Cough and exhaled nitric oxide levels: what happens with exercise?

Acute Effects of Exercise at Different Temperatures on Clinical Symptoms and Nasal Blood Flow in Patient with Allergic Rhinitis: A Randomized Crossover Trial

Allergic rhinitis (AR) affects the nose and is triggered by allergens. However, no research studies have analyzed the acute effect of aerobic exercise at different temperatures in AR patients. This study was to determine the acute effect of aerobic exercise at different temperatures on rhinitis symptoms and nasal blood flow (NBF) in AR patients. Fifteen AR patients aged 18-24 years were randomized in a crossover fashion into two protocols: 60 minutes of aerobic exercise at temperatures of 25 °C and 34 °C. The NBF, rhinitis symptoms, peak nasal inspiratory flow (PNIF), fractional exhaled nitric oxide (FeNO) and oxygen saturation (SpO2) variables were measured. During exercise at 25°C, a notable reduction was observed in NBF, nasal congestion, and sneezing in comparison to exercising at 34°C (p < 0.05). The SpO2 demonstrated significant decreases at 34°C compared to exercise at 25°C after 30 minutes post exercise. The rhinitis symptom scores and NBF in both exercise at 25°C and 34°C significantly decreased and PNIF increased during and after exercise compared to before exercise (p < 0.05). In conclusion, both exercising at 25°C and 34°C can contribute to the alleviation of allergic rhinitis symptoms by decreasing rhinitis symptom and NBF. However, exercising in a room at 25°C exhibits a more significant reduction in nasal blood flow, nasal congestion, and sneezing compared to the 34°C setting.

Cough and cough hypersensitivity as treatable traits of asthma

Cough is a common and troublesome symptom in people with asthma and is often associated with poorer asthma control and exacerbations. Apart from asthma, other causes or comorbidities might underlie cough in asthma, such as rhinosinusitis and bronchiectasis. Eosinophilic inflammation and bronchoconstriction can lead to an acute episode of cough or worsen chronic cough. Cough hypersensitivity with laryngeal paraesthesia, allotussia, and hypertussia might underlie the cough of asthma through augmented sensory nerve excitability of upper-airway vagal sensory nerves. Cough associated with bronchoconstriction and type 2 inflammation should respond to inhaled corticosteroids and long-acting β-adrenoceptor agonist therapy. For cough hypersensitivity in adults, speech and language therapy and neuromodulators (eg, gabapentin) could be considered. In children, there is no consistent association of asthma with cough sensitivity or between cough and asthma severity. Further research is needed to realise the potential of cough as a measure of asthma control, to understand the mechanisms of cough in asthma, and to develop safe, effective treatments and a precision-medicine approach to the management of cough in asthma in children and adults.

Tai-Chi-Chuan Exercise Improves Pulmonary Function and Decreases Exhaled Nitric Oxide Level in Both Asthmatic and Nonasthmatic Children and Improves Quality of Life in Children with Asthma

Tai-Chi-Chuan (TCC) is an exercise of low-to-moderate intensity which is suitable for asthmatic patients. The aim of our study is to investigate improvements of the lung function, airway inflammation, and quality of life of asthmatic children after TCC. Participants included sixty-one elementary school students and they were divided into asthmatic (n = 29) and nonasthmatic (n = 32) groups by the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Among them, 20 asthmatic and 18 nonasthmatic children volunteered to participate in a 60-minute TCC exercise weekly for 12 weeks. Baseline and postintervention assessments included forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR), fractional exhaled nitric oxide (FeNO) level, and Standardised Pediatric Asthma Quality of Life Questionnaire (PAQLQ(S)). After intervention, the level of FeNO decreased significantly; PEFR and the FEV1/FVC also improved significantly in both asthmatic group and nonasthmatic group after TCC. The asthmatic children also had improved quality of life after TCC. The results indicated that TCC could improve the pulmonary function and decrease airway inflammation in both children with mild asthma and those without asthma. It also improves quality of life in mild asthmatic children. Nevertheless, further studies are required to determine the effect of TCC on children with moderate-to-severe asthma.

Does moderate intensity exercise attenuate the postprandial lipemic and airway inflammatory response to a high-fat meal?

We investigated whether an acute bout of moderate intensity exercise in the postprandial period attenuates the triglyceride and airway inflammatory response to a high-fat meal (HFM) compared to remaining inactive in the postprandial period. Seventeen (11 M/6 F) physically active (≥ 150 min/week of moderate-vigorous physical activity (MVPA)) subjects were randomly assigned to an exercise (EX; 60% VO 2peak) or sedentary (CON) condition after a HFM (10 kcal/kg, 63% fat). Blood analytes and airway inflammation via exhaled nitric oxide (eNO) were measured at baseline, and 2 and 4 hours after HFM. Airway inflammation was assessed with induced sputum and cell differentials at baseline and 4 hours after HFM. Triglycerides doubled in the postprandial period (~113 ± 18%, P < 0.05), but the increase did not differ between EX and CON. Percentage of neutrophils was increased 4 hours after HFM (~17%), but the increase did not differ between EX and CON. Exhaled nitric oxide changed nonlinearly from baseline to 2 and 4 hours after HFM (P < 0.05, η (2) = 0.36). Our findings suggest that, in active individuals, an acute bout of moderate intensity exercise does not attenuate the triglyceride or airway inflammatory response to a high-fat meal.

Exhaled nitric oxide and the management of childhood asthma--yet another promising biomarker "has been" or a misunderstood gem

Childhood asthma is a common chronic condition. Approximately five percent of all children in western countries are prescribed treatment with inhaled corticosteroids (ICS) to prevent asthma symptoms. Current guidelines advocate titrating ICS dose to symptoms but this approach is not without problem, e.g. how to discern asthmatic from non-asthmatic symptoms? And when to reduce ICS dose? This review describes the strengths and weaknesses of fractional exhaled nitric oxide (FENO) as an objective index for individualising asthma control in children. Epidemiological and mechanistic evidence suggest that FENO should be a promising biomarker for eosinophilic airway inflammation (a hall mark for asthma) but somewhat surprisingly, clinical trials in children have not consistently found benefit from adding FENO to a symptom-based approach to ICS treatment in children. There are a number of reasons why FENO has apparently failed to translate from promising biomarker to clinically useful tool, and one reason may be a lack of understanding of what merits a significant intrasubject change in FENO. This review describes the rise and apparent fall of FENO as biomarker for asthma and then focuses on more recent evidence which suggest that FENO may prove to have a role in the management of childhood asthma, and in particular preventing exacerbations.

Adult and paediatric cough guidelines: Ready for an overhaul?

Cough is one of the most common reasons that patients seek medical attention. Cough guidelines from numerous countries and societies are available to assist the clinician to investigate and manage patients with cough. We review some of the recent progress in the field of cough that may lead to revision of these guidelines. In adults with chronic cough, new causes such as obstructive sleep apnoea have been identified. A new terminology, cough hypersensitivity syndrome (CHS), has been proposed for patients with chronic cough, which emphasises cough reflex hypersensitivity as a key feature. New therapeutic options are now available, particularly for patients with refractory or idiopathic chronic cough, which include gabapentin, speech pathology management and morphine. There has been great progress in the assessment of cough with the development of validated quality of life questionnaires and cough frequency monitoring tools. In children, common aetiologies differ from adults and those managed according to guidelines have better outcomes compared to usual care. New diagnostic entities such as protracted bacterial bronchitis have been described. Paediatric-specific cough assessment tools such as the Parent/Child Quality of Life Questionnaire will help improve the assessment of patients. Further research is necessary to improve the evidence base for future clinical guideline recommendations. Guidelines in future should also aim to reach a wider audience that includes primary care physicians, non-specialists and patients.