Changes in serum eosinophil cationic protein levels after exercise challenge in asthmatic children

An Overview on the Primary Factors That Contribute to Non-Allergic Asthma in Children

The prevalence of non-allergic asthma in childhood is low, peaking in late adulthood. It is triggered by factors other than allergens, like cold and dry air, respiratory infections, hormonal changes, smoke and air pollution. In the literature, there are few studies that describe non-allergic asthma in pediatric age. Even though it is a less common disorder in kids, it is crucial to identify the causes in order to keep asthma under control, particularly in patients not responding to conventional treatments. In this review, we discuss non-IgE-mediated forms of asthma, collecting the latest research on etiopathogenesis and treatment.

Pulmonary disorders in athletes

Exercise is rarely limited by pulmonary causes in normal individuals. Cardiac output and peripheral muscle disease are usually the limiting factors. Although minute ventilation rises steeply during exercise, normal individuals maintain a substantial breathing reserve. Exercise in patients, however, can be limited by pulmonary disorders. Acute pulmonary causes (exercise-induced bronchospasm, vocal cord dysfunction, exercise-induced anaphylaxis, and exercise-induced urticaria) or chronic disorders (obstructive and restrictive lung disorders) reduce exercise tolerance. Exercise testing has proved the mainstay for diagnosis and treatment of these disorders.

Exercise-induced asthma: critical analysis of the protective role of montelukast

Exercise-induced asthma/exercise-induced bronchospasm (EIA/EIB) is a prevalent and clinically important disease affecting young children through older adulthood. These terms are often used interchangeably and the differences are not clearly defined in the literature. The pathogenesis of EIA/EIB may be different in those with persistent asthma compared to those with exercise-induced symptoms only. The natural history of EIA is unclear and may be different for elite athletes. Leukotriene biology has helped the understanding of EIB. The type and intensity of exercise are important factors for EIB. Exercise participation is necessary for proper development and control of EIA is recommended. Symptoms of EIB should be confirmed by proper testing. Biologic markers may also be helpful in diagnosis. Not all exercise symptoms are from EIB. Many medication and nonpharmacologic treatments are available. Asthma education is an important component of managing EIA. Many medications have been tested and the comparisons are complicated. Montelukast is a US Food and Drug Administration-approved asthma and EIB controller and has a number of potential advantages to other asthma medications including short onset of action, ease of use, and lack of tolerance. Not all patients improve with montelukast and rescue medication should be available.

Exercise-induced asthma

PURPOSE OF REVIEW

Exercise has been recognized as a trigger of bronchospasm for centuries. However, there remains much debate regarding the mechanism of this response, nomenclature to describe it, optimal tests for diagnosis, and treatment options. There is a need to review recent findings in this area both for clinicians and to highlight areas in need of additional research.

RECENT FINDINGS

Recent data have confirmed the high prevalence of exercise-induced bronchospasm among athletes and raise concern that many of these athletes may be unaware of this diagnosis. Variability in nomenclature, classification, and diagnostic testing methods continue to make comparisons among reported trials difficult. Both in-vitro and animal studies reveal a heterogeneous inflammatory response correlated with exercise-induced bronchospasm. This variability may underlie the variable response to pharmacotherapy.

SUMMARY

Clinicians need to be alert to the nonspecific nature of exercise-induced symptoms and increase utilization of objective testing for accurate diagnosis. Future research is needed to better define the optimal diagnostic test or algorithm. Clinical outcome and translational studies should focus on more precise phenotyping of participants and include more global measures of inflammation.