Asthma in medium altitude--exercise-induced bronchoconstriction in hypobaric environment in subjects with asthma

What do we know about travel for children with special health care needs? A review of the literature

BACKGROUND

Children travel with their families, including children with chronic illness. We know that adults with chronic illness who travel are more likely than their healthy peers to become sick while traveling. A review of the literature was undertaken to identify what is known about traveling with children with special health care needs and to identify gaps in our knowledge.

METHODS

An Online search of the PubMed, CINAHL and Google databases of English language literature was conducted June 2016, October 2017, June 2018 and April 2019 using the terms children and travel, air travel, travel health, disabled child, children with special healthcare needs, parents of disabled children, vacations, recreation, international, wheelchairs, planning techniques, asthma, diabetes, altitude, cystic fibrosis, inflammatory bowel disease, sickle cell disease, depression, food allergies, Attention Deficit Hyperactivity Disorder (ADHD), and seizures. The search was limited to years 2000-2019. A secondary search of relevant articles was conducted using the reference sections of articles identified in the primary search.

RESULTS

185 papers were examined for travel health related outcomes for children and adults with chronic diseases. Articles were excluded if they addressed the educational needs of students with disabilities traveling abroad, did not directly address travel health (e.g travel skills, travel itineraries), contained outdated policy statements, or were case reports of a single patient. The remaining 84 papers were organized and reviewed by organ systems. The articles were primarily descriptive and did not lend themselves to a systematic review.

CONCLUSION

Children traveling with chronic and complex health conditions are a heterogeneous group of vulnerable travelers. Closing the knowledge gap about how to best help these travelers requires a multipronged approach. Research is urgently needed to identify best practices for five of the most common chronic childhood diseases: asthma, depression, ADHD, food allergies and autism. For less common illnesses, ones typically cared for in specialty clinics, expert consensus opinion and multi-center studies are needed. Families and disease advocacy societies should be included in the research as they may have already identified the most pressing travel-related health concerns and solutions for these problems.

The effect of mouth breathing on exercise induced fall in lung function in children with allergic asthma and rhinitis

OBJECTIVES

Exercise induced bronchospasm (EIB) represents a common feature of childhood asthma which is most commonly revealed during free running. On the other hand aerobic exercise shows significant beneficial effects in asthmatics especially on the reduction of the level of systemic inflammation and is recommended as part of its treatment. The aim of this study was to test how mandatory mouth breathing influences the exercise induced level of decrease in lung function according to the level of severity of allergic rhinitis (AR).

METHODS

Free 6-minute running test preceded and followed by spirometry done with and without a nose clip a day apart was conducted in 55 children with moderate persistent asthma and AR. Children were divided into two groups according to the severity of nasal symptoms.

RESULTS

There was a greater fall in forced expiratory volume in one second after exercise with a nose clip in children with less nasal symptoms than in children with more nasal symptoms (mean ± SD; -5.28 (7.91) vs. -0.08 (4.58), p = 0.0228) compared to testing without the nose clip (mean ± SD; LNS, -1.31 ± 3.89%, p = 0.2408; MNS, -1.47 ± 3.68%, p = 0.2883).

CONCLUSION

Our results show that regular mouth breathing due to nasal congestion may lessen the degree of EIB in patients with persistent AR and allergic asthma.

Exhaled nitric oxide concentration upon acute exposure to moderate altitude

The purpose of this study was to assess immediate changes in the partial pressure of nitric oxide (NO) in exhaled gas (PE NO ) in healthy trained subjects who were acutely exposed to moderate altitude. One group of nine and another group of 20 healthy subjects were exposed to an ambient pressure of 728 hPa (546 mmHg) corresponding to an altitude of 2800 m for 5 and 90 min, respectively, in an altitude chamber. PE NO was measured offline by sampling exhaled gas in tight metal foil bags at 5, 30, 60, and 90 min. A correction for increased expiratory flow rate due to gas density effects at altitude was performed (PE NO corr). PE NO was significantly decreased by 13-16%, while the fraction of NO in exhaled gas (FE NO) was increased by 16-19% compared to sea level. There was no significant change in PE NO corr after exposure to altitude for 5, 30, 60, and 90 min. We conclude that there was no change in PENO upon arrival at altitude after correcting for gas density effects on expiratory flow rate. Corrections for altitude effects must be done before comparing measurements performed at different altitudes when using measurements of FENO to monitor athletes who have asthma during training at altitude.

Bronchial asthma: advice for patients traveling to high altitude

This article examines the possibility of traveling to altitude for patients suffering from bronchial asthma. The mountain environment, the adaptations of the respiratory system to high altitude, the underlying patho-physiologies of asthma, and the recommendations for patients, according to altitude, are discussed. In summary, staying at low altitude has a significant beneficial effect for asthmatic patients, due to the reduction of airway inflammation and the lower response to bronchoconstrictor stimuli; for staying at moderate altitude, there is conflicting information and no clinical data; at high altitude, the environment seems beneficial for well-controlled asthmatics, but intense exercise and upper airway infections (frequent during trekking) can be additional risks and should be avoided. Further, in remote areas health facilities are often difficult to reach.

Exercise capacity and exercise-induced bronchoconstriction (EIB) in a cold environment

INTRODUCTION

Exercise in a cold environment has been reported to increase exercise-induced bronchoconstriction (EIB). However, the effect of a cold environment upon exercise capacity in subjects with EIB has, to our knowledge, not been previously reported.

PURPOSE

Primary: To examine the influence of changing environmental temperature upon exercise capacity measured by peak oxygen uptake (VO(2 peak)), peak ventilation (VE(peak)) and peak running speed in subjects with diagnosed EIB. Secondary: To assess the influence of changing environmental temperature upon EIB.

METHODS

Twenty subjects (10-45 years old, male/female: 13/7) with EIB underwent exercise testing by running on a treadmill in a climate chamber under standardised, regular conditions, 20.2 degrees C (+/-1.1) and 40.0% (+/-3.3) relative humidity [mean(+/-SD)], and in a standardised cold environment, -18.0 degrees C (+/-1.4) and 39.2% (+/-3.8) relative humidity in random order on separate days. Oxygen uptake (VO(2)), minute ventilation (V E), respiratory exchange ratio (RER), heart rate (HR) and running speed were measured during exercise. Lung function (flow volume loops) was measured before and 1, 3, 6, 10 and 15 min after exercise and 15 min after inhalation of salbutamol.

RESULTS

VO(2 peak) decreased 6.5%, from 47.9 (45.0, 50.8) to 44.8 ml kg(-1)min(-1) (41.2, 48.4) [mean (95% confidence intervals)] (p=0.004) in the cold environment. Also running speed was significantly lower in the cold environment (p=0.02). No differences were found for VE(peak), RER(peak) or HR(peak). The post-exercise reduction in forced expiratory volume in 1s (FEV(1)) (DeltaFEV(1)) increased significantly from 24% (19,29) to 31% (24,38), respectively (p=0.04) after exercise in the cold environment. No correlation was found between reduction in VO(2 peak) and the increased maximum fall in FEV(1) in the cold environment.

CONCLUSION

Exercise capacity (VO(2 peak) and peak running speed) was markedly reduced during exercise in a cold environment whereas EIB increased in subjects suffering from EIB.

Humidity influences exercise capacity in subjects with exercise-induced bronchoconstriction (EIB)

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.