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Berger S, Pini N, Lucchini M, Nugent JD, Acosta L, Angal J, Rauh VA, Elliott AJ, Myers MM, Fifer WP, Perzanowski MS. Neonatal rhinorrhea, heart rate variability, and childhood exercise-induced wheeze. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100149. [PMID: 37781655 PMCID: PMC10509928 DOI: 10.1016/j.jacig.2023.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/19/2023] [Accepted: 06/20/2023] [Indexed: 10/03/2023]
Abstract
Background There is increasing evidence linking infant rhinorrhea to school-age exercise-induced wheeze (EIW) via a parasympathetic nervous system pathway. The ratio of the root mean square of successive differences in heart beats (RMSSD) measured in quiet sleep versus active sleep (RMSSDQS:AS) is a novel biomarker in asthma. Objective We tested the hypotheses that (1) neonatal rhinorrhea predicts childhood EIW independent of other neonatal respiratory symptoms, (2) neonatal RMSSDQS:AS predicts childhood EIW, and (3) RMSSDQS:AS mediates the association between neonatal rhinorrhea and childhood EIW. Methods Participants from the Safe Passage/Environmental Influences on Child Health Outcomes (PASS/ECHO) prospective birth cohort had heart rate variability extracted from electrocardiogram traces acquired in the first month of life. Parents reported on rhinorrhea in their child at age 1 month and on EIW in their child at ages 4 to 11 years. Results In models (N = 831) adjusted for potential confounders and covariates, including neonatal wheeze, cough and fever, neonatal rhinorrhea-predicted childhood EIW (relative risk [RR] = 2.22; P = .040), specifically, among females (RR = 3.38; P = .018) but not males (RR = 1.39; P = .61). Among participants contributing data in both active and quiet sleep (n = 231), RMSSDQS:AS predicted EIW (RR = 2.36; P = .003) and mediated the effect estimate of neonatal rhinorrhea predicting EIW among females. Half of the females with a higher RMSSDQS:AS and neonatal rhinorrhea (n = 5 of 10) developed EIW as compared with 1.8% of the other females (n = 2 of 109) (P < .001). Conclusions Our findings support dysregulation of the parasympathetic nervous system in infancy as one of the possible underlying mechanisms for the development of EIW later in childhood among females, which could aid in the development of future interventions.
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Affiliation(s)
- Sophie Berger
- Division of Pulmonology, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Nicolò Pini
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY
| | - J. David Nugent
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY
| | - Luis Acosta
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, Sioux Falls, SD
| | | | - Virginia A. Rauh
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, Sioux Falls, SD
| | | | - Michael M. Myers
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - William P. Fifer
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY
| | - Matthew S. Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, Sioux Falls, SD
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Chaves Quirino PG, Rizzo JÂ, Hunter S, de Albuquerque Rodrigues Filho E, Sarinho E, de Almeida Santos CM, Medeiros D, Costa EC, Silva AS, Farah BQ, de Valois Correia Júnior MA. Is there cardiac autonomic dysfunction in children and adolescents with exercise-induced bronchospasm? Expert Rev Respir Med 2023; 17:823-831. [PMID: 37795708 DOI: 10.1080/17476348.2023.2265819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The pulmonary impairment in patients with bronchoconstriction induced by eucapnic voluntary hyperpnea(EVH) goes beyond the respiratory system, also impairing autonomic nervous modulation. This study aimed to evaluate the behavior of cardiac autonomic modulation in young asthmatics with and without EIB after the EVH test. RESEARCH DESIGN AND METHODS A cross-sectional study design using 54 asthmatics(51.9% female), aged between 10 and 19 years, investigated with the EVH test. Forced expiratory volume in one second(FEV1) was measured at 5, 10, 15, and 30 min after EVH. Heart rate variability(HRV) measures of time were assessed pre and 30 min-post EVH. The diagnosis of Exercise-Induced bronchoconstriction with underlying clinical asthma(EIBA) was confirmed by a fall in FEV1 ≥10% compared to baseline. RESULTS Thirty(55.5%) asthmatics had EIBA. Subjects with EIBA have reduced mean of the R-R intervals in relation to baseline until 15 minutes after EVH. Individuals without EIBA had increased parasympathetic activity compared to baseline(rMSSD) from 5 min after EVH(p < 0.05). This parasympathetic activity increase in relation to baseline was seen in individuals with EIBA after 25 minutes (rMSSD = 49.9 ± 5.3 vs 63.5 ± 7.2, p < 0.05). CONCLUSION Young asthmatics with EIBA present a delay in the increase of the parasympathetic component after EVH when compared to asthmatics without EIBA.
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Affiliation(s)
- Polyanna Guerra Chaves Quirino
- Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - José Ângelo Rizzo
- Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil
| | - Steve Hunter
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, London, UK
| | | | - Emanuel Sarinho
- Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil
| | - Camila Matias de Almeida Santos
- Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Decio Medeiros
- Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil
| | - Emilia Chagas Costa
- Postgraduate Program in Nutrition, Universidade Federal de Pernambuco, Recife, Brazil
| | - Alexandre Sérgio Silva
- Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
| | - Breno Quintella Farah
- Department of Physical Education, Universidade Federal Rural de Pernambuco, Recife, Brazil
| | - Marco Aurélio de Valois Correia Júnior
- Associated Postgraduate Program in Physical Education, Universidade de Pernambuco and Universidade Federal da Paraiba, Recife, Brazil
- Allergy and clinical immunology department, Hospital das Clínicas. Universidade Federal de Pernambuco, Recife, Brazil
- Postgraduate Program in Hebiatrics, Universidade de Pernambuco, Recife, Brazil
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Schiwe D, Vendrusculo FM, Becker NA, Donadio MVF. Impact of asthma on heart rate variability in children and adolescents: Systematic review and meta-analysis. Pediatr Pulmonol 2023; 58:1310-1321. [PMID: 36719098 DOI: 10.1002/ppul.26340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Asthma is associated with abnormal autonomic function, and heart rate variability is considered a simple, accurate, and noninvasive tool for monitoring the autonomic system. Thus, the aim of this study was to investigate the impact of asthma on heart rate variability in children and adolescents. METHODS This systematic review of observational studies and clinical trials evaluated heart rate variability in children and adolescents with asthma compared to healthy controls. The data were extracted independently by two reviewers. The quality of the selected articles was assessed using Agency for Health Care Research and Quality indicators. Random effects meta-analysis was performed for each outcome, with the effect size reported as standardized mean difference. RESULTS Fifteen studies were included, of which five were classified as having high methodological quality. In the meta-analysis, long-term recording of the standard deviation of all normal-to-normal sinus R-R intervals differed significantly between groups (standardized mean difference [SMD] = -0.46 [95% confidence interval {CI}: -0.79 to -0.14], p < 0.005, I2 = 0%). Moreover, R-R intervals (long-term) were significantly shorter in asthmatic children than controls (SMD = -0.47 [95% CI: -0.68 to -0.25], p < 0.0001, I2 = 0). There were no significant differences between adjacent normal R-R intervals that exceed 50 ms (long-term) and the root mean square of successive differences between normal sinus R-R intervals (short-term). Regarding frequency-domain variables, long-term low frequency measurements differed significantly between groups (SMD = -0.34 [95% CI: -0.58 to -0.10], p < 0.005, I2 = 15%). There were no differences in high frequency measurements or in the ratio between low/high frequency powers (short- or long-term) between groups. CONCLUSION The results confirm the impact of asthma on heart rate variability in children and adolescents, indicating lower heart rate variability and sympathetic modulation.
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Affiliation(s)
- Daniele Schiwe
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Fernanda Maria Vendrusculo
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Nicolas Acosta Becker
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Márcio Vinícius Fagundes Donadio
- Laboratory of Pediatric Physical Activity, Infant Center, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Department of Physiotherapy, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
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Ali H, Brooks C, Tzeng YC, Crane J, Beasley R, Gibson P, Pattemore P, Stanley T, Pearce N, Douwes J. Heart rate variability as a marker of autonomic nervous system activity in young people with eosinophilic and non-eosinophilic asthma. J Asthma 2023; 60:534-542. [PMID: 35468039 DOI: 10.1080/02770903.2022.2070763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE An imbalance in autonomic nervous system (ANS) activity may play a role in asthma, but it is unclear whether this is associated with specific pathophysiology. This study assessed ANS activity by measuring heart rate variability (HRV) in eosinophilic (EA) and non-eosinophilic asthma (NEA) and people without asthma. METHODS HRV, combined hypertonic saline challenge/sputum induction, exhaled nitric oxide (FeNO), skin prick tests to measure atopy, and spirometry tests were conducted in teenagers and young adults (14-21 years) with (n = 96) and without (n = 72) generally well-controlled asthma. HRV parameters associated with sympathetic and parasympathetic ANS branches were analyzed. EA and NEA were defined using a 2.5% sputum eosinophil cut-point. Airway hyperreactivity (AHR) was defined as ≥15% reduction in FEV1 following saline challenge. RESULTS HRV parameters did not differ between asthmatics and non-asthmatics or EA and NEA. They were also not associated with markers of inflammation, lung function or atopy. However, increased absolute low frequency (LFµs2; representing increased sympathetic nervous system (SNS) activity) was found in asthmatics who used β-agonist medication compared to those who did not (median: 1611, IQR 892-3036 vs 754, 565-1592; p < 0.05) and increased normalized low frequency (LF nu) was found in those with AHR compared to without AHR (64, 48-71 vs 53, 43-66; p < 0.05). CONCLUSION ANS activity (as measured using HRV analysis) is not associated with pathophysiology or inflammatory phenotype in young asthmatics with generally well-controlled asthma. However, enhanced SNS activity can be detected in asthmatics with AHR or who use β-agonist medication.
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Affiliation(s)
- Hajar Ali
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Collin Brooks
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
| | - Yu-Chieh Tzeng
- Centre for Translational Physiology, University of Otago, Wellington, New Zealand
| | - Julian Crane
- School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Peter Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Philip Pattemore
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Thorsten Stanley
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Jeroen Douwes
- Research Centre for Hauora and Health, Massey University, Wellington, New Zealand
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5
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Karakaya Z, Cavkaytar Ö, Tosun Ö, Arga M. Subclinical cardiovascular dysfunction in children and adolescents with asthma. J Asthma 2020; 59:451-461. [PMID: 33251886 DOI: 10.1080/02770903.2020.1856866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is close association between asthma and cardiovascular functions as both diseases share common inflammatory pathways. The current study was aimed at investigating the risk factors, associated with endothelial and cardiac functions in children with newly-diagnosed mild-persistent asthma. METHODS A total of 33 steroid-naive asthmatic children [median(interquartile-range); 9.1 years(7.8-13.5)] and 16 healthy controls [11.5 years(9.9-13.6)] were included. Their demographic, clinical and laboratory findings were recorded. Carotid Artery intima-media thickness (CIMT), stiffness, distensibility and strain were measured as atheroclerosis markers. Conventional and tissue Doppler imaging was performed to evaluate ventricular function. RESULTS The patients with asthma had higher CIMT and stiffness and lower strain and distensibility compared to controls (p < 0.001 for all). There was a significant correlation between the duration of asthmatic symptoms and subclinical-atherosclerosis as well as peripheral eosinophil count (p < 0.001, p < 0.05). The patients had lower tricuspid-annular-plane-systolic-excursion (TAPSE), ejection time, and higher isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and left ventricle myocardial performance index (LVMPI) than the control subjects (p < 0.001 for all). A positive correlation was also observed between the duration of asthmatic-symptoms and cardiac-function parameters. CONCLUSION Children with mild persistent asthma had subclinical atherosclerosis and ventricular dysfunction even in the early stage of disease. Symptom duration was closely associated with both subclinical atherosclerosis and ventricular dysfunction. Myocardial performance index was abnormal in the asthmatic children when assessed by tissue Doppler Imaging even though they had normal ejection fraction in conventional echocardiography. Future prospective studies with larger sample sizes are needed to confirm these findings and to assess the possible protective effect of ICSs in the prevention of subclinical atherosclerosis.
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Affiliation(s)
- Zeynep Karakaya
- Department of Pediatrics, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Özlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Öykü Tosun
- Department of Pediatric Cardiology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
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6
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Stensrud T, Rossvoll Ø, Mathiassen M, Melau J, Illidi C, Østgaard HN, Hisdal J, Stang J. Lung function and oxygen saturation after participation in Norseman Xtreme Triathlon. Scand J Med Sci Sports 2020; 30:1008-1016. [PMID: 32153035 DOI: 10.1111/sms.13651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine evidence of exercise-induced bronchoconstriction (EIB) defined as ≥10% reduction in forced expiratory volume in one second (FEV1 ) and exercise-induced arterial hypoxemia (EIAH) defined as ≥4% reduction in oxygen saturation (SpO2 ) from before to after participation in the Norseman Xtreme Triathlon. Secondarily, to assess whether changes in FEV1 and SpO2 are related to respiratory symptoms, training volume, and race time. METHODS In this quasi-experimental non-controlled study, we included 63 triathletes (50♂/13♀) aged 40.3 (±9.0) years (mean ± SD). Fifty-seven (46♂/11♀) measured lung function and 54 (44♂/10♀) measured SpO2 before the race, 8-10 minutes after the race (post-test 1) and the day after the race (post-test 2). Respiratory symptoms and training volume were recorded with modified AQUA questionnaire. ANOVA for repeated measures was used to detect differences in lung function and SpO2 . Statistical significance was accepted at 0.05 level. RESULTS Twenty-six participants (46%) presented with EIB at post-test 1 and 16 (28%) at post-test 2. Lung function variables were significantly reduced from baseline to post-test 1 and 2. Thirty-five participants (65%) showed evidence of mild to moderate EIAH. No significant correlations were observed except a weak correlation between maximal reduction in FEV1 and respiratory symptoms (r = 0.35, P = .016). CONCLUSION Our results demonstrated that 46% of the participants presented with EIB and 65% showed evidence of EIAH after the Norseman Xtreme Triathlon. Changes in FEV1 and SpO2 were not correlated to weekly training hours or race time. We observed a weak correlation between maximal reduction in FEV1 and respiratory symptoms.
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Affiliation(s)
- Trine Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Øyvind Rossvoll
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Jørgen Melau
- Prehospital Division, Vestfold Hospital Trust, Tønsberg, Norway
| | - Camilla Illidi
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Centre of Health, Exercise and Performance, College of health & Life Sciences, Brunel University, London, UK
| | - Hege N Østgaard
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Jonny Hisdal
- Department of vascular surgery, Oslo University Hospital, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Julie Stang
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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7
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Serrão NF, Porta A, Minatel V, Castro AAM, Catai AM, Sampaio LMM, Arena R, Borghi-Silva A. Complexity analysis of heart rate variability in chronic obstructive pulmonary disease: relationship with severity and symptoms. Clin Auton Res 2020; 30:157-164. [DOI: 10.1007/s10286-019-00659-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
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8
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Paciência I, Rufo JC, Silva D, Martins C, Mendes F, Rama T, Rodolfo A, Madureira J, Delgado L, de Oliveira Fernandes E, Padrão P, Moreira P, Severo M, Pina MF, Teixeira JP, Barros H, Ruokolainen L, Haahtela T, Moreira A. School environment associates with lung function and autonomic nervous system activity in children: a cross-sectional study. Sci Rep 2019; 9:15156. [PMID: 31641175 PMCID: PMC6805928 DOI: 10.1038/s41598-019-51659-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/04/2019] [Indexed: 01/10/2023] Open
Abstract
Children are in contact with local environments, which may affect respiratory symptoms and allergic sensitization. We aimed to assess the effect of the environment and the walkability surrounding schools on lung function, airway inflammation and autonomic nervous system activity. Data on 701 children from 20 primary schools were analysed. Lung function, airway inflammation and pH from exhaled breath condensate were measured. Pupillometry was performed to evaluate autonomic activity. Land use composition and walkability index were quantified within a 500 m buffer zone around schools. The proportion of effects explained by the school environment was measured by mixed-effect models. We found that green school areas tended to be associated with higher lung volumes (FVC, FEV1 and FEF25–75%) compared with built areas. FVC was significantly lower in-built than in green areas. After adjustment, the school environment explained 23%, 34% and 99.9% of the school effect on FVC, FEV1, and FEF25–75%, respectively. The walkability of school neighbourhoods was negatively associated with both pupil constriction amplitude and redilatation time, explaining −16% to 18% of parasympathetic and 8% to 29% of sympathetic activity. Our findings suggest that the environment surrounding schools has an effect on the lung function of its students. This effect may be partially mediated by the autonomic nervous system.
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Affiliation(s)
- Inês Paciência
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal. .,Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal. .,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - João Cavaleiro Rufo
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal.,Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Diana Silva
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | - Carla Martins
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | - Francisca Mendes
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | - Tiago Rama
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | - Ana Rodolfo
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | - Joana Madureira
- Institute of Science and Innovation in Mechanical Engineering and Industrial Management (INEGI), Porto, Portugal
| | - Luís Delgado
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal
| | | | - Patrícia Padrão
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Pedro Moreira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Maria Fátima Pina
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal.,Instituto de Engenharia Biomédica (INEB), Universidade do Porto, Porto, Portugal.,Health Communication and Information Institute, Fundação Oswaldo Cruz (ICICT/FIOCRUZ), Rio de Janeiro, Brazil
| | - João Paulo Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Environmental Health Department, Portuguese National Institute of Health, Porto, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública da Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Lasse Ruokolainen
- Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - André Moreira
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal & Centro Hospitalar São João, Porto, Portugal.,EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Faculdade de Ciências da Nutrição e Alimentação da Universidade do Porto, Porto, Portugal
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9
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Lehavi A, Golomb N, Leiba R, Katz Y(S, Raz A. One-minute heart rate variability - an adjunct for airway obstruction identification. Physiol Rep 2019; 7:e13948. [PMID: 30632302 PMCID: PMC6328920 DOI: 10.14814/phy2.13948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 11/24/2022] Open
Abstract
Heart rate variability (HRV) reflects cardiac and autonomic nervous system activity. It is usually measured over a relatively prolonged period and presented using multiple parameters. Here, we studied rapid HRV changes during airway obstruction using a short (1 min) sampling window. Forty healthy volunteers underwent a trial of obstructed breathing. Heart rate was recorded during three consecutive sets comprised of 1-min control followed by 1 min of obstructed breathing, with 1 min of rest between sets. Time and frequency domain analysis were used to compare HRV during control versus obstructed breathing. Compared with control, HRV intensely increased during obstructed breathing: R-R intervals (time between consecutive R waves) standard deviation increased from 65 to 108 msec (P < 0.0001), root mean square of successive R-R interval from 61 to 82 msec (P = 0.001), number of pairs of successive R-R intervals that differ by more than 50 msec (NN50) from 16.5 to 25.3 events (P < 0.0001), and proportion of NN50 divided by total number of R-R intervals from 26.6 to 35.1% (P = 0.001). Low frequency power increased by more than fourfold (P < 0.0001), allowing 90% sensitivity and 75% specificity for identifying airway obstruction (ROC area 0.88, P < 0.0001). We observed a rapid intense increase in HRV during obstructed breathing, significant enough to detect during a short 1-min sampling window. These findings suggest that HRV may be useful for rapid detection of airway obstruction, especially in situations where end-tidal CO2 monitoring is not optimal, such as during partial airway obstruction.
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Affiliation(s)
- Amit Lehavi
- Department of AnesthesiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Neta Golomb
- Department of AnesthesiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Ronit Leiba
- Department of EpidemiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Yeshayahu (Shai) Katz
- Department of AnesthesiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
| | - Aeyal Raz
- Department of AnesthesiologyRambam Health Care Campusthe Ruth and Bruce Rappaport Faculty of MedicineTechnion – Israel Institute of TechnologyHaifaIsrael
- Department of AnesthesiologyUniversity of WisconsinMadisonWisconsin
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Dynamic Changes in Heart Rate Variability and Nasal Airflow Resistance during Nasal Allergen Provocation Test. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2016:1245418. [PMID: 27196870 PMCID: PMC5058568 DOI: 10.1155/2016/1245418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 01/19/2016] [Indexed: 11/18/2022]
Abstract
Allergic rhinitis is a major chronic respiratory disease and an immunoneuronal disorder. We aimed at providing further knowledge on the function of the neural system in nasal allergic reaction. Here, a method to assess simultaneously the nasal airflow resistance and the underlying function of autonomic nervous system (ANS) is presented and used during the nasal provocation of allergic and nonallergic subjects. Continuous nasal airflow resistance and spectral heart rate variability parameters show in detail the timing and intensity differences in subjects' reactions. After the provocation, the nasal airflow resistance of allergic subjects showed a positive trend, whereas LF/HF (Low Frequency/High Frequency) ratio and LF power showed a negative trend. This could imply a gradual sympathetic withdrawal in allergic subjects after the allergen provocation. The groups differed significantly by these physiological descriptors. The proposed method opens entirely new opportunities to research accurately concomitant changes in nasal breathing function and ANS.
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Paggiaro P, Latorre M. Reply. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 4:793. [PMID: 27393790 DOI: 10.1016/j.jaip.2016.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy.
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
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Chevalier G, Patel S, Weiss L, Pruitt C, Henry B, Chopra D, Mills PJ. Effects of Grounding (Earthing) on Massage Therapists: An Exploratory Study. Health (London) 2018. [DOI: 10.4236/health.2018.102019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Stang J, Stensrud T, Mowinckel P, Carlsen KH. Parasympathetic Activity and Bronchial Hyperresponsiveness in Athletes. Med Sci Sports Exerc 2017; 48:2100-2107. [PMID: 27285494 DOI: 10.1249/mss.0000000000001008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE A high prevalence of asthma and bronchial hyperresponsiveness (BHR) is reported in swimmers and cross-country skiers. It has been suggested that increased parasympathetic nervous activity is involved in asthma development in endurance athletes. We aimed to assess the associations of BHR to parasympathetic activity in healthy and asthmatic swimmers and cross-country skiers and healthy nonathletes. METHODS Parasympathetic activity was measured by pupillometry and heart rate variability at the onset of exercise with the cardiac vagal index calculated in 28 cross-country skiers (♂18/♀10), 29 swimmers (♂17/♀12), and 30 healthy nonathlete controls (♂14/♀16) on two different days. All subjects performed a methacholine bronchial challenge with the provocation dose causing 20% decrease in the forced expiratory volume in 1 s calculated (PD20met). Data were analyzed by robust regression analysis and presented as β coefficients with 95% confidence intervals (CI). RESULTS PD20met was negatively associated with cardiac vagal index (-13.9, 95% CI = -26.8 to -1.0) in all subjects. When adjusted to the type of sport, this association was stronger in swimmers (-8.3, 95% CI = -13.0 to -3.6) as compared with controls and nonsignificant in cross-country skiers. Percent pupil constriction was significantly associated with PD20met in swimmers (-9.4, 95% CI = -15.4 to -3.4) only after adjusting for the type of sport. Fourteen swimmers (48%) and 16 cross-country skiers (57%) had doctor-diagnosed asthma in combination with current BHR and/or current use of asthma drugs. Seventy-two percent swimmers, 44% cross-country skiers, and 39% controls had a PD20met ≤8 μmol (P = 0.015). Fourteen swimmers had a PD20met ≤2 μmol as compared with one cross-country skier (P < 0.001). CONCLUSION Parasympathetic activity measured in the heart is more closely related to BHR as compared with parasympathetic activity measured in the pupils. The type of sport influences BHR severity and its relationship to parasympathetic activity.
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Affiliation(s)
- Julie Stang
- 1Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, NORWAY; 2Department of Pediatrics, Oslo University Hospital, NORWAY; and 3Faculty of Medicine, University of Oslo, NORWAY
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STANG JULIE, COUTO MARIANA, STENSRUD TRINE, MOWINCKEL PETTER, MOREIRA ANDRÉ, CARLSEN KAIHÅKON. Assessment of Parasympathetic Activity in Athletes. Med Sci Sports Exerc 2016; 48:316-22. [DOI: 10.1249/mss.0000000000000769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Boudreau M, Lavoie KL, Cartier A, Trutshnigg B, Morizio A, Lemière C, Bacon SL. Do asthma patients with panic disorder really have worse asthma? A comparison of physiological and psychological responses to a methacholine challenge. Respir Med 2015; 109:1250-6. [PMID: 26383174 DOI: 10.1016/j.rmed.2015.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/30/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Panic disorder (PD) has been linked to worse asthma outcomes. Some suggest that asthmatics with PD have worse underlying asthma; others argue that worse outcomes are a result of their tendency to over-report symptoms. This study aimed to measure physiological and psychological responses to a simulated asthma attack (methacholine challenge test: MCT) in asthmatics with and without PD. METHODS Asthmatics with (n = 19) and without (n = 20) PD were recruited to undergo a MCT. Patients completed subjective symptom questionnaires (Panic Symptom Scale, Borg Scale) before and after a MCT. Physiological measures including heart rate (HR), and systolic and diastolic blood pressure (SBP/DBP) were also recorded. RESULTS Analyses, adjusting for age and sex, revealed no difference in methacholine concentration required to induce a 20% drop in forced expiratory volume in one second (FEV1: F = 0.21, p = .652). However, PD patients reported worse subjective symptoms, including greater ratings of dyspnea (F = 8.81, p = .006) and anxiety (F = 9.44, p = .004), although they exhibited lower levels of physiological arousal (i.e., HR, SBP/DBP). An interaction effect also indicated that PD, relative to non-PD, patients reported more panic symptoms post-MCT (F = 5.05, p = .031). CONCLUSIONS Asthmatics with PD report higher levels of subjective distress, despite exhibiting lower levels of physiological arousal, with no evidence of greater airway responsiveness. Results suggest that worse outcomes in PD patients may be more likely due to a catastrophization of bodily symptoms, rather than worse underlying asthma. Interventions designed to educate patients on how to distinguish and manage anxiety in the context of asthma are needed.
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Affiliation(s)
- Maxine Boudreau
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin West, Montréal, Québec, H4J 1C5, Canada; Department of Psychology, University of Quebec at Montreal (UQAM), P.O. Box 8888, Succursale Center-Ville, Montreal, Quebec, H3C 3P8, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin West, Montréal, Québec, H4J 1C5, Canada; Department of Psychology, University of Quebec at Montreal (UQAM), P.O. Box 8888, Succursale Center-Ville, Montreal, Quebec, H3C 3P8, Canada; Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - André Cartier
- Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Barbara Trutshnigg
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin West, Montréal, Québec, H4J 1C5, Canada
| | - Alexandre Morizio
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin West, Montréal, Québec, H4J 1C5, Canada; Department of Exercise Science, Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec, H4B 1R6, Canada
| | - Catherine Lemière
- Université de Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Cœur de Montréal, 5400 Gouin West, Montréal, Québec, H4J 1C5, Canada; Department of Exercise Science, Concordia University, 7141 Sherbrooke St. West, Montreal, Quebec, H4B 1R6, Canada.
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Bougault V, Blouin E, Turmel J, Boulet LP. Airway response to methacholine following eucapnic voluntary hyperpnea in athletes. PLoS One 2015; 10:e0121781. [PMID: 25789614 PMCID: PMC4366214 DOI: 10.1371/journal.pone.0121781] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 02/09/2015] [Indexed: 11/18/2022] Open
Abstract
Aim To evaluate the changes in airway responsiveness to methacholine inhalation test (MIT) when performed after an eucapnic voluntary hyperpnea challenge (EVH) in athletes. Methods Two MIT preceded (visit 1) or not (visit 2) by an EVH, were performed in 28 athletes and 24 non-athletes. Twelve athletes and 13 non-athletes had airway hyperresponsiveness (AHR) to methacholine, and 11 athletes and 11 non-athletes had AHR to EVH (EVH+). Results The MIT PC20 post-EVH was significantly lower compared to baseline MIT PC20 by 1.3±0.7 doubling-concentrations in EVH+ athletes only (p<0.0001). No significant change was observed in EVH- athletes and EVH+/EVH- non-athletes. A significant correlation between the change in MIT PC20 post-EVH and EVH+/EVH- status and athlete/nonathlete status was found (Adjusted R2=0.26 and p<0.001). Three (11%) athletes and one (4%) non-athlete had a change in the diagnosis of AHR when MIT was performed consecutively to EVH. Conclusion The responsiveness to methacholine was increased by a previous indirect challenge in EVH+ athletes only. The mechanisms for such increase remain to be determined. MIT and EVH should ideally be performed on separate occasions as there is a small but possible risk to obtain a false-positive response to methacholine when performed immediately after the EVH. Trial Registration ClinicalTrials.gov NCT00686491
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Affiliation(s)
- Valérie Bougault
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
- Université de Lille, EA4488 « Activité physique, muscle, santé », Lille, France
| | - Evelyne Blouin
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - Julie Turmel
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
| | - Louis-Philippe Boulet
- Centre de recherche de l’Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada
- * E-mail:
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Couto M, Silva D, Santos P, Queirós S, Delgado L, Moreira A. Exploratory study comparing dysautonomia between asthmatic and non-asthmatic elite swimmers. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:22-9. [PMID: 25854132 DOI: 10.1016/j.rppnen.2014.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/14/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Dysautonomia has been independently associated with training and exercise-induced bronchoconstriction. In addition, neurogenic airway inflammation was recently associated with swimmers-asthma. We aimed to assess the relation between autonomic nervous system and airway responsiveness of asthmatic elite swimmers. METHODS Twenty-seven elite swimmers, 11 of whom had asthma, were enrolled in this exploratory cross-sectional study. All performed spirometry with bronchodilation, skin prick tests and methacholine challenge according to the guidelines. Pupillometry was performed using PLR-200™ Pupillometer. One pupil light response curve for each eye was recorded and the mean values of pupil's maximal and minimal diameters, percentage of constriction, average and maximum constriction velocities (parasympathetic parameters), dilation velocity, and total time to recover 75% of the initial size (sympathetic parameters) were used for analysis. Asthma was defined using IOC-MC criteria; subjects were divided into airway hyperesponsiveness (AHR) severity according to methacholine PD20 in: no AHR, borderline, mild, moderate and severe AHR. Differences for pupillary parameters between groups and after categorization by AHR severity were assessed using SPSS 20.0 (p ≤ 0.05). In individuals with clinically relevant AHR, correlation between PD20 and pupillary parameters was investigated with Spearman's correlation test. RESULTS No statistically significant differences were observed between asthmatic and non-asthmatic swimmers regarding parasympathetic parameters. When stratified by AHR, maximal and minimal diameters and percentage of constriction were significantly lower among those with severe AHR. Among swimmers with clinically relevant AHR (n = 18), PD20 correlated with parasympathetic activity: maximal (r = 0.67, p = 0.002) and minimal diameters (r = 0.75, p<0.001), percentage of constriction (r = -0.59, p = 0.011) and latency (r = 0.490, p = 0.039). CONCLUSIONS No significant differences were observed between asthmatic and non-asthmatic swimmers regarding parasympathetic parameters, but among those with relevant AHR an association was found. Although limited by the sample size, these findings support the relation between dysautonomia and AHR in asthmatic swimmers.
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Affiliation(s)
- M Couto
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), Portugal; Instituto CUF & Hospital CUF Porto, Allergy Unit, Portugal.
| | - D Silva
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal
| | - P Santos
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal
| | - S Queirós
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal
| | - L Delgado
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), Portugal
| | - A Moreira
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), Portugal
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Stang J, Couto M, Carlsen KH, Stensrud T. Increased bronchial parasympathetic tone in elite cross-country and biathlon skiers: a randomised crossover study. Br J Sports Med 2014; 49:bjsports-2014-094053. [PMID: 25416197 DOI: 10.1136/bjsports-2014-094053] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increased parasympathetic activity in endurance-trained athletes has been reported by heart rate variability and pupillometry. Our primary objective was to assess parasympathetic activity and tone in the lower respiratory tract by investigating the effect of cholinergic antagonism by inhaled ipratropium bromide compared to the β2-receptor stimulating effect of inhaled salbutamol in elite cross-country and biathlon skiers. We also examined the medications' relationship to cholinergic sensitivity as measured by bronchial responsiveness to methacholine (PD20met). METHODS In a randomised crossover study, 20 cross-country and two biathlon skiers (14♂/8♀) aged 20-37 years from the Norwegian national teams measured reversibility to inhaled ipratropium bromide and inhaled salbutamol and PD20met on three separate days. A positive reversibility test was defined as an increase in forced expiratory volume in 1 s (FEV1) of ≥12%. Spirometry was performed before and 45 and 15 min after inhaled ipratropium bromide and inhaled salbutamol, respectively. Bronchodilating medication was withheld according to the European Respiratory Society (ERS) guidelines. Correlations were assessed by Pearson's correlation coefficient (r). RESULTS Five athletes had significant reversibility after inhaled ipratropium bromide, and none after inhaled salbutamol. Twelve athletes (54.5%) had PD20met <8 μmol (1.57 mg). PD20met correlated negatively with ▵FEV1 after inhaled ipratropium bromide (r=-0.85, p<0.0001), but not after inhaled salbutamol (r=-0.308, p=0.16). CONCLUSIONS In elite skiers, cholinergic sensitivity (PD20met) had a highly significant inverse correlation to the cholinergic antagonism of inhaled ipratropium bromide, but not at all to the bronchodilating inhaled salbutamol. This markedly increased bronchial parasympathetic tone may represent an important cholinergic role in the development of skier's asthma.
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Affiliation(s)
- J Stang
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - M Couto
- Immunology Lab, Faculty of Medicine, University of Porto, Porto, Portugal Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal
| | - K-H Carlsen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway Department of Pediatrics, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T Stensrud
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Couto M, Silva D, Santos P, Queirós S, Delgado L, Moreira A. WITHDRAWN: Exploratory study comparing dysautonomia between asthmatic and non-asthmatic elite swimmers. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014:S0873-2159(14)00095-6. [PMID: 25017767 DOI: 10.1016/j.rppneu.2014.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 05/11/2014] [Accepted: 05/14/2014] [Indexed: 11/29/2022] Open
Abstract
This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.05.004. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Mariana Couto
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), Portugal; Instituto CUF & Hospital CUF Porto, Allergy Unit, Portugal.
| | - Diana Silva
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal
| | - Paulo Santos
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal
| | - Samuel Queirós
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal
| | - Luís Delgado
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), Portugal
| | - André Moreira
- Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal; Immunoallergology Department, Centro Hospitalar São João EPE, Porto, Portugal; Center for Research in Health Technologies and Information Systems (CINTESIS), Portugal
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Cardiovascular changes in workers exposed to fine particulate dust. Int J Occup Med Environ Health 2014; 27:78-92. [PMID: 24526496 DOI: 10.2478/s13382-014-0234-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 12/18/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Epidemiological studies provide evidence that airborne particulate matter may contribute to the increased incidence and mortality rates due to pulmonary and cardiovascular diseases. Only some of them address the problem of occupational exposure to particulate air pollution. The aim of our study was to assess cardiovascular reaction and autonomic regulation in workers exposed to fine particles. MATERIALS AND METHODS All workers had medical examination, resting ECG with heart rate variability analysis (HRV), 24-h ECG, and ambulatory blood pressure monitoring (ABPM) performed. The subjects were 20 male workers (mean age: 32.14.0 year) of a ceramic ware factory exposed to the dust and 20 workers who were not exposed (mean age: 39.4±7.8 year). The period of employment under exposure amounted to 5.6±2.1 year. Dust exposure was measured using individual dosimeters. RESULTS The geometric mean total dust concentration was 44±1.5 mg/m(3) and the FPD (fine particulate dust) concentration amounted to 11.5±1.6 mg/m(3). No abnormalities were noted in the resting ECG in both groups, in 24-h ECG 2 subjects, both from exposed and control groups, had ventricular heart rhythm and repolarization disturbances. Blood pressure in ABPM, both systolic as well as diastolic, was normal and did not differ between the groups. Resting heart rate in the exposed group was significantly lower (p = 0.038) than in the control group. In the exposed group STD R-R from short-term records was significantly higher (p = 0.01). Fast Fourier Transform (FFT) analysis showed that the low frequency power spectrum (LF) did not differ in the exposed and the control group, while high frequency (HF) was significantly higher in the exposed group. LF/HF ratio was significantly lower in the exposed in comparison with the control group. CONCLUSIONS Although we did not reveal significant abnormalities in ECG as well as in ABPM in the exposed group, it seems that neurovegetative disturbances (parasympathetic predominance) may serve as an early indicator of fine particulate dust effect on cardiovascular system.
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Zedan M, Alsawah GA, El-Assmy MM, Hasaneen B, Zedan MM, Nasef NA. Clinical asthma phenotypes: is there an impact on myocardial performance? Echocardiography 2012; 29:528-34. [PMID: 22329380 DOI: 10.1111/j.1540-8175.2011.01635.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Asthma is a systemic disease, which affects various body systems. We aimed to assess the impact of clinical asthma phenotypes on myocardial performance in asthmatic children using tissue Doppler imaging (TDI). METHODS We enrolled 58 children with moderate persistent asthma and 62 age- and sex-matched healthy controls. Asthmatic children were classified according to clinical asthma phenotypes into shortness of breath group (n = 26) and wheezy group (n = 32). Pulmonary function tests, and conventional and TDI echocardiography were performed. RESULTS TDI echocardiography assessment of the studied groups showed that asthmatic children as a group had significant left and right ventricular dysfunction when compared with healthy controls. Children in the shortness of breath group had a significant diastolic dysfunction of both ventricles in the form of lower tricuspid and mitral annular early myocardial diastolic velocity (Em), early to late myocardial diastolic velocity (Em/Am) ratio, and prolonged isovolumetric relaxation time when compared with wheezy group (P < 0.001). In the shortness of breath group, TDI-derived myocardial performance index (MPI) of both ventricles was significantly higher when compared with wheezy group (P < 0.001) reflecting global myocardial dysfunction. Conventional echocardiography of both ventricles showed RV diastolic dysfunction in the form of a significantly lower tricuspid E/A ratio in the shortness of breath group when compared with wheezy group. CONCLUSION Clinical asthma phenotypes have an impact on myocardial function especially those presented with shortness of breath. Thus, measurement of MPI by TDI can detect subclinical changes in the cardiac performance in asthmatic children.
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Affiliation(s)
- Magdy Zedan
- Pediatric Allergy and Pulmonology, Children's Hospital, Mansoura University, Mansoura, Egypt
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Connes P. Altered Autonomic Nervous System Function in Sickle Cell Disease. Am J Respir Crit Care Med 2011; 184:398-400. [DOI: 10.1164/rccm.201105-0941ed] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Goyal M, Jaseja H, Verma N. Increased parasympathetic tone as the underlying cause of asthma: a hypothesis. Med Hypotheses 2010; 74:661-4. [PMID: 20044211 DOI: 10.1016/j.mehy.2009.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 11/16/2009] [Indexed: 02/08/2023]
Abstract
Asthma is a chronic inflammatory disease of airways that is characterized by increased responsiveness of the tracheo-bronchial tree to multiple number of stimuli. Immunological theory does not explain all features in asthma, for example hyper-reactivity of the airways. Neurogenic theory also fails to explain the pathogenesis of asthma comprehensively. Higher parasympathetic tone has been reported in asthmatics but has never been suggested as a major underlying cause of asthma. This article attempts to explain the occurrence of hyper-responsiveness, inflammatory/allergic reactions and broncho-constriction in asthma on a common basis of inherent higher parasympathetic tone in asthmatics. The higher background parasympathetic firing leads to increased nitric oxide (NO) production owing to its co-localization with acetylcholine (ACh) in inhibitory non-adrenergic and non-cholinergic (i-NANC) nerves. NO is a neurotransmitter of i-NANC system and it mediates bronchodilation. Increased NO release has been found to be responsible for hyper-responsiveness and increased inflammation in the airways. The authors suggest that an inherently higher background parasympathetic tone in concert with inflammation or a specific genetic background could modify the effects of NO on lung homeostasis in humans leading to increased susceptibility to an asthmatic state.
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Affiliation(s)
- Manish Goyal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi 110 029, India.
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Studying noninvasive indices of vagal control: the need for respiratory control and the problem of target specificity. Biol Psychol 2008; 80:158-68. [PMID: 18775468 DOI: 10.1016/j.biopsycho.2008.08.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 08/10/2008] [Accepted: 08/10/2008] [Indexed: 01/01/2023]
Abstract
Respiratory sinus arrhythmia (RSA) is a popular index of cardiac vagal control; however, research has rarely adequately addressed respiratory influences on RSA. In addition, simplistic views of the parasympathetic system have resulted in an overinterpretation of RSA as a general indicator of vagal control. Research using a respiration-corrected time-domain index of RSA has yielded plausible findings that substantially deviate from uncorrected RSA. Paced breathing, which is used for baseline calibration of RSA in this correction procedure, allows for a representative sampling of respiratory influences on RSA and has minimal impact on autonomic regulation. Past research has largely focused on cardiac vagal activity and ignored the extent of target specificity in the parasympathetic system. More research is needed on new noninvasive indices of vagal control at other organ sites. Studies also need to address muscarinic receptor sensitivity before noninvasive vagal indices can be interpreted as markers of central vagal outflow.
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Zeybek C, Yalcin Y, Erdem A, Polat TB, Aktuglu-Zeybek AC, Bayoglu V, Akdeniz C, Celebi A. Tissue Doppler echocardiographic assessment of cardiac function in children with bronchial asthma. Pediatr Int 2007; 49:911-7. [PMID: 18045296 DOI: 10.1111/j.1442-200x.2007.02486.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate the role of tissue Doppler echocardiography in assessment of ventricular function in pediatric patients with bronchial asthma (BA). PATIENTS AND METHODS Fifty-one pediatric patients with BA and 30 age- and sex-matched healthy subjects were studied. BA patients were divided into two groups: mild BA (n = 33) and moderate to severe BA (n = 18). All subjects were examined on conventional and tissue Doppler echocardiography, and 44 patients had pulmonary function tests on spirometry within 1 week of echocardiographic examination. RESULTS Conventional echocardiographic parameters were all similar in mild asthmatic patients and control subjects. Tricuspid E velocity, E/A ratio and isovolumetric relaxation time (IVRT) in moderate and severe cases differed significantly from mild cases and control subjects. E', A', E'/A' ratio and IVRT of the lateral tricuspid annulus, and IVRT of the medial and lateral mitral annuli were different between mild cases and control subjects. E' velocity and IVRT of the lateral tricuspid annulus and IVRT of the medial and lateral mitral annuli were also different between mild cases and moderate to severe cases. Pulmonary function tests correlated well with E', E'/A' and IVRT of lateral tricuspid annulus. CONCLUSION Patients with BA have subclinical right ventricular diastolic dysfunction even in the early stages. The severity of the functional impairment is parallel with the severity of the disease. Tissue Doppler echocardiography has a greater predictive value than conventional imaging, and is useful for evaluating ventricular function in patients with BA.
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Affiliation(s)
- Cenap Zeybek
- Pediatric Cardiology, Dr Siyami Ersek Cardiovascular Research Hospital, Istanbul, Turkey.
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Pichon A. Cardiovascular variability is/is not an index of autonomic control of circulation. J Appl Physiol (1985) 2007; 102:503. [PMID: 16990499 DOI: 10.1152/japplphysiol.01038.2006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Nickel C, Lahmann C, Muehlbacher M, Pedrosa Gil F, Kaplan P, Buschmann W, Tritt K, Kettler C, Bachler E, Egger C, Anvar J, Fartacek R, Loew T, Rother W, Nickel M. Pregnant women with bronchial asthma benefit from progressive muscle relaxation: a randomized, prospective, controlled trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2006; 75:237-43. [PMID: 16785773 DOI: 10.1159/000092894] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asthma is a serious medical problem in pregnancy and is often associated with stress, anger and poor quality of life. The aim of this study was to determine the efficacy of progressive muscle relaxation (PMR) on change in blood pressure, lung parameters, heart rate, anger and health-related quality of life in pregnant women with bronchial asthma. METHODS We treated a sample of 64 pregnant women with bronchial asthma from the local population in an 8-week randomized, prospective, controlled trial. Thirty-two were selected for PMR, and 32 received a placebo intervention. The systolic blood pressure, forced expiratory volume in the first second, peak expiratory flow and heart rate were tested, and the State-Trait Anger Expression Inventory and Health Survey (SF-36) were employed. RESULTS According to the intend-to-treat principle, a significant reduction in systolic blood pressure and a significant increase in both forced expiratory volume in the first second and peak expiratory flow were observed after PMR. The heart rate showed a significant increase in the coefficient of variation, root mean square of successive differences and high frequency ranges, in addition to a significant reduction in low and middle frequency ranges. A significant reduction on three of five State-Trait Anger Expression Inventory scales, and a significant increase on seven of eight SF-36 scales were observed. CONCLUSIONS PMR appears to be an effective method to improve blood pressure, lung parameters and heart rate, and to decrease anger levels, thus enhancing health-related quality of life in pregnant women with bronchial asthma.
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Affiliation(s)
- Cerstin Nickel
- Clinic for Psychosomatic Medicine, Inntalklinik, Simbach/Inn, Germany.
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