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Abstract
Drowning is a leading cause of death in children. Each year there are thousands of injuries in children, some fatal, associated with aquatic adventure sports. Personal water craft rapidly accelerate children to high velocities, as does being towed behind boats on skis or tubes, whereupon children have no control of their speed or direction. Canoeing and white-water kayaking particularly stress the upper limbs and shoulder dislocations are a primary concern. Surfing and kite-surfing generate more injuries to the head and face than other parts of the body and, in scuba diving, children most frequently injure their ears due to the acute pressure changes experienced. Aquatic injuries cost more in children than in adults and residual functional deficits may last a lifetime. There is a pressing need for research into the prevalence and incidence of aquatic injuries in children, so the effectiveness of preventive interventions can be determined.
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Affiliation(s)
- Peter Buzzacott
- a Injury Monitoring and Prevention , Divers Alert Network , Durham , NC , USA.,b School of Sports Science Exercise and Health , University of Western Australia , Crawley , Australia
| | - Anna Mease
- a Injury Monitoring and Prevention , Divers Alert Network , Durham , NC , USA
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2
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Hallstrand TS, Leuppi JD, Joos G, Hall GL, Carlsen KH, Kaminsky DA, Coates AL, Cockcroft DW, Culver BH, Diamant Z, Gauvreau GM, Horvath I, de Jongh FHC, Laube BL, Sterk PJ, Wanger J. ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing. Eur Respir J 2018; 52:13993003.01033-2018. [PMID: 30361249 DOI: 10.1183/13993003.01033-2018] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/20/2018] [Indexed: 12/20/2022]
Abstract
Recently, this international task force reported the general considerations for bronchial challenge testing and the performance of the methacholine challenge test, a "direct" airway challenge test. Here, the task force provides an updated description of the pathophysiology and the methods to conduct indirect challenge tests. Because indirect challenge tests trigger airway narrowing through the activation of endogenous pathways that are involved in asthma, indirect challenge tests tend to be specific for asthma and reveal much about the biology of asthma, but may be less sensitive than direct tests for the detection of airway hyperresponsiveness. We provide recommendations for the conduct and interpretation of hyperpnoea challenge tests such as dry air exercise challenge and eucapnic voluntary hyperpnoea that provide a single strong stimulus for airway narrowing. This technical standard expands the recommendations to additional indirect tests such as hypertonic saline, mannitol and adenosine challenge that are incremental tests, but still retain characteristics of other indirect challenges. Assessment of airway hyperresponsiveness, with direct and indirect tests, are valuable tools to understand and to monitor airway function and to characterise the underlying asthma phenotype to guide therapy. The tests should be interpreted within the context of the clinical features of asthma.
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Affiliation(s)
- Teal S Hallstrand
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Joerg D Leuppi
- University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, and Medical Faculty University of Basel, Basel, Switzerland
| | - Guy Joos
- Dept of Respiratory Medicine, University of Ghent, Ghent, Belgium
| | - Graham L Hall
- Children's Lung Health, Telethon Kids Institute, School of Physiotherapy and Exercise Science, Curtin University, and Centre for Child Health Research University of Western Australia, Perth, Australia
| | - Kai-Håkon Carlsen
- University of Oslo, Institute of Clinical Medicine, and Oslo University Hospital, Division of Child and Adolescent Medicine, Oslo, Norway
| | - David A Kaminsky
- Pulmonary and Critical Care, University of Vermont College of Medicine, Burlington, VT, USA
| | - Allan L Coates
- Division of Respiratory Medicine, Translational Medicine, Research Institute-Hospital for Sick Children, University of Toronto, ON, Canada
| | - Donald W Cockcroft
- Division of Respirology, Critical Care and Sleep Medicine, Royal University Hospital, Saskatoon, SK, Canada
| | - Bruce H Culver
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA
| | - Zuzana Diamant
- Dept of Clinical Pharmacy and Pharmacology and QPS-Netherlands, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.,Dept of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Gail M Gauvreau
- Division of Respirology, Dept of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ildiko Horvath
- Dept of Pulmonology, National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Frans H C de Jongh
- Dept of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Beth L Laube
- Division of Pediatric Pulmonology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter J Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jack Wanger
- Pulmonary Function Testing and Clinical Trials Consultant, Rochester, MN, USA
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3
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Rasi H, Kuivila H, Pölkki T, Bloigu R, Rintamäki H, Tourula M. A descriptive quantitative study of 7- and 8-year-old children's outdoor recreation, cold exposure and symptoms in winter in Northern Finland. Int J Circumpolar Health 2018; 76:1298883. [PMID: 28346080 PMCID: PMC5405444 DOI: 10.1080/22423982.2017.1298883] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: In Finland, children spend a lot of time outdoors in winter. Outdoor recreation in winter has a wide variety of effects on children’s well-being. Although children are a subgroup that is vulnerable to cold exposure, remarkably little research has been done on the subject. Objective: The aim of this study was to describe children’s outdoor recreation, cold exposure and symptoms in winter in Northern Finland. Design: This was a descriptive quantitative study. The participants consisted of 30 children aged 7–8 years who were living in the provinces of Lapland and Northern Ostrobothnia in Finland. Data were collected by using electronic data-logging thermometers fixed on children’s outerwear for a month. The thermometers recorded the environmental temperature every five minutes and from that temperature data, we were able to discern the exact amount and duration of children’s outdoor recreation. In addition, information on the children’s cold symptoms was collected with structured daily entries. Results: Cold weather was not an obstacle to children’s outdoor activities in Finland. However, the duration of outdoor recreation shortened when the outdoor air temperature decreased. There were no significant differences between boys and girls in terms of time spent outdoors. Remarkably, every child reported symptoms associated with cold. Almost half of the children reported experiencing respiratory symptoms and some children also experienced cold pain and numbness. Conclusions: The results of this study illustrate the many and varied effects that cold exposure can have on children’s health and well-being. In order to prevent negative health effects of cold exposure on children, structured prevention strategies are needed: therefore, children’s exposure to cold should be studied more. Future research should also bring out more the positive health effects of outdoor recreation on children’s growth and development.
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Affiliation(s)
- Hanna Rasi
- a Nursing and Health Administration Science Research Unit , Oulu University , Oulu , Finland
| | - Heli Kuivila
- b Nursing and Health Administration Science Research Unit , University of Oulu , Oulu , Finland
| | - Tarja Pölkki
- c Clinical Nursing Science , Oulu University Hospital, Children and Women , Oulu , Finland
| | - Risto Bloigu
- d Medical Informatics and Statistics Research Group , University of Oulu , Aapistie , Oulu , Finland
| | - Hannu Rintamäki
- e Finnish Institute of Occupational Health , Aapistie , Oulu , Finland.,f Research Unit of Biomedicine, University of Oulu , Oulu , Finland
| | - Marjo Tourula
- g Arctic Health, Faculty of Medicine and Thule Institute, University of Oulu , Aapistie , Oulu , Finland
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4
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Grissom CK, Jones BE. Respiratory Health Benefits and Risks of Living at Moderate Altitude. High Alt Med Biol 2017; 19:109-115. [PMID: 28375663 DOI: 10.1089/ham.2016.0142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Grissom, Colin K., and Barbara E. Jones. Respiratory health benefits and risks of living at moderate altitude. High Alt Med Biol 19:109-115, 2018.-The respiratory system plays a critical role in the series of physiologic responses that occur at high altitude and allows individuals to adapt to and tolerate hypobaric hypoxia. Persons with underlying lung disease may have complications, but sometimes derive benefits, related to residence at high altitude. This review will focus on health benefits and risks of patients with underlying asthma, chronic obstructive pulmonary disease, pulmonary hypertension, or obstructive sleep apnea, who live at altitudes of 1500 to 4500 m. We will also discuss maladaptive responses of the respiratory system at high altitude in previously healthy persons, including development of pulmonary hypertension and sleep-disordered breathing.
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Affiliation(s)
- Colin K Grissom
- 1 Pulmonary and Critical Care Medicine, Intermountain Medical Center , Murray, Utah.,2 Pulmonary and Critical Care Medicine, The University of Utah , Salt Lake City, Utah
| | - Barbara E Jones
- 2 Pulmonary and Critical Care Medicine, The University of Utah , Salt Lake City, Utah.,3 Pulmonary and Critical Care Medicine, Salt Lake City Veterans Affairs Health System , Salt Lake City, Utah
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Anderson SD, Kippelen P. Assessment of EIB: What you need to know to optimize test results. Immunol Allergy Clin North Am 2013; 33:363-80, viii. [PMID: 23830130 DOI: 10.1016/j.iac.2013.02.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Respiratory symptoms and asthma control questionnaires are poor predictors of the presence or severity of exercise-induced bronchoconstriction (EIB), and objective measurement is recommended. To optimize the chance of a positive test result, there are several factors to consider when exercising patients for EIB, including the ventilation achieved and sustained during exercise, water content of the inspired air, and the natural variability of the response. The high rate of negative exercise test results has led to the development of surrogates to identify EIB in laboratory or office settings, including eucapnic voluntary hyperpnea of dry air and inhalation of hyperosmolar aerosols.
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Affiliation(s)
- Sandra D Anderson
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales 2050, Missenden road, Australia.
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6
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Abstract
UNLABELLED Diving with self-contained underwater breathing apparatus (SCUBA) has become a popular recreational activity in children and adolescents. This article provides an extensive review of the current literature. CONCLUSIONS Medical contraindications to SCUBA diving for adults apply to children and adolescents, too, but must be adapted. Additional restrictions to the fitness to dive must apply to both, children and adolescents. Children should always be accompanied by a trained adult when diving.
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Affiliation(s)
- Bernd E Winkler
- Department of Anaesthesiology, University of Ulm, Ulm, Germany.
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7
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Abstract
Large numbers of people travel to high altitudes, entering an environment of hypobaric hypoxia. Exposure to low oxygen tension leads to a series of important physiologic responses that allow individuals to tolerate these hypoxic conditions. However, in some cases hypoxia triggers maladaptive responses that lead to various forms of acute and chronic high altitude illness, such as high-altitude pulmonary edema or chronic mountain sickness. Because the respiratory system plays a critical role in these adaptive and maladaptive responses, patients with underlying lung disease may be at increased risk for complications in this environment and warrant careful evaluation before any planned sojourn to higher altitudes. In this review, we describe respiratory disorders that occur with both acute and chronic exposures to high altitudes. These disorders may occur in any individual who ascends to high altitude, regardless of his/her baseline pulmonary status. We then consider the safety of high-altitude travel in patients with various forms of underlying lung disease. The available data regarding how these patients fare in hypoxic conditions are reviewed, and recommendations are provided for management prior to and during the planned sojourn.
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Affiliation(s)
- Joshua O Stream
- University of Utah, Department of Anesthesiology, 30 North 1900 East, Room 3C444, Salt Lake City, UT 84132, USA.
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Philpott J, Houghton K, Luke A. Physical activity recommendations for children with specific chronic health conditions: Juvenile idiopathic arthritis, hemophilia, asthma and cystic fibrosis. Paediatr Child Health 2011; 15:213-25. [PMID: 21455465 DOI: 10.1093/pch/15.4.213] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As a group, children with a chronic disease or disability are less active than their healthy peers. There are many reasons for suboptimal physical activity, including biological, psychological and social factors. Furthermore, the lack of specific guidelines for 'safe' physical activity participation poses a barrier to increasing activity. Physical activity provides significant general health benefits and may improve disease outcomes. Each child with a chronic illness should be evaluated by an experienced physician for activity counselling and for identifing any contraindications to participation. The present statement reviews the benefits and risks of participation in sport and exercise for children with juvenile arthritis, hemophilia, asthma and cystic fibrosis. Guidelines for participation are included.
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Weiler JM, Anderson SD, Randolph C, Bonini S, Craig TJ, Pearlman DS, Rundell KW, Silvers WS, Storms WW, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, Lang DM, Nicklas RA, Oppenheimer J, Portnoy JM, Schuller DE, Spector SL, Tilles SA, Wallace D, Henderson W, Schwartz L, Kaufman D, Nsouli T, Shieken L, Rosario N. Pathogenesis, prevalence, diagnosis, and management of exercise-induced bronchoconstriction: a practice parameter. Ann Allergy Asthma Immunol 2011; 105:S1-47. [PMID: 21167465 DOI: 10.1016/j.anai.2010.09.021] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/26/2010] [Indexed: 02/06/2023]
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10
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Evaluation of the thermal insulation of clothing of infants sleeping outdoors in Northern winter. Eur J Appl Physiol 2010; 111:633-40. [PMID: 20949360 DOI: 10.1007/s00421-010-1686-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2010] [Indexed: 10/19/2022]
Abstract
It is a common practice in Northern countries that children aged about 2 weeks to 2 years take their daytime sleep outdoors in prams in winter. The aim was to evaluate the thermal insulation of clothing of infants sleeping outdoors in winter. Clothing data of infants aged 3.5 months was collected, and sleep duration, skin and microclimate temperatures, humidity inside middle wear, air temperature and velocity of the outdoor environment were recorded during sleep taken outdoors (n = 34) and indoors (n = 33) in families' homes. The insulation of clothing ensembles was measured by using a baby-size thermal manikin, and the values were used for defining clothing insulation of the observed infants. Required clothing insulation for each condition was estimated according to ISO 11079. Clothing insulation did not correlate with ambient air temperature. The observed and required insulation of the study group was equal at about -5 °C, but overdressing existed in warmer and deficiency in thermal insulation in colder temperatures (r (s) 0.739, p < 0.001). However, even at -5 °C a slow cooling (ca. 0.012 °C/min) of mean skin temperature (T (sk)) was observed. When the difference between observed and required insulation increased, the cooling rate of T (sk) increased linearly (r (s) 0.605, p < 0.001) and the infants slept for a shorter period (r (s) 0.524, p = 0.001). The results of this study show the difficulty of adjusting systematically the optimal thermal insulation for outdoor sleeping infants during northern winter. Therefore, the necessity for guidelines is obvious. The study provides information for adequate cold protection of infants sleeping in cold conditions.
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Physical activity recommendations for children with specific chronic health conditions: juvenile idiopathic arthritis, hemophilia, asthma, and cystic fibrosis. Clin J Sport Med 2010; 20:167-72. [PMID: 20445355 DOI: 10.1097/jsm.0b013e3181d2eddd] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As a group, children with a chronic disease or disability are less active than their healthy peers. There are many reasons for suboptimal physical activity, including biological, psychological, and social factors. Furthermore, the lack of specific guidelines for 'safe' physical activity participation poses a barrier to increasing activity. Physical activity provides significant general health benefits and may improve disease outcomes. Each child with a chronic illness should be evaluated by an experienced physician for activity counselling and for identifying any contraindications to participation. The present statement reviews the benefits and risks of participation in sport and exercise for children with juvenile arthritis, hemophilia, asthma, and cystic fibrosis. Guidelines for participation are included.
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12
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Philpott J, Houghton K, Luke A. Les recommandations en matière d'activité physique pour les enfants ayant une maladie chronique précise : l'arthrite juvénile idiopathique, l'hémophilie, l'asthme ou la fibrose kystique. Paediatr Child Health 2010. [DOI: 10.1093/pch/15.4.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Cappaert TA, Stone JA, Castellani JW, Krause BA, Smith D, Stephens BA. National Athletic Trainers' Association position statement: environmental cold injuries. J Athl Train 2009; 43:640-58. [PMID: 19030143 DOI: 10.4085/1062-6050-43.6.640] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To present recommendations for the prevention, recognition, and treatment of environmental cold injuries. BACKGROUND Individuals engaged in sport-related or work-related physical activity in cold, wet, or windy conditions are at risk for environmental cold injuries. An understanding of the physiology and pathophysiology, risk management, recognition, and immediate care of environmental cold injuries is an essential skill for certified athletic trainers and other health care providers working with individuals at risk. RECOMMENDATIONS These recommendations are intended to provide certified athletic trainers and others participating in athletic health care with the specific knowledge and problem-solving skills needed to address environmental cold injuries. Each recommendation has been graded (A, B, or C) according to the Strength of Recommendation Taxonomy criterion scale.
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Stensrud T, Berntsen S, Carlsen KH. Exercise capacity and exercise-induced bronchoconstriction (EIB) in a cold environment. Respir Med 2007; 101:1529-36. [PMID: 17317135 DOI: 10.1016/j.rmed.2006.12.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Revised: 12/08/2006] [Accepted: 12/15/2006] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- T Stensrud
- Norwegian School of Sport Sciences, P.O. Box 4014 Ullevaal Stadion, NO-0806 Oslo, Norway.
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15
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Abstract
OBJETIVO: Descrever os mecanismos da asma induzida pelo exercício (AIE), bem como os efeitos de diferentes tipos de treinamento físico na função pulmonar e nas capacidades aeróbia e anaeróbia. Destaca-se a importância de um diagnóstico correto mediante o teste de exercício e, no manejo, o uso de drogas beta-adrenérgicas e anticolinérgicas. FONTE DOS DADOS: Os artigos foram criteriosamente escolhidos utilizando as bases de dados PubMed e Scielo pelo ano de publicação e dando preferência a ensaios clínicos randomizados, com critérios de seleção da amostra bem definidos. SÍNTESE DOS DADOS: Os mecanismos para explicar a AIE permanecem sem conclusão, mas parece haver uma interação fisiológica entre as hipóteses aqui apresentadas. O uso de medicamentos e as freqüentes crises durante o exercício aparecem como fatores limitantes para a prática de exercícios físicos, conduzindo para um estilo de vida sedentário. CONCLUSÃO: Deve-se incentivar a prática de exercícios devidamente prescritos e minimizar as restrições aos sujeitos com AIE.
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Hawkins MN, Raven PB, Snell PG, Stray-Gundersen J, Levine BD. American College of Sports Medicine position stand: prevention of cold injuries during exercise. Med Sci Sports Exerc 2007; 39:103-7. [PMID: 17218891 DOI: 10.1249/01.mss.0000241641.75101.64] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It is the position of the American College of Sports Medicine that exercise can be performed safely in most cold-weather environments without incurring cold-weather injuries. The key to prevention is use of a comprehensive risk management strategy that: a) identifies/assesses the cold hazard; b) identifies/assesses contributing factors for cold-weather injuries; c) develops controls to mitigate cold stress/strain; d) implements controls into formal plans; and e) utilizes administrative oversight to ensure controls are enforced or modified. The American College of Sports Medicine recommends that: 1) coaches/athletes/medical personnel know the signs/symptoms and risk factors for hypothermia, frostbite, and non-freezing cold injuries, identify individuals susceptible to cold injuries, and have the latest up-to-date information about current and future weather conditions before conducting training sessions or competitions; 2) cold-weather clothing be chosen based on each individual's requirements and that standardized clothing ensembles not be mandated for entire groups; 3) the wind-chill temperature index be used to estimate the relative risk of frostbite and that heightened surveillance of exercisers be used at wind-chill temperatures below -27 degrees C (-18 degrees F); and 4) individuals with asthma and cardiovascular disease can exercise in cold environments, but should be monitored closely.
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Affiliation(s)
- Megan N Hawkins
- Institute for Exercise and Environmental Medicine, Presbyterian Hospital of Dallas, 7232 Greenville Avenue, Dallas, TX 75231, USA
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Blumberg MS, Johnson ED, Middlemis-Brown JE. Inhibition of ultrasonic vocalizations by beta-adrenoceptor agonists. Dev Psychobiol 2005; 47:66-76. [PMID: 15959896 DOI: 10.1002/dev.20070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infant rat ultrasonic vocalizations (USVs) are widely believed to result from the induction of an emotional state of anxiety or distress. This perspective, however, is not easily reconciled with the demonstration by W. J. Farrell and J. R. Alberts 2000 that norepinephrine, a nonselective beta-adrenoceptor agonist with anxiogenic properties, inhibits production of USVs. Here, Farrell and Alberts' finding was replicated and extended with 12-day-old rats using a conventional isolation paradigm. First, treatment with norepinephrine (1 mg/kg) significantly inhibited ultrasound production while also increasing body temperature. Next, treatment with the beta-2 agonist terbutaline (1 mg/kg) and the beta-3 agonist CL-316243 (1 mg/kg), but not the beta-1 agonist dobutamine (1 mg/kg), inhibited ultrasound production; only CL-316243 increased body temperature. The unexpected inhibition of USVs by terbutaline, a potent bronchodilator, was replicated using a slightly modified procedure; again, body temperature was unaffected by terbutaline administration. In no experiment was inhibition of USVs related to changes in motor activity. Altogether, these results suggest either that ultrasound production is not a valid indicator of anxiety or that anxiety in infant rats is produced by neuropharmacological mechanisms that differ fundamentally from those in adults.
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Affiliation(s)
- Mark S Blumberg
- Department of Psychology, University of Iowa, Iowa City, Iowa 52242, USA
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18
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Evans TM, Rundell KW, Beck KC, Levine AM, Baumann JM. Airway Narrowing Measured by Spirometry and Impulse Oscillometry Following Room Temperature and Cold Temperature Exercise. Chest 2005; 128:2412-9. [PMID: 16236903 DOI: 10.1378/chest.128.4.2412] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE The efficacy of using impulse oscillometry (IOS) as an indirect measure of airflow obstruction compared to spirometry after exercise challenges in the evaluation of exercise-induced bronchoconstriction (EIB) has not been fully appreciated. The objective was to compare airway responses following room temperature and cold temperature exercise challenges, and to compare whether IOS variables relate to spirometry variables. DESIGN Spirometry and IOS were performed at baseline and for 20 min after challenge at 5-min intervals. SETTING Two 6-min exercise challenges, inhaling either room temperature (22.0 degrees C) or cold temperature (- 1 degrees C) dry medical-grade bottled air. At least 48 h was observed between these randomly assigned challenges. PARTICIPANTS Twenty-two physically active individuals (12 women and 10 men) with probable EIB. INTERVENTIONS Subjects performed 6 min of stationary cycle ergometry while breathing either cold or room temperature medical-grade dry bottled air. Subjects were instructed to exercise at the highest intensity sustainable for the duration of the challenge. Heart rate and kilojoules of work performed were documented to verify exercise intensity. MEASUREMENTS AND RESULTS Strong correlations were observed within testing modalities for post-room temperature and post-cold temperature exercise spirometry and IOS values. Spirometry revealed no differences in postexercise peak falls in lung function between conditions; however, IOS identified significant differences in respiratory resistance (p < 0.05), with room temperature-inspired air being more potent than cold temperature-inspired air. CONCLUSIONS Correlations were found between spirometric and IOS measures of change in airway function for both exercise challenges, indicating close equivalency of the methods. The challenges appeared to elicit the EIB response by a similar mechanism of water loss, and cold temperature did not have an additive effect. IOS detected a difference in degree of response between the temperatures, whereas spirometry indicated no difference, suggesting that IOS is a more sensitive measure of change in airway function.
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Affiliation(s)
- Tina M Evans
- Marywood University, 2300 Adams Ave, Scranton, PA 18509, USA
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Evans TM, Rundell KW, Beck KC, Levine AM, Baumann JM. Cold air inhalation does not affect the severity of EIB after exercise or eucapnic voluntary hyperventilation. Med Sci Sports Exerc 2005; 37:544-9. [PMID: 15809550 DOI: 10.1249/01.mss.0000158186.32450.ec] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Exercise-induced bronchoconstriction (EIB) is thought to result from osmotic and thermal events of air conditioning during exercise at high ventilation rates. The purpose of this study was to evaluate lung function after exercise and eucapnic voluntary hyperventilation (EVH) while breathing both room-temperature and cold-temperature dry bottled air. METHODS Twenty-two subjects were identified as EIB probable by a fall of >or=7% in forced expiratory volume in the first second of exhalation (FEV1) using a 6-min room-temperature EVH challenge (RTEVH; 22.0 degrees C). Subjects then randomly performed three 6-min challenges: cold-temperature EVH (CTEVH; -1 degrees C), room-temperature exercise (RTEX; 22.0 degrees C), and cold-temperature exercise (CTEX; -1 degrees C), with a period of at least 48 h observed between challenges. Spirometry was performed at baseline and at 5, 10, 15, and 20 min postchallenge. RESULTS Reasonable agreement was found between challenge modes and room-temperature and cold-temperature challenges. Postchallenge percent falls in FEV1 were -15.21, -13.80, -13.12, and -10.69 for RTEVH, CTEVH, RTEX, and CTEX, respectively. RTEVH resulted in a significantly greater percent fall in FEV1 than CTEX (P=0.048); no other differences in FEV1 were observed. CONCLUSION Similar postchallenge percent falls in FEV1 for room- and cold-temperature EVH and exercise suggest that dryness is essential to test conditions, as cold temperature did not have an additive effect to the EIB response.
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Knöpfli BH, Bar-Or O, Araújo CGS. Effect of ipratropium bromide on EIB in children depends on vagal activity. Med Sci Sports Exerc 2005; 37:354-9. [PMID: 15741830 DOI: 10.1249/01.mss.0000155436.31581.90] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Ipratropium bromide (IB) has been used to prevent exercise-induced bronchoconstriction (EIB), but its effect varies among individuals. We hypothesized that such variability may reflect individual differences in vagal activity (VA), and therefore determined whether a correlation exists between VA and the effect of IB on EIB in 13.0 (+/-0.8)-yr-old children with asthma and documented EIB. METHODS Subjects served as their own control and were tested on three occasions in an ambient temperature of 5 degrees C. Visit I included no treatment. In visits II and III (counterbalanced sequence) subjects inhaled either 500 microg IB or 0.9% NaCl as a placebo, 45 min before exercise provocation. Investigators and the subjects were blinded to the inhaled substance. VA was assessed by a 4-s exercise test (3). The ratio of resting ECG R-R-interval at full inspiration to the lowest R-R interval during 4-s cycling was taken as an index of VA. Eight-minute cycling at constant work rate (HR=173+/-4 bpm) at 5 degrees C was used to provoke EIB. A two-factor (treatment x time) repeated-measures ANOVA was used. RESULTS The exercise-induced drop in FEV1 was similar in the three sessions. However, because the IB caused a 15.7+/-4.1 increase in FEV1 preexercise, the postexercise values after a placebo or no treatment were consistently lower than after IB. The beneficial response to IB, compared with no treatment and with placebo, was positively correlated to VA (for FEV1: r=0.91, P=0.002; and r=0.90, P=0.002, respectively). CONCLUSION We suggest that the therapeutic effect of IB on exercise-induced asthma may be related to vagal activity.
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