
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Affiliation(s)
- Albert Coreno
- Center for Academic Clinical Research, Case Western Reserve University School of Medicine, Department of Medicine of MetroHealth Medical Center, Cleveland, OH 44109, USA
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40
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Zeitoun M, Wilk B, Matsuzaka A, KnOpfli BH, Wilson BA, Bar-Or O. Facial cooling enhances exercise-induced bronchoconstriction in asthmatic children. Med Sci Sports Exerc 2004; 36:767-71. [PMID: 15126708 DOI: 10.1249/01.mss.0000126466.67458.5b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Exercising in cold air enhances bronchial responsiveness (BR) as compared with exercising in warm air. This may be due to intrathoracic cooling or to increased vagal activity caused by facial cooling. The purpose of this study was to compare the effects on BR of cold air inhalation and of facial exposure to cold air, as well as the combined effect of both. METHODS Fourteen children with asthma (eight girls) performed four exercise challenge tests in a climatic chamber, under one of the following conditions: 1) inhaling warm air while the face was exposed to warm air (WW, 21 degrees C, 25% relative humidity (RH)); 2) inhaling warm air while the face was exposed to cold air (WC, 0 degrees C, 80% RH); 3) inhaling cold air while the face was exposed to cold air (CC); and 4) inhaling cold air while the face was exposed to warm air (CW). The study was analyzed, using a one- and two-way ANOVA. RESULTS Postexercise forced expiratory volume in the first second (FEV1) and maximal mid-expiratory flow (MMEF) values as percent predicted (% pred) showed significant reductions over time (P < 0.001), significant differences among the four experimental conditions (P < 0.001) and a significant condition x time interaction (FEV1:P < 0.001, MMEF:P < 0.01). FEV1 was significantly lower for CC and WC, as compared with WW and CW at 5 and 10 min postexercise. The lowest postexercise values for FEV1 occurred in the CC and WC sessions (76% predicted in both). A similar pattern was obtained for MMEF. CONCLUSION Facial cooling combined with either cold or warm air inhalation causes the greatest EIB, as compared with the isolated challenge with cold air inhalation. We suggest that vagal mechanisms play a major role in exercise and cold-induced bronchoconstriction.
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Affiliation(s)
- Mona Zeitoun
- Children's Exercise and Nutrition Centre, McMaster University, Hamilton, Ontario, Canada
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41
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Abstract
Even since the late 19th century, a relationship has been suspected between upper airway disease and the subsequent development or aggravation of asthma symptoms. To date, it has been generally accepted that pathologic conditions of the upper airways, e.g. allergic rhinitis, chronic sinusitis and nasal polyposis, may influence the lower airways. However, the mechanisms underlying this relationship were, for a long time, poorly understood. Recently, evidence has been accumulating which indicates a systemic connection as one of the responsible mechanisms in nasobronchial crosstalk. In this review, the pathophysiologic and immunologic aspects of the interaction between upper and lower airways will be discussed.
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Affiliation(s)
- G-J Braunstahl
- Department of Pulmonary Medicine, Erasmus Medical Center Rotterdam, The Netherlands
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42
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Moloney ED, Griffin S, Burke CM, Poulter LW, O'Sullivan S. Release of inflammatory mediators from eosinophils following a hyperosmolar stimulus. Respir Med 2003; 97:928-32. [PMID: 12924520 DOI: 10.1016/s0954-6111(03)00119-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Airway dehydration and subsequent hyperosmolarity of periciliary fluid are considered critical events in exercise-induced bronchoconstriction (EIB). It has been shown that an in vitro hyperosmolar stimulation of basophils and mast cells with mannitol can induce the release of histamine and leukotrienes. The aim of this study was to establish if a hyperosmolar challenge could trigger activation of eosinophils to release chemokines and lipid mediators. Peripheral blood eosinophils were isolated from seven asthmatic and six non-asthmatic subjects. Hyperosmolar stimulation of eosinophils with mannitol (0.7 M), resulted in a significant increase in LTC4 levels compared to baseline in both asthmatic (15.2+/-4.6 vs. 70.1+/-9.5; P = 0.0002) and control subjects (14.3+/-4.0 vs. 55.6+/-5.6; P = 0.0001). ECP levels did not increase significantly above baseline following mannitol stimulation in either group. This study shows that eosinophils can be activated by a hyperosmolar stimulus. Therefore it seems reasonable to suggest that eosinophils could contribute to EIB.
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Affiliation(s)
- E D Moloney
- Department of Respiratory Medicine, James Connolly Memorial Hospital, Dublin, Ireland.
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43
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Mannix ET, Roberts M, Fagin DP, Reid B, Farber MO. The prevalence of airways hyperresponsiveness in members of an exercise training facility. J Asthma 2003; 40:349-55. [PMID: 12870830 DOI: 10.1081/jas-120018634] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Athletes have a high prevalence (11-50%) of exercise-induced asthma, which may be caused by the hyperventilation accompanying repetitive bouts of strenuous exercise. We hypothesized that recreational exercisers would display a similar trend. Eucapnic voluntary hyperventilation (EVH) bronchoprovocation (breathing 21% O2, 5% CO2, and 74% N2 at 60% of MVV for 5 minutes) was performed to determine the prevalence of airways hyperresponsiveness (AHR) in adults (n=212, 146 males, mean +/- standard deviation, age 32 +/- 10 years) who exercised regularly (10 +/- 10 years, 31 +/- 28% of their lives): none had a previous diagnosis of asthma. AHR was defined by at least a 10%, 20%, or 25% decline in FEV1, FEF(25-75), or PEFR, respectively, by spirometry at 1, 5, 10, and 15 minutes post-EVH. Forty-one of 212 (19%) tested positive for AHR: 20 of 41 (49%) were positive by FEV1, 28 of 41 (68%) by FEF(25-75), and 27 of 41 (66%) by PEFR. Comparing responders with nonresponders: pre-EVH lung function was equivalent, except for FEV1, which was reduced (p<0.05) in responders (96 +/- 13 vs. 102 +/- 12% predicted). Mean maximal negative deflections for responders were: for FEV1, -17 +/- 7%; FEF(25-75), -31 +/- 10%; PEFR, -38 +/- 11%. Ranges of decline for responders were: FEV1, -10 to -33%; FEF(25-75), -20 to -59%; PEFR, -25- to -70%. We conclude that in these regular exercisers, the prevalence of AHR is high and comparable with some athletic populations.
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Affiliation(s)
- Edward T Mannix
- Division of Pulmonary, Allergy, Critical Care and Occupational Medicine, Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana, USA.
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44
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Abstract
In the overwhelming majority of exercising youngsters, exercise tolerance is limited by cardiovascular and muscular factors, not the lungs. Even at exhaustion, pulmonary reserve is considerable. Yet some young athletes do experience respiratory problems with exercise. These problems can be assigned to several categories, including those related to underlying acute and chronic respiratory conditions (principally respiratory tract infections, asthma, cystic fibrosis, chest wall deformities, and neuromuscular disorders), and apparent but nonpathological problems (the heavy breathing of anaerobic exercise, relative deconditioning, and anxiety). There are also situations that seem to be problematic but need not be (having the diagnosis of asthma or cystic fibrosis). Pharmacologic management of respiratory problems and perceived problems can be difficult and is discussed with the particular disorder.
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Affiliation(s)
- David M Orenstein
- Antonio J. and Janet Palumbo Cystic Fibrosis Center Children's Hospital of Pittsburgh, PA 15213, USA.
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45
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Moloney E, O'Sullivan S, Hogan T, Poulter LW, Burke CM. Airway dehydration: a therapeutic target in asthma? Chest 2002; 121:1806-11. [PMID: 12065342 DOI: 10.1378/chest.121.6.1806] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Airway dehydration triggers exercise-induced bronchoconstriction in virtually all patients with active asthma. We are not aware of any investigations of airway dehydration in patients with naturally occurring asthma exacerbations. We wish to investigate whether airway dehydration occurs in acute asthmatic patients in the emergency department, and its functional significance. METHODS In a pilot study on 10 asthmatic patients and 10 control subjects in the emergency department, respiratory rate was counted manually, and relative humidity of expired air was recorded using an air probe hygrometer. In parallel laboratory studies carried out over 2 consecutive days, 19 asthmatics and 10 control subjects were challenged initially with dry air, and on the second day with humidified air. FEV(1) and humidity measurements were made immediately before and after the tachypnea challenges. RESULTS In the emergency department, the asthmatic group was more tachypneic (p < 0.0001) and their expired air was drier (p < 0.0001) than the control group. Following a dry-air tachypnea challenge in the laboratory, which caused dehydration of the expired air in all subjects, half of the asthmatics, but none of the control subjects, demonstrated a fall of > 10% in FEV(1) from baseline. This bronchoconstriction was prevented by humidifying the inspired air; tachypnea with no water loss did not affect lung function in asthmatic subjects. CONCLUSIONS Dehydration of the expired air is present in asthmatic patients in the emergency department. The bronchoconstriction triggered by dry-air tachypnea challenge in the laboratory can be prevented by humidifying the inspired air. Airway rehydration merits further investigation as a potential adjunct to acute treatment of asthma exacerbations.
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Affiliation(s)
- Edward Moloney
- Departments of Respiratory Medicine, James Connolly Memorial Hospital, Dublin, Ireland
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Gruber W, Eber E, Malle-Scheid D, Pfleger A, Weinhandl E, Dorfer L, Zach MS. Laser acupuncture in children and adolescents with exercise induced asthma. Thorax 2002; 57:222-5. [PMID: 11867825 PMCID: PMC1746279 DOI: 10.1136/thorax.57.3.222] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Laser acupuncture, a painless technique, is a widely used alternative treatment method for childhood asthma, although its efficacy has not been proved in controlled clinical studies. METHODS A double blind, placebo controlled, crossover study was performed to investigate the possible protective effect of a single laser acupuncture treatment on cold dry air hyperventilation induced bronchoconstriction in 44 children and adolescents of mean age 11.9 years (range 7.5-16.7) with exercise induced asthma. Laser acupuncture was performed on real and placebo points in random order on two consecutive days. Lung function was measured before laser acupuncture, immediately after laser acupuncture (just before cold dry air challenge (CACh)), and 3 and 15 minutes after CACh. CACh consisted of a 4 minute isocapnic hyperventilation of -10 degrees C absolute dry air. RESULTS Comparison of real acupuncture with placebo acupuncture showed no significant differences in the mean maximum CACh induced decrease in forced expiratory volume in 1 second (27.2 (18.2)% v 23.8 (16.2)%) and maximal expiratory flow at 25% remaining vital capacity (51.6 (20.8)% v 44.4 (22.3)%). CONCLUSIONS A single laser acupuncture treatment offers no protection against exercise induced bronchoconstriction in paediatric and adolescent patients.
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Affiliation(s)
- W Gruber
- Respiratory and Allergic Disease Division, Paediatric Department, University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria
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Dillard TA, Ewald FW. The use of pulmonary function testing in piloting, air travel, mountain climbing, and diving. Clin Chest Med 2001; 22:795-816, x. [PMID: 11787666 DOI: 10.1016/s0272-5231(05)70067-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Millions of people engage in occupational or leisure activities at high altitude or at variable depths below sea level. This article presents an overview of the utility of pulmonary function testing in evaluating complications and other consequences of exposure to high and low pressure environments. The authors review recent literature concerning expected changes in pulmonary function with hyperbaric and hypobaric exposures. The article provides guidance for clinicians evaluating mountain climbers, pilots, aircrew members, airline passengers and deep sea divers.
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Affiliation(s)
- T A Dillard
- Medical College of Georgia and the Veteran's Administration Medical Center, Augusta, USA
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48
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Thole RT, Sallis RE, Rubin AL, Smith GN. Exercise-induced bronchospasm prevalence in collegiate cross-country runners. Med Sci Sports Exerc 2001; 33:1641-6. [PMID: 11581546 DOI: 10.1097/00005768-200110000-00005] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the prevalence of exercise-induced bronchospasm (EIB) in collegiate cross-country runners using a protocol involving an intense exercise challenge conducted in the same environment in which the athletes train and compete. METHODS One-hundred eighteen collegiate cross-country runners from the Los Angeles, California, metropolitan area participated in the study. All testing took place on a track at the time and location of a normal practice session. The baseline peak expiratory flow rate (PEFR) measurements (best of three) and preexercise heart rate were recorded, after which the athletes ran 2000 m on a track at 85% of maximum heart rate. The postexercise heart rate was recorded and then PEFR measurements at 2, 5, 10, and 30 min after exercise were recorded. The athletes completed a 16-item questionnaire regarding asthma symptoms and health history. Those athletes with a history of asthma and currently taking medications for the asthma were then excluded from statistical analysis of the questionnaire responses. A decrease in PEFR of 15% was considered positive for EIB. RESULTS Of the 114 athletes not currently taking medications for asthma, at least 14% (16 athletes) were EIB positive. There was a poor correlation between reported symptoms of asthma and testing positive for EIB. CONCLUSION This study demonstrates a high prevalence of EIB in collegiate cross-country runners (at least 14%) and that reported symptoms are a poor predictor of actual EIB.
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Affiliation(s)
- R T Thole
- Kaiser Permanente Sports Medicine Fellowship, USA
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Rogers IR, Inglis S, Speedy D, Hillman D, Noffsinger B, Jacobs I. Changes in respiratory function during a wilderness multisport endurance competition. Wilderness Environ Med 2001; 12:13-6. [PMID: 11294549 DOI: 10.1580/1080-6032(2001)012[0013:cirfda]2.0.co;2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To document the changes in respiratory function seen in competitors during a typical wilderness multisport endurance event. METHODS A prospective observational cohort study measuring forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) at baseline, midrace, and end of race in competitors in a 105-km ski/run/cycle/paddle race held midwinter in the mountains of Victoria, Australia. RESULTS Twenty-five adult subjects (22 men) between 20 and 42 years of age were studied. The mean decline in FEV1 was 15.1% (95% CI 10.3-19.8) and for FVC was 13.0% (95% CI 8.1-17.9). Fourteen (56%) of the 25 subjects had a >10% decline in FEV1 and FVC, and 7 (28%) of the 25 subjects had a >20% decline. In 9 control subjects, aged between 21 and 55 years, there was no significant change in FEV1 or FVC from prerace to end of race. CONCLUSIONS Significant declines in FEV1 and FVC are common during wilderness multisport endurance events. The focus of future research should be the etiology, which as yet remains speculative.
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Affiliation(s)
- I R Rogers
- Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Australia
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Abstract
Provocation with cold air in the nose causes broncho-obstruction while warm air causes bronchodilation in patients with asthma, but not in healthy subjects. These findings have suggested the existence of a nasobronchial reflex. The present study aimed to block this effect and evaluate the mechanisms underlying the effect on lung function after cold stimulation of the nose. Lung function, as measured with specific conductance and forced expiratory flow, was reduced after cold stimulation of the nose, but this effect could not be blocked by anesthetizing the nose or by inhaling an anti-cholinergic drug before the provocation. These results confirm the presence of a nasobronchial relationship, but not of a nasobronchial reflex.
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Affiliation(s)
- A Johansson
- Department of Lung Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
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